What Can Health Care Teach Business about Managing its Lawyers? Seeking Answers at the Mayo Clinic (Part 2 of 3)

In Part 1 I described how the Mayo Clinic simultaneously achieved both the highest clinical standards and robust new efficiencies in its heart surgery department.

In looking to the Mayo Clinic for ideas on how to better manage the work that lawyers do for our businesses, I’d like to look in this Part 2 at one of that organization’s hallmarks:

Teamwork medicine rather than a star-performer focus.


Warren Buffett has long used the word “moat” to describe a company’s competitive advantage. In his annual letter to Berkshire Hathaway shareholders for 2007, Warren Buffett cited teamwork medicine — as contrasted with individual superstar doctors — as the key to the Mayo Clinic’s appeal to patients:

” … If a business requires a superstar to produce great results, the business itself cannot be deemed great. A medical partnership led by your area’s premier brain surgeon may enjoy outsized and growing earnings, but that tells little about its future. The partnership’s moat will go when the surgeon goes. You can count, though, on the moat of the Mayo Clinic to endure, even though you can’t name its CEO.”

Management Lessons from Mayo Clinic: Inside One of the World’s Most Admired Service Organizations, described the experience of Dr. Keith Kelly, a retired Mayo Clinic surgeon:

“A Mayo surgeon recalled an incident that occurred shortly after he had joined the Mayo surgical staff as the most junior member. He was seeing patients in the Clinic one afternoon when he received a page from one of the most experienced and renowned surgeons on the Mayo Clinic staff.

“The senior surgeon stated over the phone that he was in the operating room performing a complex procedure on a patient with a difficult problem. He explained the findings and asked his junior colleague whether or not what he, the senior surgeon, was planning seemed appropriate.

“The junior surgeon was dumbfounded at first that he would receive a call like this from a surgeon whom he greatly admired and assumed had all the answers to even the most difficult problems. Nonetheless, a few minutes of discussion ensued, a decision was made, and the senior surgeon proceeded with the operation.

“The patient’s problem was deftly managed, and the patient made an excellent post-operative recovery.”

Because the Mayo Clinic models teamwork medicine at the top, the entire team — junior to senior and across specialties — know that they’re expected to speak up with all colleagues — and to listen and learn from them as well.

As Jeffrey Bolton — the Mayo Clinic’s chief administrative officer — put it last month to Knowledge@Wharton: If a Mayo Clinic physician sees a patient with a problem they’re unsure about, “you pick up the phone and call a colleague — either within your specialty or another specialty — and seek out insight.”

” … While many medical centers claim [a patient focus] … the Mayo Clinic is actually structured to support [a patient focus] as a goal. The health system is organized to foster teamwork, not hierarchy.”

The business legal structure stands the Mayo Clinic approach on its head. It fosters hierarchy, not teamwork:

  • The business legal sector is organized around partners supervising associates in law firms, and in-house counsel supervising outside counsel. Command-and-control and duplication of effort. Not much “pick up the phone and call a colleague”.
  • The legal business model emphasizes billings by inexperienced junior associates. “Pick up the phone and call a colleague” doesn’t work if the colleague is still in apprenticeship.
  • The perverse incentives of the billable hour (here) mean that every time a lawyer might, “pick up the phone and call a colleague”, the proverbial meter is running. Prompting questions about the lawyer’s true motivation. No such meter at the Mayo Clinic.

On “teamwork-not-hierarchy” in the business legal sector I’ve got to say a word about Dr. Heidi Gardner of Harvard Law School and her, Smart Collaboration: How Professionals and Their Firms Succeed by Breaking Down Silos, Harvard Business School Press, 2017.

A brilliant call to action against hierarchy (“silos” is her term) and for teamwork. But — for the business legal sector — hers is a voice crying in the wilderness.

In Part 3 I look at the Mayo Clinic’s practice of paying its doctors salaries — rather than fee-for-service — as a possible management lesson.

Part 1

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