John H. Noseworthy, MD, Neurology editor-in-chief since 2007, is poised to become the next president and CEO of the entire Mayo Clinic enterprise, which includes operations in Minnesota, Florida, and Arizona, in November.
Dr. Noseworthy has held numerous leadership positions throughout his career. He came to Mayo in 1990 and chaired the neurology department from 1997 to 2006. In 2006, he served as chair of the AAN Science Committee. He is currently a professor of neurology, vice chair of the Mayo Clinic Rochester Executive Board, and medical director of the Mayo Clinic department of development
“I will always draw from my experience in neurology, but I will say that Mayo Clinic does a good job grooming its leaders,” he said. “The discipline of clinical neurology teaches the value of careful listening and focused problem-solving. These skills will be valuable to me going forward.”
He spoke with Neurology Today about the challenges of moving into the CEO position and his plans for Mayo Clinic.
WERE YOU SURPRISED ABOUT YOUR NEW APPOINTMENT?
The current president and CEO, Denis Cortese, MD, had announced his retirement a few months ago. The Board of Governors and Board of Trustees then set up the selection process that evolved along a carefully planned process through the first quarter of 2009.
There is no typical career path to the CEO position at the Mayo Clinic. The Mayo Clinic bylaws require that the CEO be a physician who has been a member of the voting staff of Mayo Clinic Rochester, Mayo Clinic Jacksonville, and/or Mayo Clinic Arizona for at least the preceding five years. The president is nominated by the Mayo Clinic Board of Governors and is then elected by the Mayo Clinic Board of Trustees.
I was fortunate to be one of a handful of finalists for the position, and then chosen on May 8. I'm both humbled by this opportunity and confident as I move into the position in November when Dr. Cortese retires.
WHAT PREPARED YOU FOR THIS POSITION?
Although one never knows how these things will work out, I felt that my experience in leadership as a department chair, as chair of the Mayo Clinic Rochester operations group, as the medical director of development and as the leader of the long range visioning exercise for Mayo Clinic (“Mayo Clinic in the Year 2020”) had prepared me for this role.
WHAT ARE YOUR PLANS AND IDEAS FOR MAYO AS THE CEO?
As I move through this transition process working with Dr. Cortese, I will do a lot of listening and observing. While our business models may change to engage a broader community and encompass new modes of care and delivery, Mayo Clinic must always contribute to the medical arts and sciences for the good of humanity. Equally important, the adaptation of Mayo Clinic into its next evolution must include a realistic, and realizable, assessment of priorities and allocation of resources. We will never lose sight of our primary value —“the needs of the patient come first” — or our mission to provide the best care to every patient every day. The role of leaders is to strengthen and perpetuate the organization. That will be my primary role in these difficult economic times.
WHAT ARE THE CHALLENGES OF MOVING INTO THE CEO POSITION OF THIS MAJOR MEDICAL INSTITUTION?
To maintain its mission and meet the needs of patients in the future, Mayo Clinic must deliver an unparalleled patient experience for all who experience Mayo Clinic, including those at one of our campuses and those we interact with through advanced Web-based technology. Given the current economic environment, Mayo Clinic must affirm and strengthen its core business proposition, making Mayo Clinic appropriately available, accessible, and affordable. We are facing the immediate challenges of the global recession. This economic downturn will eventually stabilize and recover, cycling back to prosperity. The crisis of health care in this country, however, demands transformational change in how we care for patients. These changes will be long-term and require remarkable innovation if we are to be successful in delivering high value care to all who need this care.
WE HEARD THAT LAST YEAR MAYO'S PATIENT NUMBERS WERE STABLE, BUT INCOME FROM PATIENT CARE FELL BY ALMOST A THIRD. WHY IS THIS?
Income from patient care was $205 million in 2008 compared to $293 million in 2007, a decrease of $88 million. There was some increase of bad debt and charity care in 2008, but this was not the primary driver for the decline in income.
The year 2008 was difficult for Mayo Clinic from a financial perspective, as it was for the broader US economy. Mayo Clinic ended the year in a break-even position. Our expenses significantly outpaced revenue growth — expenses grew 7.6 percent compared to a 4.5 percent growth in revenue.
We're working to improve revenue growth, drive down costs, find ways to cost-effectively care for our patients, and ensure that we see a broader mix of patients. We have put in place actions that are aimed at improving financial performance by almost $200 million in 2009.
HOW WILL YOU MANAGE MAYO DURING THIS RECESSION?
We recognize that there is significant variability of investment results from year to year. In 2008, our investment portfolio was down 18 percent, or about $700 million, for the year. This performance is better than many in the industry but still represents a significant loss in value.
Mayo Clinic's primary value — “the needs of the patient come first” — and strategic priorities — quality, integration, individualized medicine, and the science of health care delivery — will continue to guide the organization through this economic downturn. Although the economy is a significant concern, conserving assets, investing in people, and building resources will allow Mayo Clinic to move confidently into the future. We are actively refining our immediate, short-, and long-term vision (“what will Mayo look like”) and the strategic steps to allow us to achieve this vision (“how do we get there”).
FUNDRAISING EFFORTS WERE DOWN LAST YEAR. HOW ARE EFFORTS GOING THIS YEAR?
Mayo Clinic is exceedingly successful at fundraising. People give to Mayo in recognition of the excellent care they receive and the passion they have for our not-for-profit mission. The most important thing that we can do is continue to provide the best care to every patient every day.
We are in the final year of a five-year, $1.25 billion campaign, Mayo's first-ever philanthropic campaign, and we are on target to achieve the financial goal before year-end. The economy in 2008 affected grateful patients' ability to give in the last quarter of the year when the highest giving typically occurs. We had a tremendous start of the year in 2008 with the highest first two quarters in our campaign. We began to feel the impact of the economic situation in October/November of 2008.
We are off to a good start in our fundraising efforts this year despite the economic downturn and are confident of further success as the economy recovers.
WHAT ARE YOUR PLANS FOR NEUROLOGY? WHAT WILL YOU MISS?
I have come to realize that I cannot continue as editor-in-chief of Neurology given the demands of this new role. This has been one of the highlights of my career. The work has been remarkably stimulating and the editorial staff are true professionals. I will miss the work and I will miss each of the staff members. I am working with AAN leadership to effect a smooth transition. I have written a progress report summarizing what we have accomplished during my tenure as editor and this appeared online June 30 and then in the July 7 print journal.