ROCHESTER, Minn. -- Mayo Clinic is 157 years old, but during the past year, Monty Flinsch felt like he was working at a startup.
“We went from really kind of comfortable office workers to a crisis control center,” the senior business analyst for Mayo’s intranet team said.
He and his colleagues helped maintain Mayo’s online network — a vital service for remote workers — as well as the COVID-19 informational center. “It happened in about two weeks. I mean, it was nuts. It was exhilarating.”
From Flinsch’s team to research students and frontline workers, many sectors of the Mayo Clinic system became more nimble during the coronavirus pandemic. Confronting one challenge after the next, the healthcare behemoth shed bureaucratic steps in order to give staff the power to combat a wily virus. Through the long hours and hardships, employees say they’ve gained a new sense of what it means to work at the clinic, and leaders say the institution emerges from the past year bearing changes that will last long after the pandemic.
Maintaining 'Mayo magic'
In April, the financial predictions were dire: Mayo’s team projected a $3 billion shortfall. (Their most recent annual report showed, instead, that total revenue increased 1.5% from 2019.)
Thousands of staffers were furloughed, others had their pay docked, and the institution halted non-essential surgeries to comply with orders from Gov. Tim Walz.
“That was a really scary time,” said Dr. Amy Williams, executive dean for Mayo Clinic Practice. “Mayo Clinic is pretty magic inside the walls. The buzz is incredible. The collaboration, excitement, commitment to patients everyday ... and we were afraid we were going to lose that magic.”
Some leaders looked to how Mayo weathered the Great Depression as a guide, even browsing the Board of Governors minutes from that period. Of course, how to respond to a highly contagious respiratory virus wasn’t part of the Depression playbook.
So, an interdisciplinary team of Mayo personnel jumped together to make their own. Seeing these engineers, infectious disease experts and product designers collaborate to ensure spaces across Mayo’s campus were safe was one of the most exhilarating parts of the year for Williams.
“That was the fun part. Watching people innovate constantly, and come together in teams to figure out for the first time ever how are we going to do this, and watching it succeed,” she said.
In spite of the grim financial forecast, Chief Administrative Officer Jeff Bolton said this period pushed leaders to change the clinic’s operations for the better.
“Empowering and simplifying decision-making were key learnings,” Bolton said. Williams agreed that the clinic will act more boldly than ever to pursue medical advances because of how the pandemic shook up the clinic's traditional structure.
This echoes a national trend healthcare institutions have seen this year, said Dr. Vikas Saini, president of the Lown Institute, a nonpartisan healthcare-focused think tank.
“When you get this type of a massive crisis, quite often, the old kind of leadership models and chains of command have to get disrupted. Because if you have to move quickly, there's a lot of native intelligence in the rank and file or on the front lines,” Saini said. “Crises like this kind of allow some of that knowledge, which is practical knowledge, to be made available.”
One of the most cited areas in which physicians were empowered to make quick decisions was in the field of telemedicine.
Dr. Sean Caples, a leader of Mayo’s tele-ICU program for years, was one of the practitioners who spearheaded Mayo’s remote medical support of a hospital near New York City when a surge in COVID-19 infections overwhelmed the area.
In the later stages of the pandemic, he and his team turned their attention regionally, using the power of telemedicine to focus services on Mayo Clinic’s Rochester campus, as well as surrounding institutions. During Rochester’s surge, Caples said they even used tablets to communicate with patients without having to enter the hospital room as a way to conserve personal protective equipment
“I remember the day that we knew we were in the midst of a crisis. That was Nov. 10. And that's kind of when we put all hands on deck,” Caples said. In that time, Mayo reported more than 900 employees had contracted the virus in a two-week span. Olmsted County reported 700 to 800 new cases a week.
“Those three months are kind of a blur now. But it was pretty dicey,” he said.
After the fog clears, he thinks remnants of this time will remain engrained in Mayo Clinic’s approach to synergizing technology and medical care, but to a lesser extent than in the throes of the crisis.
“We’ll probably have to come back to a happy medium that is partially reliant on technology and partially reliant on the person,” Caples said. “I think we’re still trying to figure out what that’s going to look like, but it’s not going to look exactly like it did in the midst of the pandemic.”
'Screeching to a halt' : research stalls, researchers innovate
Anders Asp was nearing a pivotal point in his neuromodulation research after 1 1/2 years of countless experiments and validations, his dissertation finally on the horizon.
“The fun was about to happen. That's when real discovery happens. One of my favorite things about science is being the first person in the world to discover something, and, then that was kind of taken away and put on hold,” Asp said. “Right at the edge of discovery, but then screeching to a halt.”
Asp and his research colleagues faced an unexpected exodus from the lab in March, a major impediment for scientists whose research depends on the use of specific equipment and animals. Students spent the weeks or months working from home (labs filtered students back at varying times) in different ways. Some read up on publications they had missed. Others, like Asp, dug into old data. He also adapted part of his dissertation into a patent.
“For those resilient young students who I work with, they'll do fine. They were not damaged by this experience,” said Dr. Jim Maher, professor of Biochemistry and Molecular Biology and former Dean of Mayo Clinic Graduate School of Biomedical Sciences. “They were probably delayed or distracted to some extent, but there were plenty of positives that came out of this.”
For his lab, one of the positives was increased collaboration on a COVID-related project. Three students got to work creating “libraries” of molecular shapes — hundreds of trillions of them — to investigate the molecules that can inactivate key parts of a virus.
Emma Goddery, whose PhD work centers on the interactions between the immune and central nervous system, said some of the lab’s time-sensitive aging studies were significantly delayed. Yet as a group, they found workarounds.
“We did what we could to kind of salvage them. We didn't want to waste ongoing experiments,” Goddery said.
As lab leaders and students reflect on their work during the past year, they acknowledge several areas in which Mayo’s research arm has changed. For one, students have been afforded more flexible work environments. If reviewing literature at home is more productive, many say they feel free to stay away from the lab that day. The global scientific community has also become much more collaborative, several said, allowing students to access research or conferences they previously couldn’t. Finally, they see a shift toward computational research as a way to propel work independent of the lab.
Remote work and the Rochester downtown
One of the most visible effects of the pandemic for Mayo Clinic and the nation may be the shift to remote work. Before this year, about 20,000 of Mayo's Rochester employees worked primarily in the downtown. After this year, Bolton anticipates at least 1,500 will continue to work remotely.
The movement of Mayo employees “had a huge effect on downtown starting last March,” said Holly Masek, executive director of the Rochester Downtown Alliance. The lunch crowd, typically fueled by Mayo workers who had the flexibility to leave their office to grab a sandwich or coffee, plummeted. Customers at downtown shops supplying everything from cards to gifts to shoes disappeared.
Starting in the summer, the RDA team regularly met with Mayo leaders to talk about financing downtown businesses. “You don’t want to have a dark downtown by the end of this pandemic. You want to have a great place for your patients to come,” Masek said.
Mayo stepped up, offering $1 million in support for downtown businesses during the pandemic through the RDA Small Business Relief Grant.
Masek said she’s seen business owners become more determined to create a sustainable customer base within the Rochester community, even if that doesn’t include Mayo personnel.
“I do think that there's a new recognition that local Rochester is their customer too, and it's absolutely worth the effort to understand that customer and connect with that customer.”
More workers may be returning to the downtown area with the introduction of “hoteling” spaces — flexible areas where employees can drop in as needed to work. Mayo officials estimate 1,000 drop-in spaces will be available by the summer or fall.
Despite furloughs, trauma, employees persist
In late April, when Mayo Clinic announced furloughs for 30,000 staff members, Bolton approached their virtual town hall meetings with a twinge of apprehension.
“We would go into these and expect people — you know, you can't throw tomatoes virtually, but you could imagine — but the support for the decisions we were making was just amazing,” Bolton said.
Although many staffers understood the reasons behind the furloughs, some expressed concern about how the reduced workforce would impact patient care if there was a major surge.
“We didn't feel like you could have enough people around. And to see folks being furloughed was a little bit worrisome,” Caples said. Thankfully, there was no shortage of staff when the clinic needed them most in November. “You have to credit the institution for that. I mean, they played it safe early on. But when we really needed the resources, they were there for us.”
Jamie Gulley, president of SEIU Healthcare Minnesota — a union that represents Minnesota healthcare workers — was involved in negotiating furlough agreements with healthcare institutions around the region. In April, he and his team encouraged healthcare facilities to institute furloughs because of the availability for CARES Act funding — $600 per week for eligible employees forced out of work.
The issue Gulley took with Mayo’s proposed furloughs was they planned to extend them longer than other healthcare systems, beyond July 31 when CARES Act supplements expired.
“I think some people would have liked to furlough, but were uncomfortable volunteering to furlough, versus in the other systems where it was just a ton of volunteers,” Gulley said.
Aside from the stress of furloughs or pay cuts, the past year has been an incredibly punishing for healthcare professionals as they’ve witnessed the virus ravage their community.
“You've all heard the stories of the nurses and providers getting in their cars and just sitting in the parking lot crying,” Williams said. Mayo Clinic set up a hotline for healthcare workers to support them during what some say was the most grueling time of their careers. “We made sure that there were safe environments ... that our staff could reach out anonymously, to gain comfort.”
An annual survey of Mayo Clinic employees showed that employee satisfaction increased, burnout for physicians decreased, and commitment to Mayo's mission soared in 2020. The one area that plummeted? Joy in the workplace.
“The unrelenting nature of it was different than what I've experienced in the past,” said Caples, who went months without taking a day off. In the middle of the chaos and pain, he said there was a unique sense of fulfillment about his work over the past year, a sentiment employees in all sections of Mayo’s operations echoed.
“We all knew this is why we do what we do.”