Visiting sociologist describes how 'everyone in Rochester is involved in healthcare'
Editor's note: This article was written by Dr. Gary David, an associate professor of sociology at Bentley University in Waltham, MA. It first appeared on his website, ethno-analytics.com. We are republishing the text with his permission.
Rochester, MN is a one-horse (or one-goose) town, if you consider that the horse (or goose) in question employs approximately 37,000 people locally and contributes billions to the state economy. I am not sure how many cows there might be in the surrounding area. There are enough to spare a couple for the 25th Annual Cow Milking Competition at the Rochester Honkers baseball game. They were real beauties. I am happy to report that the manager of the Honkers upheld the pride of Rochester by out-milking the manager from the other team. I don't know where that puts Rochester in terms of the other 24 years, as no one seemed to be keeping track.
My earliest memories of hearing about the Mayo Clinic come from watching the television show M*A*S*H. In the episode “Sometimes you hear the bullet”, character Lt. Col. Henry Blake tells another character, Hawkeye Pierce, “If I had the answer, I’d be at the Mayo Clinic. Does this place look like the Mayo Clinic?” For some reason, those references stuck with me, wondering what was this place known as the Mayo Clinic.
I was able to answer this question when I attended three-day workshop on Video Reflexive Ethnography, and recognized that the "Mayo Clinic" is far more than a clinic — it is a joint venture of the [city] of Rochester — everyone in town works in some capacity for the Mayo. This is because it is literally everywhere. Walking about during lunch is like walking in an open-air hospital cafeteria. You see people in scrubs, people in wheelchairs, people wearing masks, medical building badges, and the like.
After 19 years in Boston, I have become somewhat of a snobby and provincial New Englander. Not the kind that is bred after generations and centuries of lineage and Daughters of the American Revolution events, but I’m trying to catch up. Given that, my immediate question at seeing all of this activity was, “Why would anyone come to Rochester, MN, in the middle of nowhere, when you could come to Boston?” I mean, we have some pretty good hospitals and medical schools as well, and it is not located in the middle of a corn field (that is no expression; Rochester is surrounded by corn). I asked this question to a restaurant waiter in downtown Rochester. He started to tell me about how people come to Mayo from all over the world because Mayo is just better than everyone else.
What added to our conversation was the serendipitous detail offered by a young couple at an adjacent table. She was in a wheelchair; he sported tattoos and a Mohawk haircut. They felt strongly enough about the topic to interrupt their dinner on a lovely summer evening to talk about her condition, their struggles to find a diagnosis and treatment, and then their relationship with Mayo. The spoke with the medical knowledge either gained by years of clinical study as a medical student, or as a medical patient facing a difficult prognosis.
Their journey likely is similar to other journeys. It started with vague symptoms. They struggled to get an accurate diagnosis. They were denied tests that were claimed to be not necessary. They had to battle with doctors to get their complaints taken seriously. They had problems scheduling appointments and having them start on time. They traveled to many hospitals to try to get better care. It was at one moment, when they pressed a doctor in private for where they should go to get help for her spinal cancer, the answer was “Go to Mayo.”
Beyond the clinical care coordination element, which has been well documented, what was striking is that everyone in Rochester is involved in healthcare. I don’t mean that everyone works for Mayo. What I mean is that even those that work outside of Mayo are involved in the care of patients. It is unavoidable. There are so many patients out and about, so many family members staying locally, so many people who work for Mayo that are out in the community, that no matter who you are, you are involved in healthcare.
The couple at the table described it as “Midwest nice.” It was more than that. In talking to people around town, they would mention family members working at Mayo. Internships at Mayo. Upcoming jobs at Mayo. Past jobs at Mayo. Not only is Mayo the identity, but the point of pride of the community. People seemed to care regardless of their job. The person serving drinks at a local bar is involved in care as is the person drawing blood. People come to Rochester to stay for weeks or months. They go through hours of travel, to endure days on end of treatment, for conditions with terminal end points. The salve for this is contact with other people, those who see their role as caretakers for those who visit their city seeking medical help, and needing human connection.
And then they want a meal. Then they want a room to escape and rest. Then they want to have a drink to de-stress, for a moment to do the little things that other people do. They want to go for a walk, explore the city, be as normal as you can feel in a place that is not home, for a condition that you didn’t want, for costs you might not be able to bear, and for a future that you don’t know if you’ll ever have. This is the city of Rochester’s job, not just Mayo’s job.
A journey is more about an ending; it is about the touch points along the way. The goal of the journey is clearly important, but the experience of it is made up of all the steps and experiences. Each person in Rochester is a potential touch point for a person receiving care at Mayo. This they seem to know, feel pride in, and respond to. Not that this is meant to be naïve or Pollyanna. I’m sure there are rude people in Rochester, those who do not take this care across the community model to heart. But these potentially are outliers, and not the core of the community. It would be great to interview those not employed by Mayo about how they see themselves in relation to the care of those who visit their city.
Mayo is in the midst of trying to achieve the creation of a Destination Medical Center, a place where people around the globe come for healthcare. The DMC is described as “an unprecedented partnership between the state, local jurisdictions, Mayo Clinic and community organizations.” By taken a customer experience approach, to this I would add “and the people of Rochester.” Everyone is potentially involved in making Mayo a Destination Medical Center, and it gets to the local everyday touch points that can result in a moment of potential frustration turning into a moment of respite, and making the patient experience. A medical center is after all just a place. It is the people who inhabit a place that make it a community.
Gary David, PhD, CCS is an associate professor of sociology at Bentley University in Waltham, MA. He also runs the experience design consultancy Ethno-Analytics. His work focuses on experience design, examining relationships in the workplace, and technology at work. He has done work on medical transcription, clinical document improvement programs, speech rec systems, mental health informatics, and EHR systems. He is the current President of the Association for Applied and Clinical Sociology.