Enough Mayo Clinic employees have voiced concern about the clinic's focus on productivity to draw the attention of Mayo leadership.

It's hard to know if the concerns of current and former staffers about Mayo's leadership style are valid. It can take time for evidence to show up in patient-safety reports, surveys or national rankings.

But employees have expressed worry that Mayo risks compromising its core value — Dr. Will Mayo once said "the best interest of the patient is the only interest to be considered," and Mayo Clinic has lived by that mantra ever since.

A broad range of staff from front-line workers to respected leaders have complained that Mayo's work atmosphere has changed, they're supposed to concentrate on efficiency instead of patient care, that adequate staffing isn't the priority it once was and that constructive criticism is a career risk.

So far, the best evidence countering employees' concerns is Mayo's recent first-ever No. 1 ranking by U.S. News and World Report as the best hospital in the country. Based on employee surveys, Forbes also ranked Mayo in 2012 as the 71st-best U.S. company to work for.

And Dr. John Wald, Mayo's medical director for public affairs, emphasized to me last week that Mayo values "are the thread that holds every one of us together."

As a practicing neuroradiologist, Wald is on the front lines of patient care at Mayo. His own colleagues, he told me, say things like, "Where are we going? What are we doing?"

Thus, Wald said, "we are aware of the concerns."

Such concerns are not unique to Mayo. MD Anderson Cancer Center in Houston, Wald noted, has also struggled with staff worries about patient safety and working conditions.

Results of a 2013 Mayo employee survey triggered an increased emphasis on employee-engagement efforts that were already underway. Wald didn't disclose survey details, so it's unclear how widespread employee discontent has become.

For several months, the criticism I have heard personally from current and former Mayo employees has been mingled with praise. But in recent weeks, many have begun to express anxiety about Mayo's drift from the needs-of-the-patient-come-first philosophy, and other Mayo values, such as treating all patients, regardless of ability to pay, and maintaining a Franciscan focus.

Wald said Mayo's five-year plan, for successful patient care and a successful business model, is focused on "keeping the patient in the center, supported by the Franciscan values — Mayo Clinic values."

Mayo systemwide is addressing pockets of employee angst by reviewing its 130 departments and divisions to see where morale is high to replicate it via employee input, Wald told me.

"Dr. Noseworthy has challenged every one of the staff to think of solutions for every one of their work areas," he said.

Concerns about top-down management style, he said, do not match Noseworthy. At every meeting Wald has seen Noseworthy at the past two years, the CEO "either started or ended the meeting by saying, 'How is the staff?'"

Input can be provided via employees' supervisors, department chairs or clinical-practice committees and Noseworthy genuinely wants it.

"The best solutions are going to come from the people that are at the bedside," Wald said. "We'll get through this period of change. But we'll get through it based on the ideas and ideals of staff who are working day-to-day, face-to-face with patients."

Mayo has invited the Post-Bulletin to cover the clinic's handling of employee concerns, and solutions workers propose to improve the work environment.

Will Mayo Clinic maintain its high national rankings?

"We can't wait for the patients to start saying there's a problem," Wald told me, emphasizing Mayo is actively addressing employee frustrations.

It may be that Mayo workers in Rochester and elsewhere are simply catching up to the business model most other workers across the country now perceive as normal — work faster, work harder, with fewer resources, for less money.

But it's time for an open conversation about the issues that Mayo Clinic staff and retirees have begun to candidly express to trusted family, friends, neighbors and colleagues.

Pulse on Health is a weekly column by health reporter Jeff Hansel (285-7615). Follow him on Twitter @JeffHansel.

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