Harvard Business School Working Knowledg e Archive

Clueing in Customers - Why Docs Don't Wear White Coats or Polo Shirts at the Mayo Clinic

3/17/2003
The Mayo Clinic works hard to build relationships with patients and their families. In this excerpt from Harvard Business Review, the authors explain how Mayo uses visual and experiential clues to tell a compelling story to customers.

In health care, the visual clues about an institution's core values and the quality of care are particularly difficult to separate from the actual service because people spend significant time in the facility—some stay for days or even weeks. The physical environment is also connected to medical outcomes: The potential of design to promote healing through stress reduction has been documented in dozens of studies. For these reasons, more medical institutions are making an effort to create open, welcoming spaces with soft, natural light. Mayo Clinic goes further with its design philosophy, which is perhaps as well honed and articulated as that of any major service provider in America, and pays strict attention to how every detail affects the patient's experience.

From public spaces to exam rooms to laboratories, Mayo facilities have been designed explicitly to relieve stress, offer a place of refuge, create positive distractions, convey caring and respect, symbolize competence, minimize the impression of crowding, facilitate way-finding, and accommodate families. In the words of the architect who designed Mayo Rochester's new twenty-story Gonda Building: "I would like the patients to feel a little better before they see their doctors."

A well-designed physical environment has a positive impact on employees as well, reducing physical and emotional stress—which is of value not only to employees but also to patients because visible employee stress sends negative signals. In our interviews, patients commented on the lack of apparent stress; one said, "It did not seem like a doctor's office when we went to Mayo. There was no tension."

Feast for the eyes
The Gonda Building has spectacular wide-open spaces, a marble stairwell and floor, glasswork sculpture suspended above, and a multi-story wall of windows looking onto a garden. The building's soaring lobby houses a cancer education center because, as one administrator put it, "the more visible the center, the more you remove the stigma of having cancer." The lobby of Mayo Clinic Hospital in Scottsdale is also visually stunning, with its atrium, indoor waterfall, stonework, and wall of windows overlooking a mountain range.

The resuscitation equipment in pediatric examination rooms is hidden behind a large picture.
— Leonard L. Berry and Neeli Bendapudi

Mayo doesn't limit its facilities' clue management to public spaces. After all, the scary stuff in a medical facility happens elsewhere—in the catheterization lab, in diagnostic imaging, in the hospital room. At Mayo hospitals, staff members write the names of attending doctors and nurses on a white board in every patient's room, which helps stressed-out patients and families keep track of multiple caregivers and serves as a visible clue that there's a real person they can talk with about any concerns. In-hospital showers, microwave ovens, and chairs that convert to beds are available for family members because, as one staff member explained, "People don't come to the hospital alone." The pediatric section of the emergency department of Mayo's St. Mary's Hospital in Rochester transformed artwork by local schoolchildren into a colorful array of wall and ceiling tiles. The resuscitation equipment in pediatric examination rooms is hidden behind a large picture (which slides out of the way when the equipment is needed). While the hospital was under construction at the Scottsdale campus, officials arranged to have an automobile lifted into the building so physical rehabilitation patients would be able to practice getting in and out of a car in the privacy of the hospital.

Environmental clues in the outpatient setting are orchestrated just as carefully. Mayo Clinic buildings include quiet, darkened private areas where patients can rest between appointments. Public spaces are purposely made softer with natural light, color, artwork, piano music, and the sights and sounds of fountains. In examination rooms, the physician's desk is adjacent to a sofa large enough for the patient and family members, a design that removes the desk as a barrier between doctors and their patients.

Mayo also understands that the way employees present themselves sends a signal to patients. Patients don't encounter doctors in casual attire or white coats. Instead, the more than 2,800 staff physicians wear business attire, unless they are in surgical scrubs, to convey professionalism and expertise. It's a dress code that some outside Mayo have called "pretentious," yet we'd argue that it's no more pretentious than, say, the dress code for airline pilots. Airline passengers don't want to see their pilot in a polo shirt, and patients feel the same way about doctors. In effect, Mayo Clinic doctors—just like service workers in many other industries—work in a uniform; it's a visible clue that communicates respect to patients and their families.

Patients don't encounter doctors in casual attire or white coats.
— Leonard L. Berry and Neeli Bendapudi

The tiniest detail
Such attention to visual clues extends to the most minute detail. Mayo Rochester employee Mary Ann Morris, the administrator of General Service and the Office of Patient Affairs, often tells a story about her early days with the organization. She was working in a laboratory—a job that required her to wear a white uniform and white shoes—and after a hectic morning getting her two small children to school, she arrived at work to find her supervisor staring at her shoes. The supervisor had noticed that the laces were dirty where they threaded through the eyelets of Morris's shoes and asked Morris to clean them. Offended, Morris said that she worked in a laboratory, not with patients, so why should it matter? Her boss replied that Morris had contact with patients in ways she didn't recognize—going out on the street wearing her Mayo name tag, for instance, or passing patients and their families as she walked through the halls—and that she couldn't represent Mayo Clinic with dirty shoelaces.

"Though I was initially offended, I realized over time [that] everything I do, down to my shoelaces, represents my commitment to our patients and visitors," Morris told us. "Twenty-eight years later I still use the dirty shoelace story to set the standard for the service level I aspire to for myself and my coworkers."

A dirty shoelace might seem pretty minor, given the important work of caring for the ill. But a shoelace is something a customer can see, whereas medical expertise and technical ability are not. It's a piece of evidence, a small but integral part of the story Mayo tells to its customers.

Leonard L. Berry is a marketing professor at Texas A&M University in College Station. Neeli Bendapudi is an associate professor of marketing at Ohio State University in Columbus.

Excerpted by permission from "Clueing in Customers," Harvard Business Review, Vol 81., No. 2, February 2003.