"The best interest of the patient is the only interest to be considered, and in order that the sick may have the benefit of advancing knowledge, union of forces is necessary." — Dr. Will Mayo

Back in the early years of St. Marys Hospital, the Mayo Brothers maintained an “open-door” policy, allowing other members of the medical profession to view their surgeries and learn. Eventually, the sidelines became so crowded that elevated metal stands were put in to allow for better views of the operations.

Their methods were based on the best medical practices from across the world. Lifelong students of medicine, the brothers would travel to clinics near and far to observe new procedures and ideas.

It was in this spirit of collaboration that Mayo Clinic would rise from the cornfields to become a global model for patient care.

Now, well into the 21st century, Mayo continues to leverage new innovations and partnerships to strengthen its position as a world leader in health care. In this report, produced with students from the University of Minnesota Rochester, we explore the ways Mayo is expanding its footprint through technology, research and business to reach more people than ever before.

Informing the world

Mayo Clinic is known globally for its ability to produce research and accurate content. Currently, the nation's No. 1 hospital is able to bring this expertise to people using modern technologies.

From syndicated radio programs to video documentaries, Mayo's new delivery team rivals that of many traditional newsrooms. Each month, more than 200 pieces of external content are produced and pumped out through its robust system of media partnerships and social channels (on Twitter alone, Mayo has 1.8 million followers).

"There's so much noise out there right now, and there's a huge appetite for credible, reliable info," said Ron Petrovich, director of communications, news and news delivery at Mayo. "We can deliver that. Everything we have is reviewed by physicians and researchers — so we tell the human stories with data to back it up."

Mayo has developed an arsenal of medical content so strong that in 2015 Google announced it had partnered with the clinic to deliver accurate health information through its search engine.

Now, when users around the world search for common health conditions — from a concussion to a cold — the first result is a list of relevant medical facts, like how common the condition is or whether it's contagious.

"[Google] found that patients were getting information that was inaccurate," said Dr. Sandhya Pruthi, associate medical director of Mayo Clinic Global Business Solutions. "So Google approach Mayo and asked us: since you guys have a very trusted, knowledgeable website that people go to, can we partner with you to provide them Mayo expertise and to review content?"

Its latest project is through Amazon. Mayo Clinic is offering non-emergency medical advice through the company's voice assistant, Alexa. "We were watching trends in knowledge, and discovered that consumers were starting to use voice-enabled devices and voice assistance to help them find their health information," said Dr. Pruthi.

Known as Mayo Clinic First Aid, the free program provides users with voice-driven, self-care instructions for dozens of common medical occurrences, from conducting CPR to treating a burn. The skill was developed by Mayo's global business arm.

mayo expertise, in China

For decades, Mayo has been able to export its model of care across the country, from St. Peter, Minn. to Scottsdale, Ariz. Today the clinic employs over 60,000 people across three campuses — Minnesota, Florida and Arizona — and more than 60 regional satellite clinics in the upper Midwest.

In recent years, though, Mayo has begun implementing new strategies to significantly expand the number of individuals it can reach — all without any direct patient contact.

In 2011, Altru Health System in Grand Forks, N.D. became the first hospital to join the Mayo Clinic Care Network. Since then, more than 40 organizations have signed on to become members of the system.

The Care Network gives affiliated hospitals — stretching from here in the U.S. to Singapore, the United Arab Emirates, and elsewhere — access to Mayo Clinic specialists, education and other resources.

As the Star Tribune explains: "the arrangement means access to some of the finest medical specialists in the world. For Mayo, the network is an opportunity to expand its footprint without having to build or acquire new hospitals. It also gets to market its world renowned expertise to patients — many with the most complex cases — who might not otherwise travel to Mayo clinics in Minnesota, Florida or Arizona."

The most recent addition to the Care Network, Sir Run Run Shaw Hospital, is in Hangzhou, China. The Hangzhou metro is home to more than 21 million people, making it the fifth most populous metro in China. Sir Run Run Shaw Hospital has two locations and serves about 2.6 million patients annually (double Mayo Clinic).

“China is among the countries where we have seen the greatest growth in recent years,” said Dr. Stephanie L. Hines, chairwoman of executive health and international medicine at Mayo Clinic.

Mayo has a stringent process of reviewing hospitals to make sure they are the right fit. Once accepted into the Care Network, hospitals have access to products and services that can improve patient care.

“The Care Network is 45 medical institutions that we’ve done a lot of due diligence vetting," said Dr. Steve Ommen, a cardiologist and medical director for AskMayoExpert, an online information and communications portal available to member hospitals.

That includes "making sure they are culturally similar to Mayo Clinic in terms of their focus on the patient, and quality standards, delivery of medicine, those kinds of things," said Ommen.

Another focus for Mayo in recent years has been the use of telemedicine. Using video conferencing, Mayo physicians can connect directly with patients from hundreds of miles away. This technology has proven especially beneficial for patients in rural areas, where medical specialists are fewer and far between.

“The biggest value is for the patients, and for us to make it more convenient to them," said Dr. Ommen. In many cases, he said, telemedicine can be as effective as a personal visit. “We’re not replacing care with something robotic, and non-personal, but rather using the tools to enhance what you would get otherwise."

Building relationships

Dr. Philip Fischer, a pediatric physician and researcher, had an interesting path that led him to practicing medicine at Mayo. Starting with med school in California and a residency in Salt Lake City, Dr. Fischer moved to France, then England, and finally landed in Africa for six years. At that time, he was the only pediatrician with 1.5 million children in the area.

“There were a lot of patients to take care of, but then it also pointed out the necessity of education," said Dr. Fischer. "There were also a lot of things that I didn’t know, which meant we did some research to figure things out. So, just like Mayo has clinical research at the core with education and research intertwined, I was primarily a clinician, but everything was all intertwined.”

For Dr. Fischer, his values aligned with those of Mayo even before moving to Rochester, where he is now faculty development chair for the Department of Pediatric and Adolescent Medicine.

“I come into medicine [at Mayo] with a view and a desire to be useful to the whole world, so the view of global health has always been there," he told us in an interview.

For generations, Mayo's brand, synonymous with "putting the patient first," has attracted medical professionals from far and wide to enlist in its ranks. Increasingly, it has also emerged as a powerful tool for businesses looking to test new markets.

Al Berning, a well-known entrepreneur in Rochester, and CEO of Ambient Clinical Analytics, works on developing several Mayo-licensed technologies. Berning said what the name "Mayo" brings to his products is monumental in its ability to market and sell them.

“It is important for people in China to hear the name 'Mayo,' opposed to just any other tech company," Berning told us. "Because they value the name."

Al Berning, right, meets with Dr. Zhang Jiwu, CEO of Meehealth in China

Founded in 2013, Ambient has established agreements to bring its products to the world market, notably in China and India. Ambient, according to its website, "sells clinical decision support and alerting tools to hospitals to reduce overall health care costs and improve patient outcomes."

One of its products works to identify potential Sepsis conditions, which can be life-threatening, when they occur and help guide the care team through detection and the process of care. “We believe that Mayo has the best product for detection of sepsis on the market, and in fact, it is the only one that is FDA approved," said Berning.

We found that whether it be a formal business venture, charity work, or clinical research, in some capacity Mayo Clinic reaches dozens of countries around the world — from India to Somalia — through partnerships comprised of clinicians and researchers.

“I’m not even sure if Mayo knows all the partnerships, research, etcetera, going on with all of their doctors," added Berning.

Dr. Phil Fischer evaluating a 4-day old infant in the Democratic Republic of the Congo

With a focus on the study of nutritional problems, Dr. Fischer travels all over the world to teach, learn, and research both general pediatrics and the more focused areas of nutritional deficiencies, like those present in beriberi (Cambodia) and rickets (Nigeria).

Back at home, he continues his mission of helping those in need. Dr. Fischer has hosted international patients receiving charity care at his home for weeks at a time. Many come to Rochester for life-saving treatments that they may not be able to get anywhere else.

“Personally, we have had a bunch of these kids stay with us when they are getting heart surgery, and it’s incredibly fun to be involved with," said Dr. Fischer. "We have the privilege of living with them for three to six weeks while they are getting surgery, and recovering from it, and then going home fine. It's phenomenal to see medicine through the eyes of other people.”

'A very unique place'

Rochester has become an international hub for students and young professionals looking to learn the practices and culture that have made Mayo one of the most respected names in medicine.

In 2016, Tara NicDhonaill traveled to Rochester as part of a special link between Mayo and her Irish residency program in Galway, Ireland. While here, she traversed the sub-zero temperatures for the chance to work alongside leading experts in patient care.

"I had the opportunity to look after patients from all over the world, some flying to the Mayo Clinic for their appointments or care," NicDhonaill told us via email from Ireland. "I was delighted to meet people and other residents from all parts of America."

"It is a very unique place," she added.

Mayo Clinic Gonda Building / William Forsman

David Tse, a Mayo graduate student originally from Malaysia, said it was an opportunity to participate in Mayo Clinic’s SURF program that first brought him to Rochester.

“I really enjoy the atmosphere of the research at Mayo," said Tse. "Other places, I feel like don’t have as much of an environment that encourages [positive] interactions between students and faculty.”

Additionally, Mayo's inclusive culture has made international students feel welcome, said Tse. It is not uncommon for groups of students to share their cultural backgrounds with peers, as well as the general community. “Every one of us are from all different places, so it’s an open diverse group," added Sowmiya Palani, a Ph.D. student in biochemistry and molecular biology.

With Destination Medical Center plans in gear, Rochester is poised to add in the upwards of 30,000 jobs over the next two decades. Doing so, leaders say, will require Rochester to be purposeful in its efforts to attract a new generation of students and workers.

"If cities aren’t focused on younger populations and younger generations, they will simply age out of existence,” said Patrick Seeb, DMC's director of economic development and placemaking. Therefore, he added, “DMC is intentional about wanting to appeal to and attract young people.”

Balancing the needs of different subsets of the population, including those of different ages, will be key, said Nicole Nfonoyim-Hara, a writer with studies in urban anthropology.

She cautioned that amid all the change, it can be easy to lose sight of how diverse the community already is.

“Rochester is a lot more diverse and rich culturally than it gives itself credit for,” said Nfonoyim-Hara.

Last year's PlaceMakers Prototyping Festival was one event designed to ask the community what creative models they saw as being helpful with this idea of maintaining the inclusive culture of Rochester for the patients, the employees, the students, and the local residents across all races, cultural backgrounds, and ages.

PlaceMakers Multilingual Pedestrian Signage

Out of the festival came Edgar Mtanous’s idea for multilingual street signage, above, along with Nfonoyim-Hara's protoype for a “Town Cube." Both installations focus on making people, regardless of who they are or where they come from, feel like they belong.

“As much as you love or hate what’s happening, I think the best thing is to just speak up and be as engaged as possible," said Nfonoyim-Hara. "And then when you are in those spaces to ask, ‘Who’s not here? Who needs to be at the table?' "

This report was published by Med City Beat in partnership with the University of Minnesota Rochester's Community Collaboratory course. Authors: Lauren Anderson, Mariah Arneson, Mikayla Bjerke, Hannah Quarnstrom and Sean Baker.