Welcome to How Leaders Lead, where every week you get to listen in while I interview some of the very best leaders in the world. I break down the key learning so that by the end of the episode, you'll have something simple you can apply as you develop into a better leader. That's what this podcast is all about. Today's guest is Dr. John Nosedworthy, CEO Emeritus of Mayo Clinic. People come from all over the world to get treatment at Mayo. Their doctors and researchers make major breakthroughs that have made life better for all of us. I mean, we're talking about one of the very best hospitals in our country. And listen, it takes a special leader to step into an established organization like Mayo with a sterling reputation and make it even better. And Dr. Nosedworthy is a special leader. He knew it was critical to keep that level of excellence, but also to build on it. In his 10 years at the helm, he was relentless about driving out inefficiency and waste, doing that freed up resources so they could reinvest in all the great research and in all the care that they're known for. Now, I got to tell you, it wasn't easy. I mean, change never is, right? And that's especially true in an organization where people already feel like things are going pretty darn well. But a great leader drives change even in high performing organizations. I can't wait for you to see how John does it and how you can do it too. So here's my conversation with my good friend and soon to be yours, Dr. John N osedworthy. I can't wait to go deep into how you lead and how you've just taken Mayo Clinic to new heights. But first, I want to play name that band with you. Are you ready for this? Okay. Now get ready. Here it comes. Oh, that would be Edward Sharp and the magnetic zeros. I was hoping you would get that because I know your son is the guitar son on that great band. But I have to ask you, I have to ask you before we go on, do you have any musical talents yourself? Not much, but when both the boys were little, I used to sit on the edge of the tub while they were having a bath and I'd play guitar and sing little kids songs to them. And both the kids grew up to be musicians. So that was good, although one's a physician, but Mark is a professional musician, as you mentioned. I'm very proud of them. How many patients has Mayo impacted and can you give us the cliff notes of its scope and its impact? David Mayo Clinic is about 160 years old, was founded by a surgeon and his two sons. It started in Rochester, Minnesota. It's now national with major campuses in Jacksonville and Phoenix. And through its affiliated network, touches 40 other memberships around the world and tens of millions of patients every year. So it's a not-for-profit academic medical center that integrates education with research and practice. And it's a marvelous institution. I was the highlight of my life was to be a physician there for 28 years and to be the CEO for the last 10 years of my career. You mentioned that Mayo is non-profit. How does that business model work? So it's a non-profit because we have such a commitment to our community as well as to our patients and it invests all of its earnings in education and research. There are no public options, obviously, and no bonuses for employees or CEOs. Business model for healthcare for the not-for-profits is a tricky one or a tough one because most large medical centers, including Mayo Clinic, have a predominance of patients who are over 65, who are Medicare patients or Medicaid patients who are disabled and often disadvantaged in many ways. The reimbursement for government-paid patients doesn't cover the cost of the care. And so you can imagine me trying to explain to our public trustees, we lose money on 55% of our patients right out of the chute, which is not a business model that many of your CEOs that you interview would want to take. But with careful engineering of the practice and balancing payments from insurance companies and so on, if one's clever and has a good staff, one can make sufficient margin at the end of the year to invest in research and education in the community. But it's tricky. I remember when we had lunch and we were talking about how you led Mayo. You really said the key was that you put the patient at the center. You know, explain what that concept is and how you operationalized it. Well, this goes right back to the original model of the Mayo Clinic where essentially, and you would notice that David, as a patient, your medical record at Mayo Clinic is shared with all the doctors that see you. And that's been the case since the early 1900s. And so when a patient would come into my office as a neurologist, I could see what the other doctors had said about her earlier in the day or yesterday and so on. And we all would converge on that patient to see how we together as a team could meet their needs quickly and efficiently and in the best possible way. And at the end of the three or four days that the patients here meet with the patient and say, the group of us feel that this is the best solution for your problem. The team-based care has been engineered into the system for well over 100 years , as I mentioned. And it makes it a great privilege to work there because everyone is focused only on the patient and only on working together. So it's a great model. It's hard to replicate other places I've worked to have been able to do it, but it works well at Mayo, but it does have to be nurtured. You're going into a collaboration system when you usually have people who work in silos and inpatient care. You know, that's very tricky, I would think, John. And you know, when people come into Mayo, how do you get them to really embrace that concept? People are attracted to work at Mayo Clinic because they want to do the right thing for their patients. It's mostly a specialty practice. They want to see patients with serious and complex problems. They want to work with others and they don't want to be worried about chasing the bills and that sort of thing. So they accept the fact that you're hired on a salary. It's a salary model. You're led by physicians and as a physician, you will lead in your area. We see patients from about 130 different countries every year. They fly in to see us because there's a serious or a complex problem that needs to be solved. So it selects very quickly for those who would rather be on a great team than be a solo practitioner. So our question, Dave, that I often get is, who's the best ankle surgeon in Delaware or on the East Coast? And medicine is set up to be a system of stars. Who's the most famous plastic surgeon? Who's the best heart doctor in California, whatever? Whereas at Mayo Clinic, they've built an engineered system that works to make sure that the right people see that patient together to get an answer quickly. And you can only really do that with a salaried system and a system that has been built for that to be the output. When you have a complex diagnosis or a complex procedure, certainly the surgeon or the radiologist or whomever is terribly important. You want that person to be outstanding. But they generally are supported by a dozen or 15 or 20 people in the background who are waking up, putting you asleep and following you afterwards, making sure that everything's working. And at Mayo Clinic, that's where the focus has been. The Mayo brothers, well over 100 years ago, said, "We need engineers, literally engineers, to be embedded in the practice to make sure that the place runs like a Swiss watch." Now they wouldn't have said it that way. But what most people say to me before I retired, when they come to Mayo, they can't believe it. They've been here a day and a half and they've already seen five different specialists and have answers to their questions that took weeks from months elsewhere. It's all under one roof and it works very well. And again, any team works well when people are proud to be on that team and respect each other. People who are recruited here and who are voted on the staff and allowed to stay, they generally don't leave because they know that they can't do this anywhere else. You make it sound like, "Well, this has just been built into culture for years and that's what Mayo is." But as CEO, you've got to keep it alive. You've got to keep taking it to the next level. What in particular did you do to really drive the culture and make sure that it did stay front and center? And you could recruit those people who wanted to have that team orientation. I became the CEO in 2009 during the Great Recession just before the Affordable Care Act came out. Reimbursement for healthcare was in decline, was under great deal pressure. To be honest, the margins were too thin for us to continue to invest in research and education. And so we basically had to do a reorg or a restructuring of Mayo Clinic to make it more efficient, drive the quality, but really drive the efficiency as well. And you can imagine how difficult that was at first blush with a group of world famous and wonderful doctors and nurses, roughly 5,000 of them, who immediately said, "Wait a minute, you're going to destroy our culture." And that's literally what I was told. You're going to ruin the Mayo Clinic. And I said, "No, I'm not actually." And if I do, you'll fire me in a week and you'll get somebody else. But essentially, we're going to use the culture to better serve our patients, to make sure that we're here for the next 100 years. And so again, when you lead an organization that has a rich culture, my advice to CEOs would be, "Understand that culture," and remind the staff that you get it and that they're going to help you keep that culture strong. By doing so, by literally re-engineering hundreds of practices over the matter of a decade, we're able to drive out a lot of waste, drive up our margins so we had enough margin at the end of the year to invest in research and education and in our staff. And our quality got better. I mean, Mayo Clinic always had great quality, but it got much better because people were focused on what is it that we do that makes a difference to the outcome of that patient? How can we get better outcomes, fewer infections, fewer readmissions, fewer duplication of services and so on and so forth? And really, David, if you're the CEO and you've got 68,000 people who come to work every day with one purpose in mind of making it better for patients, it's a pretty fun job. You mentioned that you did have those naysayers that thought you were crazy when you embarked on this mission. What have you learned about how you handled naysayers? And do you have a story about that? Well, probably the best story, literally, is a thought leader at the clinic, stood up in the auditorium, literally stood up with his hand up in the air and said, "Dr. N ourhsworthy, and we were friends. I mean, we'd seen patients together for 15 years. He said, "You're going to ruin a Mayo Clinic." You know, that's kind of like day one on the job. So you basically have to just absorb it, have a sense of humor. It's nice to be trusted and known. I mean, for me, I'd work there forever and had seen patients with always people done research with all these people. So there's a vast majority realized, even though we're not for profit, if Mayo Clinic operates in the red, we're not immune, we'd have to close. And then how could we help patients if we can't sustain the business model? So physicians at Mayo, salaried physicians, recruited for their excellence, didn't need to know much about the business of medicine. And so they hadn't been instructed in it. They really didn't know. People would regularly say, "Look at my revenues." And I'd say, "Yep. Would you like to look at your expenses? Why, is that important? Yes. We're actually losing money on your practice. But I've generated this and that, these bills or whatever. So physicians, they're not stupid people, as you know, but they're not primarily business people. And if they're working in a place like Mayo, where they are protected from the business model, they need to be instructed. And so you take a step back and you reevaluate with them. Is the primary value still the same? We're here to meet the patient's needs. Do we believe we need to drive up quality? Do we need to invest more in research? Do we need to invest in your pension? Do we need to build better facilities? Do we need to grow so we see more patients? Yes, yes, yes, yes, yes. Okay. So if you're not going to invest in your own business model, you're going to invest in your own business model. So if you're not going to invest in your own business model, you're going to invest in your own business model. So if you're not going to invest in your own business model, you're going to invest in your own business model. So if you're not going to invest in your own business model, you're going to invest in your own business model. So if you're not going to invest in your own business model, you're going to invest in your own business model. So if you're not going to invest in your own business model, you're going to invest in your own business model. Because people don't like anything that's new. And that person said, "You're going to ruin the place." I said, "Well, we did this during the Depression, and it worked. We did it during World War II, and it worked, and we're going to do it now, and it'll work, and it did." You know, you mentioned a little bit earlier that one of the things that Mayo is known for is its incredible ability to diagnose, perhaps better than anybody else in the world. Is there a story along those lines that you're particularly proud of? And I was the highlight of my life as a CEO because literally every day I would come home with three or four stories about what great work people were doing, doctors and nurses working together, and so on, finding answers that had been elusive. And sometimes the answer comes from a particularly careful physician. Often it comes from a team of two or three different specialties looking at the same problem together. What I found when I moved there, the cases that came to Mayo were so complicated and so unique that before long I was seeing cases I had never seen before. Now, in my field as a neurologist was multiple sclerosis. I'd seen lots of multiple sclerosis patients, obviously. But when I came to Mayo, I was seeing all the rare diseases, and I'd see, you know, 50 or 75 of those a year, that mimic multiple sclerosis, and I was able to say, g ee, this isn't multiple sclerosis, it's this other condition because I've seen five of those. When you're surrounded by people whose practice is rich with all these unusual cases or unusual presentations of cases such as this, answers come very quickly. One thing we did, just as an example for anyone who's spent any time in healthcare, in neurology, if you were seeing a case that was really a puzzle, or it was really a wonderful case to teach other people on. I would ask my patients, do you mind if I bring in three or four of my colleagues for about 10 minutes and let them see you and ask you some questions? And of course, every patient said, of course, I would love to see some more doctors looking at me as the subject of their interest. And so I pick up the phone in those days or buzz the desk and say, 1,000 in my office, the term 1,000 meant, knows where these got a hot one, come and see it. And literally within three minutes, there'd be four or five neurologists or graduate students, whatever, at my door. And I'd say, this is Mrs. Jones or Mr. Jones. He has this problem. I can't figure it out. I've never seen the eyes move like this or the tremors like that or walking like this. Can you help me? And we'd walk the patient up and down the corridor, ask a few questions. Or I think this patient has this condition, which is a canary. It's extremely rare. What do you think? So that patient would benefit literally at no charge over a period of 10 minutes to get five other opinions and that allowed us to solidify the diagnosis really fast and really well. And I can't do that at other places. Hey, you know, because you're listening to this, I can tell you're the kind of person who wants to learn how to lead well. But there's a lot of companies out there who want to take that desire and charge you $500 or $1,000 or heck, even $20,000 to try and show you how to lead. That's just not right. If you want to be a better leader, I believe you deserve to have access to something that will truly help you and it shouldn't cost a fortune. So I want you to go to howleaderslead.com and start my leadership class. It's really and truly free. And after you take this class, you're going to feel more confident in your role and you'll be on your way to getting big things done with your team. Go check it out at howleaderslead.com. One of the other things that as I understand it, you were a big driver of was holistic medicine. Explain what that really is and how you drove it at Mayo. Well, I didn't really have to drive it, David, because it was getting a lot of attention from many of our staff, it always had, but again, it was becoming a little bit more mainstream. And people whose interest in wellness and disease prediction and prevention, we had lots of those experts. And so we brought them together to work differently to try to predict and prevent illness. That led to the Center for Individualized Medicine, where we began to use gen omics and other technologies to find why this family has so many problems in it and so on and so forth. We then kind of industrialized that concept with special clinics for diagnostic puzzles or diagnostic problems. And those would be seen by a panel of experts in this area who would try to solve the problems and provide best advice to patients. So it was an amplification of what had been done for 100 years with, of course, the ideas would come to me and I would just operationalize it with my team and let these good people do their work. You're a very humble guy, you know. Just let these other guys do the work. But that's your old mindset, isn't it? It's really to turn it over to people and give them the challenge and go for it . That's the whole story. That's the whole story, David. You've written about this. You've written a book about this. Take people with you, right? I mean, that's, but if you look at my career, I've had a wonderful career. But essentially, I realized at a pretty young age that I was bright enough, but I'm never going to be the brightest guy in the room. But if we wanted to make a difference, if I was going to be smart, I had to be able to recruit people around me who had a common interest, a common vision, and how are we going to solve this problem? And I realized at a very young age, that was something I was good at, not the ultimate solution, but coercing friends and others to work together. And so when Mayo Clinic approached me and said, "We'd like you to visit Mayo Clinic," a good friend of mine said, "Oh, I hear you're moving to the Mayo Clinic," literally. And I said, "No, I'm not." He said, "Yes, you are." And I said, "No, I'm just going there to give a lecture." And he said, "John, you're going to go there. You're going to fall in love, and you're going to hope they recruit you, and I bet they do because that's kind of how you are. You like to work with other people. You're not trying to do it all on your own." And he was right, and it was the best thing that ever happened to me. Mayo, as you mentioned earlier, it is a global destination for health and wellness and for health care. And how do you go about building awareness of your capability and become a global destination? So it already was, and in spite of the fact it's in Rochester, Minnesota, and now in the last 40 years in Jacksonville and Phoenix, but the mothership, if you will, is in Rochester, Minnesota, people have been coming from all over the world to Mayo Clinic forever, in spite of the fact it's never been easy to get to. But here's the thing. Mayo, when I joined it and when I was working there the first, whatever, 15, 20 years, it's been a very quiet institution. It never talks about itself. It never advertises. I remember going, it was a young man going to the CEO and saying, "You know, people don't even know we do research here. They don't know about all the wonderful things." And the answer was, "Oh, they'll find out." Well, what happened if you go back 15 years, health care, especially the competition for these fly-in patients that you're describing, global destination, people coming from all over the world, it's much easier to go to Germany or it's much easier to go to Boston or to Cleveland or to Los Angeles and so on than to go to Rochester, Minnesota. So literally, David, I went to the trustees and said, "I think we're going to have to start to talk a bit about what we do. We're going to have to actually tell the world what we're doing." And when I went to New York and was interviewed by the newspapers there and so on, they said, "You know, Mayo has always made us guess what you're up to." And I said, "Well, in today's world, I don't think that's to our advantage. We should just tell you what we do and see if that helps you find us more easily." The trustees supported that and we were able to convince the legislature in Minnesota to provide a destination medical center opportunity funding for Little Rochester, Minnesota to get whatever was $285 million over 20 years to build the infrastructure, basically plumbing, sidewalks, bridges, all those things your tax base pays for. But when you're a small city, you don't have the tax base to do that. And that was to build up and make it easier for Rochester to grow and have the amenities for patients from all over the world, restaurants, culturally appropriate hotels, that sort of thing. So that was a big initiative and that's gone extremely well. But the reason people come is because you have the highest quality in the world and you're the highest rated healthcare organization in the world. And so that drives patients, especially from Europe and Asia and so on. Well, you were really smart to go after that because you can have all that if people don't know about it. It's hard to go after it. And it obviously worked for the community and for Mayo. Let's shift gears a little bit. I want to take you back a long ways, John. Maybe not that long, but go back to your prep school days. And one thing I was surprised to learn in my research is that you struggled academically and you even said you struggled mightily to fit in. What kind of impact did that period of life have on you? Probably the best thing that ever happened to me in my life was that I had a whole bunch of failures early in my life. They didn't crush me, but they almost did. But what I learned was if you don't understand what people expect of you, you 're going to fail. I guess I was an underperforming junior high school kid. And the teacher said, look at his test scores, the national test or whatever test they put the kids through. And look what you got. He needs to be challenged and he needs to go to a tough school. So they sent me to a wonderful school called St. Marks outside of Boston. And at Christmas, the headmaster called my parents and said, you know, John can go back to public school because he's not going to make it here. And I just didn't have any idea what was expected of me academically. My dad was a Episcopal clergyman. Thankfully, I passed theology and I also passed math, but I failed everything else. And I mean, I'll never forget this, David. If you ever had an experience like this as whatever I was, 14 year old or something in ninth grade, my parents said, do you want to go back to public school? I remember crying and saying, no, I'm going to be fine. Just don't give up on me. And I learned how to study and life went on. I did well and had choices for the rest of my life. When I finished as an MD, a neurologist, years later, I decided at that time it seemed to be the appropriate thing to go and do basic science research to help you advance the field that you were working in. And I worked at a Nobel Prize winning laboratory at a top university. And within 18 months, I realized I was a fish out of water. I was really struggling. Like my goodness, the country's invested in me and blah, blah, blah. But someone reached in and said, we still believe in you, come back, we'll put you on staff and good things will happen. And so when you fail and you learn from your failure or when you have setbacks and you learn from it, life gets increasingly easier. I've used that repeatedly as you've probably seen in various talks I've given and so on and mentoring young people, you've really got to know who you are. That's job one. Pay a lot of attention to who you are as a young person to develop your career. If you're in the wrong lane and you're sure you're in the wrong lane, be honest with yourself and get into another lane. Plan B is better than plan A. You're never going to be happy. Move on to something else. Now, if you're on plan Q or plan T or something, you're obviously an unfocused person. But many of us end up in the wrong place for a while. And the best thing in that situation is to get to a different place. So knowing who you are, self-awareness, spending that time and realizing, I want to love what I'm doing, I want to be challenged, I want to make a difference. I don't think I can do it here. I've got to figure out where I can do it. You know, you joined the neurology team at Mayo in 1990. You became the chairman of that department in 1997. And I'm curious, as your experience as a neurologist, people always talk about people being right-brained and left-brained or... Is that literally true? I can't say that right-brained people are more creative, but creative people often have a hyper-functioning, what we would call a non-dominant side of the brain. The left brain is where we speak from and where we use our right hand, if you 're a right-handed person. But much of the creativity and originality does come from the non-dominant side of the brain, but many, many clever people are clever with both sides of their brain and others are just clever and we don't know why. So it's not quite so simple, but it works. It's good to have a good right-brained. It's good to have a good left-brained. It's best, in my opinion, to have a little bit of both. We go from a doctor to CEO, what was the biggest skill you had to pick up? What I really had to get good at was communicating and leading change, and that 's hard. Nobody likes change, and you come in and try to change a successful organization just a little bit, and before you know it, you've got 5,000 vice presidents who are basically telling you that you're going the wrong way. So how you manage that, how you corral that expertise to help us get there is a skill that I had some talent with and I got better at it. It wasn't always pretty, David. I mean, the same mistakes I'd make as an eighth grader or as a postdoc at a Nobel Prize-winning lab, I made lots of mistakes as a CEO. The key thing, I think, for your audience is if you're the CEO, own those mistakes. They're yours. Own them and use them to move forward. Give us an example when you did that, John. Give us a time when you had to own up to a mistake and move forward. Going back to the earliest time of my leadership 2009-2010, we were experimenting with that holistic message that you talked about and bringing the public in. If we got the public involved in their health and their health characteristics, could we help them be healthier? So we said, well, let's do an experiment. Let's open an office at the Mall of America in Minneapolis where there's just literally millions of people from all over the world walking through every day, lots of traffic. We put all these offerings in place for them as consumers and said, would you like to have a health evaluation? Just as an example. Would you like to do that online? Would you like to get involved? It turned out that although people were talking about, the marketplace wasn't ready for people to invest in their own health care. Does my insurance pay for this? No, but it's $65 and we might find out if you're going to develop cancer. It's not a lot of money. Now, I don't want that, but I'll buy a hat and a cookbook and out there we go. Literally, it was just incredible. We had all these wonderful things, but patience, the market wasn't ready for people to do. So we had to close it. People said, oh, you made a big mistake at the Mall of America. It wasn't a big mistake. We invested a few hundred thousand dollars. Someone told me that's market research. That's what we were doing. And the market wasn't ready. The dogs didn't eat the food, so it wasn't dog food, whatever. It's move on. You became CEO really at the height of technology, just really, really taking off. You talk about change management and I know you were a big advocate for telemed icine and you had to get Mayo to really become much more technologically savvy. How did you take people through that change? Or am I overstating the case? Yes, I was the CEO when that was coming on board. That's another great example. From everything we learned, we thought the world would want to have a relationship with Mayo Clinic remotely, even if they never came. And we had a goal to see, I don't know what it was, 200 million people a year remotely. It's a big audacious number, a big change. By having the technology in place to have a relationship with people in China, in Alaska, in South America, whatever, number one, there was no sustainable business model for that. Nobody would pay for that. So that was not going to work. And number two, I'll just say it, the doctors really didn't like having a relationship with patients that they could only see on a video screen. They preferred, physicians are very patient oriented, very people oriented. And we said, well, look, rather than the patient take three days to come and see you or the whole afternoon off or whatever, we could do it remotely. And the physician said, I'd rather see them face to face. We said, yeah, but you could see more patients at shorter time and the patients wouldn't have to have any expense. They could do it from their living room. So it's better for the patients. Well, that was like pushing rope. Now we got better at it and it grew and we became multinational in our footprint, but it didn't take off really until the pandemic. And then patients said, wait a minute, I don't want to go in to see my doctor or he doesn't want to see me or she doesn't want to see me. The pandemic really, really advanced that. And as you and your listeners know, it's really helped the medical profession reach the inner city, reach the rural community much better through technology. But it was hard at the beginning because the market wasn't ready for it. We'll be back with the rest of my conversation with Dr. John Nosedworthy in just a moment. Now John's task was to drive change at an organization that was already successful. But many times, new leaders have to step into situations when things aren't going so well. That was the case for Alberto Carvallo when he took over as a superintendent of Miami Day public schools. And in our conversation, he shares how important it is in those situations to start by defining reality, even when it's ugly. When I became superintendent, we were facing three levels of bankruptcy. For me, incredible challenge, but quite frankly, was a diamond of an opportunity because things were so bad anything we would do. We could blame it on the economy. We could blame it on circumstances around us outside of our control. So never allow a crisis to go to waste. Look for the opportunities that it actually leverages. Go back and listen to my entire conversation with Alberto Carvallo, episode 50 here on How Leaders Lead. You mentioned earlier, you do have this incredible management challenge. If you get these people who are so talented, let's take these heart surgeons. They're the rock stars. I mean, they're at the very top. I've been around a lot of rock stars and hospitals. There's some big, big time egos there. And you got to have them to go in there. I mean, to operate, you want somebody that's very competent. Has the story come to mind where you really brought somebody into that team mode who you didn't know would get there? Well, I think as I said earlier, the system identifies people who will flourish in an organization like Mayo Clinic. And Mayo has a very unique and well thought out process for who gets to be on the voting staff, who gets a permanent position at Mayo Clinic. And nobody gets to be on the staff with a voting position and a full member of the staff until three years has passed, three years of working at Mayo Clinic. So if we recruit someone from away, even if they're very famous, even if they have a large administrative position elsewhere, they're still not a member of the staff until the staff votes on it three years down the road. And so literally if they don't fit in, most of them who won't fit in will self- select. They'll say, "Wait a minute. I'm really more about me than about us." They don't say it that way, but either we identify it, the peers identify it, say this person doesn't fit in. Or at the end of that period, it's just not going to work and they don't come on staff. It's unusual, it's not unheard of when you have 5,000 physician scientists that some folks who are there for five or 10 or 15 or 20 years, occasionally a little more individualistic than you would like or a little more creative than you would like or a little more opinionated than you would like. But bright, creative, innovative, entrepreneurial people are also critical for the lifeblood of an organization. So you have to manage those, but we really don't have a big problem with ego on our staff. And equally importantly, we haven't talked about this, David, but the members of the Mayo Clinic Board of Directors, the Board of Trustees, are who's who of thought leaders in the country or in North America? And I won't lift them, but I remember I was giving a talk at a fancy place and someone said, "How do you manage the egos? Do you have the most remarkable group of people on the Board of Trustees at Mayo Clinic? How do you manage the ego?" And I said, "To be honest, they check it at the door if they even have one. Most of the people don't have an ego problem amongst this group, but a few of them are pretty strong. But when they come to work at Mayo, they're coming for the purpose of the place . They really are. They're going to invest that kind of time and energy. They're driven by the purpose and that mission of Mayo, the primary value of the clinic that needs the patient come first, drives people to want to work there. And they're surrounded by people who believe that. And so it kind of takes care of itself. You act like that and people look at you and kind of go, "That's not a very good answer." Mayo has such an incredible system, it seems like. But the success of this system is contingent on developing the next generation of leaders for sure. How's leadership development scaled throughout the organization? When I became the CEO in 2009, when I was named to be the CEO, Mayo did not have a very formalized leadership development program, as most companies now do, the war on talent, all the things that we know about. And as soon as the announcement was made, as soon as the board voted, this person, who I won't name, called a meeting of just the public trustees and me. And this person who was not the chair of the board, the chair was Jim Barksdale , so it's a peer of Jim's, but it wasn't Jim. This person said, "Dr. Noseworthy, we don't know who you are and we don't know if you're going to still be here in a year." But if you are, a year from now, we require that you have built a leadership development program, so we never have to do this again. We never have to pick somebody who we don't know, who hasn't been adequately vetted and tested. So I left the room and said, "Well, that went well. It sounded like a year." Whatever. So at that point, I went to the team and said, "I don't know what a leadership development program, who's got the best one?" and we found who had the best one, we brought them in, and we put in place what has evolved to be a really good leadership development program. And for 250, roughly, this is before I retired, I don't know where it is now, but for roughly 250 major leadership positions, we had a ready now, ready in a year, ready in three years. All the sort of things that all major companies now have in place. So by the time I've been CEO for just three years, I had a group of people who we were grooming for or testing to be, could they be the next CEO. And so when my time was over, the trustees who were charged to find my successor already knew people and they'd been tested with big assignments just like you get in a Fortune 500 company. What would be your message for first-year medical students? First-year medical students, I would say, for the next three years, spend your time on two things. One, be honest, who are you? What do you want to do? What are you good at? What are you interested in? Be really focused on you yourself because you've got to get it right for all the reasons I mentioned earlier. If you're in the wrong lane, it's not going to work. And number two, be patient. Young medical students, it's stressful. And they may say, "Oh, I want to be a pediatrician or I want to be a neurolog ist or I want to be a heart surgeon." That's what I'm going to be. And they close their mind. So be patient and try to make sure that that's going to be a match for who you are. Some people are innovators, some people are entrepreneurs, some people are basically caring people, some people are basically technicians. You've got to get that right. And I think that's good advice no matter what career you're in. Absolutely. You know, John, this has been a lot of fun and now I'd like to have a little bit more fun with my lightning round of questions. Are you ready for this? We'll see. We'll see, right? What are three words others would use to describe you? Well, he's determined and resilient. I think they kind of go together. He's crazy about his family and he's a champion of others. He's a cheerleader for other people. If you could be someone beside yourself for a day, who would it be and why? Oh, any day with Winston Churchill would be great. I'd like to have six months from May to October 1940. I'd like to be right there with him during the Battle of Britain. Why? Because I'd like to see how you handle really tough stuff and come out on the other side. Because that would have been a good training for me. What's your biggest pet peeve? Oh, insincere, cynical people, passive-aggressive people. You're a Canadian by birth. What's something about Canada you'd only know if you're a Canadian? Oh, who won the Canada Cup 20 years ago? Or how many times have they beaten the US hockey team? That's probably the Americans remember that for 24 hours. The Canadians never forget it. If you turn on the radio in your car, what would we hear? Edward Sharp. Okay, then what's your favorite Edward Sharp and the magnetic zero song? Nobody knows the song. It's a song called "Mela" M-A-Y-L-A. It's a young girl. A young girl's name. It's the daughter of one of the musicians. It's my ringtone. So every time my phone rings, this wonderful song comes on. And David, it's funny. I'm a slow learner. But every time my phone rings, I think, "Oh, I love that song." And I say, "Wait a minute. I've got to answer the phone." That's funny. My son's got a great guitar riff in that that I just love. "Doctor, what's your favorite quote?" My favorite quote, and I use it all the time. If you want to go fast, go alone, if you want to go far, go with others. And I've used that for everywhere I've gone. And everything I've ever done is how do you get the right people with you and move and make a difference? When was your last, "I can't believe this is happening to me" moment? Oh, the last time I picked up a golf club. And what's something about you a few people would know? Well, I took a painting about a decade ago and no one's ever seen anything I've painted except my family. And I'm a late life learning to play the piano because I've always wanted to and never had time. That's the end of the lightning round. You can relax now. But you've been married to Patricia for almost 50 years. What's made that relationship work even in seasons when I'm sure it was difficult to keep family a priority? I mean, you had a 24/7 job for a long time. Well, Pat, we were lucky. We met when we were 17 and we basically grew up together. I think we compliment each other. We have different styles and she's really smart and really perceptive. We'd like each other and we'd love each other. It's been great. We were out sitting out back in the evening just before I became the CEO, I think. Pat said to me, "You've changed." And I was like, "Oh my God, that'll make, when your wife says that, that's like the blood turns cold." And I said, "That doesn't sound good." And she said, "No, it's not that. I married you. You wanted to be a doctor. You enjoyed that. Now you've spent the last number of years getting ready for and going into what essentially is running a large business." And she said, "You're taking that on with the same enthusiasm and you really enjoy it." And I said, "Well, what's your side of that story?" And she said, "How lucky we are, we've had several careers together. That's kept everything fresh and interesting. Of course, she's the person who I would talk to every day, every night, and ask her what I should be thinking and should be doing. And she would speak truth to me. And I'm a lucky man. And you have two sons. What's a big lesson that parenting has taught you? Well, we should ask Pat because you could imagine David. If I had a do over, I'd hopefully have more time with my kids. We're lucky. We have two wonderful boys. Love them and let them go after what they want to go after. Peter decided he wanted to have a career in medicine. And as we've talked a bit about, Mark decided he wanted to be a musician. That wasn't the easiest thing in the world for me, David, as a young physician, because I knew how many talents he had in addition to music. But believe in your kids, support them, and love them. Listen to them. No, they're going to be fine. Let's work for us. What's your unfinished business? This is really serious. The question I got often when I was CEO is when will the United States have a sustainable, affordable, high quality healthcare system that's available to the public? And my answer used to be very long, David. You can imagine as a young CEO. By the time I finished, I said when it becomes a national priority. And the fact is, again, this is a serious message. Nobody has figured out healthcare, but the United States should figure out healthcare. And we need a healthcare system that is sustainable, highest possible quality, driven by science, and available and somehow affordable to the country. And there's nothing I would rather work on than that. But it's not a national priority. And I'm very proud to be a physician in the United States. Don't get me wrong. But that's an unfinished business. Someday the country will figure it out, but it hasn't got it figured out yet. What would you do if you could make a wave of magic wand? What would you do? I would bring all the parties together. I would put physicians and patients at the center of that because I think they know the most about what they want in healthcare and how they can deliver it. And then I would bring in the life science companies and big pharma and the universities and the government and say, okay, how do we create that? It has to be a win for everybody, but you can't all win in everything. We're all going to have to give a little. Nobody wants the system quite like this country or that country or this country or that country. But nobody wants the system we have here. We have unacceptably high maternal mortality. We know that. It's one of the worst in the developed nations. We don't have full access to healthcare on an equal basis. There's just a long way to go. I think that's a really important issue for this country to solve. And I'm sure they will. And I would love to work on it, but no one's ready to take that on. I'll wrap this up with one last question here. What's one piece of advice you'd give to aspiring leaders? I think they really need to learn how to listen and then learn how to communicate. Learning how to listen is really important. I mentioned it already. Be courageous enough to own the failures and credit others with success. Success has many fathers and make sure people know that, many mothers and fathers. I think that humility and that attention to listening well is really important. And David, I had to learn that. I got better at it, but I had to be pretty focused on learning how to do that. It's not easy. You know, doctor, I would say you learned it very well. And the mark that you've made on the Mayo Clinic and the world is something that I think you should be very, very proud of. And you're admired across the industry by so many leaders because of the kind of impact you have. And I want to thank you for your service to our country, to health, which is important to all of us and for just being such a hell of a nice guy. Well, thank you, David. It's a privilege to have you as a friend and to spend time with you today. And thank you so much. Well, it's clear to me that Dr. Noseworthy was exactly the change agent the Mayo Clinic needed. He took an organization that was already at the top of its game and found ways to make it even better, more efficient, more innovative, and even more focused on patients. Now, you know, as well as I do, being a change agent is never easy, but I'll be honest, it is a little easier when the people you're leading know things need to change . But try driving change when people don't think things need fixing. That's a whole new level of taking people with you. And it's so great to see how John did it. It's a reminder for all of us that we can always find things to improve on. So let me ask you, what area of your organization is already going pretty well? This week, have the courage to ask, are there ways we can take this great part of our business and make it even better with more efficiency or higher quality? Be willing to drive change even when things are going well, and you're going to unlock a whole new level of performance and leadership. So do you want to know how leaders lead? What we learned today is that great leaders aren't afraid to improve on what's already working. Coming up next on how leaders lead is Ray Scott, president and CEO of the Lear Corporation, a global automotive technology leader in seating and E-systems to make every drive better. Having that courage to say, listen, this is a great business for us today, but if we don't get ahead of it, somebody else will, and they'll displace us. That's been the challenge, is how you move the team to the future. And that takes constant communication, constant time, the right collaboration, and the right team members. So be sure to come back again next week to hear our entire conversation. Thanks again for tuning in to another episode of How Leaders Lead, where every Thursday you get to listen in while I interview some of the very best leaders in the world. I make it a point to give you something simple on each episode that you can apply to your business so that you will become the best leader you can be. [BLANK_AUDIO] [BLANK_AUDIO]