Rafael Miranda, Mayo Clinic, Arizona
Sean Glenn, Mayo Clinic, Arizona
Jonathan Leighton, M.D., Mayo Clinic, Arizona
Shabana Pasha, M.D., Mayo Clinic, Arizona
Suryakanth Gurudu, M.D., Mayo Clinic, Arizona
Harry Teaford, M.D., Mayo Clinic, Arizona
Lester Mertz, M.D., Mayo Clinic, Arizona
Howard Lee, M.D., Mayo Clinic, Arizona
Sylvia Mamby, M.D., Mayo Clinic, Arizona
Margaret Johnson, R. N., Mayo Clinic, Arizona
T. S. Raghu, Arizona State University

The emerging changes in healthcare impose significant burdens on integrated outpatient specialty services with respect to setting patient expectations, handling outside medical records, and coordinating specialty appointments scheduling. Moreover, because of the evolution of the electronic health record and its pervasive use, it is critical that patient and physician interaction is maintained and clerical tasks are minimized. In the context of increased government regulation, declining reimbursement, and the rise of new payment models, outpatient practices need to be reimagined so that they are more efficient for the patient and the provider. The redesign of integrated outpatient specialty services can be accomplished only through teamwork, innovation, and efficient use of technology. To address these challenges, Mayo Clinic, Arizona’s Department of Medicine implemented an ideal practice design initiative that leveraged a hybrid set of change strategies. The change strategy, which was initiated after examination of current practices and design options, engaged key stakeholders and patients. A number of enablers and barriers to adoption were identified as a result of the implementation experience.


Miranda, R., Glenn, S., Leighton, J. A., Pasha, S., Gurudu, S., Teaford, H., Mertz, L., Lee, H., Johnson, M., Raghu, T. S., “Using Hybrid Change Strategies to Improve Patient Experience in Outpatient Specialty Care.” Journal of Healthcare Management, 2015, 60(5), pp. 363-376.