Former surgeon trades scrubs to build Mayo’s future

June 27, 2007

By hammersmith

by Leslie Harris
Flinn Foundation

For more than two decades, Dr. Victor Trastek was a thoracic surgeon for Mayo Clinic, doing what he considered his life’s work. After being offered the position of chief executive officer for Mayo Clinic in Arizona, however, Trastek was presented with a difficult decision—continue pursuing his passion for surgery, or accept a once-in-a-lifetime opportunity to lead a major medical system on the brink of significant growth?

In the end, Trastek opted for the bigger picture, trading his scrubs for a suit and entering the world of medical administration. Since then, he has helped develop a critical 40-year plan for the clinic that centers on the development of two campuses in northeast Phoenix and Scottsdale. Because of the intensive planning and foresight involved, says Trastek, Mayo has reached many of its initial growth goals much more quickly than expected, and is working steadily on providing the highest levels of quality, safety, and service to patients.

Though he still has yet to abandon his dreams of returning to the operating room, Trastek says that—for now, at least—such plans are on hold. For the foreseeable future, he is committed to seeing his vision for Mayo become a reality. Recently, Trastek sat down with us for a few moments to provide insight into just what this vision involves.


What are your biggest priorities for Mayo Clinic Arizona?

Well, Mayo Clinic is just coming to its 20-year anniversary in Arizona at the end of June, so we’re still very much in the building process, trying to bring the Mayo Clinic model of care to the Southwest and Arizona. So our priorities are based around becoming the premier patient-focused academic medical organization, and embodying the types of values that Mayo has had for over a century. We believe that the patient comes first, and we’re focused on using teamwork, integration, and coordination to bring excellence to the patient. And then we take our research and education and integrate them into this process, also for the benefit of our patients. We’re working to build on that. Since we’re a multi-specialty group practice, we also emphasize the more tertiary care of complex patients—those who are difficult to diagnose—focusing today primarily on cancer, heart disease, transplantation, and the neurosciences. We’re also working on our broader collaborative efforts. We have a lot of collaborative partners in the Valley—Arizona State University, Phoenix Children’s Hospital, Hospice of the Valley, the Translational Genomics Research Institute (TGen), and multiple other partners.

I noticed you mentioned patient care as a main priority. What steps has Mayo taken to excel in this area?

Well, the key paradigm for Mayo has always been that the needs of the patient come first. That is, and will always be, our focus. We are just people taking care of people, and the patient that we’re taking care of is the most important thing we’re doing. So we try never to forget that. There are a lot of pressures in healthcare to change, and that’s one thing we will not change. So everything we do at Mayo has the patient at the center. We build our processes and systems around the patient. We build our staff teamwork around the patient. Everyone here works for Mayo, and all of the physicians are salaried, so there’s no incentive for anybody to do anything but take care good of the patient. No decisions are based on anything except patient care. Mayo’s ability to bring in multiple doctors around the patient, to have many people see your lab and x-ray results all within a short period of time are all things we think help improve patient care. And obviously, research and education are an important part of what we do, and that helps. And the quality, safety, and service that we work on very hard: “best outcomes, no defects, great service”—those are our goals. Everything’s built around the patient.

I understand that Mayo has a 40-year plan for the future. Why do you believe such long-term planning is necessary?

The 40-year plan, which we did about four years ago, is probably now more of a 25-year plan. Having a roadmap of how we were going to transition from one campus to another and knowing where the buildings were going to go so that everything fit together functionally has allowed us to move faster than we’d expected. We have added seven or eight buildings to the Phoenix campus within the last four years, we have three more going up this year, and we have two more being planned. So it’s all happening much faster. Of course, part of that is the fact that the Valley is growing so fast, and the demand for healthcare is so large that it’s pushing us to move faster than we’d ever even considered. So the 40-year plan is much less than that at this point. We’re just trying to keep up.

Have you encountered any problems meeting the demands of staffing such growth?

That is a concern we face in the Valley, just like every other healthcare organization here. How can we get enough good help? There’s always going to be a little bit of a shortage because the Valley’s growing so fast. Fortunately, the nursing schools are ramping up a little bit, and our collaborations with ASU’s nursing program and with junior colleges are very helpful. We’re fortunate that Mayo Clinic is an educational institution—it’s one of our major missions—and if you look across all of Mayo Clinic, we train more doctors than anyone else in the country. We probably have 1,500 residents in training at any one time across the country. In Arizona, Mayo just graduated 50 residents, 20 of whom will stay in the Valley, and probably two or three will work here at Mayo. It’s the nurses and the allied health workers that we really need to work hard on recruiting and training—because the patient care part is the largest component, frankly.

You mentioned that you have teamed with Arizona State University’s nursing program. What form does that collaboration take?

Our connection with ASU is a very broad and deep one. We’ve tried to build a web of connections between us. We have connections at the research level, at the medical school level, at the business school level, and at the nursing level. And those are just some them. The nursing school collaboration started because we recognized that there was a need to train more nurses. ASU already had the nursing school, and we developed a separate cohort for the last two years of training that would be conducted at Mayo Clinic Hospital. That program started about three years ago with 20 nurses, and we graduated the first class last summer. Fourteen stayed at Mayo. Now we’re training our second cohort of 20, so hopefully the same number will stay from this class as well. But regardless, it’s a great way to bring more nurses to the Valley.

So what do you think is the value of collaboration?

In healthcare, there’s so much need, there’s so much to do, and the science is growing so fast, that no one group can keep up with it all. And the beauty of the Valley is that it’s an environment where people are willing to work together. By collaborating, you don’t duplicate resources and efforts. At ASU, there’s a large biodesign effort going on in many areas related to cancer and other diseases that we can connect with and use to bring good things to patients. In the engineering school, there are a lot of bright minds that can help develop new products and solutions. Why should we develop our own engineering efforts, when we can work with ASU, where they have one of the largest engineering efforts in the country? They have ideas, and we have the applications. By leveraging and collaborating, you use your resources wisely, and at the end of the day, the patient wins.

Do you think that there are any major obstacles involved in Arizona’s collaborative efforts?

In my mind—and maybe I’m biased—Arizona probably has the best collaborative environment in the country because, for the most part, we’re starting off fresh, and not a lot of the battle lines have been drawn. And, to make an analogy, the pie is growing faster than we can worry about how big our piece is. The competitive part is always there to some degree, and that could be a barrier, but we’re all trying so hard to keep up that we don’t seem to worry about that as much. It’s not perfect, but it’s sure a great environment, and it’s probably the best one in the country. Besides competition, the other barrier in my mind is having enough resources to keep everything going. We need to have enough nurses and health workers. And I think that we’re a little undiscovered when it comes to biotech and bioscience. We have a very interesting starting point with TGen, ASU, University of Arizona, and other organizations, but we’re just kind of coming out of the ground, and a lot of the people who invest in these things around the country are looking, but they aren’t sure yet. So until we can convince them that this is a great place to invest money, we aren’t quite there yet.

Given your extensive administrative duties, do you have still have time to remain active as a surgeon or researcher?

That’s a very sensitive question, because the answer is, no, I don’t, and that’s been very hard for me. The hardest part of my new job was giving up my old job. I’m a cardio-thoracic surgeon specializing in what we call general thoracic—lung cancer and esophageal cancer. I really enjoyed patient care and surgery, and I wasn’t prepared to give it up. In fact, I didn’t give it up when I first took this job. But the administrative duties kind of started to overwhelm me, and I found that, because we have two campuses that are 12 miles apart, I was always in the wrong place at the wrong time. I’d be in a board meeting, and a patient would need me at the hospital, or I’d be in the middle of an operation at the hospital, and the board would be waiting for me to show up. So I was doing a bad job at both things, I guess you might say, and I realized that I needed to give up my surgical career to concentrate on the job that I was appointed to do. And that was very difficult and still is today. I have a hard time accepting that fact, and it’s difficult to even watch doctor shows on TV like ER because that’s what I used to do. But on the other hand, life’s a journey, careers are a journey, and I’m very excited to be doing what I’m doing now. It involves a lot of creative energy, I get to work with great people, and the state is a great collaborative environment to be in. So I gave up a lot, but I gained a lot.

Do you have any hopes or plans to return to surgery?

Well, it depends on how long I get to do this job. I’ve been out of surgery for more than three years now, and the further I get away from it, it will probably be harder to go back. I’m pretty invested in finishing what I’ve started here. To me, this is a 10-year project, and I’m halfway done, so I’ve got five years to go in my mind. By then, it may be difficult to go back to surgery, but I’m not giving up on it either.

So what are the major milestones you would like to see accomplished in the next five years?

Well, as long as they want me to continue to serve, I’m willing to try to finish what I started. We are still building Mayo Clinic here in the Valley, so there’s still a lot of work to do. We’re trying to build across the three sites—getting Mayo Clinic in Rochester, Jacksonville, and Arizona together as one seamless organization. We’re working in the field of individualized medicine across all three sites, and that’s something we’d like to move forward. We want to provide healthcare in a different way—to not only take care of patients when they’re sick, but also to partner with them when they’re well. Individualized medicine is all about predicting and preventing diseases, and I’d like to see Mayo Clinic be more involved with taking care of people when they’re well. And we’d really like to ramp up the quality and service that patients receive. I’d also like to get our big outpatient building in place on the Phoenix campus, so that we’re truly in one place. The Phoenix campus will become the center of our main inpatient-outpatient operations, and the Scottsdale campus will evolve over time to a collaborative campus—maybe around wellness, maybe around cancer prevention or science discovery. We’re still working on it. But these are the types of things I’m working pretty hard on.

What are your proudest career accomplishments?

I’m going to generalize here, because I think in healthcare, you really need to take a step back. The thing that really excites me and makes me the most proud is really our ability to take care of patients. The fact that we’re here, building something that can serve patients—I could get up every morning and go home every night and really feel proud about that, because that’s really what our purpose is. We’re actually building the programs, we’re building the places, we’re building the quality and safety. The other thing that I really, really enjoy is the people that I work with. This is a passionate group of pioneers. They came here 20 years ago and they built this Mayo Clinic from scratch, one brick at a time. We started with 30 doctors, and there are now 350 doctors and 4,000 employees. I’m proud of the people who put the time and passion and energy into making it happen.

So do you find it difficult to maintain personal contact with everyone in such a large organization?

Well, yes and no. I’m a surgeon, and if you know how surgeons work, they kind of migrate through the whole organization—they’re in the OR, in the ICU, in the hospital, in the clinic, and all around. So you keep in pretty close touch with everybody, and that’s what I’m used to doing. Sitting here in the office is foreign to me. It’s much more common for me to be out walking through the organization, and I try to do that as much as I can. I really try to keep in touch with the pulse of the organization. And the way you do that is you stand at the front door and you greet the patients as they come in, you talk to the people who are serving food at the cafeteria, you talk to the people who are housekeepers—you relate to everybody in the organization from the top to the bottom, and then you really get an idea of what’s going on.

What are you most looking forward to in the future?

Everyday is an adventure here in Arizona, so I kind of take it one day at a time. But the ability to continue to build our Mayo Clinic here is really what I’m excited about. To get the integration of the campuses completed; to see our ability to take care of more patients, and sicker patients; to bring destination-therapy care to our heart patients; to see our cancer and stroke care really grow in breadth and depth—it’s exciting to see all of that happen. But everyday is a new adventure. It’s still the Wild West out here, and we’re still building it.