Baylor University Medical Center Proceedings October 2017 - 484

ground, under water, and in outer space. Strontium-90 had
been determined to be too dangerous for humanity. Today,
56 countries operate 240 nuclear reactors, and similar radioactive material powers nuclear ships and submarines. Yet, thanks
to the radium girls whose experiences led directly to the regulation of radioactive industries, atomic power is able to be
operated, on the whole, in safety.
Decade after decade, the dial-painting girls came to the
Center for Human Radiobiology to be tested. They agreed to
have bone marrow biopsies, blood tests, x-rays, and physical
exams. They ﬁlled out questionnaires about their mental and
physical health, took breathe tests, and had their body radium
measured in the iron rooms beneath the earth. Autopsies were
performed in some. Thousands of women helped with the study.
Their contributions to medical science are incalculable.
The radium companies did not fare well. In 1979, the US
Environmental Protection Agency (EPA) found that the former
USRC site in Orange had levels of radioactivity 20 times higher
than was safe. There was widespread contamination, both at
the dial-painting site and at landﬁlls where the company had
dumped its radioactive waste. Almost 750 homes had been built
on top of that waste. They too needed decontamination. More
than 200 acres of land were aﬀected in Orange, some to a depth
of more than 15 feet. The EPA ordered the corporate successor
of USRC to perform the cleanup work, but it declined. The
courts were not forgiving. In 1991, the New Jersey Supreme
Court found USRC "forever" liable for the contamination and
declared the ﬁrm had had "constructive" knowledge about the
dangers at the time it operated there. Residents sued the ﬁrm.
Cases were eventually settled out of court. As for Radium Dial,
despite the wartime boom, it went bust in 1943. The building
it left behind in the center of Ottawa was found to be heavily
contaminated. The building itself was destroyed in 1968.
The dial painters who had survived early did not escape
unscathed. Some women were stricken early and then endured
a half-life for decades. One girl was bedridden for 50 years.
Many suﬀered signiﬁcant bone changes and fractures; many
lost their teeth. Many developed bone cancer, leukemia, and
anemia. Some were given blood transfusions for years. Some
developed severe osteoporosis with collapsed vertebrae requiring
multiple operations. Many had amputations.
It was not until 1978 that the luminous processing plant in
Ottawa, Illinois, was shut down. Inspectors found radiation levels there 1666 times higher than was safe. The abandoned building became something of a boogeyman for Ottawa residents,
who became afraid to walk or even drive past it. The company,
which was not apologetic, wiggled out of paying cleanup costs.
The companies obviously put proﬁts before people.
THE MAYO CLINIC 2020 INITIATIVE
The Mayo Clinic is recognized worldwide as maybe the best
patient-care institution in the world. Despite its 153-year success,
Dr. John Noseworthy, Mayo's chief executive oﬃcer, decided in
2009 that the institution needed to change because of declining
revenue from government health programs, private insurers, and
employers (4). When the head of cardiac surgery at Mayo asked
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him for two more operating rooms to meet the future demand
for open-heart surgery, one of the clinic's major revenue sources,
Dr. Noseworthy not only said no, but insisted that they redesign
all facets of heart surgery care and cut costs by 20%. That initial
request sparked a year-long revamp-part of a wrenching Mayo
Clinic overhaul involving nearly every aspect of the institution's
renowned system. "Overhaul," the Mayo Clinic's 2020 initiative,
has involved >400 projects aimed at squeezing costs and improving quality and services. Dr. Noseworthy indicated that dozens
of major reengineering projects have helped cut an accumulated
$900 million in costs over the past 5 years.
The clinic also sought new areas for growth. Mayo took the
lead-including committing $3 billion of its own capital-on
a $5.6 billion urban development project now underway to
transform its headquarters city of Rochester into a destination
medical center.
The Mayo Clinic, with major facilities in Florida, Arizona,
and a community-based health system of 19 hospitals and
44 clinics within 125 miles of Rochester, has 64,000 employees.
It reported $11 billion in revenue in 2016, up 6% from 2015.
The Mayo Clinic's reputation for "patient-centered care" was embedded in its approach long before the term became a marketing
buzzword. For Mayo, the concept includes bringing a team of
specialists together to focus on the needs of patients with complex problems, typically providing a schedule of appointments
within hours of patients' arrival at the clinic. Patients do not
have to make each appointment themselves or travel to specialists
in diﬀerent organizations. Mayo patients are welcomed by the
volunteers who escort them to their appointments. A common
medical record makes it gel. Instead of each physician keeping
a private record for each patient, one record follows the patient.
Today at Mayo, nearly 1 in 5 operations involve multiple
teams. The patient is nobody's particular case; it's Mayo's case,
said Dr. Noseworthy. That is hard to do at other places where
people work in isolation. Mayo physicians are salaried, so there
is no competition over fees or any incentives to order tests or
procedures that a patient does not need in contrast to the much
more common fee-for-service model in most medical centers.
Dr. Noseworthy, a Canadian-educated neurologist, started
the inquiry into the institution's readiness to face the future a
year before he became CEO in 2009. Retooling projects included restructuring care for children with complex feeding,
breathing, and swallowing disorders. The eﬀort reduced average
time to diagnosis to 4 days from 210 days and cut the use of
anesthesia and imaging tests by nearly 50%.
Expanding the role of nurses in the care of epilepsy patients
shaved an average of 17 minutes oﬀ the time doctors spent on
a visit, increasing slots for new patients. Adding more clinicians to the emergency room during the afternoon reduced
patient waiting times during high-demand evening hours. The
initiative dubbed "eliminate white space," intended to optimize
physician calendars, allowed the scheduling of more time for
new complicated patients while booking shorter (30-minute)
times for follow-ups of "established" patients.
The heart surgery project began in 2009, the year that the
surgeons asked for two more operating rooms. The surgeons,

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