Why Mayo Clinic’s success is a blueprint for companies wanting to join open source

The Beginnings

Soon after a tornado devastated Rochester, Minnesota, in 1883, a local doctor and a religious group realized that their city desperately needed a modern and permanent hospital. Thus began the evolution of Mayo Clinic, one of the most esteemed healthcare organizations in the world. How did Mayo Clinic grow from a tiny hospital into a world-renowned nonprofit?

One critical driver of the Mayo Clinic’s success has been its innovative group-practice model of medicine. Dr. William J. Mayo, the elder son of Mayo Clinic founder William Worrall Mayo, was known to say that patients are not like wagons that could be taken apart and repaired in pieces; they need to be examined and treated as whole people. Ultimately, the clinic’s mission was to provide the very best care to every patient every day through education, research, and practice. 

This philosophy calls for various types of medical specialists to come together in order to provide patients with the best and most comprehensive care. In 1914, the clinic’s founders instantiated a group-practice model when they opened the first Mayo Clinic building.

From the start it was designed to facilitate collaboration and allowed the administrators to bring in physicians from around the world to share ideas and learn new medical approaches.  Because of this dedication to constant education, research, and practice, their early practices were able to introduce many new innovations which continue today.  Some of these early successes include:

1. Centralized medical records shared throughout the building via pneumatic tubes  
2. The adoption of an open model deciding to secure the future of the mayo clinic by establishing an endowment and making it non-profit
3. The discovery of the anti-inflammatory steroid cortisone
4. During WW-II discoveries such as the high altitude mask and the anti-blackout g-suit
5. The use of raised operating rooms where visiting physicians could observe operations as they happened

Group collaboration and the open sharing of ideas, resources, and practices are foundational to the open source model, and the Mayo Clinic pioneered these things long before open source even existed. In seeking to build upon some of the ideals that made the Mayo Clinic such an enduring success, 1904labs spoke to clients about the questions and concerns they have about open source and how it is currently used in their organizations.

It can be hard to implement open source because of the various challenges faced by organizations in different domains. Many larger companies choose to handle the complexities of open source by forming an office or committee that can help them comply with all of the legal aspects. The open source initiative has created the TODO Group (TODO stands for Talk Openly, Develop Openly - https://todogroup.org/) dedicated to running effective open source projects and programs. As we visited with many of our clients feedback varied widely, but four key areas emerged. We will expound upon the four throughout and return to them again through a series of posts.

Intellectual Property

Universally, clients said that if we engage in open source, then we need a strategy to protect intellectual property.  Everyone was concerned with the distinction of what is specific to the business and what isn’t. Sometimes this question isn’t black and white, and as a result policy and governance should be set up to help evaluate on a case-by-case basis. For example, an algorithm may represent a competitive advantage for a company, but it may be written in a generic enough way that other people could benefit from it. Other times, products are specific to the domain and represent an effort that the company will want to maintain and protect for trade reasons. Speaking of trade reasons, there are many reasons for safe-guarding information, including the possibility of sharing secrets or credentials that you don’t want to release. While there are tools that can scan for some of these situations, they have to be enabled and policies have to be in place and enforced to be sure this kind of information is caught before it is released. We will return to this in a follow-up post, as it deserves quite a bit of attention. The Linux foundation has done an excellent job of outlining guidelines for using open source shown below:

1. Tracking Usage - doing an inventory of what libraries, tools, and services are in use. 
2. Compliance - is usage in compliance with licenses, etc.
3. Policy for Usage - under what circumstances can an open solution be used. 
4. Code Review Process - what is the process for review how should the source we are releasing to the community look. 
5. Source Code Scanning - Are there any vulnerabilities, bugs, etc that need remediation before release. 
6. Identification and Resolution - A process for acting on any of the issues found in scanning. 
7. Legal Review - Produce a legal opinion of the tool being considered for use. 
8. Architecture Review - A diagram of the collaborating components of a solution. 
9. Final Review - Approval or Rejection of the library, tool, or service. 

This is a comprehensive list and it deserves more attention. However for the IP-concerned executive or organization it quickly becomes apparent how these layers and policies can safeguard the company as it starts embracing the open source environment. Moving to a more open and collaborative model can pay dividends but it takes thoughtful preparation.

Audience

In 1989 Kevin Costner played Ray Kinsella, an Iowa Farmer who kept hearing, “If you build it, he will come.” Upon building a baseball diamond on his land, long-dead players started to come out of the corn fields to play the game at night. While that makes for a compelling story, taking your code and putting it out on GitHub slapped with the open source license of your choice won’t necessarily guarantee that developers (dead or alive) will come out in droves to use your project. In creating your program, you need to create a space where your developers can talk to other developers and discuss the techniques they’re employing in the code. This creates demand, it provides depth to projects, it creates opportunity for discovery, and it is ultimately a big part of driving the community forward. It also creates discipline as developers learn new techniques, and part of ingraining those techniques is to write about them in a way that can be recalled later. Going back to the Mayo example, this allows people to share their education and research, and can lead to other learning, creating a feedback loop that is as important for the organization as it is for the community.

Executive Sponsorship

If your organization is creating an open source program or thinking about adopting some of the open source initiatives ideals, executive sponsorship is another huge part of adoption, particularly at larger companies.  Any executive team will need to understand the impact, opportunity costs, and return on investment, and it’ll need to have the background necessary to create a compelling vision around the program. A big part of the impact of open source is being able to speak to a larger audience of potential engineering and development talent.  In a world where people are saying demand for software engineering talent outstrips supply, companies need to do everything they can to attract the attention of today’s top development talent.

Vision is another key aspect of adoption, and building vision has to do with building compelling use cases around the proposal.  Consider this quote from the audacity website, an open source audio editing software regarding product support:

The Audacity Team is indeed much smaller than many imagine – a small group of enthusiastic volunteers around the world, working together to provide the most widely used multi-track audio editor in the world. There is actually no headquarters, no physical building, no command center, but a group of individuals, spread across three continents, working in small studies, bedrooms or at kitchen tables, providing a level of support that is rightly the envy of commercial competitors.

https://www.audacityteam.org/audacity-hq-754-december-8th-2007/

Value Creation

The subject of value creation is in the eye of the beholder. One client we spoke with asked me to quantify the value of the software that companies are using, and to determine the impact of removing that software. It’s more than you think, starting with Linux and ending with node.js, and occupying every space in between, including database technologies like mysql and mongodb, to frontend javascript frameworks like react and angular. There are countless hours that have been spent creating the software and tools we use everyday, and if we were left to recreate those tools on a per-organization basis, the costs would be staggering.

Open source promotes learning by giving developers a window into how new technologies work. It promotes collaboration in the form of developers — both inside and outside the organization — submitting and reviewing pull requests.  Choosing to adopt an open strategy doesn’t mean you have to give away the secret sauce. It means contributing and giving back to a community that’s driving innovation in a variety of industries. What’s more, companies don’t have to go all-in at once: They can start small and work up to a larger push into the open space.  Learning and collaboration are foundational to supporting today’s modern knowledge worker, and they can be transformational to your organization. In the words of William J. Mayo, M.D.

"I look through a half-opened door into the future, full of interest, intriguing beyond my power to describe, but with a full understanding that it is for each generation to solve its own problems and that no man has the wisdom to guide or control the next generation."
- William J. Mayo, M.D.

The emphasis above is mine, as I think this statement underscores the need for collaboration and community, and this is one of the main reasons we’ve invested so much time into understanding this space.  We believe the community is a powerful force and in it are found the keys to the next great innovations.