When cardiologist Eugene Braunwald, who loved classical music, visited the Mayo Clinic, he said, “We have a fantastic string quartet. They have an orchestra.”

“He was giving the message that we might feel jealous and we might have something to learn from that. How would that comment go over with your respective organizations?” asks Tom Lee.

Emme Deland, Senior Vice President and Chief Strategy Officer at NewYork-Presbyterian Hospital, responded in concert. “We actually hired an orchestra to come and play for us in front of all of our senior leadership to listen to how they work together to play — there were 90 of them — to see what they did to make sure they were in concert and coordinated as a demonstration of the kind of work that we need to do,” she says. In the words, “we are napkins, searching to be a tablecloth,” Deland adds that her team recognizes the need to be more coordinated, and that they’re taking steps to get there.

“We have an accountable care organization that we started, and we are part-owners with our two schools. I think it’s a significant step forward to the recognition that we need to work together and we need to be more of an orchestra than a string quartet,” Deland says.

Jeff Balser, President and CEO at Vanderbilt Medical Center, agrees, and makes an important point — that the Mayo Clinic functions so well like an orchestra because it’s been practicing for a long time.

“Great orchestras don’t just form and sound wonderful in a half a year. They practice for years and years before they really sound good,” says Balser. He adds that academic medical centers “now have religion about this” and are starting to work toward functioning more like an orchestra. But, he adds, the country needs to have a little bit of patience.

“We’re moving large aircraft carriers in a very much different direction than they’ve functioned for probably for 150 years, and that will take time,” Balser says. “We will get better and better at this. And I think we’re inexorably moving in the right direction.”

From the NEJM Catalyst event New Risk, New Business Models held in Boston, October 6, 2016.