Harvard Business Review highlighted innovation at the Mayo Clinic. They cite three contributing factors, limited resources, connectedness and diversity. The three combine to form a passion for learning and providing high quality care.
The founding Mayo brothers placed doctors on salary, such that they could focus on the patient. It gave clinicians "space for creativity, education, and research."
While health reform promises a focus on paying for what works, it incentivizes doctors with pay for performance. Mayo Clinic went past what worked to find what worked better. They fostered intrinsic motivation and became the best in the world.
Health reform relies on extrinsic motivators, pay for performance. It will sub-optimize the system. Dr. W. Edwards Deming would ask, will they ever learn?
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