Biology in Three Dimensions

After doing his medical training in his native country of Hungary, Dr. Ordog studied neuroendocrine biology, touching on topics like electrical signals in the hypothalamus regulating the menstrual cycle. He started as a junior faculty member at the University of Nevada, Reno, before coming to Mayo Clinic in 2006. In 2012, he helped found the Epigenomics Program at the Mayo Clinic Center for Individualized Medicine. In 2020, he moved to work with the Center for Cell Signaling in Gastroenterology.

Now he and Jeong-Heon Lee, Ph.D., are hard at work creating a first-of-its-kind research enterprise: a core dedicated entirely to spatial biology.

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“‘Spatial’ is a little bit of a misleading term,” says Dr. Ordog, “because currently almost everything we do is in two dimensions [like flat X-rays of body parts], but there is no theoretical limit to why anything we discover doesn’t apply in 3D.”

Spatial biology is essentially what it sounds like: the study of tissues, cells and genes put into terms of how they relate to each other in three dimensions. Think of an organ or a tumor as a complex city, where each cell is a building with its own role and relationships to its neighbors. Some cells might be driving a disease, while others are trying to fight it off. Traditional methods could tell us what types of buildings existed in the city, but not how they are arranged or how they influence each other. Spatial biology changes that by creating a detailed 3D map of every cell in a tissue sample, showing not just what genes each cell is expressing, but how those cells work together — or against each other — in the complex ecosystem of a complete tissue.

The Perfect Partnership

Drs. Ordog and Lee make a top-notch team. Dr. Ordog brought Dr. Lee, then a postdoctoral researcher at Indiana University, to Mayo Clinic to tune the technology he developed there toward human health applications. Dr. Lee’s primary focus now is an area called spatial transcriptomics, studying how gene expression in one cell affects gene expression in its neighbors.

“The ultimate goal is to build a 3D model of any tissue we study, providing information about how the cells are positioned relative to each other and how they behave — as in what genes and molecules they express,” says Dr. Ordog.

Molecules and genes are just the beginning. To Drs. Lee and Ordog, spatial biology isn’t just about the relationship between cells in one modality, but in all the ways they can relate to one another — their genes, their proteins, the ways they contact one another, cells dividing in one region and dying in another. Dr. Ordog calls this “spatial multiomics,” combining different techniques in the same space.

“We want these to be more than the sum of their modalities,” says Dr. Ordog. “The goal is to bring all these elements — the study of genes, molecules, proteins, etc. — into all relevant tissues.”

The Power of Spatial Multiomics

Bringing together all these different scientific threads will help Mayo Clinic do something completely unprecedented: create a whole new kind of pathology.

“Spatial biology shortens the translational pipeline,” says Dr. Ordog. Rather than needing to start with preclinical models, doctors and researchers can now start primary discovery with a tissue biopsy or surgical materials directly from a patient. They are looking for the needle in the haystack that might lead to a new discovery or therapy. 

The bottom line is that we want to increase the amount of information gathered from the precious biopsy material taken from our patients.

— Tamas Ordog, M.D.

“That’s what modern biology has enabled. You can pick out your molecule of interest based on whatever you’re studying,” says Dr. Lee. “You can study diseased versus not-diseased tissues. Say you discover molecules in diseased state that aren’t in healthy tissues, that’s your target.” Then scientists can go back to the lab and examine what they’ve discovered in other models to look for treatment options, armed with the knowledge that what they have found is directly involved in a patient’s health.

From Lab to Clinic

Dr. Ordog envisions a “virtual patient vignette”: A patient comes in with a form of cancer that comes in multiple forms, each with different prognoses, signs of progression and immune cell profiles, and each responds to different therapies. In the past this would be a dizzying knot to untie, but with spatial multiomics, it becomes clearer. A biopsy taken from the patient is serially chopped into sections, each of which gets processed a different way. Then the data is put back together into a three-dimensional image.

Instead of trying different therapies to see what works, clinicians could use this approach to examine the tumor's cellular architecture and predict which treatment would be most effective, saving precious time in the fight against cancer.

“The bottom line is that we want to increase the amount of information gathered from the precious biopsy material taken from our patients,” says Dr. Ordog. “Spatial biology can increase the understanding that comes out of the tissue exponentially.” That, in turn, can allow for in-depth machine learning and artificial intelligence analysis of patient data, which Dr. Ordog hopes to test sometime in the future.

All in all, Dr. Ordog, Dr. Lee and the entire team are hopeful their work will simplify the detective work that doctors and patients often experience when hunting for a diagnosis or treatment. Looking over a slide deck he uses to explain the technology, Dr. Ordog sounds a hopeful note.

“We can find the needle in the haystack without having to grind all the hay up.”

The post Reconstructing a Tumor Cell by Cell appeared first on Mayo Clinic Magazine.

Now, thanks to an innovative technology known as spatial transcriptomics, Mayo Clinic experts are able to examine how genes are expressed in a tissue sample in three dimensions, providing unprecedented insights into cellular relationships and tissue structure.

Understanding ‘Omics’

“Omics” is a term used to describe the collective study of biological molecules, from genes to proteins and beyond. Transcriptomics specifically refers to the study of gene expression — how our genetic code, or DNA, gets transcribed into RNA, which is then used to build proteins.

Understanding gene expression can help scientists better understand human biology by providing insights into where and when genes are turned on and off during development and disease. This is important for knowing how different cells function and how they interact with one another in the healthy body, as well as what changes when someone gets sick. Transcriptomics can be especially helpful for identifying biomarkers of disease, which can aid in diagnosis and treatment.

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Traditionally, transcriptomics is focused on understanding the overall gene expression within a tissue — for example, a researcher might examine the gene expression of healthy pancreatic tissue and compare it to the gene expression in a pancreatic cancer tumor, or even how a single cancer cell compares to a single healthy one. But these approaches do not preserve organizational information about how genes are expressed in different areas of a tissue or a tumor, or whether there might be variations in that expression across a sample.

A New View Through Spatial Transcriptomics

Spatial transcriptomics is radically advancing our understanding of biology thanks to the fact that with this technology researchers can see not just what genes are being expressed, but exactly where a gene is active within a tissue. This means that scientists can examine the gene expression within individual cells while preserving the broader context of how those cells are interacting with their neighbors.

This feat is accomplished through tissue preservation and microscopy techniques that maintain the tissue’s structure while measuring the expression of many different genes across the sample. This produces a detailed map of how different cells are behaving and communicating within, for example, a biopsy from a cancerous tumor.

In cancer, this is particularly impactful because it means that researchers and pathologists can now see exactly where certain genes are active within a tumor, allowing for a clearer picture of the molecular dynamics of the disease and opening new avenues for treatment.

Pioneering the Future

Mayo Clinic’s investment in spatial biology is another step toward truly personalized medicine. Led by Tamas Ordog, M.D., and Jeong-Heon Lee, Ph.D., a team of Mayo Clinic scientists are building a first-of-its-kind research core dedicated entirely to spatial biology, beginning with spatial transcriptomics. Supported by machine learning and artificial intelligence tools that analyze the 3D data generated from patient samples, they say this tool will reimagine how diseases are classified and treated.

This technology is already transforming how Mayo Clinic approaches complex cancers, as researchers work to create new ways to examine biopsy samples to predict which therapies will be most effective based on a tumor's unique cellular architecture and molecular signatures.

As the spatial biology technique develops, the team plans to build detailed tissue atlases to map the progression of various diseases in unprecedented detail, potentially revealing early intervention points and novel therapeutic targets that would otherwise remain hidden in the complex biology of human disease.

The post What Is Spatial Transcriptomics? appeared first on Mayo Clinic Magazine.

The warehouse, which sits across the street from a quiet row of ranch houses, seems an unlikely hub for the transformation of healthcare. But the work happening within is forging a new future for patients everywhere. The warehouse contains Mayo Clinic’s Tissue Registry Archive, and by digitizing a significant sampling of material from this collection — 13.4 million slides so far and up to 16.5 million by the end of October — Mayo Clinic is unlocking previously unimaginable health insights and creating cutting-edge new treatment options.

Joaquín J. García, M.D., (left) and Joseph J. Maleszewski, M.D., (right), with the robots helping to digitize the material in Mayo Clinic's Tissue Registry Archive.

Photography by Paul Flessland

“This discovery effort is like the biggest treasure hunt you can imagine,” says Joaquín J. García, M.D., chair of the Division of Anatomic Pathology, which oversees the archive, and medical director of Mayo Clinic’s Digital Pathology Program. Researchers are now able to draw on digitized images and data from slides to develop artificial intelligence (AI) programs that automatically recognize features of various diseases in tissue samples. They’re also working to identify novel biomarkers and treatments for diseases such as cancer.

Serving Patients Across Generations

The unparalleled depth of the archive allows Mayo Clinic to generate insights that no other healthcare institution can. Most hospitals keep tissue samples for only 10 years. Mayo’s tissue archive goes back well over a century.

This practice of preserving tissue samples is rooted in Mayo’s commitment to putting the needs of the patient first. “Mayo Clinic has long viewed itself as the medical home for its patients,” Joseph J. Maleszewski, M.D., the medical co-director of the archive, explains. “And many of our patients’ conditions are genetic in nature, so it’s not uncommon for us to see not only patients but also their family members.” He adds that sometimes, decades after a tissue sample was created, relatives of the patient return to Mayo Clinic with questions about their own health.

“Through the generations, our goal has been to preserve patient tissue so we can return to it should new testing or new diagnostic insights become available,” Dr. Maleszewski says.

He adds that the archive digitization project has been driven in part by a desire to add an additional layer of protection for patients. “We view our role as keeping the tissue safe should our patients ever need it in the future,” he says.

Preserving the Past

In the Rochester warehouse, a dedicated team of archivists work alongside the robots to prepare and digitize the collection. The oldest tissue sample in the archive dates back to 1891 — just eight years after country doctor William Worrall Mayo, M.D., and Mother Alfred Moes of the Sisters of St. Francis famously shook hands and agreed to open a hospital in Rochester. “In terms of medical records, we have tissue from Mayo Clinic patient No. 3,” Dr. Maleszewski says.

Of course, challenges can arise when digitizing slides that are essentially historical artifacts. Dirt and damage are major concerns. Recognizing this, Mayo Clinic partnered with Pramana, a robotics and microscopy startup based in Cambridge, Massachusetts. Working together, Pramana and Mayo developed the first robotic scanner on the market capable of processing these older slides with a high level of quality control. Now, these scanners are powering the digitization project.

Living Forever: The Journey of a Digital Pathology Slide

STEP 1

COLLECTING

A biospecimen is taken from a patient, placed in a chemical solution that protects and preserves it, and sent to the Mayo Clinic Histology Laboratory.

STEP 2

EMBEDDING

After several preparatory steps in the lab, the patient sample is embedded in paraffin wax. Once the wax has solidified, the biospecimen can be cut into very thin sections — usually around 5 microns in thickness.

STEP 3

MOUNTING

These sample sections are placed in warm water. Glass slides are dipped into the water to pick them up.

STEP 4

STAINING

Once a slide has dried, the patient sample is stained so that cellular structures are easier to view, and a cover slip is placed over the sample. The slide is now ready to be examined under a microscope.

STEP 5

ARCHIVING

Once it has been viewed and analyzed, the slide becomes part of Mayo Clinic’s Tissue Registry Archive. Physical slides are stored in a climate-controlled warehouse in Rochester.

STEP 6

DIGITIZING

Each slide is also scanned and digitized, with the images and information it contains entering Mayo Clinic’s digital repository.

STEP 7

PRESERVING

The digitized data from the slide is preserved forever and can be used for a variety of purposes, including algorithm development and the creation of personalized health guidance and care plans for patients.

Supercharging the Future of Care

Meanwhile, in areas across Mayo Clinic, newly digitized data from the Tissue Registry Archive is already driving discoveries as researchers embark on Dr. Garcia’s “treasure hunt.”

For example, data from the archive is boosting research on one of the deadliest types of cancer — pancreatic cancer. Ryan Carr, M.D., Ph.D., a Mayo Clinic oncologist specializing in gastrointestinal malignancies, turned to the archive when he began work on an algorithm that will predict how different types of pancreatic tumors respond to treatment after surgery. Despite major advances in surgical techniques, a significant risk of cancer recurrence remains, so having new information to guide treatment decisions post-surgery will be transformative.

Using slides from as far back as 1991, Dr. Carr looks at factors such as the location of cancer cells and their relationships with other cells, including immune cells and cancer-associated fibroblasts.

Photography by Matthew C. Meyer

Photography by Leonard Julin

Mayo Clinic technicians prepare slides in a histology laboratory in 1933 (below) and 2020 (right), ensuring that the health information of Mayo patients will be preserved into the future.

“Using this data, the algorithm can predict sensitivity to particular chemotherapies that we can then apply,” he explains. Mayo Clinic teams can then create individualized care plans for each patient. This new treatment pathway promises to offer hope and targeted solutions to patients struggling with a difficult diagnosis and challenging treatment process.

Having access to the vast collection of assets in the Tissue Registry Archive is also changing the nature of pathology itself. Already, biopsies from current patients can be processed instantly and added to Mayo Clinic’s digital repository. With more data at pathologists’ fingertips, diagnoses and analyses can take place in hours or even minutes, not weeks. And patients are being empowered to learn more about their condition and make data-driven decisions about the types of treatment they would like to pursue. Dr. Garcia offers the hypothetical example of a patient facing a colon cancer diagnosis.

"In the future, when that patient decides they want a second opinion, they’re not going to jump through the hoops of the clinic or hospital,” he explains. “They can seek that extra opinion, and if they want someone to assemble it based on 50 colon biopsies over the last 30 years and assimilate that with 50 additional biopsies from their siblings, they can. That future is right around the corner with digital pathology.”

As the Tissue Registry Archive team approaches its goal of scanning and digitizing Mayo Clinic’s rich collection of material by the end of 2024, Dr. Garcia is reflective about the way this work bridges Mayo Clinic’s past and future — and furthers its legacy of serving patients.

“When we place tissue into paraffin wax, whether it’s in 1891 or today, we regard it as immortalized,” he says. “And we now have over a century’s worth of this tissue. We’re going to be able to piece together stories and predict new treatments for patients in ways we never imagined."

The post The Biggest Treasure Hunt You Can Imagine appeared first on Mayo Clinic Magazine.

EACH YEAR, MAYO CLINIC physicians and scientists conduct high-impact, cure-enabling clinical trials that provide patients around the world access to novel diagnostics and therapeutics as part of Mayo’s integrated medical practice. Mayo Clinic welcomed Owen Garrick, M.D., as the dean of clinical trials in October 2023 and tasked him with strengthening Mayo Clinic’s standing as a national leader of innovative, demand-generating clinical trials for patients everywhere. Dr. Garrick spoke with Mayo Clinic Magazine as he embarked on his new role.

Why did you choose to join Mayo Clinic?

The easy answer is — it’s Mayo Clinic. It’s like playing for the New York Yankees in baseball. What I’ve seen thus far at Mayo is that all the people here are first-rate, fantastic individuals. The teams of people at Mayo are really smart and very dedicated. During my interview process, a physician told me that a lot of clinicians and researchers aren’t in the news, because at Mayo Clinic, we feel the patients are the heroes. There was a sincerity around that, and that honesty and openness really drew me toward this opportunity.

Our patients always deserve better and deserve more, so we work harder in research to find those answers.”

What is your definition of clinical trials?

Clinical trials are all about creating and finding new ways of curing disease, preventing disease, supporting patients — and that could be new molecules, new drugs and compounds, new devices, new surgical techniques, new population health and population science, and more. But more than that, it’s the notion of never being satisfied with what we have now. Our patients always deserve better and deserve more, so we work harder in research to find those answers.

How do you plan to transform clinical trials?

There’s already an established level of excellence here in terms of research and clinical trials, and there’s a willingness for continuous improvement. When you’re recognized as No. 1, it’s because you’re providing the best healthcare, the best education and the best research experiences. We don’t just want to reduce the burden of patients participating in clinical trials, we want them to be excited. And when they’re excited and engaged about their healthcare, they can help us think through what the next research questions are that we need to evaluate and find answers for.

What trends can we expect in clinical trials?

The first is broadly personalized medicine, or making sure that new drugs and approaches work in all populations and knowing what does not work for a segment of the population. That leads into making sure that all populations are represented in research. There are a couple of approaches. One, include more ethnic, racial and geographic diversity in trials, but also, decentralize trials, which is really about having broader populations participate. We actually bring research to the patients versus having them come to where the researchers are. I think it’s fantastic because it decreases the burden to participate in research and expands the pool. And with a representative sample of the population, you can begin to see what truly works to open up personalized healthcare for more individuals.

The post Transforming Clinical Trials With Owen Garrick, M.D. appeared first on Mayo Clinic Magazine.

Mayo Clinic Platform: Transforming Healthcare With AI, Global Reach and Visionary Leadership as Platform President John Halamka, M.D., M.S., Reveals Even More Ambitious Goals

Indeed. But for a more nuanced story about Mayo Clinic Platform, the headline needs more human touch and less assistance from AI or any other technological advances dominating recent news cycles.

It, too, comes with a message worth reading twice.

“If your doctor can be replaced by AI, then your doctor should be replaced by AI,” Dr. Halamka told Mayo Clinic Magazine in a recent editorial board interview. “But that’s not the reason we go to the doctor. We go to the doctor for listening, empathy and respect. It’s just as much social as it is medical.”

And that’s where AI can play a growing role in the patient experience, augmenting human knowledge, like it has in so many other fields. Dr. Halamka, also recognized as the Michael D. Brennan, M.D., President’s Strategic Initiative Professor, believes that good doctors become even better when using AI and its mathematical abilities to instantly consider millions of other factors like demographic information, risk assessments, data points and the latest scholarly articles.

This powerful combination of connecting physicians and data supports the goal of Mayo Clinic Platform: to use collaborative tools and new technologies to create better healthcare and outcomes for all patients everywhere.

More Data, More Solutions

Mayo Clinic Platform is a coordinated portfolio of products focused on harnessing the transformational powers of AI, disseminating new AI-enabled treatment models and democratizing access to quality care. In his role, Dr. Halamka is helping Mayo Clinic develop new ways of thinking, new partnerships and new specialized skills to meet evolving patient needs while upholding Mayo’s long-standing values.

“At its core, the nature of what a platform is remains the same — it’s an enabling set of technologies, policies and processes that bring partners and collaborators together on a grand scale,” Dr. Halamka says. “However, how we execute this concept has evolved significantly.”

Mayo Clinic Platform was launched in 2020 with the idea that Mayo Clinic could turn the data of past patients into new cures and treatments for future patients. By taking more than 150 years’ worth of patient data and de-identifying it, innovators — from small startups to large companies — could develop new solutions for disease.

But with data came a few realizations over the past several years. Despite seeing 10 million patients, Mayo Clinic mostly sees people from the Midwest, Arizona and Florida, meaning the data are not representative of populations around the world. And it’s global impact that the Mayo Clinic Platform team is after.

“The question is, ‘Are we going to be able to take technologies, like emerging AI, and make them fair, appropriate, valid, equitable and safe? How can you reach even beyond Mayo Clinic’s extraordinary data and harness the data of the world?’” asks Dr. Halamka.

Bold Moves, Big Connections

In May 2023, the Platform expanded its distributed data network to include Hospital Israelita Albert Einstein in Brazil, Sheba Medical Center in Israel and University Health Network in Canada. The organizations joined Mercy, a health system based in St. Louis, Missouri, which was the first member. The goal is to bring together health systems from around the world to join this peer-to-peer network.

We go to the doctor for listening, empathy and respect. It’s just as much social as it is medical.”

— JOHN HALAMKA, M.D., M.S.

The Platform’s federated architecture — known as Data Behind Glass — ensures a secure architecture where data and intellectual property remain under the control of each individual organization. It also ensures that all data are de-identified, and that Mayo Clinic Platform partners do not see or interact with identifiable data at any point. The repository is now more representative of a global population and contains 40 million patient records.

“It took almost a year of legal, privacy, compliance and information security working together to create a repeatable model for de-identifying data,” Dr. Halamka says. “Our dataset is 99.6% de-identified. The best that had been done before the Platform was about 80%.”

And that’s what the Platform is enabling — safe, responsible and accelerated medical innovation using de-identified data on a global scale.

Already, Mayo Clinic Platform has supported the creation of more than 200 AI projects. These AI projects span different departments and specialties — from cardiovascular disease detection to an AI algorithm for radiation oncologists that auto-contours head and neck cancers more quickly and accurately than traditional contouring methods.

“In the last three years, more data meant more solutions, which meant more healthcare organizations wanted to participate, which meant more data, which meant more solutions,” Dr. Halamka says. “And so, in a true platform fashion, every participant is creating value for every other participant.”

Disrupting Healthcare

Dr. Halamka joined Mayo Clinic in 2020, leaving behind an endowed professorship at Harvard University that he held for 25 years. He was attracted to Mayo because of its goal to truly transform and disrupt the healthcare system.

“We’re not going to get new business models that are disruptive and transformative unless we take risks,” Dr. Halamka says. “And Mayo didn’t just say that. They really stood behind it.”

One of the most disruptive, mature Platform solutions is an at-home hospital program that allows high-acuity patients to receive hospital-level care virtually anywhere. Launched in July 2020, the program has now treated 26,000 patients around the nation through the Advanced Care at Home program, in partnership with Medically Home.

Advanced Care at Home eliminates or shortens hospital stays and allows patients to avoid skilled nursing facilities, while improving outcomes and satisfaction. In addition to the in-home care providers who visit patients’ homes, Mayo Clinic patients enrolled in the program receive 24-hour access to a Mayo Clinic provider through audiovisual technology and software. Under the direction of Mayo Clinic care teams operating out of the Florida-based R. Halsey & Lisha S. Wise Family Foundation Command Center, patients receive skilled nursing care, remote monitoring, phlebotomy services and other essential services from a network of EMTs, nurses and medical technicians.

The quality, safety and outcomes are the same as — and in some cases better than — brick-and-mortar care. The cost is 30% less, and the readmission rate is 50% less than in-hospital care. Patient satisfaction rates also are higher than traditional inpatient satisfaction rates.

“This was a situation where we were going to disrupt our own business model,” Dr. Halamka says. “What this implies by 2030 is a true transfor­mation of healthcare, because many patients will have the option to be treated in their home instead of in the hospital.”

With healthcare rapidly changing, Dr. Halamka recognizes the bright future ahead. He’s looking forward to watching people’s lives improve on both an individual and global scale, thanks to the innovations through Mayo Clinic Platform.

“If we’re going to reach 4 billion patients globally with these solutions, there’s work to do,” says Dr. Halamka. “Our job is to make Mayo Clinic’s practice better while also spurring global transformation.”

The post Platform Powers Answers appeared first on Mayo Clinic Magazine.

Humility, Love & Service

The purpose of life is to love and be loved — in that order."

This was one of many lessons Alan Mulally learned from his parents, Lauraine and Charles.

“It was education and service from the day I was born,” says Alan, with his parents reminding him daily of the values that were part of his formation as a person and a leader. “I had this tremendous love from my mom and dad. They were the best examples I could ever have.”

Alan also was deeply moved by the Rev. Dr. Dale Turner of the Plymouth Congregational Church in Lawrence, Kansas, and he set off to incorporate the values of humility, love and service leadership in his life.

Those lessons inspired and motivated Alan. He rose from humble beginnings to contribute to the design of every Boeing commercial airplane and lead the development of Boeing’s 777 airplane, the world’s largest twinjet and the most popular wide-body airplane in history.

Then, he helped save Ford Motor Company from the brink of insolvency through a set of collaborative leadership service skills that is the foundation of his “Working Together” leadership and management system that he created and nurtured. Alan’s leadership led Boeing to be the No. 1 global commercial airplane company and Ford to be the No. 1 automobile brand in the United States.

Alan’s service — and his steadfast belief that it’s nice to be important, but it’s more important to be nice — makes him a widely sought leadership teacher, coach, consultant and speaker worldwide.

His service also led him to Mayo Clinic, where he served on the Board of Trustees from 2017 until 2022, which ultimately led to his family’s philanthropic support of Mayo Clinic and the President’s Strategic Initiative Fund.

The President’s Strategic Initiative Fund is focused on a group of strategic priorities meant to continuously improve healthcare, and it allows the president and CEO maximum flexibility in investing in the most meaningful innovations to serve unmet patient needs.

“My mission is service for the greater good,” Alan says. “I was inspired and motivated to learn that the Mayo brothers created Mayo Clinic initially with philanthropic, technical and financial contributions as well as their leadership service skills that were similar to the ‘Working Together’ system.”

precision 
philanthropy

THE PRESIDENT’S STRATEGIC INITIATIVE FUND at Mayo Clinic is a powerful precision instrument in the hands of President and CEO Gianrico Farrugia, M.D.

It allows for dollars to be swiftly directed — at Dr. Farrugia’s discretion — to the most urgent projects across Mayo Clinic.

In the past two years, the fund has made possible healthcare transformation through the creation and expansion of the Cancer CARE Beyond Walls program, which recently celebrated a milestone — successfully providing patients with chemotherapy in the comfort of their own homes in a pilot program. The fund also supports research into new RNA therapies for previously incurable diseases, and it helped create artificial intelligence models that will result in earlier detection of disease and more cures as well as increase the comfort of the patient experience.

The President’s Strategic Initiative Fund empowers bold actions by Dr. Farrugia. This ensures that Mayo Clinic continues to be a world leader in healthcare, creating and advancing the latest treatments and technologies for the benefit of patients. — KATHLEEN HULL

Alan's Formation

Alan’s formation started with a very humble beginning. “All I really wanted was a pair of Levi’s and Weejun shoes so I could fit in, and maybe get a car and attend the University of Kansas in my hometown, which was my window to the world to serve,” Alan says of his upbringing in Kansas. “I realized my parents’ values were so right: To serve is to live.”

Alan’s service started with delivering newspapers, mowing lawns, bagging and checking groceries, constructing homes, and working and supporting farmers and ranchers. In college, he served his professors while studying engineering at the University of Kansas, and while studying leadership and management at Massachusetts Institute of Technology.

Alan met his wife, Nicki, at the University of Kansas, and they have been happily married for 54 years. They have raised five children and have been blessed with five grandchildren.

Alan served at Boeing for 37 years, including as Boeing executive vice president, president of Boeing Information Space and Defense Systems, and president and CEO of Boeing Commercial Airplanes, and at Ford Motor Company for eight years as president and CEO. Through it all, he believed there were three elements critical for the success of one’s life and any company — humility, love and service.

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Alan’s Leadership Formation and Development

Alan Mulally’s leadership formation, development and service journey is the foundation of his “Working Together” Leadership and Management System with its Connected Culture of Love by Design. It consists of these axioms rooted in his upbringing in Lawrence, Kansas.

• The purpose of life is to love and be loved … in that order.
• To serve is to live.
• Seek to understand before seeking to be understood.
• By working together with others, you can make the most positive contribution to the most people.
• Expect the unexpected and expect to deal with it … positively.
• Lifelong learning and continuous improvement.
• Respect everyone … we are all creatures of God and worthy to be loved.
• Develop one integrated life that is your life’s work of service.
• It’s nice to be important, but it’s more important to be nice.

Lifelong Learning

Alan’s lifelong learning contributed to his continuous improvement of his humility, love and service. One of his most important learnings came from studying other companies making significant contributions for the greater good.

Alan studied Mayo Clinic thoroughly and in detail. “Mayo Clinic is one of my heroes for their service that benefited all their stakeholders and the greater good,” Alan says. “I just couldn’t get enough of understanding how Mayo Clinic really worked in detail.”

That led to a chance to meet John Noseworthy, M.D., Mayo Clinic’s then-president and CEO, which eventually led to an invitation for Alan to join Mayo Clinic’s Board of Trustees. The relationship blossomed further under the leadership of Gianrico Farrugia, M.D., Mayo’s current president and CEO.

“When I was asked to join, I said yes immediately,” Alan recalls. “I have consulted with over 200 CEOs and their teams, and I’ve never been more aligned with any organization than with Mayo Clinic.”

While on the board, Alan was asked his thoughts on how to enhance Mayo Clinic’s services and productivity and continue Mayo Clinic’s top-ranked care, education and research programs.

“While I loved sharing my thoughts with Mayo Clinic from my leadership service, can you imagine how neat it was to learn even more from the Mayo Clinic team?” Alan says.

Giving Forward

The Mulallys supported Mayo Clinic’s compelling mission through a gift to the President’s Strategic Initiative Fund. The family also supports Mayo Clinic’s Poverello Foundation, which helps people who cannot otherwise pay for medical and surgical care. For their generosity, Mayo Clinic recognizes the Mulally family as Principal Benefactors.

“Clearly, Mayo Clinic is one of the most phenomenal organizations I’ve ever known for many reasons. And it also is the reason our family decided to philanthropically support Mayo Clinic,” Alan says. “I don’t know of any other organization someone could support with better service of hope and healing.”

Lessons in Leadership

Alan Mulally on building a best-in-class organization.

Dig deeper into Alan’s biography and his insights on the power of working together and building transformative teams.

• Alan Mulally Bio
• Work Is Love Made Visible: A Collection of Essays About the Power of Finding Your Purpose from the World’s Greatest Thought Leaders, Frances Hesselbein, Marshall Goldsmith, Sarah McArthur, foreword Alan Mulally.
• “Alan Mulally’s Engine: Humility, Love, and Service for the Greater Good,” Eric Lindner, The Engine Under the Hood. December 2022.
• “A Conversation with Alan Mulally about His “Working Together”© Strategic, Operational, and Stakeholder-Centered Management System,” Alan Mulally and Sarah McArthur, Leader to Leader, Volume 104.
• The Extraordinary Power of Leader Humility: Thriving Organizations – Great Results, foreword and chapter by Alan Mulally about how leader humility enables and nurtures effective working together by great teams, Marilyn Gist, PhD.Ph.D.
• Twenty-First Century Jet: The Making and Marketing of the Boeing 777, Book and Video, Karl Sabbagh.
• American Icon: Alan Mulally and the Fight to Save Ford Motor Company, Bryce Hoffman.

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