He won't claim much of the credit, but Robert Waller left a lasting personal imprint on America's healthcare industry. An ophthalmologist by training, Waller was instrumental in helping transform the Mayo Clinic from a single, self-contained medical clinic in southeast Minnesota to a far-flung, fully integrated national healthcare system with hospitals as distant as Jacksonville, Fla., and Scottsdale, Ariz.
The Mayo Clinic-a $340 million-a-year operation with about 840 physicians in the mid-1980s-didn't even own a hospital until 1986, about the time Waller emerged on the institution's board of trustees as a key proponent for diversification.
Under Waller's leadership as president and chief executive officer beginning in 1988, the Mayo Foundation grew into the powerful organization it is today, with $3.5 billion in annual revenue, more than 2,800 staff physicians, 13 owned or affiliated hospitals and a vast network of 62 clinics and hospitals in three states.
But don't ask the 66-year-old Waller about his role in the success of the internationally renowned healthcare organization. Soft-spoken and, by all accounts, sincerely humble, he will sidestep any effort at praise or appreciation, crediting everyone but himself for the organization's success during his decade-long tenure as Mayo's chief executive until his retirement in 1998.
"I just filled a slot, temporarily, with a wonderful organization," says the self-effacing Waller. "Mayo has a gift of special core values, which we all tried to adhere to. I served Mayo, then I passed the baton-I passed the baton to people far more capable than I am. I was thrilled to do it."
Waller, who was appointed to Mayo's board in 1978, remains semi-active as the organization's president emeritus. He's now retired and living in his longtime home of Memphis, Tenn.
Expressing good-natured surprise at his selection to the Hall of Fame, Wall abruptly dismisses any notion that he left behind some sort of a personal legacy at Mayo. He points out that chief executives at the conservative, buttoned-down system are unlike their high-powered, high-profile counterparts at big multinational corporations. In other words, he's no Jack Welch.
All Waller was concerned about, he says, was continuing the mission of Mayo: quality care, top-flight research and the best medical education available.
"I don't even like to answer that question," he says in polite protest when asked about his legacy. "CEOs at Mayo are not the traditional chief executives you see in business and the corporate world. You have to understand that I progressed through the leadership ranks. I was part of a team. I don't look at having a `legacy' of any sort."
It's not that Waller wasn't well-known or highly regarded outside the healthcare establishment. He was a prime mover with the Jackson Hole Group beginning with his appointment in 1993, and has served since 1999 as president of the loosely organized healthcare think tank comprising academics, executives, policymakers, politicians and providers.
He served for two years as chairman of the prestigious Healthcare Leadership Council, a coalition of top executives from America's leading hospitals, for which he still serves as chairman emeritus; and enjoyed enough political heft to win an appointment to George W. Bush's transition advisory team for health and human services three years ago.
High praise from high places
Waller's nomination for the Health Care Hall of Fame, which was initiated by Mayo officials, was backed by a stack of recommendations filled with praise from several celebrated businessmen and politicians, including Paul Volcker, a former chairman of the Federal Reserve Board; J. Willard Marriott Jr., chairman of the international hotel company that bears his name; and Walter Mondale, the two-term Democratic senator from Minnesota who served as President Carter's second-in-command and later lost a presidential bid to Ronald Reagan.
As much as Waller might wince from words of high praise, Mondale-whose decade-long service on the Mayo board coincided with much of Waller's stewardship-characterizes him as a man who helped to transform an entire institution with his vision and leadership.
"He had the ability to see the issues, to organize, to unify people and to make everybody feel good while he did it," Mondale says. "If you look at any indicator of what counts in an institution like Mayo, every single one of them improved substantially during Bob's leadership."
Mondale calls Waller "intelligent, thoughtful and one of the nicest guys I know."
It didn't surprise him, Mondale adds, that Waller was reluctant to take credit for Mayo's successful expansion under his watch. "It's typical of him. One of the things he did was to give other people credit. A lot of people deserve credit, but he really had a spectacular career."
Waller was clearly one of the principal leaders of Mayo's expansion in the mid-1980s, says the foundation's current CEO, Michael Wood, an orthopedic surgeon.
"He played a key role in formulating strategy for the geographic diversification and in guiding us through about 12 years of that diversification," Wood says. "If you go back to the time when Bob Waller was assigned the job (as chairman of the diversification committee), Mayo Clinic was a group practice of physicians-one location, no hospital."
He credits Waller with acting as the "unifying and cohesive" force in holding together a bold and difficult expansion that essentially involved exporting a "profoundly important brand" to remote locations as much as 1,500 miles away, in communities far different from Rochester, Minn.
"Bob will be the first to deny the singularity of (his role)," Wood says. "Obviously, there were many people involved. But he was the single, top entity that kept this together. He provided the leadership."
He describes Waller as a man of "impeccable integrity and consistent equanimity, laced with a nice sense of humor."
"He has been a difficult act to follow," he adds with a laugh.
Waller, married and the father of three children, spent almost his entire career at Mayo. He earned his undergraduate degree from Duke University, Durham, N.C., in 1958, and graduated from the University of Tennessee College of Medicine in Memphis four years later. After serving a one-year internship at the City of Memphis Hospitals, he began his career in Rochester with an internal medicine residency in 1967. Tabbed early on as a future leader, he was appointed to the board 11 years after he was hired, then moved up rapidly through key administrative roles, serving as vice chairman of the executive committee when the clinic merged in 1986 with its first two hospitals, Saint Marys Hospital in Rochester and Rochester Methodist Hospital.
During that same period, Waller served as chairman of the board's diversification committee, the group that helped to push for an expansion that led to the opening of clinics in Jacksonville and Scottsdale. Typically, he is quick to give much of the recognition for this successful expansion to the then-CEO, William Eugene Mayberry, an endocrinologist who was Waller's immediate predecessor as Mayo's top administrator.
"Gene Mayberry was the chairman of the board-and that's where the direction was set," Waller says. "Clearly, it was a team effort."
Mayberry, who served as Mayo's CEO for about nine years, calls Waller a "natural leader" with the rare ability to unify and motivate a "very independent group of physicians."
Although Mayberry, as president and CEO, directed Mayo's expansion to Florida and Arizona, he credits Waller with much of the success in carrying out those plans and says his successor had a "major responsibility in developing Mayo Clinic into the multistate hub that it is today."
Indeed, Waller was an articulate early advocate of the expansion, which he believes transformed Mayo into "more of a national organization."
"It was an important strategy," Waller says, "because it was the best way to position us for the new century. It was very important to consider the merger with hospitals in Minnesota, the development of other models in distant locations, and the search for alternative sources of revenue to help fund research."
A national role
As Mayo's CEO, Waller also exerted considerable influence in directing or molding national healthcare policy, joining debates on a wide range of issues, including Medicare reform, the evolution of medical education, patient choice, access, safety and the quality of care. His prominence in that vocal and influential role was another example of Mayo's makeover from a comparatively sleepy little clinic to a national powerhouse.
"I think our trustees made it very clear during the mid- to late 1980s that Mayo should have a seat at the tables where healthcare reform was discussed," says Waller, who recently joined the National Advisory Council for the Agency for Healthcare Research and Quality. "Traditionally, Mayo had been more introspective about these things. We started looking outside, and we tried to contribute what we could to the principles underlying healthcare reform. That became part of the chief executive officer's job."
If the size, structure and scope of the Mayo Foundation changed dramatically under Waller, its international reputation for quality care preceded his tenure and continues to this day, he notes. The reason, he says, is as simple and basic as his style of leadership.
"It has to do with a value system," Waller says. "Mayo was very fortunate to have founders who were just uncanny in setting down a set of values that has served us so well for so many years. We're doing the job of taking the best care of patients we can. And I think we've always tried to stay focused on a common mission: meeting the needs of our patients. I think we try very hard to send a happy patient home."