The BRMiBOK in Practice: How Mayo Clinic Made the Case for BRM
Based on the BRM Institute webinar featuring Neal Sanger, member of the Mayo Clinic CIO executive leadership team
The case for BRM is never made once.
Leaders change. Budgets tighten. A new CIO arrives who has never worked alongside a BRM and quietly wonders whether the role is worth the headcount. Every BRM capability, no matter how established, will eventually need to justify itself again.
That reality is exactly why Mayo Clinic’s story matters. In this BRM Institute webinar, Neal Sanger, a member of CIO Cris Ross’s executive leadership team, walked through how he built, funded, and defended a BRM capability at one of the most recognized healthcare institutions in the world. What makes his account so useful to the global BRM community is not just that it worked. It’s that nearly every move he described maps directly to the frameworks in the BRM Body of Knowledge. Mayo Clinic is the BRMiBOK in practice, at scale, with results.
A capability, not a collection of roles
The BRMiBOK draws a distinction that Sanger’s story brings to life: BRM is a capability before it is a role. A capability is something an organization deliberately builds, resources, and matures. A role is one expression of it.
Before 2021, Mayo Clinic had the role without the capability. Relationship work belonged to senior IT managers who already carried full-time delivery jobs. When Sanger asked those leaders how much time they truly spent engaged with the business, understanding their partners’ world rather than delivering software into it, the honest answer was a day a week at best.
The relationship was a hobby. And the BRMiBOK is unambiguous about what happens to relationship management done as a hobby: it becomes reactive, it becomes inconsistent, and it disappears the moment delivery pressure rises.
Sanger’s pitch to his CIO rested on that single insight. Not new activities. Dedicated focus on activities everyone already agreed mattered and nobody had time to do. Today Mayo Clinic’s capability includes 12 to 15 dedicated BRMs organized in a four-level job family, from Business Relationship Manager to Senior Business Relationship Director, sitting within a centralized customer organization that reports directly to the CIO.
Climbing the relationship maturity ladder
The BRMiBOK describes relationship maturity as a progression: from order taker, through service provider, toward trusted advisor and strategic partner. Mayo Clinic named its starting point out loud.
The second paragraph of the organization’s refreshed IT strategy states plainly that IT had too often been seen as an order taker, and that it intends to become something more. That ambition has a champion at the very top. Mayo Clinic CEO Dr. Gianrico Farrugia challenged IT to become “allies to the business,” a phrase that now anchors the strategy itself.
Sanger is honest about where they are on the climb. He does not claim Mayo Clinic has fully arrived at trusted advisor across every relationship. He claims something more credible: they are rapidly advancing, and they can show the receipts. That honesty is itself a BRMiBOK principle. Relationship maturity is measured, not declared.
It’s worth noting what made the climb possible in healthcare specifically. Mayo Clinic’s founding ethos, that the needs of the patient come first, is already a relationship-centered idea. The organization didn’t have to invent a relationship-centered culture. It had to extend one it already lived at the bedside into how the enterprise works with its service provider.
Convergence in action: the neurology story
The single strongest proof point in Sanger’s presentation is a direct application of two BRMiBOK instruments: the strategic relationship plan and the value forecast. Sanger credits the BRM Institute for both by name.
Neurology, unlike its close cousin cardiology, had no multi-year IT strategy roadmap. The department’s Business Relationship Director facilitated a multi-month application portfolio management exercise that produced one, embedded it as a section of the strategic relationship plan, and paired it with a value forecast that put measures behind every intention: reduced referrals to competitors, expanded access to a growing North American market, increased procedure volumes translating to annual net income, and an EEG equipment rationalization projected to reduce vendor costs and clinical burden alike.
Notice what the BRD actually did, because it answers the question every skeptical executive asks. He did not build the roadmap alone. He convened the right internal specialists, translated between them and a clinical department they did not deeply understand, and shaped demand toward the initiatives that mattered most. Having come from an operations role supporting neurology, he could speak the department’s language. In his own words, he now serves as the point of accountability that promotes awareness of and adherence to the roadmap.
This is convergence as the BRMiBOK defines it. Not IT aligned to the business from the outside, but business and service provider planning as one, with shared ownership of shared results.
Value realization does not end at go-live
The BRMiBOK teaches that value is not delivered when a project ships. It is realized when the promised results actually appear, and someone has to own that distinction.
Sanger described the failure mode most organizations know too well. A business case gets built, the project starts, and everyone pivots to activation while the forecasted value quietly evaporates. At Mayo Clinic, the BRM owns value through delivery. If a design will not produce the outcomes in the value forecast, the BRM is the one who says stop before go-live, not after.
The same discipline is taking root as an annual rhythm: a look back at the value realized, a look forward at what comes next. Results, then relationships, then results again.
Shaping demand before it arrives
Two of Sanger’s examples show demand shaping working in opposite directions.
The Center for Digital Health had too much unstructured demand. An IT vice chair was spending nearly 30 percent of every week meeting with leaders in that single group. A dedicated BRM, put in place in 2021, absorbed and organized that engagement, returning senior leadership capacity to the rest of the enterprise. In research IT, five or six infrastructure leaders sat on one subcommittee, regularly pulling agendas into technical depths nobody requested. One BRM replaced them all.
The Department of Medicine had the opposite problem: no demand signal at all. The department would arrive with purchases already made and expect support. Sanger’s team recognized what the BRMiBOK warns about. Silence is not the absence of need. Today a BRM is embedded with the department’s Clinical Transformation Office, pulling IT architects into planning conversations early, while design decisions are still decisions.
Demand shaping is not about saying no. It is about being present early enough that the right things get asked for.
Trust, measured in the partner’s own words
The BRMiBOK holds that trust is built through consistent, personal, value-producing interaction, and Mayo Clinic recently rebuilt its voice of the customer program around exactly that principle. Instead of sending senior business leaders a survey, Sanger holds thirty-minute conversations. What’s working. What’s not. A score. What should we be thinking about next.
The answers came back in the language of relationship. Nursing called their BRM a great navigator and a tremendous strength. Pharmacy praised the traffic control. The Department of Medicine said their BRD brings ideas they had not considered and has been instrumental in bridging business and IT conversations. The leader of Mayo Collaborative Services, home to a major reference lab and biopharma initiative, described the BRD as filling a crucial role in business planning itself.
And then there is the data point no survey could manufacture. A business area leader approached Sanger and offered to fund a dedicated BRM from their own budget to get to the front of the line. When the business pays for the relationship, the value conversation is over.
The satisfaction runs both directions. Mayo Clinic’s BRMs post some of the strongest employee engagement scores in the IT organization, and team members regularly describe the role as the job their entire career prepared them for. People, purpose, and possibility, visible in a staffing survey.
The verbs of the role
Sanger keeps a set of answers ready for the objection every BRM leader eventually hears: I already have people who engage the business.
His response is a compact restatement of the BRM role as the BRMiBOK frames it. For a BRM, the relationship is the day job, not the hobby. Mayo Clinic’s BRMs are individual contributors, free of administrative burden that competes for attention. They pair deep business knowledge with the ability to navigate a 3,000-person IT organization. And the verbs that define their work are advising, leading, collaborating, navigating, and coordinating.
Sanger goes further, and the point deserves emphasis. If a BRM could be single-handedly credited with a technical delivery, they would not be succeeding. They would be playing the wrong position. The BRM’s value is the value they make possible through others, which is precisely why organizations that measure BRMs like delivery resources never see what they have.
The standing message to Mayo Clinic’s business partners is disarmingly simple: if you’re not sure about anything involving IT, just call your BRM. That posture has earned BRMs seats on customer committees, advisory groups, and decision-making bodies across the institution. Presence, then trust, then influence.
Building the capability: what Mayo Clinic would tell you
For leaders assembling their own BRM proposal, Sanger’s guidance reads like a field-tested companion to the BRMiBOK’s capability-building guidance.
Start small and gain success. Do not attempt to cover every business partner at once. Target friends of IT where need is high and wins will be visible. Maturity is built one relationship at a time.
Look for solid matches. Mayo Clinic hires most BRMs internally, not from reluctance to develop outside talent, but because business partners consistently say the same thing: help me navigate this organization. Pairing organizational fluency with genuine knowledge of the partner’s world is what makes a BRM effective fastest.
Recruit with the business, not for them. Sanger asks the most senior leader in each business area, often the department chair, to partner in recruiting their BRM. The partner becomes invested in the person from day one. As Sanger put it, it is hard to find a business partner who doesn’t love their BRM.
Make the launch deliberate. Mayo Clinic’s capability existed in limited form through the late 2010s. The turning point came in February 2021, when Sanger and CIO Cris Ross formally introduced BRM to the entire IT organization at a department meeting. A capability that is named, explained, and funded behaves differently than one that is merely tolerated.
Invest in the discipline itself. Every BRM at Mayo Clinic, including Sanger, completes BRMP training. It is not a hiring prerequisite, but it is a requirement of the role, and Sanger funds the certification for others across the organization who want to pursue it. His reasoning is the community’s reasoning: it’s great for the discipline.
From BRMConnect to today
Sanger went deeper at the 2024 World BRMConnect Conference, unpacking the pivot points of Mayo Clinic’s decade-long BRM journey, the practices his team built alongside the BRM Institute and its Knowledge Provider community, and where the capability heads next as the organization continues its climb toward trusted advisor.
The Mayo Clinic story is one chapter in a much larger book. BRMConnect 2026, coming to Denver this September, brings a new slate of storytellers and panels spanning industries well beyond healthcare, each one proof that the frameworks in the BRMiBOK translate wherever relationships drive results. If Mayo Clinic’s journey resonated, this year’s stories will show you how far the discipline reaches.
The single best summary of Sanger’s message, though, fits in a sentence. The BRMiBOK is not theory waiting for proof. At Mayo Clinic, it is the operating manual.