Donna Shalala, former U.S. Secretary
of Health and Human Services, inspired participants at a recent
NCCI workshop in Miami Beach, Florida. She is now President of the
University of Miami. Shalala’s years as a presidential cabinet
member were preceded by four years as chancellor at the University
of Wisconsin-Madison. While at UW-Madison, Shalala initiated the
campus's quality improvement efforts, focusing first on students
as customers. (Subsequently, UW-Madison became a charter member
of NCCI.)
With trademark vivacity, President Shalala shared stories of what
works in creating and supporting a culture of continuous improvement
and quality. Citing her experience at UW-Madison, she advised creating
a "buzz" around campus, first with small visible things,
then focusing on a few important and highly visible issues. She
recalled opening a Madison newspaper to the front page photo of
the Bursar’s office with students waiting in lines that stretched
out the doors. Using the publicity as an opportunity, she encouraged
the staff to identify the process bottlenecks. A simple change in
procedure dissolved the lines, improved the situation for students
and staff, and created awareness around campus of the power of process
improvement.
Recalling her initial interview with president-elect Clinton in
Little Rock, Arkansas, she said, "We spent half our time talking
about quality improvement opportunities, though we didn’t call
them that." The important and highly visible challenges she
took on as HHS secretary included Social Security, Medicare and
child immunization.
During her appointment, the quality improvement efforts she supported
transformed Social Security from the federal agency reporting the
worst customer satisfaction to the agency reporting the best customer
satisfaction.
A reminder post card from the veterinarian regarding shots for
her dog, Bucky, suggested improvement possibilities for America’s
child immunization system. When she took over as Secretary, the
U.S. had the second-worst record in the world for childhood immunization.
(Only Haiti was lower.) By approaching this complex problem from
a number of angles, the percent of children immunized has grown
from 47% to 85%. (One of the public information tools used was notices
about immunizations on McDonalds™ placemats!)
Her highly visible priorities at Wisconsin included private fund-raising,
enhancing undergraduate education, and athletics, an effort that
ultimately netted three Rose Bowl appearances.
"Always focus on your customers–students--and get the
academic side of the university hooked," she said, citing her
experience taking a large group of faculty members to Proctor &
Gamble for a week of presentations and discussions with top P &
G leaders about customer focus and quality improvement.
Succession planning is essential for constancy of purpose and ensuring
that interest in quality and continuous improvement continues, she
advised. After Shalala left UW-Madison for Washington, D.C., then-provost
David Ward assumed the chancellor’s position. Last year, John
Wiley, who had been provost under Ward, took over as chancellor.
Flying to and from Miami football games provided a further illustration
of starting with small, highly visible, highly symbolic gestures.
When she first took over as president, players all rode in economy
class, while coaches and administrators traveled in the first class
section. Shalala changed that traditional arrangement so that now
players who are seniors travel in first class section. Such changes
speak loudly about what is valued, she said.
Her first impression of the Miami campus was that it looked too
perfect. It was beautiful, but not inviting, she recalled. Thus
one of her early goals has been to "Mess up the campus, make
it more comfortable, add tables and chairs, so that it’s a
welcoming environment for our students." She is also working
to create a faculty club space so that faculty members from across
the campus have opportunities to meet, talk, and create friendship
and collegial links.
As critical as it is to provide top down leadership, it is also
essential she said to support and encourage bottoms-up innovation.
"Don’t tie quality to budget savings," she advised,
"or it will be dead on arrival." Rather, focus on quality
as a way to improve those things that people value.
Communicate the story of quality and improvement. Success stories
especially around visible issues are powerful tools for encouraging
process improvement. Notice where faculty members concerned with
quality improvement are placed on campus. Take advantage of the
newly emerging bodies of scholarship on quality and get those top
academic leaders involved.
Shalala encouraged the quality professionals gathered in Miami
to be strategic in selecting areas for improvement. "Don’t
try to fix what isn’t important or doable."
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