[The following article appears in the October 1994 edition of
_TQM_in_Higher_Education_, pages 3 and 8.]

                      RX FOR A HEALTHY INSTITUTION
                                    
                              Michael Kurtz

     While there are over 3,600 colleges and universities in the
U.S., 95% of the research in science and engineering is conducted
is approximately 200 institutions.

     Competition for research dollars has become due to declining
amounts available from government agencies, as well as from
corporate and private sponsors. And many instiutions are being
forced to look at funding alternatives.

     The Theodore Cooper Surgical Research Institute, a division
of the surgery department at St. Louis U. Health Sciences Center
is no exception. Founded in 1951, research in the Institute was
historically funded by clinical revenue-dollars generated from
the delivery of patient care.

     Recently, significant cuts in Medicare reimbursement,
increased competition from private hospitals for patients,
increased competition for insurance company and HMO contracts,
along with impending health care reform have led to a significant
reduction in the availability of these types of funds for
research and development. In an effort to become more competitive
for the dwindling supply of extramural research dollars, the
Institute began a TQM program in 1990.

A Cutting-Edge Philosophy

     We chose TQM because it seemed illogical for an institution
performing cutting-edge research to be burdened with a management
system that employed archaic, outdated, and disproved management
techniques.

     We first established a scientific advisory board and chose a
scientific director and associate director to bring the
management structure to a level appropriate to the breadth and
intensity of the department research activities.

     As a basis for implementing TQM throughout the Institute, we
adopted a new mission statement, which would clearly articulate
our vision. Our mission became: to perform clinically-relevant
research, which will improve surgical care of patients; to
provide research opportunities and training to clinicians and
students; and to develop financial resources to support research
activities.

     Next, we began a process of cultural assessment--determining
where we were, what we did best, and where we wanted to be. Using
the scientific advisory board and the Institute's management
structure as a leadership tree, we began communicating the
following philosophy throughout our organization:

     -- have mutual respect,
     
     -- share responsibility,
     
     -- criticize ideas, not people, and
     
     -- practice constructive listening.
     
     We established cross-functional teams consisting of both
faculty and staff, and empowered them with responsibility and
authority. Teams included: safety facility teams (to run common
use facilities such as cell culture rooms and surgical suites),
and teams to review marketing, publications, proposal
development, and technology transfer.

     We used team-building techniques, including role
clarification and group feedback to enhance their effectiveness.
At monthly meetings of faculty and staff, each team reports on
issues related to their responsibility, and receives prompt
feedback.

     Every team is charged with establishing measurable, agreed
upon, and realistic goals with timed implementation of such.
Teams focus on their own set of internal and external customers
and suppliers, utilizing TQM techniques to attain continuous
improvement and to meet their customers' expectations.

     For example, the quality team responsible for making sure
that research equipment is operational and calibrated, uses run
and control charts to ensure that the equipment is operating
within acceptable levels.

     When it's not, a flowchart establishes procedures to be
followed to correct the problem. As a result, the customer--the
user of the equipment--can expect the equipment to be operative.

Results

     Results of our TQM strategy have been impressive. In our
animal surgical facility, the utilization rate (days used/days
available) increased from 26.9% in 1991, to 56.7% in 1992, and to
71% 1993. From 1992 to 1993, there was a 24% increase in the
number of procedures performed. The average cost of supplies for
each procedure decreased from $71 to $59.

     Between FY92 to FY93, our animal care expenses were reduced
by $86,000 as a result of:

     -- more effective communication between scientists,
     
     -- piggy-backing experiments, and
     
     -- switching from the use of animal models to in vitro
     models.
     
     One of our goals of the TQM process was to depend less on
clinical funds and more on grants and revenues from other
sources, such as contract research.

     In the four years since we implemented TQM, the percentage
of clinical funds used for research purposes dropped from 91% to
50% of expenses, while the percentage of grant funds increased
from 6% to 42%. Contracts and other revenues have increased from
3% to 8%. In addition, a research endowment, which began in 1990,
has increased by $1 million.

     The implementation of these concepts wasn't without
challenges, for example, turf battles that had to be overcome and
faculty perceptions of loss of academic freedom that had to be
changed. However, the process has provided numerous opportunities
to gain a further understanding of the research environment.

     Along our TQM journey, we're continuing to study ways to
improve our employee evaluation and compensation system, improve
purchasing practices, develop more effective training programs,
and find additional sources of benchmarking.

     We've concluded that TQM is adaptable to the scientific
research environment and results in increased quality,
productivity, cost savings, and improved employee morale. Key to
the implementation of TQM is a leadership tree supportive of the
mission and the environment in which the mission is carried out.

     To learn more, contact: Mike Kurtz, Associate Director,
Surgical Research Institute, Department of Surgery, St. Louis U.
Health Sciences Center, 3635 Vista and Grand, St. Louis, MO
63110; Ph: 314/268-5310; Fax: 314/268-5180. 

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