2016 David Rall Award
An Interview with Donna E. Shalala
Every year, the National Academy of Medicine awards the David Rall Medal to an NAM member who has demonstrated distinguished leadership as chair of a study committee or other such activity, showing commitment above and beyond the usual responsibilities of the position. The 2016 Rall Medal was awarded to Donna E. Shalala, President of the Clinton Foundation and Trustee Professor of Political Science and Health Policy at the University of Miami. In the interview that follows, Dr. Shalala discusses her chairmanship of the Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing, which produced the most-downloaded report in Institute of Medicine history.
You were chair of the committee that authored The Future of Nursing: Leading Change, Advancing Health, which is the most-read report in IOM history. What do you think made it so successful?
The number 1 reason the report was so successful was timing. The nursing profession was ready to take a larger and larger role as it increased education, visibility, and responsibilities in the health care system. As health care was changing, the role of professionals other than physicians was becoming critical. The era when nurses were considered the “hand maidens” of the health care system was obviously over. It took teams to deliver high-quality health care, and both nurses and doctors were absolutely critical to those teams. Nurses and doctors working together as partners. So the timing was right for a clear report about how to build that partnership. The second major reason for its success was that the recommendations had widespread support and were very clear. I think the most successful reports have a great combination of clarity and timing.
The Robert Wood Johnson Foundation, which sponsored the report, also played a very critical role. They were not only willing to provide resources, they were prepared after the report came out to join with the AARP to establish a Campaign for Action to focus on implementation of the report. It’s very rare to have that many resources tied to a report for implementation.
Of course, the real credit goes to a remarkable committee — for tolerating my chaos strategy for doing reports.
You were instrumental in assembling the committee, and you made sure that the group had broad expertise beyond just nurses and physicians. Why was this diversity so important?
This committee was particularly interesting because it was actually not dominated by nurses and doctors, but by people who knew the broader health area, or had broad government experience. So Bob Reischauer, former director of the Congressional Budget Office and president emeritus of the Urban Institute, was on the committee, as well as Bruce Vladeck of Nexera, Linda Burnes-Bolton of Cedars-Sinai, and Jack Rowe of Aetna. Of course, we had nursing experts as well.
We were focused not only on the substance of the report, but on building support for it at the same time. Perception is everything. I believed that the broader the committee, the more likely the report was to get widespread acceptance.
The report has had a lot of impact since its release in 2010. What’s left to achieve its full vision?
There are still barriers that prevent nurses from practicing to the full extent of their training. There is momentum to expand nurses’ scope of practice, but it has to be done state by state. If the federal government could do it, it would be done. But regulation over scope of practice is the role of the states. Many states have expanded nurses’ scope of practice, but others have not. There’s a lot more work to do in this area. This was the key recommendation in the report.
Why do you choose to volunteer your time with the National Academies?
I’ve been a member of the National Academy of Medicine for 15 years, and I served on National Academies committees long before that. The National Academies are an important advisor to policy makers, and the work really does have an impact. When I was Secretary of the Department of Health and Human Services, we hired the National Academies to do reports, and we regularly asked for their advice on making scientific and other appointments.
Tell us about one of your role models.
Philip R. Lee, the great expert in public health, former Chancellor of the University of California, San Francisco. He was an important mentor to me during my 8 years at HHS because he had such a broad vision of health and public health.
Any advice for future committee chairs?
Pay attention to who’s on the committee. It’s the mix of committee members that makes for a successful report, not just the leadership.