The health care industry is undergoing rapid change. While improvement work is often linked to a specific project or program, fostering an organization-wide improvement culture can have long-term impacts on health outcomes and customer satisfaction. Southcentral Foundation’s Nuka System of Care (Nuka) is structured for continuous improvement using the voice of the patient (called “customer-owners”) and grounded in the Malcolm Baldrige National Quality Award framework.

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Nuka uses several methods for collecting feedback data and community input for organizational improvement:

  1. A survey system, including a customer satisfaction survey delivered on tablets and an annual employee satisfaction survey (supporting work processes, employee performance, and links to customer satisfaction, with 55 percent of employees who are Alaska Native or American Indian).
  2. A trend-reporting database used for non-qualitative data, which allows Nuka to make changes desired by customer-owners quickly and efficiently.
  3. Community advisory boards, such as the Elder Advisory Council and Tribal Health Advisory Councils, provide feedback directly to leadership.
  4. Community events, such as the Southcentral Foundation Annual Gathering, promote wellness programs and provide opportunities for customer-owners to share feedback.

Leadership is committed to several principles to support employees as they make improvements desired by customer-owners. They encourage calculated risk-taking innovation and creativity on the part of employees, who are encouraged to try out new ideas and look for new approaches to problems.

Additional Resources


The 5 Most Adopted Ideas From SCF’s Nuka System of Care


Understanding Baldrige Criteria for Performance Excellence


Using the Voice of the Customer to Drive Improvement


Southcentral Foundation Receives Second Presidential Honor: 2017 Baldrige National Quality Award