The city of Austin, Texas, wanted to be listed as one of the top five places to live in the United States. Explaining that vision to the various municipal departments wasn’t difficult. Managers set about benchmarking from previous years, looking at the numbers, and deciding where they should take the big steps to improve performance, such as with emergency-response time.

One of the areas that needed improving was infant mortality; data pointed to several root causes such as illegal immigration, measles, and infant diarrhea. Elaborate plans were made to address the causes. These included educating medical personnel and the agencies that interact with parents who, for fear of deportation or who prefer home remedies, didn’t go to clinics. Inoculations were planned, and educational pamphlets were prepared. Compliance audits were also scheduled.

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