Former Quest Diagnostics CEO on the Power of Small Changes

As the COVID-19 pandemic spread across the United States in early March of 2020, Steve Rusckowski, SM ’84, just so happened to be in Washington when the White House called.

“That’s an example of when you’re sitting in the seat and you get a call. The question is, how do you step up and answer that call?” the former chairperson, CEO, and president of Quest Diagnostics told the audience in Wong Auditorium.

Rusckowski, who retired as CEO in November 2022 and chairperson in March 2023, returned to campus in October for a conversation with John C Head III Dean David Schmittlein, students, faculty, and other members of the MIT Sloan community for the iLead Speaker Series.

The right thing to do

After the first phone call in early March 2020, Rusckowski sat in on additional calls and meetings with the White House Coronavirus Task Force to help them figure out how to quickly and safely implement widescale testing across the country.

This required a significant overhaul of Quest Diagnostics facilities and processes, which were typically designed for phlebotomy, or blood draw. Early (and later) tests relied on nasal swabs, so Rusckowski and his team had to rapidly transform the organization’s capabilities while simultaneously addressing a major downturn in business as usual.

“A large part of our business was based on physicians seeing patients. At the time, physicians were starting to no longer see patients, so our base business was turning off. We literally went from 100% to 50% within three to four weeks,” said Rusckowski.

With responsibilities to his employees and shareholders, Rusckowski described it as an “unbelievably stressful time.” This was compounded by the fact that Quest Diagnostics’ involvement in the White House’s efforts to develop and administer testing from scratch required more time and money that, at that point, came with no promise of reimbursement.

“There was no CARES Act yet. There was no reimbursement commitment. There was nothing, but this was the right thing to do, so we did it. We began to invest, but at the same time we needed to, in good consciousness, be able to plan for how the company would operate,” said Rusckowski.

It was a leap of faith, and it echoed a question Rusckowski began asking himself and his team at Quest Diagnostics when he became CEO and president in May of 2012: Where is health care headed?

A method for answering this question and others like it is innovation, which, as Rusckowski explained, has an enormous role to play in advancing health care, medicine, and technology. This was especially the case throughout the pandemic.

“A large part of innovation is not just in the medicine but also in the workflow and the processes that you can automate,” said Rusckowski, a former MIT Sloan Health Systems Initiative (HSI) board member who helped to develop the HSI Lab on Employee Population Health in October 2022. “There are many more opportunities for such innovation throughout health care.”

Changes, big and small

One of the first things Rusckowski changed when he took the Quest Diagnostics job was who could access the top floor of the company’s headquarters, then located in Madison, New Jersey.

“I met with my management team and asked, ‘What would you keep the same? What would you change?’” To the person, they all said, ‘You need to open up the top floor. All the doors are locked up there. We can’t get access, even as members of the CEO’s staff,’” said Rusckowski.

Sure enough, access to the top floor was heavily restricted, so Rusckowski decided to remedy the problem as quickly as possible. First, he asked his administrative assistant to temporarily open the doors with wedges until a permanent solution could be devised. Then he unlocked all the keypads.

“That spread like wildfire throughout the company,” said Rusckowski. “You don’t really understand, when you enter a job or a situation like that, that what might be viewed as a small change can actually be very symbolic. It changes the culture.”

Wildfire or not, Rusckowski is quick to add that cultural change takes decades to form and develop into something more lasting. Any organization, but especially one as big as Quest Diagnostics—an $8 billion company with around 50,000 employees in 2012—will already have an established culture, good or bad, when new management comes on board.

The former Philips Healthcare CEO knew how delicate his new role was, especially since the board wanted him to “come in and make change.” But this did not mean he could—or should—come in and reconfigure the company as he saw fit. As Rusckowski explained, he could not walk into a new environment and assume it would become his culture.

He set about building trust with his employees, the management team, and the customers who worked with Quest Diagnostics. After a first town hall meeting, at which Rusckowski said he would return in six months with a plan to revitalize the company, the new CEO and president did just that.

Dubbed “Our New Quest,” the new platform helped Rusckowski and his team talk to shareholders about what they wanted to accomplish, and gave them the chance to engage with employees and customers—to ask them what direction Quest Diagnostics should be heading in.

Looking forward

“These are the kinds of experiences that are tough to prepare for, but you will enter some strange circumstances when you’re at that stage of your career,” said Rusckowski.

Reflecting on his decade at Quest Diagnostics and his career in the health care industry, Rusckowski, a member of the MIT Sloan Americas Executive Board, said he was looking forward to celebrating the 40th anniversary of his graduation next year.

“I am very thankful for having had the opportunity, and it’s nice to be able to say I made a contribution, but it’s time for a change,” he said.