1. Make the Baldrige Framework “How You Work”: Lessons from Adventist Health Castle

    February 21, 2020 by BPIR.com Limited

    Originally posted on Blogrige by Christine Schaefer

    When Steve Bovey first learned about the Baldrige Excellence Framework, he was impressed that it was not “another flavor of the month” among management fads. In contrast, he said he saw that it is “a systematic framework that can apply to any type of business, which can use whatever flavor (performance improvement system) it has already chosen.”

    “The Baldrige framework doesn’t need to replace what you have,” he added. “It makes what you have more effective.”

    In the case of Adventist Health Castle (AHC)—the 2017 Baldrige Award recipient in Hawaii where Bovey serves as quality improvement coordinator—he summed up the benefits this way: “The Baldrige framework has helped us look at our organization from the 30,000-foot view to enhance alignment and integration.”

    “The [Baldrige] Criteria have helped us identify our blind spots and become more systematic in our methodology through the use of ADLI. When we became more systematic about our real work, we achieved the results that we needed.”

    How AHC Makes Baldrige “How We Work”
    With a focus on how his health care system uses the Baldrige framework to continue to support excellent performance today, Bovey looks forward to leading a session at the Baldrige Program’s upcoming Quest for Excellence® Conference. “Our time is too valuable to be doing extra work, so we have made a conscious effort to make Baldrige ‘how we work,’” said Bovey recently. “During [our Quest] session, we will describe methods we have used to make this goal a reality.”

    Asked for an example of how AHC has benefited from integrating the Baldrige framework, Bovey responded, “By merging category teams with existing teams and committees, we have reduced the number of meetings and increased the effectiveness of our teams.”

    He further described how AHC teams of employees use the Baldrige process evaluation factors of Approach, Deployment, Learning, Integration (ADLI) to think about the performance of their work processes. The teams now do an annual update of responses to Baldrige Criteria questions in the category related to their function in the organization, and they use an ADLI table format to capture information in those four dimensions of process evaluation, Bovey said.

    “Our team members also have received training to become internal Baldrige examiners to evaluate organizational performance both in their category and in one other team’s category. The result of this annual examination is a prioritized list of improvement opportunities for their team in the coming year,” he added.

    Tips to Introduce Your Organization to the Baldrige Framework
    Based on AHC’s experience, Bovey shared the following tips for those in other organizations who are interested in introducing or sustaining their use of the Baldrige framework:

    1. Align Baldrige categories with the real work of organizational teams/committees.
    2. Engage team leaders and team members in an annual Baldrige application update [updating responses to Baldrige Criteria questions], but with a focus on updating bullet points in an ADLI table rather than “wordsmithing” paragraphs in a document.
    3. Train team members to be examiners and apply that training to evaluate their own work and the work of another (category) team.
    4. Use this evaluation to identify strengths and prioritize opportunities for improvement for the coming year.
    5. Develop 90-day action plans in each team.
    6. Schedule quarterly meetings for team leaders to provide updates to their 90-day action plans and to identify opportunities for integration.

    Finally, Bovey shared with me what he’d say about the Baldrige framework if he wanted to give a quick summary of the benefits to a group of senior leaders who knew little or nothing about it:

    “If you are tired of putting out fires—and of the left hand not knowing what the right hand is doing—then you may want to consider using the Baldrige framework. It’s not so much about an award as it is about helping you get the results that you need.”

  2. Leadership Practices of Memorial Hospital and Health Care Center

    May 15, 2019 by BPIR.com Limited

    Article originally posted on Blogrige by Dawn Bailey

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    Five-Part Leadership Blog Series
    In this five-part blog series on the 2018 Baldrige Award recipients’ leadership presentations at the 31st Annual Quest for Excellence® Conference (April 7–10, 2019), senior leaders of the five newest national role models share best practices and stories of how they achieved excellence.

    Addressing the Critical Care Shortage

    To relieve the critical shortage of beds in its rural Indiana area, Memorial Hospital opened its doors in 1951 for patients across eight counties. The Little Company of Mary Sisters set the direction in how the hospital cares for patients and each other, following the mission: “Christ’s healing mission of compassion empowers us to be for others through quality and excellence.”
     
    Now recognized nationally as a top regional hospital, Memorial Hospital and Health Care Center offers 137 patient beds and employs more than 1,700 staff members, with 100 physicians as active medical staff. Memorial also has 32 medical offices strategically located in its service area, annually providing care to 6,500 inpatients; 260,000 outpatients; 3,000 emergency patients; and 1,000 newborns.

    Developing Relationships
    According to Kyle Bennett, president and CEO, two constants have helped the hospital reach role-model status: the commitment and support of the Little Company of Mary Sisters and community support.

    “In order to bring care closer to where we are, we develop relationships,” said Bennett, speaking proudly of Memorial’s many collaborations, including opening a clinic in an Amish community, developing a tele-stroke inpatient program in collaboration with the University of Louisville, and partnering with the Indiana University School of Medicine to develop a family medicine residency program to open in summer 2019.

    Because of this program, “the access to primary care [will change] for many years into the future for our service area,” he said.

    Adopting Baldrige to “Be the Provider that We Needed to Be”
    “Employers and the business community look to us to be a strong health care provider, and we knew seven years ago that we needed to make some improvements in order to sustain and be the care provider that we needed to be for the communities we serve,” said Bennett.

    In looking for ways to sustain and inspire improvements, he said the hospital realized that the Baldrige framework aligned with its mission.

    “The benefits that we’ve realized have helped us define what excellence is to us for the communities we serve,” he said. “[The framework has] helped us create discipline around our processes, improved our financial performance, and improved our focus on key quality metrics.”

    Bennett said adopting the framework came with some struggles. “When we began, trying to apply the Baldrige framework was for me nothing short of awkward. It felt like something else that we had to do. I could answer the ‘what’ questions [in the Baldrige Criteria], but I really couldn’t answer ‘how’ questions. We hadn’t really defined our processes.”

    “Thankfully, today the framework is how we do our work,” Bennett added.

    Modeling “Attributes of a Servant’s Heart”
    “We knew that to make any sustainable, meaningful change, there had to be deliberate change among senior leaders,” said Bennett, so the hospital developed a Servant Leadership System, with an emphasis on building its culture.

    Bennett said senior leaders knew that they needed to model the attributes of a servant’s heart (words around the circle in the graphic): selflessness, forgiveness, honesty, commitment, patience, kindness, humility, and respect.

    According to Bennett, the blue circles on the graphic are leadership goals (e.g., set organization direction/determine priorities, engage the workforce, monitor performance), and the triangle at the heart of the model, which lists the mission, vision, core values, covenants, and core competencies, represents the building blocks of culture.

    Identifying the Keys to Success
    According to Bennett, Memorial Hospital knows that the keys to its success are related to its focus on the mission, a committed workforce, and disciple around the strategic planning process.

    “Those things have been integral to us over our journey,” said Bennett. “We work to live our mission every day. It’s the foundation of all we do. And we consistently return to it as we seek discernment and perspective.”

    Similarly, workforce members are “empowered to be and to act,” said Bennett, adding that a no-pass zone at the hospital requires that all patients and their families, as well as all workforce members, are greeted at the front door.

    “Our workforce is key to building and sustaining our culture,” he said.

    Achieving Results
    Memorial Hospital’s results have helped propel it to national role-model status. Results include the following: 

    • Centers for Medicare and Medicaid Services (CMS) 5-star rating for overall quality of inpatient care since the ratings were released
    • National top-10%, net-positive, value-based-payment performance since 2017
    • Performance excellence outcomes: zero early elective deliveries before 39 weeks (since 2015), zero pressure ulcers in the Skilled Caring Center (since 2016), zero central line-associated bloodstream infections (CLABSI; since 2016), and zero hospital methicillin-resistant staphylococcus aureus (MRSA) infections (since 2015)
    • “A” Leapfrog Hospital Safety Grade since 2016
    • CMS top-10% performance in patient safety composite results since 2017
    • Registered nurse turnover rate below 2% since the first quarter of 2016

    “Thirty-seven,” added Bennett, “That’s how many [opportunities for improvement] we had in our feedback report [received with its Baldrige Award application]. . . . We realize that we’re the recipient of this wonderful award. Our patients are the recipients of the care we provide. . . . The quality that we provide can get better, and those 37 things will help us get there.”

    View more processes and results of Memorial Hospital and Health Care Center.


  3. A war room of strategic breakthroughs and other tools

    April 7, 2018 by BPIR.com Limited

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    Originally posted on Blogrige by Dawn Bailey

    When an organization ponders a journey to performance excellence, it may wonder where to begin, what to measure, and what to expect, including what short-term successes are achievable. Such pondering could be made much simpler with a field guide.
    Jayne Pope, chief executive officer, and Emily Padula, chief strategy officer, for 2014 Baldrige Award recipient Hill Country Memorial (HCM), will share their strategy at a session titled “A Field Guide to HCM’s Remarkable Strategic Breakthroughs” at the Baldrige Program’s annual Quest for Excellence® Conference in April.

    In a recent virtual exchange (captured below), Pope and Padula collaborated on answering questions, ranging from their upcoming presentation to their funniest Baldrige moment.

    What will Quest for Excellence attendees learn at your conference session?
    Participants will learn how HCM develops its strategic goals and fully deploys them throughout the organization, with specific tools and measurable outcomes. The presentation is a field guide to achieving your next strategic breakthrough.

    How has your organization benefited from its journey to excellence?
    The Strategic Breakthrough Initiative (SBI) is one of the processes that HCM has embraced along its Baldrige journey. It has given us the focus we needed to accomplish hundreds of strategic action items. We started SBIs in 2011 and saw huge improvements within two years. We are now reaching twice as many of our strategic goals.

    As a Baldrige Award recipient, HCM started a Sharing Days program for organizations on performance excellence journeys. Over time, we have shared some of our helpful practices with hundreds of people. Our SBI process and war room format became a popular takeaway. We have since had many attendees send us back pictures of their “war rooms” and tell us how helpful the SBI process has been for them. The process has worked for all kinds of organizations, including a luxury car company, schools, banks, universities, and other hospitals.

    What are your top tips for introducing or sustaining use of the Baldrige framework to promote an organization’s success?
    At HCM, we regularly measure internally and assess our performance on all the typical items you would find in Baldrige Criteria category 7 (results). We measure externally through annual Baldrige coaching assessments, which help us identify our strengths and our performance excellence gaps.

    We learned so much from completing the Baldrige application for so many years. It was the best education process for us. We continue to complete some version of the application every year, even though we are not eligible to apply again for a few years.

    What do you view as key reasons or ways that health care organizations benefit from using the Baldrige framework?
    In health care, we owe it to our patients and community to be the best that we can be. The Baldrige framework sets the highest bar. It helps us to figure out how to be best in every aspect of our business, from workforce engagement to patient safety. We compare ourselves to the very best, and we learn from them while being challenged to become better.

    What is your “elevator pitch” about the Baldrige framework and/or assessment approach? In other words, what would you say to a group of senior leaders who are unfamiliar with the Baldrige framework if you had 1-2 minutes to tell them something about it?
    We would say that Baldrige is a proven means of making your organization great for the people it serves and those who work for you. The framework supports long-term sustainability and leads to innovation—which is especially needed right now in the health care world, as well as in many other industries.

    Do you have any funny stories or anecdotes that you’re willing to share about your experience with Baldrige?
    The funniest story happened at our Sharing Days. Two reluctant employees were sent by their boss to learn about the hospital’s Baldrige experience. By the end of the program, the women were really engaged and excited to share their Baldrige knowledge with their boss. A few days later, we received a photo of them wearing red t-shirts that said—We drank the Baldrige Kool-Aid!


  4. Being remarkable from the boardroom to the bedside

    March 31, 2017 by BPIR.com Limited

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    Originally posted on Blogrige by Dawn Marie Bailey

    “Remarkable” means extraordinary, uncommon, worthy of notice or attention, unusual.

    Would you use that word to describe your place of work? How about your hospital? Now imagine how much more confidence you would have in your health care provider if it had proven itself to be extraordinary or remarkable.

    Baldrige Award recipient Hill Country Memorial continues to work toward being remarkable every day, with continuous improvements in the care it provides and in all areas of its operations.

    At the upcoming 29th Annual Quest for Excellence® Conference, Dr. James R. Partin, chief medical officer at Hill Country Memorial, will be presenting on the hospital’s “journey from good to remarkable” and on how other organizations might learn to make their operations remarkable, too.

    In a virtual interview, Partin shared with me Hill Country Memorial’s journey.

    What makes Hill Country’s journey remarkable?

    I think what makes Hill Country’s journey remarkable is the focus on improvement at all levels of the organization; from the boardroom to the bedside, each individual is committed to providing the highest quality of care and service to our patients and community. Another key has been our ability to integrate Baldrige into our day-to-day operations. We don’t “do Baldrige,” but rather we look at our processes and determine how we can revise/improve them to meet the Baldrige Criteria [found within the Baldrige Excellence Framework] and improve performance.

    Can you share an example of your success along the journey?

    One of our biggest successes along the journey was in the deployment of our strategic plan. We integrated this deployment into our cascade of strategic goals through department goals to support the strategic targets and individual employee quarterly coaching plans; these plans address how each employee implements action plans to help his/her department achieve departmental goals that roll back up to achievement of strategic goals.

    Another success is our implementation of the Strategic Breakthrough Improvement (SBI) Process. This process includes 90-day, interdisciplinary, organizational-level improvement teams that work on strategic action plans. Through the SBI and cascading goal processes, we have improved achievement of strategic targets from approximately 50% annually to 85% annually.

    What are your top tips for using Baldrige resources to support such a journey?

    • Don’t make Baldrige another thing you are doing. Rather, look at your processes and determine how you can improve them to address the Baldrige Criteria.
    • Share results with all stakeholders. Let people know how the work they are doing is helping the organization achieve its goals.
    • Involve physicians in improving key processes within the organization.

    What else might participants learn at your conference session?

    The most striking example of how Hill Country Memorial has continued to use the Baldrige Excellence Framework is in the Strategic Development Deployment Process. We continue to use the process and timeline to define our strategy annually for managing our strengths and improving our weaknesses to meet the changing health care environment, increasing competition, and the ever-changing payment models.

    What are a few key reasons that organizations in your sector can benefit from using the Baldrige Excellence Framework?

    The Baldrige framework

    • provides an organizational approach to improvement that is balanced;
    • helps an organization focus on key results and the processes that support those results, really honing in on important improvement opportunities; and
    • uncovers gaps/opportunities that staff may not know existed in the organization.

  5. When kindness and compassion are part of a disruption

    October 31, 2016 by BPIR.com Limited

     

    Originally posted on blogrige by Dawn Marie Bailey

    If you are dissatisfied with your health care, can you get some money back? And if a health care organization was giving a money-back guarantee, how would you feel about its willingness to stand behind its services?

    The article “It Pays to be Kind at Geisinger” describes an interesting new model at Geisinger Health System in Danville, Pa., for which Baldrige Award recipient AtlantiCare is now part. Since August 2016, Geisinger has paid more than $400,000 in refunds to patients “whose experiences and expectations were not met with kindness and compassion.” Under the ProvenExperience initiative, patients can request refunds, from as little as $1 to more than $2,000, if they are dissatisfied with their hospital experience.

    “The effort is to do it right for every patient every time,” said System President and CEO Dr. David Feinberg in the article. “Just like any legitimate or ethically sound business, you back your product. Except I think the stakes are higher. You want to reduce human suffering and promote good health. That’s a pretty important product.”

    According to the article, he added, “The way I see it, if you go into Starbucks and you’re not happy with your order, they don’t sip your latte and argue that they made it correctly. They just take care of you on the spot. . . . What matters to me is that every patient is satisfied with their treatment and so I started thinking, ‘What is our guarantee? What is our refund?’”

    This initiative is a disruptive event for the organization. As Feinberg says in the article, “We need to be disruptive to move the practice of providing a great patient experience forward and so the decision was made to give unsatisfied patients their money back.”

    The Baldrige core value Organizational Learning and Agility supports disruptive events that can be triggered by innovative technologies or service introductions, economic upheaval or stress, major weather events, or social or societal demands.

    Such an initiative may not be right for your organization, but have you thought about what disruption might change things in a beneficial direction for you?

    For this health care organization, I see the ProvenExperience approach being supported in item 3.1 Voice of the Customer within the Baldrige Excellence Framework (Health Care), which includes the Baldrige Health Care Criteria for Performance Excellence. This item is all about determining patient and other customer satisfaction and engagement, including (1) how listening methods differ among types of patients and other groups and (2) how measurements capture actionable information that can be used for securing patients’ engagement in the long-term. From the article, we don’t have information on what feedback the organization received from its patients and other customers to lead to the approach, deployment, learning, or integration of the ProvenExperience process, but we can deduce that it might certainly be part of a step toward securing patients’ engagement in the long-term.

    An organization embarking on an approach to secure patient and customer loyalty and engagement might also check out Criteria item 1.1 Senior Leadership that considers the importance of creating a workforce culture that delivers a consistently positive experience for patients and other customers and that fosters customer engagement. Such a culture would be absolutely necessary to ensure that every patient or customer experience is met with kindness and compassion.

    In addition, the Baldrige core value Patient-Focused Excellence and Organizational Learning and Agility supports such an approach and provides guidance on what an organization may need to consider to be successful:

    Your patients and other customers are the ultimate judges of your performance and the quality of your health care services. Thus, your organization must consider all features and characteristics of patient care delivery . . . and all modes of customer access and support that contribute value to your patients and other customers. Such behavior leads to patient and other customer acquisition, satisfaction, preference, and loyalty; positive referrals; and, ultimately, the ongoing success of your business. . . . An additional factor is your organization’s management of patient and other customer relationships, which helps build trust, confidence, and loyalty.

    So what disruption might spur your organization or your industry to consider a new way to secure customers’ long-term engagement and loyalty?