1. Baldrige Impact in Health Care

    December 5, 2020 by BPIR.com Limited

    Originally posted on Baldrige Foundation

    In 1998, Congress expanded the scope of the Malcolm Baldrige National Quality Award by authorizing the health care and education sectors. The Baldrige Performance Excellence Program then adapted the Criteria for Performance Excellence (now called the Baldrige Excellence Framework), developing a health care-specific version of the Framework. Through 2017, a total of 24 health care organizations have received the National Quality Award. Hundreds more have been recognized for their role model performance in their respective state-based programs and nationwide through a number of Baldrige-based health care quality award programs.

    “The Charleston Area Medical Center Health System is a better organization today because we made the choice to use the Baldrige Criteria as a guiding framework for quality improvement. Baldrige helps us to achieve our mission of ‘striving to provide the best health care to every patient every day.” – Dr. Glenn Crotty, Jr., Executive Vice President and COO, Charleston Area Medical Center

    Baldrige is adaptable and applicable in many different settings, including across the health care spectrum. Each hospital and hospital system has its own unique set of needs and goals, determined in part by location, demographics, and a variety of other factors. Whether an organization is involved in ambulatory service, health maintenance, long-term care, or another health care service, the Baldrige Excellence Framework is a valuable tool for measuring performance and leading organizations of all sizes and levels of complexity in an uncertain environment.

    The Baldrige Framework is such a powerful tool for leading health care organizations that the President’s Council of Advisors on Science and Technology recommended that the Department of Commerce and the Department of Health and Human Services build on the Baldrige Award to help bring down the cost and improve the quality of health care across the United States.

    “I retired at the end of 2009, after 25 years as CEO of Heartland Health, with the knowledge and belief that any organization that adopts and implements fully the Baldrige Framework as its management model will ultimately rise to levels of performance excellence exceeding all their expectations.” – Lowell Kruse, Former CEO, Heartland Health

    We now have more than 15 years of experience with Baldrige in the health care sector, and there is overwhelming evidence that Baldrige makes a significant, positive impact on the provision of quality health care.

    The improvements reported by the individual award-winning organizations are impressive, spanning patient morbidity and mortality outcomes to cost and process efficiencies to medical and support staff and patient and family satisfaction. Some of the life-saving improvements in clinical outcomes include:

    • Advocate Good Samaritan Hospital’s risk-adjusted mortality decreased from 0.73 in 2004 to 0.25 in 2010.
    • Memorial Hermann Sugar Land ranks among the top 10 percent of hospitals nationally for its performance on measures of emergency center arrival-to-discharge time, compliance with regulations to reduce medication errors, bed turnaround times, radiology and laboratory result turnaround times, and the use of computerized physician order entry. The hospital’s readmission rates for patients treated for acute myocardial infarction, congestive heart failure, and pneumonia were lower than those of hospitals nationwide, according to data from the Centers for Medicare and Medicaid Services.
    • According to the Institute for Healthcare Improvement, Henry Ford Health System’s evidence-based global harm campaign is a national best practice. From 2008 through 2011, the campaign led to a 31 percent reduction in harm events.
    • Schneck Medical Center has maintained rates of hospital-acquired infections at or below 1 percent since 2008, and no patient has acquired ventilator-associated pneumonia since 2009.
    • Atlanticare Regional Medical Center achieved Centers for Medicare and Medicaid Services top 10 percent performance in 2008 for patient care measures related to congestive heart failure, acute myocardial infarction, and pneumonia.

    More than the year-over-year performance improvement of health care organizations as they pursue their Baldrige journey, broader studies comparing Baldrige-based health care organizations with peer organizations that have not adopted the Baldrige Framework, show that Baldrige organizations significantly outperform their non-Baldrige peers.

    “The health care industry has increasingly relied on the Baldrige Criteria as a key means to improve patient care and organizational performance. As we navigate health care’s changing landscape, the Baldrige Framework will continue to be a vital resource.” – Deborah J. Bowen, President and CEO, American College of Healthcare Executives

    According to Thomson Reuters, hospitals using the Baldrige criteria were 6 times more likely to be in the top 100 hospitals and outperformed non-Baldrige hospitals in:

    • Risk-adjusted mortality index
    • Risk-adjusted complications index
    • Patient safety index
    • CMS core measures score
    • Severity-adjusted average length of stay
    • Adjusted operating profit margin

    A study by Ronald Schulingkamp and John Latham compared Baldrige Award winning hospitals with non-Baldrige hospitals across 39 Process of Care, Patient Satisfaction, and Outcomes of Care metrics, and concluded that, “Although not all measures were statistically significant, Baldrige Award recipient hospitals had higher mean values representing higher performance than non-Baldrige Award recipient hospitals in 37 of the 39 (95 percent) study measures.

    Substantial data from case studies and comparative analyses shows that health care organizations improve their performance by adopting the Baldrige Excellence Framework for Health Care, and that they become significantly better performers than peer organizations that have not adopted Baldrige. The data proves that #BaldrigeSavesLives.


  2. 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.”

  3. Leadership Practices of Memorial Hospital and Health Care Center

    May 15, 2019 by BPIR.com Limited

    Article originally posted on Blogrige by Dawn Bailey

    mhhcc01

    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.


  4. A war room of strategic breakthroughs and other tools

    April 7, 2018 by BPIR.com Limited

    hill-country-blog-photo

    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!


  5. Being remarkable from the boardroom to the bedside

    March 31, 2017 by BPIR.com Limited

    HILL-COUNTRY

    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.