1. Best practice benchmarking project: A framework to reduce the prevalence of diabetes

    May 3, 2018 by ahmed

    DHA team receiving the trophy from DGEP’s Secretary General

    Diabetes describes a group of metabolic diseases which cause high blood sugar levels. In recent years, diabetes has become one of the leading causes of deaths worldwide. According to the World Health Organization, around 1.6 million people worldwide died due to diabetes in 2015. In 2017, an estimated 8.8 percent of the adult population worldwide had diabetes.

    Diabetes in the UAE is rising at one of the fastest rates in the world. Rapid economic growth, lifestyles and unhealthy diets have contributed to increasing the risk factors, also, an increasing population and a greater understanding of the condition have also contributed to the increase in patients diagnosed with diabetes. According to a 2017 survey, 15.2% of Dubai’s population are diabetic and 15.8% pre-diabetic (people at risk of becoming diabetic due to their high blood sugar levels) with the UAE as a whole having the 10th highest rates in the world.


    Diabetes prevalence 2017

    The Dubai Health Authority (DHA) is one of the government entities that participated in the 2nd cycle of Dubai We Learn initiative, a one year programme consisting of a range of knowledge sharing and organisational learning activities designed to fast-track organisational improvement and stimulate innovation. A key part of this initiative has been the mentoring of benchmarking projects by DGEP’s partner the Centre for Organisational Excellence Research, New Zealand. Project teams used the TRADE Best Practice Benchmarking Methodology – a rigorous 5-stage approach that involves searching for and implementing leading-edge practices.


    Stages of TRADE Benchmarking Methodology

    Terms of Reference Stage:
    The Terms of Reference (TOR) is the first stage of the TRADE Benchmarking methodology. This is where the team developed a clear aim of what they wanted to achieve, specified the resources required, and what was expected in terms of financial and non-financial benefits.
    The Dubai Health Authority’s (DHA) project aim:

    To develop & start implementing a Dubai Diabetes prevention framework based on worldwide best practices within one-year (2017); to reduce the Pre-Diabetic population, (356,460.48) adults by at least 10% by 2021.

    The target of reducing the pre-diabetic population by at least 10% by 2021 was ambitious considering the adverse trends in some of the risk factors such as obesity, unhealthy diet, smoking and lack of exercise.

    Review Stage:
    The main task of the Review stage is to study and understand the current status of the area of focus. The DHA team used several methods and techniques, such as literature review, community needs analysis questionnaire, brainstorming sessions, fishbone diagrams, and SWOT analysis. DHA recognised that it would not be able to have a significant impact on diabetes on its own and therefore needed to work closely with other stakeholders that could influence or play a role in reducing diabetes. For example, during the brainstorming sessions, DHA invited Dubai Municipality (to explore issues such as how public parks are used and the monitoring of the food offered by food outlets)) and the Dubai Sports Council (to understand how government sports clubs and initiatives can help to prevent diabetes).

    A brainstorming session with the stakeholders

    A brainstorming session with the stakeholders

    Some key findings from the Review stage:

    1. The most important factors to prevent diabetes are weight loss through healthy eating, and at least 150 minutes per week of regular physical activity. This can reduce the risk of type 2 diabetes by 58% in individuals at high risk.
    2. An important gap to be bridged is the lack of coordination between the different parties responsible for activities that lead to the prevention and control of non-communicable diseases.
    3. A screening and early detection programme for people who are most susceptible to diabetes and determine pre-diabetic cases, will allow reducing complications of diabetes as well as the burden of the disease.

    Acquire Stage:
    After setting the plan for the whole project and studying the current state, it was time to start looking for solutions or best practices to bridge the gap between the current and the desired state. The team set criteria for selecting benchmarking partners which were: organisations who have developed similar strategic initiatives that serves Dubai vision 2021, who have used public health innovations in the area of prevention, who have implemented prevention programs, who have lifestyle modification initiatives, who have achieved high success rates in terms of implementation, and who have the best health outcomes related to non-communicable diseases. DHA identified 17 potential partners which were reduced to 9 partners for site visits and internet conferencing.

    The benchmarking partners were from different fields, which enabled DHA to learn a wide variety of practices. This was besides an extensive desktop research conducted on: Health Promotion & Campaigns, Screening & Early Detection, Innovative Initiatives, Policy, Research, and Applications. In total, DHA were able to record more than 50 improvement ideas for potential implementation. For example, the best practice of Bharat Petroleum Corporation Ltd (BPCL), the winner of the 5th International Best Practice Competition Award was considered for implementation. In BPCL, all employees undergo an annual health check and receive a Wellness Index Score (WIS). The WIS of all employees are then averaged to obtain a company WIS. Initiatives such as Yoga, meditation, counselling by dieticians and health talks are provided to address the most common health challenges faced by employees. As a result, the company’s WIS has improved each year and the number of staff at risk of diabetes has dramatically reduced.

    Deploy Stage:
    In the Deploy stage, the team translated the ideas and best practices found in the Acquire stage into actions. The team developed and refined the actions through holding a number of meetings and brainstorming sessions with its stakeholders.
    By April 2018 the team was able to implement 30 improvement ideas, the three most important were:
    1- Developing a Dubai diabetes prevention framework and gaining acceptance of this within DHA and the wider stakeholder group. Previously, there was no diabetes prevention program for Dubai; there were scattered efforts, which were not systematic or collaborative

    Dubai diabetes prevention framework

    Dubai diabetes prevention framework

    For each sub-element of the Dubai diabetes prevention framework, an action plan outlines what needs to be done in co-operation with each stakeholder, it also assigns the responsibilities for each task and timeframe for implementation until 2021.

    Dubai diabetes prevention action plan

    Dubai diabetes prevention action plan

    2- Implementation of Diabetes Screening: The screening program was developed in primary health care for early detection of diabetes and the risk factors through adapting the National Periodic Assessment and Diabetes Risk Assessment tool (Finnish Diabetic Risk Assessment Score).

    3- Developing and implementing a pilot Happiness Prescription Programme. This programme was adapted from the Social Prescribing Programme from NHS (UK). The pilot phase of the Happiness Prescribing Program involved a total of 43 participants. It consisted of a comprehensive health survey, nutrition and health education and support, and various fitness classes.

    Evaluate Stage:
    The main task of the Evaluate stage is to evaluate if the project aim has been achieved and to measure the financial and non-financial benefits. Although, the main aim of the DHA project was targeted for completion in 2021, there were other objectives to be achieved within the one-year time frame of Dubai We Learn. For example, developing the Dubai diabetes prevention framework and getting all the stakeholders to approve it and be part of it within one year was a huge achievement.

    Other achievements included increasing awareness of diabetes. From 2017 till 2018, DHA held more than 460 awareness campaigns which covered more than 47,000 participants with a satisfaction rate of 98.1%. The campaigns were held in different locations such as public parks, government departments, and private sector companies. Also, to target a wider audience base, the DHA worked with the public media to conduct awareness campaigns using the social media, radio, TV, and newspapers. In total, DHA estimated they reached 560,000 people.

    Another important achievement was the successful pilot phase of the “Happiness Prescribing programme”. The 43 participants achieved good rates of weight loss ranging from 7 to 11 kg in six months. In addition to 13% risk reduction from severe to intermediate risk and 7% risk reduction from intermediate to low risk in the women’s group. For the men’s group, there was 7% risk reduction from high to moderate risk.

    DHA’s project achieves 7 stars ★ ★ ★ ★ ★ ★ ★
    Each project team of Dubai We Learn initiative gave a 15-minute presentation and submitted a benchmarking report which was assessed by an expert panel. The projects were evaluated based on the TRADE Benchmarking Certification Scheme. Three of the teams achieved 7 Stars, four teams 5-6 Stars, and four teams 3-4 Stars. These were exceptional results as even to achieve 3-4 Stars and reach TRADE Benchmarking Proficiency is challenging within a one-year timeframe. Dubai Health Authority project was evaluated as 7 Stars project, which means the project is considered as a role model in the approach and deployment of the TRADE Benchmarking methodology.

    For more detailed reports about Dubai We Learn projects, join BPIR.com and get access to best practice case studies, report, clips, and much more.

    Do you want to achieve outstanding results in your improvement projects, attend a TRADE Benchmarking workshop or email us at trade@coer.org.nz for more information about arranging an in-house workshop for your organisation. To receive the latest news sign-up to COER’s newsletter here.

  2. Another reason Health Care organizations need the Baldrige framework

    March 12, 2016 by ahmed


    Origanally posted on Blogrige by Christine Schaefer

    A panel of patient safety experts recently found that a “systems approach” is necessary to ensure patient safety in hospitals and other health care organizations. An article published late last year in the industry newsletter FierceHealthcare summarized findings of a new report from the National Patient Safety Foundation (NPSF). The December 2015 report, follow-up to the NPSF’s groundbreaking 1999 report “To Err is Human: Building a Safer Health System,” publishes findings of an expert panel on patient safety convened by NPSF early in 2015 and co-led by Dr. Donald Berwick, president emeritus and senior fellow at the Institute for Healthcare Improvement.

    The panel’s charge was reportedly to “assess the state of the patient safety field and set the stage for the next 15 years of work.” Summarizing the findings, FierceHealthcare Executive Editor Ilene MacDonald writes that the new NPSF report finds necessary “a total system approach and a culture of safety” to combat medical errors and adverse events.

    A total system approach. Surely that resonates with those of you who are already adherents of the Baldrige Excellence Framework (which includes the Health Care Criteria for Performance Excellence).

    Systems perspective is the first of 11 core values and concepts described in the Baldrige Program’s 2015–2016 Health Care Criteria for Performance Excellence. Those core values and concepts serve as the “foundation for integrating key performance and operational requirements within a results-oriented framework that creates a basis for action, feedback, and ongoing success” (page 39). The Baldrige framework’s other 11 foundational and interrelated core values and concepts are visionary leadership, patient-focused excellence, valuing people, organizational learning and agility, focus on success, managing for innovation, management by fact, societal responsibility and community health, ethics and transparency, and delivering value and results.

    The Baldrige Performance Excellence Program, author and publisher of the 2015–2016 Baldrige Excellence Framework (health care version)—as well as the next revision that will be issued early in 2017—defines systems perspective as “managing all the components of your organization as a unified whole to achieve your mission, ongoing success, and performance excellence.” According to the full definition in the booklet’s glossary, “Successfully managing overall organizational performance requires realization of your organization as a system with interdependent operations. Organization-specific synthesis, alignment, and integration make the system successful.”

    As described further in the Baldrige framework booklet, when a health care organization takes a systems perspective, its senior leaders focus on strategic directions and on patients and other customers. They monitor, respond to, and manage performance based on the organization’s results. With a systems perspective in place, a health care organization uses its measures, indicators, core competencies, and organizational knowledge to build its key strategies, link these strategies with its work systems and key processes, and align its resources to improve the organization’s overall performance and its focus on patients, other customers, and stakeholders.


    So health care organizations that have adopted the Baldrige Excellence Framework to manage their performance in and across all areas already have “a total system approach” in place. Baldrige organizations are thus in optimal position to achieve good and ever-improving patient safety results.

  3. Mosaic Life Care: Transforming Health Care to Life Care

    September 6, 2015 by ahmed

    Originally posted on Blogrige by Dawn Marie Bailey

    Since its Baldrige Award win in 2009, Mosaic Life Care (formerly called Heartland Health) has continued to be nationally recognized for quality, value, and the patient experience. In 2015, Mosaic Life Care was named to the Truven Health AnalyticsTM 100 Top Hospitals® list, given an “A” rating by The Leapfrog Group, identified as a HealthStrongTM Hospital by IVantage® Health Analytics, and named a “Most Wired” hospital by Hospitals & Health Networks magazine. Based in St. Joseph, Missouri, Mosaic Life Care remains a nonprofit, community-based integrated health system serving the residents of northwest Missouri, northeast Kansas, southeast Nebraska, and southwest Iowa—the region’s largest health system and employer. Since its Baldrige win, it has expanded its geographic reach into Kansas City north.

    But it’s the name that is a significant change for the health system, which is making a transition from providing health care to life care. In a virtual interview, I asked Martha Davis, Institute Leader at Mosaic, about the significance of the name change and how Mosaic is transforming health care. She gave me a sneak peek into her presentation for the upcoming Baldrige regional conference in Nashville about the importance of this transformation.

    How would you describe the transformation from health care to life care? Why has this been important to your success?

    We are an Accountable Care Organization and, as such, have recognized the need to move from a patient to consumer-centric approach. We’ve traditionally built service offerings around the acute and chronic health care needs of patients, but we haven’t always done a good job of engaging consumers to prevent or slow the effects of lifestyle, stress, aging, and other factors that impact one’s long-term health. Consumers are shouldering higher insurance plan deductibles and expect more cost transparency and better care experiences. We are also seeing great opportunities to partner with employers to help them lower cost through improved employee health support. Our life-care model is holistic and focused on health, wellness, and wellbeing.

    What are your top tips (e.g., 3 to 5 suggested practices) for using Baldrige to support such a transformation?

    We have built solid disciplines around planning and deployment of the Baldrige Excellence Framework, which has been invaluable as we’ve expanded into new geographic areas with very different competitive factors. Some of what we’ve learned follows:

    • While our strategic priorities have remained the same, we’ve established reasonable but stretch measures given the startup of new offerings and services in our expanded geographic service areas. The linkage between measurement and results is critical during times of transformation and innovation—we have to be discerning about what services resonate with our consumers and which ones don’t, regardless of how great of an idea we think an offering is! Maintaining process focus is also essential to this work—not only to improve efficiency and lower cost, but also to improve the provider and consumer experience.
    • In our customer focus, we are moving beyond patient satisfaction surveys to gain new insights into what our customers value. During the September session, we will talk about what we’ve learned about customer sacrifice by studying out-of-industry exemplars and adapting those learnings to our strategies. These new insights are helping us to develop life care offerings that engage and activate consumers in their own health and well-being.
    • We’ve relied heavily on the People Framework we developed as a result of our workforce focus—especially in our new markets and expanded offerings. It is imperative that we hire and onboard the right people, provide the right learning and development opportunities, and provide the right feedback and recognition—whether it is with our leaders, providers, or workforce members. We constantly battle change fatigue and continually look at ways to positively engage our providers and workforce members.

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

    Two key reasons: first, there is enormous disruption in our industry—huge pressure to lower costs and improve the patient experience. With reduced reimbursement, organizations can’t waste precious resources on non-value-added work. The Baldrige framework is an excellent way to prepare for this disruption and upheaval. Second, a population health focus requires great change in the workforce composition: acute care services must leverage technology and tightly control labor costs; clinics need to do the same and be proactive at keeping patients healthy and out of higher-cost venues; and we need to offer scalable, virtual, and other forms of services to consumers who are mostly healthy. This requires that we rethink the skill sets we will need in the future and how we will attract, prepare, and retain the best workforce members. We like to think of the framework as a huge accelerating factor!

  4. A Comprehensive Excellence Framework for Post-Acute and Long-Term Care

    July 17, 2015 by ahmed


    Originally posted on Blogrige by Christine Schaefer

    Following is an interview with Baldrige alumnus examiner Christopher E. Laxton, executive director of AMDA–The Society for Post-Acute and Long-Term Care Medicine (formerly the American Medical Directors Association). Laxton compares the Baldrige Excellence Framework (which includes the Health Care Criteria for Performance Excellence) to two other approaches used in his sector today to improve the performance of post-acute and long-term care organizations: Quality Assurance and Performance Improvement (QAPI) and Advancing Excellence in America’s Nursing Homes Campaign (AE).

    Christopher Laxton, CAE

    Christopher Laxton, CAE

    Tell us about recent developments in your industry and how those impact the focus on improving the performance of care-providing organizations.

    I work in post-acute and long-term care. This sub-sector of the health care field has gained a great deal of visibility and importance lately as many Baby Boomers move into retirement—by some estimates (Pew, AARP) at the rate of some 10,000 a day for the next 18 years.

    It is not surprising, therefore, that those who work in this sector and its federal and state regulators are looking for ways to improve the performance of post-acute and long-term care (PA/LTC) provider organizations.

    The Baldrige Excellence Framework is a helpful guide for organizations that are pursuing performance improvement. At the same time, there are other performance-improvement approaches in use across the multiple sectors of the U.S. economy. For PA/LTC organizations, two programs that have become more prominent because of their systems approach (like that of the Baldrige framework) to performance improvement are (1) AE, which comes from the provider side of this industry; and QAPI, which comes from the main federal payer and regulatory agency: the Centers for Medicare and Medicare Services (CMS).

    Would you please explain first how QAPI is similar to the Baldrige framework and approach?

    Yes. I think it is useful to look at how the QAPI and AE programs align to the Baldrige framework, both to understand their many points of connection to Baldrige Criteria categories, as well as to discern what may not be explicit in them.

    The CMS’s QAPI program was introduced in 2013 for nursing homes to voluntarily adopt a systems approach to improvement (http://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/QAPI/nhqapi.html). The program describes QAPI as “the merger of two complementary approaches to quality management, Quality Assurance (QA) and Performance Improvement (PI). QA and PI combine to form QAPI, a comprehensive approach to ensuring high quality care.”

    QAPI is defined as having five elements (see Figure 1): Design and Scope; Governance and Leadership; Feedback, Data Systems and Monitoring; Performance Improvement Projects; and Systematic Analysis and Systemic Action. These will be familiar to those organizations using the Baldrige approach to improve, since they align relatively well with 2015–2016 Baldrige Criteria categories: QAPI’s “Design and Scope” element relates to Baldrige Criteria category 2, “Strategy”; QAPI’s “Governance and Leadership” relates to Baldrige Criteria category 1, “ Leadership”; QAPI’s “Feedback, Data Systems and Monitoring” relates to Baldrige Criteria category 4, “Measurement, Analysis, and Knowledge Management”; and QAPI’s “Systematic Analysis and Systemic Action, and Performance Improvement Projects” relates to Baldrige Criteria category 6, “Operations.”


    The five QAPI elements have open, non-prescriptive definitions and guidance for applying them. This is comparable to the Baldrige framework’s approach of asking questions rather than dictating particular solutions, based on the understanding that there is no “one-size-fits-all” solution to organizational excellence. This is especially true in the PA/LTC sector, where—despite years of organizational improvement efforts and extensive regulatory oversight—there is wide variability in provider size, scope, capacity, and quality.

    Next, would you please tell us about the AE program and how it compares to the Baldrige framework?

    Of course. Advancing Excellence (AE) was founded in 2006 by a coalition of 28 organizations that included nursing home providers, quality improvement experts, and government agencies (https://www.nhqualitycampaign.org/). The Campaign now includes more than 62 percent of the nation’s nursing homes and has a local presence in every state and the District of Columbia through a network of participants called Local Area Networks for Excellence (LANEs).

    AE has identified nine quality goals (see Figure 2) that describe areas of key importance to good nursing home care that are often challenging for providers. Those areas are where it is likely that nursing homes will find opportunities for improvement, to use a Baldrige term. The AE goals are organized into two groups that will sound very familiar to Baldrige framework users: four organizational goals, which are process-focused; and five clinical outcome goals, which are results-focused.

    The nine AE goals align the Baldrige Criteria in the following ways: AE’s Consistent Assignment goal is a Baldrige Criteria category 5 (“Workforce”) goal, as is AE’s Staff Stability goal. AE’s Hospitalizations goal aligns with Baldrige Criteria category 6 (“Operations”), since it principally relates to item 6.1 (on work processes). AE’s Person-Centered Care goal is clearly a Baldrige Criteria category 3 (“Customers”) goal. And AE’s five Clinical Outcomes goals (Infections, Medications, Mobility, Pain, and Pressure Ulcers) are all Baldrige Criteria category 7 (“Results”) goals, though they each have process elements that are relevant to Baldrige Criteria categories 4 and 6.


    The AE program also identifies a seven-step process that organizations can adopt to systematically address each goal in their organization (see Figure 3). These seven steps have some alignment with the Baldrige process-evaluation factors (approach, deployment, learning, integration [ADLI]) and, to a lesser extent, the Baldrige results evaluation factors (levels, trends, comparisons, integration [LeTCI]).


    With all these similarities, do you see these approaches as competing or complementary with each other?

    While the CMS QAPI program may resonate with those familiar with the Baldrige framework, I believe it would be a mistake to “choose” one over the other. One reason is that the Baldrige framework is very inclusive—accommodating all varieties of performance improvement tools, such as Plan-Do-Study-Act, Lean, Six Sigma, and so forth. Furthermore, when you line up both the QAPI and AE programs against the Baldrige Criteria (see crosswalk of 2013-2014 Baldrige Criteria to QAPI and AE), a comprehensive performance excellence framework for the PA/LTC sector is revealed. It is well aligned with the Baldrige Criteria categories, and it is specifically focused on the highly complex and challenging organizational and customer/patient/resident environment found in this sector’s care settings.

    These are not simply academic considerations for how quality might be improved in this important and previously neglected sector of U.S. health care. The demographic shift to an older population in this country and around the world—sometimes referred to as the “Silver Tsunami”—is producing major changes in public policy and rapid and massive shifts in market forces that will have a direct impact on the care and support available to our nation’s elders.

    What do you believe needs to happen in relation to the Baldrige, QAPI, and AE improvement tools to address the current and coming challenge of caring for more senior citizens?

    It is a basic principle of organizational excellence that systems produce exactly the results that they are designed to produce—intentional and unintentional. Having worked in the long-term care field for 30 years and having served as a Baldrige examiner for seven, I am inspired by the existence of such powerful frameworks for improvement.

    Now our long-term care leaders must take up these tools and apply them. Who better to do so than those who know intimately the complexity and challenges facing this sector? If they do not, others—with less commitment and connection to preserving and enhancing the health and well-being of our seniors—are sure to impose changes on us that will be neither of our design nor of our choosing.

  5. Fanfare for Baldrige in Health Care

    June 17, 2015 by ahmed


    Originally posted on Blogrige by Dawn Bailey

    In January 2015, the 2015–2016 Baldrige Excellence Framework (Health Care)—which contains the Health Care Criteria for Performance Excellence, core values and concepts, and scoring guidelines—will be released. The Baldrige Program is grateful that there has already been much written about the value of using this Criteria for improvement.

    “Baldrige hospitals are . . . more likely to be cited for marked performance improvement over a five-year span,” writes Deborah Bowen, president and CEO of the American College of Healthcare Executives and Baldrige Fellow. In “Using Baldrige Criteria as a Tool for Hospitals’ Performance Improvement,” Bowen writes that thousands of hospitals, clinics, and health care systems have turned to the Health Care Criteria “with its established framework for improvement and innovation that builds on core values and concepts, including: patient-focused excellence; organizational and personal learning; agility; and focus on results and creating value. . . . It is clear the Baldrige framework can be useful in enhancing systemic performance and achieving better results. . . . A key component is the importance of sharing best practices and learning from those who have achieved systematic results.”

    Bowen adds, “Boards also can encourage their organizations to learn from others and adopt performance improvement processes using such resources as the Baldrige Health Care Criteria for Performance Excellence, because there is still much work to be done to improve the outcomes of health care for patients, families, and our communities.”

    In “What About Lousy Hospitals?,” John Griffith, professor emeritus, Department of Health Management and Policy, School of Public Health, The University of Michigan, writes, “Hospitals seeking excellence are pursuing various paths, but the best documented and most comprehensive is the ‘Baldrige journey.’ . . . Baldrige recipients and Magnet hospitals claim that they are ‘great places to get care’ because they are ‘great places to give care.’ Both document low workforce turnover and vacancy rates. . . . Hospitals such as AtlantiCare in Atlantic City, Henry Ford in Detroit, Sharp in San Diego, and North Mississippi in Tupelo all work in challenging economic environments. They are all Baldrige winners. Maybe the ‘lousy’ hospitals should study the public responses and start the Baldrige journey? It takes as little as three years to move from lousy to respectable or better.”

    In “Correlation Between Baldrige Award Recipients and 100 Top Hospitals Winners,” Truven Health’s Jean Chenoweth, senior vice president, Performance Improvement and 100 Top Hospitals, writes, “Once again, the selection of St. David’s HealthCare and Hill Country Memorial as 2014 Malcolm Baldrige Award winners and performance on the 100 Top Hospitals® National Balanced Scorecard overlap . . . a significant statistical association between use of Baldrige best management practices and highly balanced performance excellence. . . . This is all very good news for measurement of the impact of leadership in hard data.”

    As for any organization, its best testimonials come from its customers. Thankfully, the two 2014 Baldrige Award winners in health care have embraced the Baldrige spirit of improvement and sharing. In “Baldrige Awards are Just the Icing on the Cake for 2014 Winners,” both Hill Country Memorial and St. David’s HealthCare write that participating in the Baldrige Award process brought them improvement:

    “We never got on this journey to win—though that’s amazing and we’re super-excited—it was to improve,” says Debbye Dooley, executive director of business intelligence for Hill Country Memorial.

    C. David Huffstutler, president and CEO for St. David’s HealthCare, adds, “Obviously, our organization, our employees, our physicians are delighted. It’s something we’ve been working toward for a long time. . . . Though we have said from the beginning, while it would be nice to win the award, it really has been about the Baldrige process, and using it as a performance improvement tool.”