Lessons from the Baldrige Winners in Health Care

Here’s how three health care organizations won the top US quality award.
If you’re obsessed with organizational quality, the Malcolm Baldrige National Quality Award is as good as it gets.
Each year the US Commerce Department gives the award to only a handful of organizations. Each organization is judged in an exhaustive process that studies performance in seven categories: leadership; strategic planning; customer and market focus; measurement, analysis and knowledge management; human resource focus; process management; and business results.
Health care organizations became eligible for the Baldrige in 1999. The first winner, SSM Health Care (St. Louis, Missouri, USA), was announced in 2002. Now, in 2003, two other organizations have joined this exclusive club — Baptist Hospital, Inc. (Pensacola, Florida, USA) and Saint Luke’s Hospital of Kansas City (Kansas City, Missouri, USA). SSM Health Care implements clinical collaboratives based on the IHI Breakthrough Series Collaborative model, and Baptist Hospital is a member of IHI’s IMPACT network.
Here are quick snapshots of the three Baldrige health care winners, highlighting a few of their achievements and processes.
Baptist Hospital, Inc.
Baptist Hospital, Inc. (BHI) includes two hospitals — Baptist Hospital, a 492-bed tertiary care and referral hospital, and Gulf Breeze Hospital, a 60-bed medical and surgical hospital — and an ambulatory care complex, Baptist Medical Park. The organization employs 2,252 people.
The organization shows extremely high overall patient satisfaction marks, as measured in Press Ganey Associates surveys:
  • Inpatient satisfaction has been near the 99th percentile since 1998.
  • Outpatient satisfaction has been near the 99th percentile for Baptist Hospital since 1999 and for Baptist Medical Park since 2001.
  • Ambulatory surgery satisfaction has been above the 95th percentile since 1997 for Baptist Hospital and near the 99th percentile for Gulf Breeze Hospital since 2000.
  • Home health care has been near the 99th percentile since 1999.
Other achievements are shown by BHI’s CARE (Clinical Accountability Report of Excellence) tool, which uses an index scoring method to capture more than 50 results. One CARE indicator is the hospital-wide medication event rate: only 1.5 events occurred per 10,000 doses in fiscal year 2000 (compared to the Voluntary Hospitals of America benchmark of 18). Another CARE indicator measures the rate at which patients develop pressure ulcers, which dropped to 3.5 percent in fiscal year 2002 (compared to the VHA benchmark of 7 percent). The overall CARE score is above the 80 percent minimum identified as a goal by BHI senior leaders.
The organization employs several listening and learning approaches to determine customer needs, including surveys and customer value analysis to examine patient loyalty. Information is analyzed in a customer relationship management database to identify key requirements for each customer group and as input for strategic planning, service design, and performance improvement.
BHI’s Hospital Information System gathers, connects, integrates, and distributes data from clinical systems, employees, patients, financial systems, decision support systems, and physicians. The system is accessed via mobile terminals, a data access system for physicians, and kiosks throughout the organization.
Employee turnover at Baptist Hospital has dropped from 27 percent in 1997 to 13.9 percent in 2003, and at Gulf Breeze Hospital the turnover rate has dropped from 31 percent to 14 percent during the same period. Positive morale rose from 47 percent in 1996 to 84 percent in 2001.
All employees must receive 60 hours of learning per year. All leaders and employees get together in a “daily line-up” to communicate important operational information and reinforce values. A Bright Ideas program solicits suggestions for improvement; the number of ideas implemented has soared from 370 in 1998 to 5,000 in 2003.
SSM Health Care
SSM Health Care (SSMHC) has 22,200 employees and nearly 5,000 affiliated physicians. It owns, manages, and is affiliated with 21 acute care hospitals and three nursing homes in Missouri, Illinois, Wisconsin, and Oklahoma. It also runs health-related businesses with services that include information systems, home care management, and clinical engineering.
The organization launched continuous quality improvement (CQI) processes in 1990, and each new employee gets an introduction to CQI during orientation. SSMHC began preparing to apply for the Baldrige award in 1996.
SSMHC studies patient loyalty rates that are based on overall satisfaction, willingness to recommend to others, and overall performance relative to expectations; the benchmark is the top 10 percent of hospitals in National Research Corporation surveys. SSMHC inpatient loyalty increased from 47.5 percent in 1999 to 50.0 percent in 2001, near the 51.6 percent NRC benchmark.  Additionally, SSMHC ranked above the national benchmarks for patient loyalty in outpatient surgery, emergency department services, and home care.
As part of SSMHC’s Clinical Collaborative process, based on the IHI Breakthrough Series Collaborative model, physicians work with other caregivers, administrators, and staff to make rapid improvements in clinical outcomes. SSMHC undertook six collaboratives involving 85 teams in 2002. The results for SSMHC’s clinical collaboratives for patients with congestive heart failure and ischemic heart disease demonstrate levels that approach or exceed national benchmarks.
The organization’s strategic, financial, and human resource planning process extends over a 12-month cycle and involves the entire organization. Three-year and annual planning horizons are used. The process sets and communicates system-wide goals to each entity within SSMHC, and provides standardized forms and definitions to ensure that plans align with the system’s overall goals. Department goals are cascaded to the employees, with individual “Passports” reflecting individual goals that support the department goals. SSMHC also has set up employee councils, with rank-and-file employees who give input to executives.
The organization has established formal and informal listening and learning tools for former and current patients and their families. Tools include satisfaction surveys, market research, comment cards, a complaint management system, patient follow-up calls, and an Internet response system.
SSMHC uses an automated system to make clinical, financial, operational, customer, and market performance information available to all of its sites. For example, SSMHC makes data available to physician partners from any location via multiple devices, including personal computers, handheld computers, and fax machines. Connected physicians increased steadily, from 3,200 in 1999 to 7,288 in 2002.
The turnover rate for all employees dropped from 21 percent in 1999 to 13 percent as of August 2002. The organization tailors employee benefits to provide flexibility and respond to women employees, who make up 82 percent of its workforce. SSMHC offers flexible work hours, work-at-home options, long-term care insurance, insurance coverage for legally domiciled adults, retreats, and wellness programs. Additionally, it sponsors a “star” program in which one individual can recognize another’s work, and “Showcases for Sharing” in which successful teams show and tell what has worked for them. Training per employee averaged 45 hours in 2001.
Diversity is another key issue for SSMHC. Minorities in professional and managerial positions increased from almost 8 percent in 1997 to 9.2 percent in 2001.
Saint Luke’s Hospital of Kansas City
The largest hospital in metropolitan Kansas City, Saint Luke’s Hospital (SLH) has a workforce of 3,186 employees and 500 physicians. SLH facilities include the Mid America Heart Institute, the Mid America Brain and Stroke Institute, an ambulatory surgery center, an outpatient care center, and a nursing college.
In 2002, Consumer’s Checkbook, a consumer education organization, ranked SLH as 35th among 4,500 US hospitals. SLH’s overall score was 7,669, compared to a national average of 5,418.
SLH’s Medical Staff Clinical Indicator index tracks 58 critical measures of clinical quality such as readmitted patients and returns to the intensive care unit. In 2002, 95.3 percent of these indicators were within statistically allowed tolerances. Only 14.2 percent of patients returned after ambulatory surgery, compared to a national average of 39.2 percent for comparable national teaching hospitals.
In 2002, SLH compared its performance in surgical infection and acute myocardial infarction treatment with the 10 best peer hospitals through the Voluntary Hospitals of America. SLH came out best in surgical infection and second in acute myocardial infarction.
SLH teams design (and redesign) clinical pathways for high-volume, high-cost diagnoses. (Clinical pathways are treatment protocols aimed to standardize care and reduce variation.) SLH has 134 clinical pathways that apply to 60 percent of its patients. Patients get a version of the appropriate clinical pathway in a form that lets them and their families understand and track what will happen during treatment.
Establishing a new patient-focused care delivery model, SLH created a set of 12 customer contact requirements, such as “address patients/guests by last name unless otherwise told.”
The organization has identified centers of excellence within its clinical products and services, and focuses resources on them. Partnering with staff physicians and the University of Missouri, SLH has endowed nine research chairs focused on the specialty care provided in the centers of excellence.
SLH uses a seven-step strategic planning process to set strategic direction and performance expectations, deploy strategic plans, allocate resources, and manage the organization throughout the year. Using the strategic planning process and related process tools, initiatives are achieved with both 90-day departmental action plans and an individual performance management process.
Employee well-being, satisfaction, and motivation are assessed via formal surveys, open forums with senior leaders, targeted focus groups, Patient Safety Leadership WalkRounds, “exit” and “staying” interviews, and a peer review grievance process. Employee turnover is dropping toward 10 percent. Since 1998, the percentage of minority managers has risen by 3 percent, to 9.4 percent.
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