AAMC Reporter: June 2009

Medical Centers Take "the Baldrige Journey"

When St. Luke's Hospital in Kansas City asked its employees—every single one of them—to help develop a performance management plan as part of its campaign for the Malcolm Baldrige National Quality Award, one of the hospital's housekeepers immediately set to work figuring out how he could contribute.

"He set a goal that in the rooms he cleaned, there wouldn't be any infections," said G. Richard Hastings, president and CEO of St. Luke's, which earned the prestigious Baldrige award in 2003. "That's the kind of thing where you go from the 50,000-foot mission and move it all the way down to every detail of patient care. The Baldrige approach gets people like that housekeeper really thinking about how they can help achieve the mission."

Established by Congress in 1987 and administered by the National Institute of Standards and Technology, the Baldrige National Quality Awards are given by the president to U.S. organizations that achieve high standards of quality and performance. At first, they were strictly for businesses, but in 1999, the Baldrige awards were opened up to health care institutions, which quickly saw the value of the award. Last year, more than half of the 85 organizations applying for the Baldrige award were health care institutions.

The award is an ideal fit for health care institutions in general and academic medical centers in particular, said Harry Hertz, Ph.D., director of the Baldrige program.

"Health care really has three focal points: to improve quality, to do it cost-effectively, and to be sustainable for the long term," he said. "Everything that I believe health care is trying to achieve today is what Baldrige is asking the critical questions about."

According to those who have applied, going for the Baldrige award is a bit like training to run a marathon; the odds of winning may not be in your favor, but the strengths that develop during the process are a reward in and of themselves. Organizations pursuing Baldrige often refer to "the Baldrige journey" as a long-term driver for improving quality and service.

For hospitals and health systems, the journey begins with the Baldrige program's "Health Care Criteria for Performance Excellence." This guide outlines the seven categories of performance in which Baldrige-worthy organizations must excel: leadership, strategic planning, customer and market focus, measurement, analysis and knowledge management, workforce focus, process management, and results. Baldrige aspirants use this document to help them prepare their applications, which are then reviewed by the Baldrige board of examiners, a panel of some 500 leading experts from industry, professional and trade organizations, education and health care organizations, and government. The highest-scoring applicants receive a site visit for further review, while those not selected receive a copy of their evaluation to help them improve.

Among the 2009 Baldrige health care applicants is Clarian Health, the clinical partner of Indiana University School of Medicine that operates seven hospitals in the Indianapolis area.

"From Baldrige we thought we could get more alignment in systems," said Steven Wantz, Clarian's senior vice president of administration and human resources. "We recognized that to get to the next level of excellence, we really needed increased accountability and deployment of best practices throughout the system." Clarian did not receive a site visit in 2008, but Wantz noted that the feedback report alone has been a valuable improvement tool.

Hertz has no data on how many academic medical centers are pursuing Baldrige awards, but said he has seen several examples himself.

"About 18 months ago, I walked into [Washington, D.C.'s] George Washington University Hospital to visit a friend, and there was a huge banner hanging in the lobby: 'We're on the Baldrige Journey.' And about four years ago, my granddaughter was at Bay State Medical Center in Massachusetts. While visiting her, I walked by a meeting room that had a sign, 'Baldrige Meeting Today.'"

Another academic medical center on the Baldrige journey is Stony Brook University Hospital and Health Sciences Center in Long Island, N.Y.

"The Baldrige criteria provide a road map to get to our end game of becoming a high-reliability organization," said Carol Gomes, Stony Brook's associate director for quality management and an examiner for the Baldrige awards. "We want to win the award, of course, but that's not the main point. It's a win-win no matter what, because we're using a tried and true system to help us guide our planning processes."

There are some unique challenges for academic medical centers pursuing Baldrige, said Ingrid Philibert, senior vice president in the department of field activities at the Accreditation Council for Graduate Medical Education and a former Baldrige examiner.

"Their size can be a barrier, and the number of people you have to get involved," she said. "True change happens on the front lines, and that can be a challenge in an academic center. For example, if you go to an internal medicine inpatient unit in a teaching hospital, you have residents on a one-month rotation. You don't have them long enough to fully explain Baldrige, because in 30 days they will be on another unit."

That's true, said Hastings, but it can be done. "We do have to deal with a whole other set of customers—our students. We have to survey our students to determine if they feel they're getting value for their money and achieving the education they want to achieve. Our residents, interns, fellows, and students all get a healthy bite of Baldrige."

Bronson Methodist Hospital in Kalamazoo, Mich., was a 2005 Baldrige winner. "Pursuing Baldrige forced us to think through how we lead and run our business," said Michelle Serbenski, Bronson's vice president of performance excellence. "It's almost like a guidebook: How do senior leaders lead? How do I run this place? What's my vision? Who are my customers? How do I know what they need? Thanks to the Baldrige process, we exceeded our growth targets for our new facility, with 41 percent growth in volume so far along with high satisfaction scores from patients and employees."

The important thing about Baldrige, especially for academic medical centers, is that it is results-oriented, said Carl J. Getto, M.D., senior vice president for medical affairs at the University of Wisconsin Hospital and Clinics and a Baldrige examiner. "It's not just putting a lot of things in motion and expecting that things will get better; it's actually looking at the results and determining whether the results are worthy of what you set out to do."

—By Gina Shaw, special to the Reporter