Baldrige: A Roadmap for Patient Safety and Quality Improvement Harry S. Hertz August 22, 2007 What Is Baldrige? Why Baldrige? Lessons Learned & Results Next Steps

What Are the Baldrige Criteria? A set of expectations or requirements A structured approach to performance improvement A framework for a systems view of performance management Expectations The Criteria are a set of expectations or requirements. They define the critical factors that drive organizational success. Structured Approach The Criteria comprise seven Categories. Distributed across the Categories are 18 Items, each focusing on a major requirement. Within each Item, there is one or more Area(s) to Address containing specific requirements related to the Item. Framework The Criteria constitute a framework for understanding a systems view of performance management the key components of a performance management system the relationships among the components The Criteria emphasize the alignment of key components of the performance management system.

Basic Goals of the Criteria To help organizations enhance their performance by focusing on delivery of ever-improving value to patients, other customers, and stakeholders, contributing to improved health care quality and organizational sustainability improvement of overall organizational effectiveness and capabilities organizational and personal learning ………performance excellence The Criteria are designed to help organizations use an integrated approach to organizational performance management that results in delivery of ever-improving value to customers and stakeholders, contributing to organizational sustainability improvement of overall organizational effectiveness and capabilities organizational and personal learning Value refers to the perceived worth of a product, service, process, asset, or function relative to cost and to possible alternatives. Organizations frequently use value considerations to determine the benefits of various options relative to their costs, such as the value of various product and service combinations to customers. Performance refers to output results obtained from processes, products, and services that permit evaluation and comparison relative to goals, standards, past results, and other organizations. Performance can be expressed in financial and nonfinancial terms. Six types of organizational performance are addressed in the Criteria for Performance Excellence: (1) product and service outcomes, (2) customer-focused results, (3) financial and market results, (4) human resource results, (5) organizational effectiveness results, and (6) leadership and social responsibility results. The Education and Health Care Criteria focus on parallel sector-related results. Organizational learning includes both continuous improvement of existing approaches and adaptation to change, leading to new goals and/or approaches. Personal learning is achieved through education, training, and developmental opportunities that further individual growth and can result in (1) more satisfied and versatile employees who stay with the organization, (2) organizational cross-functional learning, and (3) an improved environment for innovation.

Criteria Purposes To help improve organizational performance practices, capabilities, and results To facilitate communication and sharing of best practices To serve as a tool for understanding and managing performance Performance Practices, Capabilities, and Results The Criteria help improve performance practices and capabilities—as well as results—by providing a set of interrelated Core Values and Concepts that are modeled on the behaviors found in high-performing organizations. They also provide a framework to help organizations to assess their performance and growth and to plan for the future. Communication and Sharing By providing a common language, the Criteria help U.S. organizations of all types communicate and share information on best practices. They offer a common set of requirements that facilitate comparisons and benchmarking, and they describe a system for overall organizational performance alignment. Performance Improvement Tool The Criteria are a tool to identify strengths and target opportunities for improving processes and results affecting key stakeholders, including customers, employees, owners, suppliers, partners, collaborators, and the public allocate resources to improve communication, productivity, and effectiveness and achieve the organization’s goals Many Award recipients state that their greatest rate of improvement occurred the year after receiving the Award.

Baldrige Health Care Criteria Framework: A Systems Perspective The framework provides a high-level overview of the Baldrige Health Care Criteria for Performance Excellence and illustrates how the Criteria provide a systems perspective for managing your organization to achieve performance excellence. From top to bottom, the framework has three basic elements—the Organizational Profile, the system operations, and the system foundation (Measurement, Analysis, and Knowledge Management). The Organizational Profile (the umbrella at the top of the figure) sets the context for the way your organization operates. Your environment, key working relationships, and strategic challenges and advantages serve as an overarching guide for your organizational performance management system. The system operations (middle of the figure) comprise two linked triads. The leadership triad—Leadership, Strategic Planning, and Focus on Patients, Other Customers, and Markets—emphasizes the importance of a leadership focus on strategy and patients/customers. The results triad—Workforce Focus, Process Management, and Results—focuses on your workforce and key processes that accomplish the work of the organization that yields your overall performance results. ALL actions point toward Results. The horizontal, two-headed arrow in the center of the framework links the two triads—a linkage critical to organizational success—and indicates the importance of feedback in an effective performance management system. The system foundation for the performance management system (bottom of the figure) is composed of Measurement, Analysis, and Knowledge Management, which are critical to a fact- based, knowledge-driven system for improving performance and competitiveness.

Beginning the Journey - 2000 A&T PROGRAMS Manufacturing Troubled Yes Primarily One Turnaround AEROSPACE SUPPORT Service New/Emerging No Geographically Dispersed Improvement Organization Situation: Recognized Crisis: Location: Reason for Baldrige:

Saint Luke’s Hospital Sustaining Performance Excellence Lessons Learned Leadership drives and sustains the process Leadership at all levels is important More difficult to change the culture than to learn the tools Valuable team building experience Trust is extremely important

Saint Luke’s Hospital Sustaining Performance Excellence Lessons Learned There are no “quick fixes” Must always focus on the customer Should never be satisfied with the present level of quality Decisions must be driven by data and compared to “best” Employees make it happen!

Lessons Learned by Education and Health Care Baldrige is a systems perspective Self-assessment facilitates learning Measurements and data are critical Baldrige focuses on results and outcomes Organizational “silos” are pervasive Need to improve internal communication

Lessons Learned by Education and Health Care (cont.) Many activities, few processes - “What” is not the same as “how” The customer concept is challenging Improvement is the goal The process itself is educational

Bronson Methodist Hospital: Cardiac Services % Market Share This is an example from 2005 health care Award recipient Bronson Methodist Hospital of results tied to strategy and action plans. The mission, values, commitment to patient care excellence, and philosophy of nursing excellence provide the foundation that supports the organizational strategy, which is illustrated in the Vision to be a national leader in healthcare quality and the three Cs or corporate strategies: Clinical Excellence (CE), Customer and Service Excellence (CASE), and Corporate Effectiveness (CORE). Excellence is the thread that ties together the Vision, Mission, Values, commitment to patient care excellence, philosophy of nursing excellence, and overall strategies. These elements, constituting the Plan for Excellence, form the culture and guide decision making. This slide demonstrates how Bronson’s measures (% market share for the cardiac service line) and results are aligned with its Corporate Effectiveness objective―in this case, achieving cardiac growth targets.

BHI: Results This is an example from 2003 health care Award recipient Baptist Hospital, Inc. (BHI), of use of comparisons/benchmarks. Results of the employee attitude surveys are provided in the figure. After the 1999 survey, Sperduto & Associates reported that BHI results were the best it had ever recorded, regardless of industry. After the 1999 survey, future results were expected to fluctuate within each individual topic’s score, but the target was to increase employee morale. In 2001, BHI received even higher levels of employee positive morale than the 1999 best-in-class score. In addition, response rates to the survey, which can be an indicator of engaged positive employees, have risen each year at BHI and remain much higher than those of its best competitor.

Organizational Knowledge Baptist Daily Modeled after Ritz Carlton best practice Began in 2001 Evolved into facility-specific

Baldrige Role Model Characteristics: 1999-2004 Visionary Leadership Guidance (1.1) Process Drive (6.1) Customer and Market Knowledge (3.1)

Early Adopters: 1999-2004 Process Driven (6.1) High Performance Work Systems (5.1) Customer and Market Knowledge (3.1) Visionary Leadership Guidance (1.1)

Harvard “The next time I go to a hospital, I’d rather see a Baldrige Award on the wall than a Harvard diploma.” Harvey Mackay Source: Minneapolis Star Tribune 4/6/95

Next Steps Organizational Profile Are We Making Progress (as Leaders)?

Organizational Profile Purpose: - Describe what is relevant and important - Ensure common understanding - Guide selection of information/data - Identify gaps/lack of deployment - Serve as first Baldrige assessment As noted in the previous slide, the focus of today’s session is on Step 4 of the Self-Assessment and Action Initiative: Preparing the Organizational Profile. The profile was formerly called the Organization/Business Overview. We renamed and revised it this year, but it is still essentially a snapshot of your organization, the key influences on how you operate, and the key challenges that you face. For all organizations, this step is critical as it sets the stage for all other steps. In preparing the Profile, your organization should gain a common understanding of what is important, and this understanding will then guide data collection and selection of information as the process continues. The Profile will also guide the assessment of approaches used by your organization, the extent of deployment of those approaches, and results achieved by it.

Organizational Profile Organizational Description Organizational Environment Organizational Relationships Organizational Challenges Competitive Environment Strategic Challenges Performance Improvement System The requirements for the Profile are basically the same for all 3 sets of Criteria that we produce - Business, Health Care and Education - with some variation in vocabulary. There are 2 major sections with subparts under each. The first section is the basic description of your organization. This includes your organizational environment (products and services, mission/vision/values, employee profile, technologies, equipment/facilities, and regulatory/legal). It also includes your organizational relationships (key customer groups/market segments, key product/service requirements, key suppliers, etc.). The second section focuses on your organizational challenges. This includes your organization’s competitive environment (competitive position, relative size and growth, number of competitors, etc.). It also includes your key strategic challenges (operational, human resources, business) and your performance improvement system (including your approach to systematic evaluation and improvement of key processes).

Are We Making Progress? Are We Making Progress as Leaders? Employee (Leadership Team) Questionnaires Seven Category Framework 40 Statements, 5-Point Scale Compare Results Focus Improvement and Communication for Your Organization

Organizational Profile and Are We Making Progress (as Leaders)? Do you know the answer? Would your organizational colleagues give the same answer?

Resources for More Information Most Baldrige National Quality Program (BNQP) documents are available both in hard copy and on the BNQP Web site. To obtain these documents, call (301) 975-2036 or visit www.baldrige.nist.gov.

Our dilemma is that we hate change and love it at the same time; what we really want is for things to remain the same but get better. Sydney J. Harris Read So - The challenge is making change occur the way you want it to happen -- and for the better. What are some of the factors that help ensure controlled change? Leadership, planning, measurement, and communication. One of the best things you can do is to do a self-assessment so that you can identify some key opportunities that would benefit from change.