For Baldrige winners, learning is in the journey

But what of the future for Baldrige?

They knew it was coming: The National Institute of Standards and Technology's (NIST) proposed budget didn't include any government funding for the Baldrige National Quality Awards. But it still comes as a shock, particularly to those who have participated in the program and know firsthand the benefits that participants reap. But that doesn't mean the end of the program, says Harry Hertz, director of the Baldrige Performance Excellence Program at NIST. The program is a partnership, and the related Baldrige Foundation is providing support for the staff while the organization looks for a "long-term funding mechanism," says Hertz. "They are committed to our future."

The exact value of the program has been calculated. One study found that benefits to the 273 winners to 2006 in cost savings, customer satisfaction, and financial gain outweigh the cost by 1,252-to-1, according to the NIST website. Further, if the value could be compared with the total cost, the 1,252-to-1 figure would probably be very conservative.

The Baldrige Foundation also took a look, this time at hospitals that had site visits as part of the application process, comparing them to the Thomson Reuters 100 Top Hospitals. Baldrige Foundation chose to conduct a comparison with the Thomson Reuters 100 Top Hospitals national study. Baldrige participants are six times more likely than peers to become 100 Top Hospitals, Hertz says, and they fall into at least the top 3% of facilities.

That isn't surprising to Sue Hawkins, MBA, senior vice president, performance excellence at Henry Ford Health System in Detroit, one of three healthcare winners of the award this year. It's a "grueling process," she notes. "It's not just about the application, but that you have to change the way you run your organization just to respond to the questions asked. Right out of the gate, they ask you how your senior leaders establish the vision for the organization and translate that to the workforce." It's just one of hundreds of "how" questions that force an applicant organization to look deeply at itself, evaluate its performance, learn from mistakes, and change what it does.

Henry Ford first applied in 2004. "If you are stumped on the second question, you know you will have to become a different organization," says Hawkins. "You realize you aren't as good as you think you are and you have to be different. It becomes a lever for your own improvement."

Over the last seven years, there have been dozens of substantial changes at Henry Ford that were eventually instrumental in helping it win the award this year. Each applicant gets a feedback report that enables it to make some changes. But only the best get site visits, and it took four years before Henry Ford achieved that. Of the 70 or so applicants, only 11 merited site visits, she says.

Eight people come on site and essentially write a "better feedback report" for the hospital. "They learn more about us, verify that what we wrote in our application was true, and give us a report that includes better guidance. The award is an honor, but the feedback is the most valuable thing. We've been using it for years now." Of the 30,000 employees, affiliated physicians and volunteers in the system, some 1,200 were interviewed during the four-day visit.

Among the changes that led to the award was the creation of a strategic planning process. "We used to write a plan every year and put it on the shelf," Hawkins recalls. "We had no way of testing how we were doing against our plan. Now we have a cyclical plan that considers the long term. We have a way to evaluate how we are doing against that plan."

The very way the leadership team was organized changed due to feedback that said it wasn't clear who was in charge of what at Henry Ford.

Patients benefit, too

In terms of patient care, a big change was an improvement in the way best practices are shared. "We are team based, but we focus on internal collaborative groups now to share processes," she says. "We have monthly meetings on reducing patient harm, we pilot ideas and test changes and then we spread them. Every employee knows they are part of this. And our outcomes are better because of it." Harm has declined by 27% in the last two years and mortality is down 40%. "Fewer people die under our watch than used to, and that's a cool thing to note. People loved to talk about what they were doing to make those numbers."

The sepsis rate in the ER is another thing that dropped as a result of Baldrige work. One of the physicians invented an anti-sepsis bundle that is now used as a national standard. Inpatient sugar levels are more under control, too.

While the application is done — they can't submit another for five years — the organization still has to stay on its toes. There have been more than a dozen requests for someone from Henry Ford to come speak about what they have done — sharing is an obligation for winners — and there is still one more feedback report that will come and provide fodder for more change. "We'll pour over that to find priorities for improvement. Maybe we don't write an application again this year, but we won't let go of the process." She hopes that Henry Ford, like so many other winners, has the best year of improvement the year following the award.

Schneck Medical Center in Seymour, IN is just 93 beds, but it is one of the best of the best, a 2011 Baldrige winner. It took five years of applications to get to this point, says Suki Wright, MSM, CSSBB, director of organizational excellence and innovation at the hospital.

Indiana doesn't have a state Baldrige program, but Ohio does, and Schneck partnered with it in the hopes of simply getting a report back from which to work. Because of the partnership, the Ohio state Baldrige organization did a site visit that first year. The process is identical to that followed by the national examiners — two of the state examiners even participated in Schneck's eventual national site visit.

Wright says she feels pressure to keep moving forward because Schneck is now a role model for other facilities. She notes they will probably even continue to do the assessment despite the fact that they can't apply to the national program for five years — although they may apply through a new three-state joint venture between Indiana, West Virginia and Ohio.

Wright thinks that someone will come through with funding for the future. "The framework is so successful that someone else will pick it up."

Meanwhile, the drumbeat continues for the winners. "Baldrige helps you understand what is important to your organization and to think always of what is best for the patient. That has helped us with every single decision we make," says Wright. "We used to do things so randomly. This process made me think differently and ensure that what we do is coordinated. We are process literate now."

For more information on this topic, contact:

Sue Hawkins, MBA, Senior Vice President, Performance Excellence, Henry Ford Health System, Detroit, MI. Telephone: (313) 874-2489. Email: shawkin1@hfhs.org.

Harry Hertz, Director, Baldrige Performance Excellence Program, Baltimore, MD. Telephone: (301) 975-2360.

Suki L. Wright, MSM, CSSBB, Director of Organizational Excellence & Innovation,

Schneck Medical Center, Seymour, IN. Telephone: (812) 522-0551.