Effective planning will help to prevent problems, provide a response if problems occur, and make available information and support needed to maintain public awareness, safety, and confidence.  Henry Ford Health System, one of the winners of the 2011 Malcolm Baldrige Quality Award for Health Care, know how to think about these big-picture issues; HFHS community benefit initiatives have increased by almost 78 percent since 2006.  HFHS’s commitment to patient safety is further emphasized through its evidence-based global harm campaign (evidence-based medicine integrates an individual doctor’s examining and diagnostic skills for a specific patient with the best available evidence from medical research) to reduce or eliminate some 23 sources of harm.  According to the Institute for Healthcare Improvement, this program is a national best practice.  HFHS’s performance in relation to overall global harm has improved from approximately 60 harm events per 1,000 patients in the first quarter of 2008 to 40 harm events per 1,000 patients in the second quarter of 2011.  A prime example of this success is HFHS’s reduction in central-line infections from 10 per year to three per year since 2008.

For many organizations, the product design stage is critical from the perspective of public responsibility.  Design decisions impact production processes and often the content of municipal and industrial waste.  Effective design strategies will anticipate environmental concerns and responsibilities.  Organizations must not only strive to meet all local, state, and federal laws and regulatory requirements, but they can treat these and related requirements as opportunities for improvement beyond mere compliance.  There is always room for improvement!

Organizations can stress ethical behavior in all stakeholder transactions and interactions, which should be monitored by the organization’s governing body.  “Societal well-being and benefit” refers to leadership and support – within the limits of an organization’s resources—of publicly important purposes.  A great example of this can be found at HFHS. Their workforce supports southeast Michigan with annually increasing levels of community service.  This includes the American Heart Association’s Heart Walk (for which HFHS is the number one contributing health system in the country and third-ranked company overall in 2011); the growing number of volunteers involved in philanthropic activities (from fewer than 1,000 in 2006 to greater than 2,300 in 2011); and an increasing number of volunteer hours (from under 300,000 in 2006 to above 500,000 in 2010).  Other examples might include improving education and healthcare in your community, pursuing environmental excellence, being a role model for socially important issues, practicing resource conservation, performing community service, improving industry and business practices, and sharing non-proprietary information.  Setting the standard as a role-model organization within your community will influence other organizations, private and public, to partner for these purposes.

Source: Juran’s Quality Handbook, The Complete Guide to Performance Excellence, 6th Edition

Source: 2011 Malcolm Baldrige Quality Award Winners

To answer these questions, I’ve launched a new project on Kickstarter to research and write a book called The Road to World-Class Healthcare. You can watch a video introducing the project and read a complete description of it here. The key to the book is the research: road trips to 20 to 25 world-class hospitals and medical centers across the country to interview leaders and learn about best practices.

To fund the research, I’ve posted the project on Kickstarter. A Kickstarter project succeeds by gaining backers who pledge financial support in exchange for rewards. Your reward for becoming a backer of The Road to World-Class Healthcare includes exclusive access to audio excerpts of key interviews, photos, and video of best practices. Invest more and the rewards increase. You can find the complete list of rewards here.

One of the reasons for posting this project on Kickstarter, other than to help fund the research, is to see if it can generate interest. If it meets the goal, the book will be written, and that book will appeal to mainstream publishers who expect authors to have a “platform” from which to market and sell their work. Kickstarter will help me build a platform.

Please take a couple minutes to check out the video and project description at Kickstarter here. I hope you will take a personal interest in supporting it. And, since this is a grassroots initiative, please take another minute to let colleagues and friends know about the project.

Thanks for your support!

Schneck Medical Center, a 2011 Baldrige Award winner, is a 93-bed nonprofit hospital in southern Indiana. “At the forefront of Schneck’s commitment to excellence,” it states on its website, “is the Patient First Culture.” That culture has enabled Schneck to score 100% on 17 of 22 core measures reported for the Centers for Medicare and Medicaid Services (CMS). Its patient satisfaction scores meet or exceed the top 10% or top 25% levels on nine of ten Press Ganey measures. Its hospital-acquired infection rate has been at or below 1% since 2008. It ranks second among 94 hospitals in its geographic region in value-based purchasing, which holds healthcare providers accountable for the quality and cost of their services.

An organization’s culture shapes its decisions. Schneck had limited treatment options for patients suffering myocardial infarctions, taking 120 minutes from the time a heart attack was diagnosed to the first intervention. To put these patients first, it collaborated with its largest competitor, located 25 miles away, to coordinate handing off patients who needed emergency cardiac catheterizations. The initiative has reduced the time between diagnosis and intervention to as low as 60 minutes.

A patient first culture does not mean that nothing else matters. Schneck also values workforce satisfaction: It has consistently been named one of Indiana’s Best Places to Work and recognized nationally as a “Best Place to Work” by Modern Healthcare magazine. Staff turnover dropped by 26% from 2007 to 2011. It values financial wellness: It has improved its bond rating and operating margin and exceeds S&P’s “A-” rated benchmark for five key financial metrics. It values good citizenship: Schneck performs health screenings at no charge to local residents and serves as a major source of health information through regularly scheduled educational programs and health fairs.

The three healthcare organizations that received 2011 Baldrige Awards could not be more different in size and services, from Detroit’s Henry Ford Health System’s 140 sites to Schneck and its single 93-bed hospital to Southcentral Foundation serving Alaska natives in 55 remote villages. Yet all integrated the Baldrige model to achieve excellence in patient and workforce satisfaction, quality outcomes, and financial results. They are roles models for any healthcare organization , of any size, in any situation, that is committed to providing world-class care.

Of those SCF serves, 45,000 live in the Anchorage, Alaska, area and 10,000 live in 55 remote villages accessible only by plane. SCF serves them through a unique health care delivery system, the Nuka System of Care, that focuses strategies and processes on wellness. The system is owned, managed, directed, designed, and driven by Alaska Native people, which SCF calls “customer-owners.”

These unique ownership and health care delivery systems are producing impressive results:

• Customer-owners can see their primary care providers on the same day if they call by 4 p.m. and arrive by 4:30. Seventy to 80% of appointment slots are open at the start of each day.
• Alaska Natives and American Indian people experience diabetes at twice the national rate. Since 2009, SCF’s performance levels for diabetes care have exceeded the 90^th percentile of the Healthcare Effectiveness Data and Information set.
• SFC manages key performance data through DataMall where it is collected, aggregated, trended, segmented, and available to managers, clinicians, customer-owners, and employees.
• SCF’s overall customer satisfaction rating in 2010 was 91%. Its overall satisfaction rating on Consumer Assessment of Healthcare Providers and Systems (CAHPS) was 73.3%, significantly higher than the CAHPS TopBox benchmark of 46%.
• Staff turnover decreased from 37% in 2008 to 17% in 2011.
• SCF’s per capita expenditures percentage change has been lower than the MGA benchmark since 2005 despite its phenomenal growth.

Notice the exceptional results across all critical areas: operations, patient care, patient satisfaction, workforce, and financial. Organizations must be good at everything and great at a few things to win a Baldrige Award, as SCF has demonstrated.

Health care organizations that want to replicate its success can start with the Nuka System of Care, which is based on four principles: (1) customers drive everything; (2) customers must know and trust the health care team; (3) customers should face no barriers in seeking care; and (4) employees and supporting facilities are vital to success. If it works for SCF in remote areas of Alaska, it can work for any health system in the country.

You can read more about SCF and its world-class results here.

To learn more about other Baldrige health care leaders, click on these articles:

• Henry Ford Health System
• Heartland Health
• AtlantiCare
• Poudre Valley Health System
• St. Luke’s Health System

Henry Ford Health System serves a three-county region encompassing Detroit and its suburbs with a workforce just shy of 30,000 employees, physicians, and volunteers. Its revenue in 2010 was $4.08 billion.

It’s hard to imagine the effort it has taken to keep this massive organization moving along the Baldrige path, but its results are a testament to its leaders’ tenacity:

• Rated #1 for member satisfaction among all health insurance plans in Michigan by J.D. Powers and Associates
• Satisfaction exceeding 90^th percentile level for HFHS’s medical centers, with 80% likely to recommend
• Performance on CMS core measures at the 90^th percentile for 75% of reporting areas across the system’s seven inpatient hospitals
• Evidence-based global harm campaign to improve patient safety recognized as a national best practice by the Institute for Healthcare Improvement
• Market leader in the area it serves, increasing inpatient market share by an average of 3% a year since 2004
• Maintained a positive net operating income despite significant increases in uncompensated care—approximately $200 million in 2010
• HFHS’s leaders model and support entrepreneurism throughout the healthcare delivery system
• Best-in-class innovations including the Perfect Depression Program, Home Health Services, Pharmacy Advantage, and OptimEyes
• Monetary support for HFHS’s communities by employees increased to just over $3 million in 2010

For more information about Henry Ford Health System, click on its Baldrige profile.

To learn more about how your organization can integrate Baldrige and achieve HFHS-like results, click on these articles:

• Baldrige Gets Results
• How to Integrate Baldrige
• 10 Steps to an Effective Baldrige Assessment

She was expertly pampered for the rest of the day, able to get out of bed for a light dinner in the evening, walking the hallways yesterday, likely to be released today. None of it felt rushed. The attention was timely, focused, and compassionate. As a son, I felt relieved at the quality and efficiency I witnessed and at the high level of care my Mom received.

Wright Medical Center is a quality leader. It has integrated Baldrige by applying for the Iowa Recognition for Performance Excellence award. Two years ago, the quality processes it was implementing were described in Quality Progress, the magazine of the American Society for Quality.

I found all of this out when I was wandering the halls waiting for my Mom to get out of surgery. It relaxed me. I’ve worked with dozens of organizations that were integrating Baldrige and all of them aspire to be the best they can be. Wright Medical Center fit that mold. It is patient and family focused. Supplies—medicine, cold packs, food, etc.—arrived when they were needed. Nurses monitored Mom’s vital signs closely after surgery and repeatedly asked about any pain she was feeling and if she needed anything. In a difficult and stressful situation, they delivered a positive experience.

Every hospital employee I talked to was friendly and helpful. By the end of the day, it was easy to see the culture that Wright Medical Center has created because every employee embodied it.

My Mom was very lucky.

To read more about world-class healthcare, click on these articles:

• Baldrige Saves Lives
• Why Baldrige? Saint Luke’s Makes the Case
• A Baldrige Winner’s Health Pyramid
• AtlantiCare’s Baldrige Journey
• Baldrige and Lean in Healthcare
• Baldrige and Magnet Recognition

Hospitals and medical centers embrace the Baldrige model for the systems perspective it provides. Senior leaders who have integrated Baldrige attest to the new knowledge it gives them about how their organizations operate, which means they gain greater control over the levers of success. In healthcare, where so many factors conspire to increase costs and decrease performance, understanding and controlling those factors is priceless.

One example is described here. Advocate Condell Medical Center, a 350-bed Level 1 trauma center in north Chicago, turned to Baldrige and Lean to tackle serious challenges at the hospital and its imaging business including:

• Ranking in the bottom quartile of patient satisfaction
• High percentage of denials and bad debt
• Negative growth
• 30% of calls abandoned or lost
• Report turnaround time of 16 hours
• A 6% no-show rate
• Cumbersome registration process
• Long patient wait times
• Low staff and physician morale

Baldrige provided the management framework for aligning and integrating strategies, plans, and activities. Lean improved process flow and eliminated waste by involving staff in identifying and eliminating wasteful steps and streamlining processes.

One year after launching the project, the hospital reported:

• Greater than top quartile in customer satisfaction
• Greater than 8% year-over-year profitable growth
• Reduced no shows to less than 2%
• Reduced report turnaround time to less than 4 hours
• Reduced abandoned/lost calls to less than 8%
• Reduced patient wait times from more than 30 minutes to less than 10 minutes
• Improved staff and physician satisfaction by more than 50%
• Confirmed year-over-year return on investment of $1.75 million

Such results quantify the benefits of a systematic approach to process improvement. With Baldrige as the roadmap and Lean as the driver, Advocate Condell Medical Center realized significant improvement in just one year while positioning itself to continue to improve performance well into the future.

To read more about Baldrige and healthcare, click on these articles:

• Why Healthcare Needs Baldrige
• Baldrige Saves Lives
• Why Baldrige? Saint Luke’s Makes the Case
• A Baldrige Award Winner’s Health Pyramid
• AtlantiCare’s Baldrige Journey