Healthcare
A Healthcare Role Model
I don’t know if the Providence Regional Medical Center in Everett, Washington, has thought about applying for the Baldrige Award, but it should. It’s already a role model for high-performing healthcare organizations.
A recent article in BusinessWeek lists its world-class attributes (“Hospitals: Radical Cost Surgery,” Catherine Arnst, January 7, 2010):
- Uses scorecards throughout the hospital to measure quality and efficiency
- Acts on innovative ideas from staff (a nursing team’s idea to check on patients every two hours to see if they need help moving around their rooms reduced falls by 25%)
- Places the day-to-day care of most inpatients in the hands of hospitalists (the program reduced length of stay, infections, and surgical complications)
- Created “single stay” wards where, after heart surgery, cardiac patients remain in one room throughout their recovery (patient satisfaction soared and average length of stay dropped by more than a day)
- Breaks even on Medicare patients while almost 60% of U.S. hospitals lose 20 cents on the dollar
- Offers financial training to 800 independent doctors affiliated with Providence to get them thinking about cost efficiencies
- Established an independent panel to investigate medical mistakes, share its finding with patients, and voluntarily offer a financial reward if warranted (Providence has two malpractice suits pending compared to 12 to 14 on average at other hospitals of similar size)
- Provides $16 million in healthcare each year that goes unpaid
- Wins awards: Top 100 Hospital and Distinguished Hospital for Clinical Excellence three years in a row and ranked #1 for cardiac and critical care, stroke, and general surgery
As Providence and Baldrige Award-winning hospitals have…
12Jan2010 | Steve George | 0 comments | ContinuedGreat, Not Perfect
SSM Health Care was the first healthcare organization to receive the Baldrige Award when it won in 2002. With 15 acute-care hospitals and two nursing homes in four states and nearly 23,000 employees, SSM has been a beacon for performance excellence, earning a number of quality awards including several state awards for SSM facilities. Sister Mary Jean Ryan, chairman and CEO, described how SSM integrated the Baldrige model in her book, On Becoming Exceptional—SSM Health Care’s Journey to Baldrige and Beyond (ASQ Quality Press, 2007).
By every measure, SSM is a great organization. But it’s not perfect. Earlier this week, the U.S. Department of Labor announced that SSM was ordered to pay $1.7 million in back wages to 4,700 employees for violating Fair Labor Standards Act overtime rules: It automatically deducted nurses’ pay for lunch periods even if the nurses worked during that time. SSM reimbursed the nurses earlier this year.
It’s important to remember that no organization is perfect. Mistakes will be made. SSM quickly rectified the situation and, based on what I know about Baldrige organizations, likely has improved its processes so that this situation does not recur.
It would have been instructive to learn how SSM responded but no mention of the issue or of the Labor Department’s settlement can be found on SSM’s Web site. I can understand why it wouldn’t want to publicize an embarrassing event, but I also think it’s important to help people who admire SSM understand that it’s not perfect and that, when it makes mistakes,…
10Dec2009 | Steve George | 0 comments | ContinuedBaldrige Saves Lives
According to Rulon Stacey, president and CEO of Poudre Valley Health System, there are people alive today because of what PVHS has done with Baldrige. PHVS, which won the Baldrige Award in 2008, will receive the Award from President Obama in a ceremony on December 2.
Located in northern Colorado, PVHS has 4,300 employees, 600 physicians, and 900 volunteers. It started integrating Baldrige in 1999. “It was a big time of change for Poudre Valley Health System,” said Pam Brock, vice president of marketing. “We’d gone through five CEOs in four years and we had a 25% turnover rate. The organization was struggling and this was when Rulon first became CEO. He knew we needed something to take the organization to a different place.” (“PVHS goes to Washington—finally,” Steve Porter, Northern Colorado Business Report, November 20, 2009)
Its results point to a very different place. Modern Healthcare magazine named it one of “America’s 100 Best Places to Work in Healthcare” in 2008. Poudre Valley Hospital was recognized as the nation’s number one hospital for sustained nursing excellence in 2007 and 2008. For five consecutive years, Poudre Valley Hospital has been one of seven U.S. hospitals named a Thomson 100 Top Hospital for superior outcomes, patient safety, and operational and financial performance. According to the Center for Medicare and Medicaid Services, its patient satisfaction scores surpass the national top 10%. And its staff voluntary turnover rate is down to 8%, well below that of its competitors.
“The thing we learned was that the Baldrige Award is…
23Nov2009 | Steve George | 0 comments | ContinuedTo Improve Hospital Care, Improve the Board
When Health Affairs surveyed a nationally representative sample of board chairs of 1,000 U.S. not-for-profit hospitals, it found that fewer than half rated quality of care as one of their two top priorities, and only one-third of the boards received formal quality training. Only 63% included quality performance on every board agenda.
The magazine ranked the hospitals by publicly-reported quality measures for acute myocardial infarction, congestive heart failure, and pneumonia. As the abstract for the article describing the survey concluded, “The large differences in board activities between high-performing and low-performing hospitals we found suggest that governing boards may be an important target for intervention for policymakers hoping to improve care in U.S. hospitals.” You can read the article online here.
The Baldrige Criteria address senior leaders’ responsibilities for improving the quality of care but do not specifically link this to hospitals’ boards. The Criteria ask how you evaluate the performance of board members and how you use those reviews to improve the effectiveness of individual members and of the board as a whole.
Based on the findings of the Health Affairs study, hospitals would benefit from providing formal quality training for their board members, making the hospital’s quality performance a part of every board meeting, and holding boards accountable for performance on key quality of care measures. When that happens, quality of care will become one of the board’s—and, one would expect, the hospital’s—top priorities.
11Nov2009 | Steve George | 0 comments | ContinuedBaldrige and Magnet Recognition
Poudre Valley Hospital of Fort Collins, Colorado, won the 2009 Magnet Prize for innovative nursing programs and practices in a Magnet organization. Poudre Valley Hospital received the Baldrige Award in 2008.
I’m often asked about the similarities of and differences between Baldrige and Magnet. The greatest similarity is that Magnet, like Baldrige, has a systems perspective of how an organization functions. In Magnet’s case, the emphasis is on the nursing organization, while Baldrige focuses on the management system of an entire organization, which would include nursing. However, the Magnet criteria ask about enough touch points between nursing and other parts of an organization to provide a broad system assessment.
In fact, the Magnet criteria align well with the seven Baldrige categories. Studer Group provides a simple table that shows the links here.
The biggest difference is in the effort required to respond to the Criteria. A Baldrige application can be no longer than 50 pages plus five pages for the Profile. A Magnet application can be no more than 15 inches in height, which translates to roughly 2,500 pages. While most of that is documentation, you may have to write 400 pages in response to Magnet’s Forces of Magnetism, not to mention the time it takes to identify, gather, copy, and assemble the supporting evidence.
You can learn more about the Magnet program here.
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Why Baldrige? Saint Luke’s Makes the Case
In a new book on Saint Luke’s Health System’s quality journey, CEO G. Richard Hastings presents his organization’s case for using the Baldrige Criteria:
Using the Baldrige Criteria is just one way to improve and create sustainability in an organization. But for Saint Luke’s Health System, the Baldrige model was the best choice.
The criteria provided Saint Luke’s leaders with common language we could use with the Health System’s 8,000 employees. As a result, we can communicate consistently, achieve cooperation, and discuss our progress and failures. The criteria also created standards and benchmarks that we use to evaluate our performance and plan for the future.
Because the criteria are adaptable to individual circumstances, we can keep the diverse cultures of our small physician offices, more rural regional hospitals, and larger urban hospitals vibrant and alive, without stifling innovation and creativity. At the same time, we’re able to maintain a consistent approach and linked and aligned processes within our large system of care.
Using the Baldrige criteria requires Saint Luke’s to focus on results and then continually compare these results with the best organizations. For an organization that strives to be “The Best Place to Get Care and the Best Place to Give Care,” it’s a natural fit.
To learn more about how Saint Luke’s achieves world-class clinical and operational results, read Our Journey to Performance Excellence by Richard G. Hastings. You can order it through ASQ here.
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Disruptive Innovation and Healthcare
Item 2.1 of the Baldrige Criteria asks how you collect and analyze information about four key factors including “early indications of risks or major shifts in technology, health care markets, health care services,” etc. In other words, how do you anticipate the kinds of changes that could transform healthcare and, in the process, radically change how you are providing it?
Clayton M. Christensen, a Harvard Business School professor, called this “disruptive innovation,” which is “an unexpected new offering that, through price or quality improvement, turns a market on its head.” He is quoted in an article in the New York Times earlier this year that introduces some of the disruptive innovations that are reshaping healthcare. (“Disruptive Innovation, Applied to Health Care,” Janet Rae-Dupree, NYTimes.com, January 31, 2009)
One such innovation is fixed-fee integrated systems offered by such providers as Mayo Clinic and Kaiser Permanente. Customers make monthly payments to these providers in exchange for “cradle-to-grave health care.” Kaiser’s integrated system cost 22% less than competing systems in 2007, in part because it promotes health and discourages overtreating.
The spiraling healthcare costs that have helped inspire healthcare reform will lead to other disruptive innovations. The question is: Do you have processes in place to recognize these innovations early and prepare for or adopt them? Because if you don’t, the ground will shift and your organization will be scrambling to recover rather than leading healthcare into a new era.
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