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

Your organization needs processes for:

• Designing your work systems
• Capitalizing on your core competencies
• Determining which processes will be internal and which will be external
• Determining work system requirements
• Managing and improving your work systems to deliver customer value and achieve organizational success and sustainability
• Control costs of your work systems including preventing defects, service errors, and rework, and minimizing the costs of inspections, tests, and process/performance audits
• Ensuring work system and workplace preparedness for disasters or emergencies

Best practices to consider:

• Unlike most organizations whose work systems evolve over time, role model organizations make a deliberate effort to identify their work systems, design or redesign them to better accomplish the work of the organization, and manage them to achieve strategic objectives and goals.
• The organization uses its strategic planning process to determine how to capitalize on its core competencies and to identify needed competencies for the future.
• The organization uses specific criteria to determine whether key processes will be internal or external, including cost/benefit analysis, internal capabilities and capacity, and the availability of external expertise.
• The organization uses lean, Six Sigma, ISO, and other tools to improve quality and cycle time and reduce costs.
• The organization maintains an emergency response plan that is deployed to all functions, each of which develops and maintains its own plan, and the plans are tested annually to see what works and what needs to be improved.

Common problems areas:

• The work systems are what they have evolved to become and have never been designed, redesigned, or reviewed.
• The organization focuses on perceived customer needs with little thought to how it can capitalize on its core competencies.
• No process exists to determine whether a key process should be internal or external.
• Cost control occurs as a reaction to problems, not as an ongoing strategy to improve quality and efficiency.
• Emergency plans are not tested or improved.

To read more about work systems, click on these articles:

• Innovation Big and Small
• The Value of Lean
• Building a Company on Baldrige

One reason is the cost of labor, which has risen enough in other countries to negate one of the biggest reasons to ship jobs overseas. Another is the threat to supply chains made painfully visible by the recent earthquake in Japan. A third reason is the productivity of American workers, which is largely responsible for the rise in profitability despite recessionary pressures and high unemployment.

One of the key drivers of profitability among American manufacturers has been the implementation of Lean. In an IndustryWeek article available here, author Gregg Gordon says, “Companies that practice Lean rely on their employees who know the process best to identify unproductive activities and replace them with productive ones. This additional productive time results in higher output with the same pace of production using the same capital expenditures.”

Gordon’s analysis explains why profits have soared without noticeable impact on the unemployment rate. In Lean Labor: A Survival Guide for Companies Facing Global Competition, Gordon explains how an organization can use Lean techniques to understand, quantify, and manage labor costs and realize the benefits of Lean in performance management: lower costs, higher quality, and faster cycle times.

Here’s a quick look at examples of Lean Labor applied to the seven wastes of Lean:

• Transport: unnecessary movement of people
• Inventory: more people than required to do the job
• Motion: manual processes that could be automated
• Waiting: too few skills or too little experience to efficiently perform a process
• Overproduction: using a person who is too highly skilled for a job; providing too much information, causing the worker to sift through it to find what he/she needs
• Over-processing: entering data multiple times into different systems
• Defects: expired or missing skills and certification that cause quality and performance issues

At a time when organizations focused on reducing costs have done so by laying people off and cutting wages, those that have implemented Lean are doing more with less by “tapping into the employees’ ability to innovate,” according to Gordon. And that helps them survive in the face of global competition.

To read more about Lean and process improvement, click on these articles:

• The Value of Lean
• The Lean/Baldrige Connection
• Go to the Gemba
• How Does Your Workforce Measure Up?
• Smart Question #1: What’s the Process?

This excerpt from Montgomery County Public Schools’ 2010 Baldrige Award-winning application could describe every Baldrige Award winner. All are process centered. A great example of what it means to be process-centered can be found in MCPS’s Road Map to Process Management and Improvement and Knowledge Management, which you can view by clicking on the title of this article or on the blue “Continued” below.

At MCPS, every office, department, and division has identified its key processes, mapped them, used a systematic and systemic model (IGOE: inputs, guides, outputs, and enablers) to identify interrelationships and interdependencies of key processes and staff, and determined how to measure process effectiveness. You can read more about IGOE and process management at MCPS in its application summary here.

All key processes have in-process measures that monitor quality such as rework and errors. And no, MCPS is not a manufacturer: It’s a school system, even though its approaches to process management sound like those of a well-run business. If rework and errors continue, a process team determines which improvement method of PDSA (plan/do/study/act) is appropriate: Lean, Six Sigma, or project management.

In its response to Item 7.5, Process-Effectiveness Outcomes, MCPS provides a one-and-a-half page table that lists its key processes, process requirements, and process improvement results. It’s not an ideal response because it doesn’t show trends, but it is certainly comprehensive, and its trends must have been just fine because it passed its site visit.

You can see the list of processes and results on pages 47 and 48 of the MCPS application, which you will find here. To read more about Baldrige and education, hover over the “Sector” tab at the top of this page and then click on “Education.”

A few years ago, I co-authored a white paper outlining The Three Keys to Six Sigma Success.  The paper concluded that, by focusing on the key principles of project selection, securing executive support, and executing the DMAIC method, quality practitioners could increase their overall project success rate. This is proven to be true time and again.

I know what you’re thinking: “OK, but these principles are neither ground-breaking nor new”—and you’d be correct. But what was fairly new at the time was Minitab’s process improvement software, Quality Companion. The all-in-one application supports continuous improvement activities across different levels of a quality program as well as many stages of improvement projects. By summarizing our voice of the customer research into a white paper, we were able to easily draw parallels between the keys for success and Companion’s features, tools, and forms.

Since then, Quality Companion has been updated with Lean Six Sigma support features, including Value Stream Mapping, and its user community continues to grow as does Minitab’s plans for ongoing software enhancements.

So, now you’re probably thinking: “Why is she writing about Lean and Six Sigma on a website that’s focused on Baldrige?”

Because, at their core, Lean, Six Sigma, and the Baldrige model are all systematic approaches to performance excellence. Regardless of the methodology in which you’re currently engaged, Companion can help you build on that systematic approach and improve how you manage projects. I suggest that you owe it to yourself to find out more.

Click the “See It. Improve It.” button on the right to discover why so many quality practitioners use Minitab to analyze their data and use Quality Companion for everything else.   Be sure to download a free 30-day trial of Companion, watch a few videos in the Minitab Theater, and sign up for free webinars.

The education part is the Executive Master of Public Administration: Concentration for Nurse Leaders program at NYU’s Robert F. Wagner Graduate School of Public Service. (Let’s see you fit that on a business card.) For their Capstone project, the six people in the program decided to analyze how much time nurses spend getting the equipment they need to get their jobs done.

They carefully observed nursing staff at New-York Presbyterian Columbia University Medical Center. They wrote down how much time nurses spent with patients. They photographed rooms after patients were discharged. They watched what nurses did when they weren’t with patients and they discovered that nurses had to get supplies for each patient from a central storeroom. It wasn’t a quick trip and it took them away from patients, which meant nurses tended to get everything they thought they might need to avoid return trips. Once supplies are brought to a patient’s room, they must be used or thrown away. If they forgot something or needed more supplies, nurses had to return to the central storeroom. They were often interrupted on their way to and from the storeroom, which increased the risk of error.

From a process management perspective, this process is fraught with waste, from unnecessary supplies being thrown away to long trips to the storeroom to additional trips that wasted valuable nursing time. The process threatens quality of care by compelling nurses to leave their patients to get supplies and distracting them while they are away.

The project’s participants addressed these problems with an elegant solution: They turned the closets in patient rooms, which were rarely used, into nursing supply closets, working with architects, cabinetmakers, and the materials-management department to create a model that is now being piloted. Now nurses can get exactly what they need without leaving the patient’s room and none of what they get is wasted.

One of the fundamental steps in process management and improvement, a step that is formalized in both Lean and Six Sigma, is to map the existing process. The people in this program did it through observation and photographs. If you want to improve a process, start by observing it until you understand exactly how it operates. Careful observation will reveal what needs to be fixed.

To read more about process management, click on these articles:

• The 3 P’s: Starting Points for Integrating Baldrige
• The Value of Lean
• The Benefits of Process Thinking
• Ask What, Not Who
• We Are All Idiots
• 10 Critical Questions: Process Management

The Baldrige Criteria ask two questions about how you keep your processes intact:

• How does the day-to-day operation of your work processes ensure that they meet key process requirements?
• How do you prevent defects, service errors, and rework and minimize costs or customer productivity losses?

The Criteria also ask how you improve your processes. Managing and improving your processes is an ongoing, neverending activity. In “Embrace Systems Thinking” (IndustryWeek, October 26, 2010), Jill Jusko talks with Robert Martichenko and Kevin von Grabe about building a lean fulfillment stream. Martichenko points out that managing and improving your processes requires developing problem-solving skills across the organization. According to Martichenko, 96% of the initial problems in supply chain and logistics can likely be solved using pareto charts, fishbone diagrams, and the “five whys.” That is probably true for work processes in any part of your organization, and the good news is, developing proficiency in these three quality tools does not require a huge investment of time or money.

The focus of the article is on the need to embrace systems thinking to overcome the limitations of the functional silos common to most organizations. Von Grabe “noted that systems thinking says that behaviors or functions are important in how they interact with one another, not how they operate in isolation.” To embrace a systems approach:

1. Understand and articulate the current state of the process.
2. Hold cross-functional, collaborative discussions among those who are suppliers to and customers of the process and those who work the process.
3. Design and deploy the ideal state of the process.
4. Develop a measurement system that focuses on horizontal thinking, not functional performance.

To read more about process management and improvement, click on these articles:

• The Benefits of Process Thinking
• Ask What, Not Who
• 10 Critical Questions: Process Management
• The Process Matrix
• The Power of Process
• The Value of Lean