THE BALDRIGE AWARD

Amit Prasad, MD, MBA

Copyright © 2021, Amit Prasad, MD, MBA. All Rights Reserved

DISCLAIMER

The views expressed in this presentation are mine and do not represent the official position of MBNQA, NIST, United Healthcare or any other official entity

In preparation for the presentation, I did the usual topic research….

In an increasingly crowded global marketplace, it can be hard to stand out. Back in the day, competition came from companies that looked just like yours. That is no longer the case. With an always-online hyper-connected economy, your competition could come from an industry so far removed from the one that you are in that it hardly makes sense…and yet if you aren’t watching, your business can find itself on the precipice of being made redundant by a company you never saw coming. (Think Uber to cabs or AirBnB to hotels…or even more recently Amazon to grocers.) It is not at all far-fetched…and with artificial intelligence and other forms of digitization, who knows what the future holds?

https://sig.org/6-positive-benefits-winning-corporate-award

Baldrige: What? Why? How?Baldrige in HealthcareInstitution or Leadership?Snapshot or Streaming?To Be or Not To Be (a Baldrige Examiner)

WHAT IS THE BALDRIGE AWARD?The Malcolm Baldrige National Quality Award, the nation's highest honor for organizational innovation and performance excellence.

Howard Malcolm “Mac” Baldrige An American businessman who

served as Commerce secretary from 1981 until his death in 1987 A proponent of quality

management Helped create the US Quality

Improvement Act of 1987

WHAT IS THE BALDRIGE AWARD?

Malcolm Baldrige National Quality AwardEstablished by the US Congress in 1987Raise awareness of Quality ManagementRecognize US companies for performance excellenceEnhance competitiveness of US business

WHY EMBARK ON A BALDRIGE JOURNEY?

The Baldrige Program provides a path to organizational excellence and a community for those dedicated to helping organizations improve.

Baldrige provides a framework to improve and sustainOffers criteria, assessments, tools, trainingOrganizations are using Baldrige to gain an edge over their competition

THE BALDRIGE EXCELLENCE FRAMEWORK

The Baldrige Excellence Framework and its Criteria for Performance Excellence incorporate proven practices on current health care leadership and

management issues into a set of questions

The criteria for performance excellence start with leadership and end with results.

The focus is on core values

PURPOSE OF THE FRAMEWORK….

The purpose of the Baldrige framework is simply to help your organization answer three questions:

Is your organization doing as well as it could?How do you know?What and how should your organization improve or change?

Aim: Performance Excellence

HOW DOES BALDRIGE WORK?

A nonprescriptive framework Empower the organization Improve results Enhance competitiveness Incorporate proven practices on L and M

By asking a set of questions that help manage all the

components of the organization as a unified

whole

WHAT ARE THE CORE VALUES? Systems perspective Visionary leadership Customer-focused excellence Valuing people Organizational agility Focus on success Innovation Management by fact Societal responsibility Ethics Delivering value and results

WHAT ARE THE MOST CRITICAL ISSUES BEFORE HEALTHCARE TODAY?

Resilience

Patient and Workforce Safety

Innovation

Diversity, Equity and Inclusion

Cybersecurity

Societal Responsibility

Digitization and Technology

HOW DOES BALDRIGE HAVE AN IMPACT?Strengthening US competitiveness

1. Improve organizational processes, capabilities, and results

2. Communication and sharing of best practices3. Tool for understanding and managing

Organizational performanceGuiding your strategic thinkingProviding learning

BALD

RIGE

AN

D HE

ALTH

CARE

ORHow did an award to improve quality of

goods and services in US companies get into healthcare?

BALDRIGE AND HEALTHCARE

• Health care organizations became eligible for the Baldrige in 1999.

• The first winner, SSM Health Care (St. Louis, Missouri, USA), was announced in 2002.

• To date: 29 HC entities have awards (2 have won it twice) out of a total of 133 awards

BALDRIGE AND HEALTHCARE• Emphasis on long-term results• Importance of levels and trends and comparisons• Focus primarily on results and secondarily on leadership• Impact on organizational alignment and integration- critical in

healthcare• They move organizations from providing good quality care for

one patient one time to all patients all of the time. • Baldrige Award to help bring down the cost and improve the

quality of health care across the United States1.

1: President’s Council of Advisors on Science and Technology

Healthcare System Awarded inCurrent CMS Star Rating (Oct 2020)

Current Leapfrog Grade (Fall 2020)

Super-score** Highlights BA on W* Other Awards since Baldrige

Greater Baltimore Medical Center 2020 5 B 9 CMS 5-star Y

6701 N. Charles St. Benchmark performance

Towson, MD 21204 Communications with doctors

https://www.gbmc.org Data and IT systems

Cash to Total Debt ratio increased 200% to 340%

Growth in inpatient market share

Wellstar Paulding Hospital 2020 4 A 9 Top-decile mortality performance N

805 Sandy Plains Road Pressure Ulcer rate of ZERO for 2 years (2018-2020)

Marietta, GA 30066 Top-decile performance on several patient engagement metrics

Employee engagement

Leapfrog A since 2017

Adventist Health White Memorial2019 3 B 7 Zero ED returns post outpatient surgery since 2018 Y-> 1 click

Leapfrog “Grade A” Fall 2019

1720 E Cesar East Chavez Avenue Near-perfect performance of Door-to-Balloon times since 2013 California Awards for Performance Excellence’s (CAPE™) Eureka Gold Award

Los Angeles, CA 90033 Creation of a "gang-neutral" zone to decrease crime Gold Plus Quality Achievement Award and Target Stroke Elite Plus Honor RollAA+ rating

Top-decile performance in complication rates

Mary Greeley Medical Center 2019 5 C 8 CMS 5-star Y Magnet recognition 2019 Feb

1111 Duff Avenue Top-declie health care results including READ, Mortality

Ames, IA 50010 Top-decile HCAPHS performance

Dominant market share despite small size

Memorial Hospital and Health Care Center 2018 5 C 8 CMS 5-star since ratings were released Y Magnet recognition 2020 Apr

800 W. 9th Street Zero pressure ulcers

Jasper, IN 47546 Zero CLABSIs

Dominant market share

Low RN turnover rate (2% compard to national average of 10%)

Adventist Health Castle2017 4 A 9 Low nosocomial infection rates Y-> 2 clicks

Lown Institute Hospital Index's list (25th nationally, #1 in HI)

640 Ulukahiki Street Zero CAUTIs

Kailua, HI 96734 Improved performance on patient safety (top quartile)

Top-decile measurements on physician engagement

Top performer in Value-Based Purchasing

Southcentral Foundation2017 N/A N/A Unique health care delivery system supports wellness Y-> 2 clicks

4501 Diplomacy Drive Top-decile HEDIS performance

Anchorage, AK 99508 Dominant market share

70% of behavioral health patients receive same day consultations

Decrased staff turnover (from 14% to 12%)

Kindred Nursing and Rehab 2016 - - CMS 5-star for 7 years APPEARS TO HAVE CLOSED

601 West Cameron Avenue Top-box customer satisfaction rates 100%

Kellogg, Idaho 83837 Employee retention rate 90%

Occupancy rates 90% (exceeding national benchmarks) from 2010 to 2016

Memorial Hermann Sugar Land Hospital2016 3 A 8 Top-decile performance on several metrics Y-> 1 click

U.S. News & World Report Hospital Rankings in speciality care (?year)

17500 W. Grand Parkway South Employee retention rate 90% Magnet award

Sugar Land, Texas 77479 90th percentile in "likely to recommend" Recognition for High Quality Stroke Care

Operating earnings have exceeded S&P's national medianThe American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP®) meritorius award

Charleston Area Medical Center Health System2015 1 D 3 Top-performer fr quality inpatient service by Healthgrades Y-> 3+ clicks

501 Morris St. Top-decile outpatient patient satisfaction metrics

Charleston, WV 25326 Reduction in sepsis-mortality

Community-benefit expenditures exceed national average by 76%

Largest provider of uncompensated care in WV

Hill Country Memorial2014 5 A 10 Top-100 Great Community Hospitals by Becker's Hospital Review in 2014 N

1020 Highway 16 South Top-decile performance in employee satisfaction

Fredericksburg, Texas 78624 Outperformed every TX hospital in VBP

Significant improvement in financial situation from 2010 to 2013

St. David's Healthcare2014 5 A 10 Top-deccile core measures performance reported by CMS (since 2009) Y

Nation's 100 Top Hospitals® By Truven Health Analytics 2014 March

98 San Jacinto Blvd., Suite 1800 First health system in TX to be named "TX Employer of the Year" Texas Ten Step Facilities 2014

Austin, Texas 78701 Improving trends in HCAHPS

Provision of uncompensated care, charity care

Sutter Davis Hospital2013 5 C 8 Top-decile performance in MI, CHF, PNA Y-> 3+ clicks

U.S. News & World Report Best Hospitals 2020

2000 Sutter Place Top-decile performance in READ, LOS for above American Heart Association/American Stroke Association Get with the Guidelines 2020

Davis, Calif. 95616Door-to-doctor time in ED decreased from 45 min to 22 min in 4 years

U.S. News & World Report Best Hospitals 2019Top-decile performance in employee satisfaction Truven Health Analytics™ Top 15 in 2016

North Mississippi Health Services2012 3 B 7 Top-decile HCAHPS Y-> 3+ clicks

The Leapfrog Group award for “A” Hospital Safety Grade Fall 2017, Fall 2018, Spring 2019, Fall 2019, Spring 2020

830 S. Gloster St.Capturing innovative ideas from workforce with 40% implementation rate

American Heart Association/American Stroke Association Get with the Guidelines 2020

Tupelo, MS 38801 Top-decile employee retention rate ACS NSQIP Meritorious Award 2015 & 2016S&P AA rating for past 18 years

Henry Ford Health System2011 2 C 5 Top-decile CMS core measures performance Y-> 3+ clicks

The American Hospital Association – McKesson Quest for Quality Prize (? Year)

1 Ford Place, 3A Positive net-operating income The John M. Eisenberg Patient Safety and Quality Award 2012 Mar

Detroit, Mich. 48202Health Plan Rated #1 in patient satisfaction among all health insurance plans in MI

Community benefit efforts contributed $5.8 B to SE MI

Schneck Medical Center2011 5 C 8 Top-decile patient satisfaction scores Y-> 3+ clicks

Magnet Recognition for Nursing Excellence 2016, 2011

411 W. Tipton St. Excellent financials Quest For Quality, American Hospital Association 2015

Seymour, Ind. 47274 Overall staff turnover decreased 25% from 2007 to 2011 Blue Distinction Center 2016Simulation lab is shared with local businesses for training Becker Hospital Review Top 100 Great Community Hospitals: 2013, 2017

Southcentral Foundation2011 N/A N/A Unique health care delivery system supports wellness

Y-> 2 clicks Anchorage School District Spirit of Tomorrow Award (2014)

4501 Diplomacy Drive PCMH recognition from NCQA Indian Health Service Director’s Award (2012)

Anchorage, AK 99508 Improved access to care

Staff turnover decreased from 37% (2008) to 17% (2011)

COMMON THEMES IN BALDRIGE WINNERSBenchmark performance

Employee engagement

Financial results

Market share

Patient outcomes

Customer satisfaction

IS BALDRIGE REALLY AN ACCURATE GAUGE OF PERFORMANCE EXCELLENCE?A 2011 Thomson Reuters study compared Baldrige hospitals (award winners and applicants receiving site visits) to 100 Top Hospitals award winners and found:

• Are more likely to win a 100 Top Hospitals national award.• Are more likely to display a faster pace of performance improvement over a

five-year period.• Are 83% more likely to win a 100 Top Hospitals national award for excellence• Baldrige hospitals outperformed non-Baldrige hospitals in practically all

individual performance measures used in the 100 Top Hospitals composite score.

….ACCURATE GAUGE?According to Thomson Reuters, hospitals using the Baldrige criteria were 6 times more likely to be in the top 100 hospitals and outperformed non-Baldrige hospitals in:

• Risk-adjusted mortality index• Risk-adjusted complications index• Patient safety index• CMS core measures score• Severity-adjusted average length of stay• Adjusted operating profit margin

HOW HAVE BALDRIGE WINNERS FAIRED?

HENRY FORD Nancy Schlichting became the CEO of Detroit-based Henry

Ford Health System in 2003

The culture, Schlichting recalls, was described as “a thousand points of veto.”

HFHS won the Baldrige in 2011 (“Hotbed of innovative solutions”)

It got to that point through Schlichting’s leadership

“You can have all the right tools at an organization. But if you don’t have the leader articulating a vision and

involving and engaging people, it is just not going to work.”

HENRY FORD IN DEC 2019 Henry Ford won a direct contract with GM that started in 2019

The five-year contract includes increasing downside financial risk tied to financial and health-quality measures.

Factors that helped Henry Ford win the GM direct contract included its: Ability to drive care delivery changes Experience with measurable, quality-driven contracts Ability to manage large amounts of data Comprehensive clinical and administrative connectivity and interoperability Ability to meet network requirements Ability to take on growing financial risk and quality requirements over the term of the

contract Ability to provide “concierge” service

ST. DAVID’S HEALTHCARE

Top-decile core measures performance reported by CMS (since 2009)

First health system in TX to be named "TX Employer of the Year"

Improving trends in HCAHPS

Provision of uncompensated care, charity care

Highlights of the Baldrige Award:(Awarded 2014)

Customer focused Recognizing people Revenue growth Market share

ST. DAVID’S HEALTHCARE TODAY*

The system remains a high achiever on the CMS and Leapfrog grades: Current CMS Star rating (Oct 2020): 5 Current Leapfrog Grade (Fall 2020): A

It remains a market leader

It continues to invest in the community

*2020

CHARLESTON AREA MED CTR HS

Baldrige 2015

Highlights then: Top-performer for quality inpatient service by Healthgrades Top decile outpatient patient satisfaction metrics Reduction in sepsis mortality Community-benefit expenditures exceed national average by 76% Largest provider of uncompensated care in WV

CHARLESTON AREA MED CTR HS NOW*

CMS Star rating (Oct 2020): 1

Leapfrog Grade (Fall 2020): D

US News Best Hospitals: Cancer scorecard: 30.4/100 Cardiology: 33.5/100 DM and Endocrinology: 30.6/100 Gastroenterology and GI surgery: 40.1/100 Orthopedics: 22.9/100 And so on….

*2020

**HS

Baldrige 2012

Baldrige Highlights: Top-decile HCAHPS Capturing innovative ideas from the workforce with 40% implementation rate Top-decile employee retention rate S&P AA rating for the past 18 years

**HS TODAY*

CMS Star rating (Oct 2020): 3

Leapfrog grade (Fall 2020): B

US News Best Hospitals: Cancer: 19.6/100 Cardiology and Heart Surgery: 19.6/100 Diabetes and Endocrinology: 32.7/100 Gastroenterology and GI surgery: 40.4/100 Orthopedics: 29.2/100 And so on….

*2020

AND THEREIN LIES A TALE

So, let us take a deeper dive into what happens if the Baldrige becomes less of a

journey and more of a destination

BALDRIGE- A JOURNEY OR DESTINATION…Institution received the award in mid 2000sWhile middle and senior leadership was involved, most physicians were notThus, physicians had no ownership in this process

“Leadership system should include both health care provider and administrative/operational

leaders”*

*Baldrige Core Value-Visionary Leadership

BALDRIGE- A JOURNEY OR….

Be Careful What You Wish ForMiddle leadership suddenly had fat resumesMoved on to bigger and greater thingsNew leadership disconnect with CEO and overall directionWhat Baldrige?

BALDRIGE- A JOURNEY OR….

Déjà vu….Consultants….Focus on the words….Leadership exit….CEO exit….What Baldrige?

AND ONE EXAMPLE FROM OUTSIDE HEALTHCARE

Why Baldrige? Reflections of a Retired New England Business Leader

Western Electric- five years later

New management stopped using the Baldrige Criteria

Unresolved failures increased

“Life was much happier and more productive”

Not long after, the plant closed. The community lost what had been a 10,000-employee factory in 1980—one that had an annual $1 billion economic impact in the

area

BALDRIGE- AN AWARD, OR….

What happens post-award?Should it BE an award?Celebrating a snapshot or streaming a movie?“Are we there yet” OR an ongoing journey?

….A CERTIFICATION?

Baldrige should be a continuing journeyInstitutions should approach this as an accomplishment to be maintainedNot a “Win it, Resume It, Move on” mindsetInvolve the whole organization and “deep bake”

BALDRIGE EXAMINER Examiner

Why did I volunteer

What it took

BALDRIGE EXAMINER

How did my “applicant-side” experience change my examiner approach?Are there roots and are they deep?

IN CONCLUSION….

Embarking on a Baldrige journey will help your organization achieve performance excellence

It is especially relevant in healthcare

As with everything in life, some achieve greatness, some maintain greatness, and some appear to squander

Leadership, leadership, leadership

Baldrige is a journey and not a destination

Serving as a Baldrige examiner is an enriching experience

Questions?