Malcolm Baldrige National Quality Award
2019 Award Recipient, Nonprofit
Located in Pittsburgh, PA, the Center for Organ Recovery & Education (CORE) is a nonprofit organ procurement organization (OPO) with a federally designated service area encompassing a population of 5.5 million in western Pennsylvania, West Virginia, and one county in New York. One of 58 independent, nonprofit OPOs designated by the Centers for Medicare and Medicaid Services, CORE’s mission is to save and heal lives through donation.
- CORE has maintained performance among the top 10% of the nation’s OPOs from 2014 through 2019.
- For all four of CORE’s key customer groups—donor families, transplant centers, corneal transplant surgeons, and tissue processors—results show satisfaction levels above 90%. The satisfaction rate for donor families has been between 95 and 100%.
- In a best-practice OPO partnership called LINC, which included two previous Baldrige Award-winning organizations, CORE has developed algorithms to help normalize results data so that OPOs can better measure and improve their performance through comparison and benchmarking. CORE’s information technology team has also worked closely with the Association of Organ Procurement Organizations (AOPO) to build a tool to examine infrastructure, data, and integration in order to advance OPOs’ best practices.
- As the result of managing the costs, efficiency, and effectiveness of its operations, which led to two on-site operating rooms and research laboratories, CORE achieved cost-savings of over $300,000 in 2014, over $600,000 in 2018, and over $2.6 million to date.
Mission-Driven Leadership with Industry-wide Impact
- Senior leaders have ensured that CORE’s mission “to save and heal lives through donation” drives the culture, as the staff works to encourage and maximize every possible life-saving donation across three states. Through CORE’s four-step leadership system, the mission, vision, and values are set; evaluated for improvement; and communicated throughout the organization, including to those based at partner. The mission-centric focus drives leaders’ decision making and all nine key processes of CORE’s donation work system: education to foster donor self-designation; evaluation of donor organs and tissues for transplantation; authorization, allocation and recovery, and disposition of donated organs and tissues; and services to honor donors’ families.
- CORE has taken a lead role as a high-performing organ procurement organization (OPO; in a best-practice OPO partnership called LINC, which includes two other Baldrige Award-winning organizations) to develop algorithms to help normalize results data so that OPOs can better measure and improve their performance through comparison and benchmarking. CORE’s information technology (IT) team has also worked closely with the industry-wide AOPO to build a tool to examine infrastructure, data, and integration in order to advance OPOs’ best practices.
Measuring and Managing Data for High Performance
- CORE has maintained performance among the top 10% of the nation’s OPOs from 2014 through 2019 for the key industry measure of organ conversion rate, which is the percentage of authorized donations obtained through first-person or next-of-kin authorization. CORE’s rolling, three-year rates have been approximately 7 to 10 percentage points higher than all but one peer in its comparison group of top-performing OPOs for five years.
- CORE continuously monitors its performance on key measures through corporate and department-level dashboards, with measures cascading from dashboards and scorecards to action plans. Measures are tracked daily, weekly, monthly, quarterly, and annually using resources such as the “data mall,” which was built in-house by CORE’s IT staff. To improve efficiency and effectiveness, CORE uses methods such as analysis of strengths, weaknesses, opportunities, and threats; a leadership-initiated “catch-ball” process that spreads best practices through workforce communication and consensus as part of the annual strategic planning process; and a program fostering employee-submitted “Great Ideas.”
- To project its future performance, CORE uses predictive analytics of historical data and external benchmarks and trend data. For example, the clinical department uses linear regression models to forecast the number of organs recovered, a key strategic measure for CORE. The human resources department uses a forecasting model to maintain optimal workforce skills and capacity; this model has been continuously improved to address the challenge of daily fluctuations in staffing needs for CORE’s uniquely reactive industry.
Operational Effectiveness and Emergency Readiness
- CORE is an industry trailblazer for having its laboratory do infectious disease testing and biopsies in house, and the organization has cut recovery-to-transplant time on life-saving organs as pathologists can review CORE’s biopsy samples remotely via computer. For the past five years, CORE has continuously improved its lab biopsy turnaround time (measured in minutes taken to complete biopsy processing). In addition, CORE has reduced its lab error rate from approximately 5.5% in 2015 to 4% in 2019. In the same period, CORE’s lab has decreased its cycle time to complete testing on specimens for transplantation from nearly 500 minutes in 2015 to well under 400 minutes in 2018. For this measure, CORE has maintained performance levels at or below comparisons since 2016, with its cycle time in 2018 at least 100 minutes less than the comparisons.
- CORE’s continuously improved methods of managing the costs, efficiency, and effectiveness of its operations led to construction of two on-site operating rooms and research laboratories. As a result of moving donors to its site, CORE achieved cost-savings of over $300,000 in 2014, over $600,000 in 2018, and over $2.6 million to date.
- CORE’s business continuity plan includes a partnership with an OPO in another state that minimizes risks for both organizations by allowing them to support each other’s operations during an emergency in order to provide continuous service to their respective areas. The comprehensive plan addresses the IT and other needs of CORE’s suppliers, partners, and workforce members. CORE’s plan was recognized by the industry wide AOPO as a best practice in 2018 in its reaccreditation survey.
- For at least four years, CORE’s results have matched or outperformed those of comparators for measures of days-cash-on-hand, operating revenue, research revenue, current ratio, and organ revenue. For example, the number of days of operating expenses that CORE could pay with its currently available funds (days-cash-on-hand) is around 600, compared to the comparisons of less than 250. And CORE’s research revenue last year of about $325,000 is more than five times that of partners (at about $60,000).
- CORE’s integrated processes for donor evaluation and organ/tissue recovery have significantly reduced costs for processing six out of eight organ types (kidney, liver, heart, single lung, double lungs, and heart/lung) relative to other high-performing peers, partner hospitals, and industry comparisons. For example, CORE’s average cost for the heart/lung combination is currently more than 50% lower than that of both comparator groups (below $40,000 per heart/lung compared to a cost of more than $60,000 for the other two groups). CORE has continued to enhance the efficiency and effectiveness of its clinical processes, with improvements such as adding in-house anesthesiologists.
- CORE’s relatively low costs mean that the organization is charging transplant centers—a key customer group—less for all organ types except pancreas and small bowel (which are both transplanted at lower volumes).
- For all four of CORE’s key customer groups—donor families, transplant centers, corneal transplant surgeons, and tissue processors—results show satisfaction levels above 90% in recent years. The satisfaction rate for donor families has been between 95 and 100%; the rate for transplant centers is above 90%; and the nearly 100% satisfaction rate for tissue processors last year outperformed the comparison of around 90%. In addition, ratings show that overall satisfaction among the corneal transplant surgeons served by CORE is averaging 5 on a scale of 1 to 5, outperforming the comparison average of below 4.8.
- CORE customer complaints declined from 2016 through 2018, and the decreasing number has exceeded corporate goals in six of eight months to date in 2019. In addition, CORE’s performance on a measure of its social reputation improved by 20 points (from 60 to 80 on a scale to 100) from 2016 to 2018.
Workforce Engagement and Development Results
- CORE’s overall employee retention rate of nearly 90% last year outperformed the national industry average of less than 85%—and is projected to reach about 95% for 2019. Results for several dimensions of CORE’s employee satisfaction survey—including connection to the mission as well as competitive benefits and salary, organizational sustainability and growth, and co-worker relationships—are in the top 25% of comparison health care organizations.
- Reflecting CORE’s commitment to workforce development, all employees must participate in at least ten hours of professional development per year. Results since 2016 show that this goal has been met and exceeded for the past four years, with CORE employees on average completing 12 to 13 hours of professional development annually, with the trend projected to increase to 15 hours for 2019. In five years, CORE has doubled its investment in professional development costs for its workforce, from less than $60,000 in 2014 to more than $120,000 in both 2018 and 2019. This investment includes supporting employees to attend conferences to obtain education and build relationships.
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