Malcolm Baldrige National Quality Award
2009 Award Recipient, Health Care
Based in St. Joseph, Missouri, Heartland Health (HH) is a not-for-profit, community-based integrated health system serving the residents of northwest Missouri, northeast Kansas, southeast Nebraska, and southwest Iowa. With more than 3,200 caregivers (employees, volunteers, and health care practitioners), HH is the region's largest health system and employer. HH was developed out of the merger of two prominent St. Joseph's hospitals with the commitment to create an exceptional health care system, contribute to the economic vitality, and improve the overall health of the region. The system is governed by a community board of directors.
- Heartland Health has achieved 90 percent ratings in overall outpatient satisfaction and in key drivers of outpatient satisfaction between 2006 and 2009.
- Members have rated HH’s Community Health Plan above the National Committee for Quality Assurance (NCQA) 90th percentile for health care and specialists’ care.
- HH is ranked in the top 15 percent of hospitals nationally for patient safety according to the HealthGrades (an independent health-care-ratings organization) “Best Hospital Scores.”
- In promoting quality improvement and deploying its core competencies as part of the organizational culture, HH applies Six Sigma methods within its Process Improvement Model to control costs; prevent rework and errors; and minimize the costs of inspections, tests, and audits. Cost savings as a result of process improvements have increased from approximately $8 million in fiscal year 2005 to more than $25 million by fiscal year 2009.
A Lasting Impact on Community Health
Heartland's Health Pyramid was created to illustrate how the system distinctly impacts community health and drives the actions of all HH business units. This visual reminder shows that the underlying cause of death and disease (the tip of the pyramid) is often the result of individual lifestyle choices (the middle of the pyramid). These behaviors (e.g., tobacco use or poor diet) have a significant and costly effect on the patient as well as the health system. The underlying drivers of these individual behavioral choices are a variety of root causes (e.g., stress or poverty) represented at the bottom of the pyramid. By spending time and resources on the middle and bottom of the pyramid, HH expects to see fewer acute illnesses and injuries at the tip of the pyramid.
The three-level Health Pyramid also depicts the structure for HH's business entities. At the top, acute illness and injury are focuses of Heartland Regional Medical Center (HRMC), a 353-bed tertiary care hospital. It provides physician and hospital care services, including cardiac, women's, children's, and primary care; oncology; surgery; orthopedics; and neurosciences. Heartland Clinic, a group practice of 107 physicians, also prevents and treats disease. In the middle of the pyramid, Community Health Improvement Solutions promotes individual health and provides disease management. Heartland Foundation is the organization's outreach arm to help build a healthier, more livable community and to address root causes (at the bottom of the pyramid) by offering lifestyle and civic programs.
The Health Pyramid aligns all HH entities to further its mission to "improve the health of individuals and communities located in the Heartland region and provide the right care" and its vision to make the area "the best and safest place in America to receive health care and live a healthy and productive life."
How well does it work? HH has achieved 90 percent ratings in overall outpatient satisfaction and in key drivers of outpatient satisfaction between 2006 and 2009.
Actions Speak Louder Than Words
Senior leaders use the framework of the Malcolm Baldrige Criteria for Performance Excellence to take action on the organization's mission and strategic objectives. Among the tools used to achieve these objectives are an integrated, organization-wide strategic planning process, balanced scorecards, and a fully deployed performance management system.
Called "Heartland 2020," the organization's strategic planning process ensures sustainability, allowing HH to anticipate health care industry changes in time for course corrections, as well as to plan for major capital, building, and strategic projects.
The balanced scorecard is an important tool in both short-and long-term strategic planning that aligns performance measures with organizational strategies. The scorecard measures are driven down to team leaders and individuals through entity, service line, department, and process performance measurement scorecards.
The People Plan ensures that every element of the caregiver (employee, volunteer, and health care practitioner) life cycle is carried out according to industry best practices and aligns with the HH mission, vision, and strategic framework. The performance management program cascades organizational goals to individual goals, supports caregiver performance through evaluations and individual education plans, and acknowledges caregivers with a rewards program.
The HH culture includes a strong focus on patient satisfaction. HH builds and manages relationships with patients through various tools and processes, including:
- RESPECTcounts: standards developed by employees
- HEART Standard: Hear — listening to the voice of the customer, both internal and external; Excellence— performing work in a professional manner; Appearance— taking pride in both personal appearance and that of the facility; Responsibility— doing all that is expected to meet customer needs and respecting the privacy of patients/ customers; and Teamwork— supporting each other to improve customer service, quality, and safety
- AIDET: Acknowledge, Introduce, Duration, Explain, and Thank, the script given to each caregiver to meet service excellence behavioral standards
The Best and Safest
Patient safety is driven by the vision "to be the best and safest" as a key element of the organizational culture. Senior leadership establishes and monitors patient-safety measures through the use of the patient-safety scorecard. When scorecard measures fail to reach goals, leaders make improvements as necessary.
In 2009, HRMC received the HealthGrades' Patient Safety Excellence Award™. An independent health care rating organization, HealthGrades presents this award to hospitals with overall patient safety records in the top 5 percent of the nation.
HH also received the following recognitions:
- HRMC is among 75 acute-care hospitals nationwide to receive the Superior Quality Merit Award from the 2009– 2010 Hospital Value Index™ study by Data Advantage, LLC.
- The Commonwealth Fund, a nonprofi t quality rating system, ranked HRMC the 19th-best hospital in the nation in 2009, based on measures of evidenced-based care, patient experience, readmission, mortality rates, and costs. In 2008 and 2009, it ranked in the top 1 percent of hospitals.
- HH consistently maintains its Moody's and Fitch bond ratings of A and A2, respectively. In fi scal year 2009, the organization exceeded the Moody's and Fitch current bond rating requirements for days cash on hand and achieved performance in both rating agencies' top 10 percent for total margin and operating margin.
- HH was recognized with the Missouri State Quality Award in both 2000 and 2005.
Contributing to the Vitality of the Community
Heartland Foundation is the catalyst for building partnerships that develop community support initiatives. It researches national and state health policy data to identify community-specific health priorities that address root causes of public health issues. With this information, it identifies partnerships and programs for HH's participation. Ongoing initiatives include the Healthy Communities Program to foster healthier, more livable communities; the Youth Health Partnership with schools to improve health, attendance, and learning; and Circle of Hope to create a system of care for the mental health needs of youth. The Project Fit America Program addresses physical fitness in 43 area schools with 10,800 students participating.
In 2007, the Heartland Foundation partnered with the Environmental Protection Agency to clean up and restore a warehouse in a federally designated "Brownfield" district (blighted/polluted real estate). In its place, the foundation opened a state-of-the-art technology learning center called EmPowerU. This center engages middle- and high-school students in a hands-on curriculum that focuses on civic education, critical thinking, team building, community problem solving, technological skill building, leadership development, and workforce readiness skills.