A Doctor Who Launched an Innovative Surgery Center during His Baldrige Fellowship

Dr. Brett Simon’s learning experiences as a Baldrige Executive Fellow in the 2014–2015 cohort paralleled his on-the-job learning at the start of his leadership of a new, groundbreaking cancer treatment facility.

In the following interview, he shares how he used the Baldrige Excellence Framework (which includes the Health Care Criteria for Performance Excellence) to enhance planning for the innovative surgical hospital he directs in New York City.

What inspired your capstone project?

I was just about to move to a new position when I started the Baldrige Executive Fellows Program in April 2014, so my capstone was essentially my new job! I joined Memorial Sloan Kettering (MSK) Cancer Center as the director of the Josie Robertson Surgery Center (JRSC), a novel short-stay surgical hospital, while it was still under construction.I was tasked with completing the planning and providing strategic and operational leadership for the facility. This was an especially exciting opportunity because the MSK leadership was committed to making JRSC an innovation center, which would be dedicated to pushing the boundaries in performing increasingly complex cancer surgery in the ambulatory (single overnight stay) setting, with a focus on a superlative patient experience, efficiency, and data-driven continuous improvement.

Since my job was essentially to build out this new organization from the ground up, learning about and visiting high-performing organizations through the Baldrige Fellows program provided amazing insights and examples that were literally “just in time” for my work at JRSC. My capstone then became three of the elements of building this organization: (1) articulating the goals and vision; (2) recruiting the “right” workforce; and (3) defining the priorities for management systems and data collection to support a culture of collaboration and continuous improvement.

What were some milestones of your project? How did feedback from sharing your capstone progress with other Fellows help you, if applicable? 

My capstone timeline very much tracked key milestones in building out the JRSC program. My first milestone of drafting the Organizational Profile [the preface of the Baldrige Criteria] paralleled my own learning about the organization I had just joined and triggered me to ask different and deeper questions than I would have asked without its comprehensive and objective guidelines. Next, revising this Organizational Profile together with my newly recruited leadership team at JRSC provided a unified starting point for establishing our organization’s mission, vision, and values. We then established a paradigm for staff recruitment based on these values, defined competencies, and cultural compatibility.

These same principles fed into defining both internal and external communications strategies and messaging—another milestone in my Baldrige Fellows capstone project. I found that having to articulate and defend these plans and processes against the Baldrige framework, combined with feedback and advice I received from other Fellows and the Baldrige team, allowed me to tap into a wealth and breadth of knowledge, varied perspectives, and experience that l would not otherwise have had access to. Because my program evolved from concept to execution during the fellowship, the advice allowed my work plans to improve in real time!

How will changes you’ve led improve your organization for the long term? Could you please describe any results or impacts so far of your project? 

The JRSC opened on schedule 18 months ago and rapidly ramped up to full speed. Since then, we have performed over 11,000 surgeries—38 percent of which involved patients staying overnight—and have demonstrated outstanding performance on all measures, including quality and safety (e.g., extremely low patient transfers, urgent care visits, and hospital readmission rates), operational efficiency (including on-time starts, turnovers, case cancellations, and supply-chain metrics), and patient satisfaction (e.g., patient-reported outcomes, satisfaction survey responses, and spontaneous communications such as letters from patients and blog posts). About 75 percent of eligible surgical cases are now performed here at JRSC, significantly decompressing the demand on overnight beds and operating room (OR) capacity at MSK’s main hospital six blocks away.

Since we are a small, contained, and nominally nimble subset of a large and traditional academic medical center, one of our goals is to develop and test new processes and technologies for eventual spread to the greater organization. Already we have been able to transfer new electronic nursing documentation that enables structured data collection for decision support and clinical pathway management; patient and family communication monitor screens (and soon, real-time text notifications); standardized preoperative patient evaluation and preparation; a new model for dedicated OR physician assistant support; and the use of a real-time locating system interfaced to the electronic medical record that automates data collection and communication to facilitate flow and keep staff members focused on patients rather than computers.

Our work with electronic, patient-reported, post-operative symptom tracking has led to a federal research grant (through the nonprofit Patient-Centered Outcomes Research Institute; PCORI) for studying different ways of managing and acting on these patient responses. The system we built to do this is being adapted and scaled to other areas of cancer care where patients have significant symptoms, such as chemotherapy.

What were your key learnings from the Baldrige Executive Fellows program?

As a physician who backed into administration from a clinical and research background, the Baldrige Executive Fellows program provided two important perspectives for me. First, it presents a compact introduction to the Baldrige framework, which is in itself an amazingly helpful approach to understanding how organizations work and how they work effectively (or don’t). Second, the insights I received from visiting Baldrige Award winners, meeting their teams and witnessing their processes, and discussing these observations and the journey to get there with the leadership all solidified the theory into real practice.

For me, concepts around defining culture (“stated beliefs AND observed behaviors”) and building the right culture ("screen for skills, recruit for culture") directly informed my actions. I also shamelessly borrowed ideas I learned during the Fellows program around communication, staff and leadership huddles, the voice of the customer, cascading goals, measurement, and valuing workforce members. I even kept a copy of the “Baldrige Core Values and Leadership Behaviors” posted above my desk!

Could you please describe the value/benefits you see of the Baldrige Excellence Framework to health care organizations like yours today?

I think that many health care organizations do many of elements of the Baldrige framework very well. However, through the Baldrige Executive Fellows Program I learned and fully agree that using this framework to make sure that all the elements are addressed is essential to building and improving an effective organization.