Expand Baldrige Model to “Substantially Improve the Quality and Cost of Healthcare”

Blog Summary: Research highlighted in the current issue of the American College of Healthcare Executives’ Journal of Health Care Management validates the long-term benefits for health care organizations of using the Baldrige Excellence Framework. Based on those findings, the author suggests that expanded use of the Baldrige framework in the sector could lead to gains for health care patients and consumers.

“The [Baldrige] model summarizes a documented, audited platform for success that has been applied to a wide range of American healthcare. . . . [More organizations using the model could bring] substantial gains for patients, caregivers, and health insurance buyers,” writes John R. Griffith, LFACHE, professor emeritus, University of Michigan Department of Health Management and Policy, Ann Arbor, in a recent article in the Journal of Health Care Management.

In “An Organizational Model for Excellence in Healthcare Delivery: Evidence from Winners of the Baldrige Award,” he writes, “Review of publicly available records suggests that [Baldrige Award recipients] sustain top-quartile performance after the award year and are able to extend it to HCOs [health care organizations] that they acquire."

Based on his research, Griffith adds, “The model could be expanded on a much larger scale. Doing so successfully would substantially improve the quality and cost of healthcare, as well as the satisfaction and commitment of care providers and other staff. The opportunity deserves further study and trial by large healthcare delivery systems, insurers, and consulting companies.”

Through a review of the publicly available applications of Baldrige Award recipients in health care, Griffith explores how excellence has often been “elusive” in American health care because of the “complexity of the healthcare process compounded by the conflicting needs of multiple stakeholders.” Quoting from other literature, he summarizes that excellence in health care requires excellence in caregivers, processes, team coordination, and the integration of teams.

“There is no similar group of documented and audited high-performing organizations” then Baldrige Award recipients, writes Griffith, adding

Winners of the Baldrige National Quality Award in healthcare have documented top-quartile clinical outcomes and patient satisfaction across a variety of American communities and a full spectrum of care. Their results also show high levels of satisfaction among physicians, nurses, and other workers, as well as effective financial performance. The managerial methods they use—collectively, the Baldrige model—are consistent with organizational theory literature and are found across all winners. The winners have sustained excellence after winning and expanded it by acquisition of other healthcare organizations.

According to Griffith, study of Baldrige Award recipients’ publicly available applications has revealed eight consistently applied practices:

1. Commitment to mission and values
2. Culture of empowerment that encourages associates and servant leadership
3. Multidimensional measures and benchmarks
4. Negotiated strategic and unit goals
5. Continuous improvement, with systematic pursuit of opportunities for improvement (OFIs)
6. Evidence-based medicine, with care protocols to guide the care of common conditions and to standardize tasks
7. Training
8. Rewards and recognition

Griffith explains that the Baldrige model differs substantially from traditional management approaches in health-care delivery, with “a shared focus on excellence, systematically responsive management, evidence-based medicine, multidimensional measures and negotiated goals, improvement of work processes, thorough training, and extensive rewards.”

Quoting from the literature, Griffith cites potential concerns with some health care models today, including a lack of understanding customer needs, identifying OFIs, improving processes, thinking from a systems perspective, communicating effectively, being transparent, and prioritizing and translating customer needs based on understanding customers. Also cited was the need for health care organizations to consider processes, including knowledge transfer, at individual, organizational, and strategic levels, as well as to use clinical quality metrics.

Winners of the Baldrige Award should be studied and emulated, writes Griffith, because applying for the Baldrige Award and receiving Baldrige Award feedback make the following statements true.

1. Baldrige Award recipients repeatedly demonstrate top-quartile performance in clinical outcomes and patient satisfaction, in meeting professional and other worker needs, and in business strategy and finance.
2. In search of best practices, they have systematically studied other high-performing organizations, adopting and improving successful processes.
3. Their Baldrige applications provide descriptions of their work processes in the public domain, following a rigorous, detailed outline.
4. Their Baldrige applications are systematically and independently evaluated by several dozen trained experts and extensively audited on-site by senior experts.

“There is no similar group of documented and audited high-performing organizations,” writes Griffith. “To put the sample in perspective: If a similar group of institutions reported an innovative protocol for a single disease and with a similar improvement from median to top-quartile outcomes, the achievement would receive widespread attention. The operating model that these HCOs have developed deserves similar attention. If there are unique conditions creating this excellence, they should be identified; if there are not, the model should be standard practice in every American HCO.”

Griffith also comments on the cost of adopting the Baldrige model and applying for feedback through the Baldrige Award: “From the outside, Baldrige looks expensive. Aggressive process improvement, added training, and bonuses will clearly cost. The winners’ evidence indicates the opposite. Publicly available bond ratings suggest that Baldrige winners are financially successful, even when performing in challenging markets. Their journeys also reveal that the transition funds itself as it goes. Large upfront capital is not required; savings are found and celebrated in the early years to fund rewards and further improvements.”

The complete article “An Organizational Model for Excellence in Healthcare Delivery: Evidence from Winners of the Baldrige Award” can be found in the Journal of Health Care Management, September/October 2017, Volume 62, Issue 5, published by Wolters Kluwer Health, Inc. Copyright © 2017, (C) 2017 Foundation of the American College of Healthcare Executives