With the Baldrige Performance Excellence Program’s 28th Annual Quest for Excellence® Conference currently underway, national role models in every sector are showcasing their best practices. They’re also sharing candid stories of their organization’s “journeys” of improvement using the Baldrige framework.
Following is the first of four blogs that will convey highlights of the plenary presentations delivered by each of the senior leaders of the four 2015 Baldrige Award recipients (in alphabetical order): Charleston Area Medical Center Health System (health care), Charter School of San Diego (education), Mid-America Transplant (nonprofit), and MidwayUSA (small business).
Charleston Area Medical Center Health System (CAMCHS)
At the outset of his leadership plenary presentation, Charleston Area Medical Center Health System President and Chief Executive Officer David Ramsey noted with amusement that his organization’s acronym has also been said by employees to stand for “Change and More Change.” “Can you think of any field that is under more transition?” he asked rhetorically, adding that health care is a large part of the national economy and under rapid change. Given that his organization opted to undertake more changes as part of its Baldrige improvement journey, he said he accepted the employee quip about “Change and More Change” as apropos and decided to adopt it as the title of his leadership presentation.
The CAMC Health System encompasses four hospitals; 38 physician sites; a foundation; and a health, education, and research institute. CAMC is the largest, not-for-profit hospital and the third-largest employer in the state, and it is also the largest non-governmental business in the region, said Ramsey. In size, the organization is in the top 1 and half percent of hospitals in the nation, he stated.
The organization has defined its mission as “striving to provide the best health care to every patient every day,” and it has adopted quality, service with compassion, respect, integrity, stewardship, and safety as its core values. CAMC Health System’s vision—to be the best place to receive patient-centered care, to work, to practice medicine, to learn, and to refer patients—“is what we’re all about,” said Ramsey. “As an organization, all of these are key to our success and what we do, day in and day out.”
Milestones of the Journey
In reviewing his organization’s performance improvement journey, Ramsey described how in 2000, when he arrived to lead CAMC Health System, “we started what we began to see as a transformational process for our organization by incorporating Six Sigma into our process improvement and quality results.” The process improvement methodology helped the organization focus on removing variation in its clinical outcomes, he said.
But by 2005, Ramsey recalled, “we decided we needed something to really help focus our organization” on all its systems because its work extended beyond taking care of patients, he explained. That year the health system began learning about the Baldrige framework. While Ramsey lightly observed that learning the Baldrige framework initially felt like learning a foreign language, he continued, “It took us down the road, and it’s been very helpful for us.” In 2007, two researchers from Harvard’s public health school identified CAMC as one of the top-quality hospitals in the nation.
According to Ramsey, the organization, proud of its clinical results at that time, then applied for the national Baldrige Award. “I’m embarrassed to tell you we got a band 2 [score],” Ramsey said. “Some of our processes needed more attention.” CAMC Health System participated in the Baldrige Award process again for the next two years, shared Ramsey, and “each time we got a little better.” In 2008, the organization took a hiatus from applying for awards and launched Transforming Care Together (TCT) to focus on improving its systems, said Ramsey.
In 2013, the organization applied for a Baldrige-based award with The Partnership for Excellence (TPE) program, which serves organizations in West Virginia as well as Ohio and Indiana. CAMC Health System received the second-level (silver) award in the TPE program that year; when it applied again in 2014, it received TPE’s highest-level (platinum) award. In 2015, CAMC Health System submitted an application for the national Baldrige Award, this time earning it. “People are the key,” Ramsey concluded of his organization’s journey and crowning achievement. “The leaders in the organization are the key.”
Lessons Learned and Role-Model Practices
Ramsey explained that the organization’s leadership system had once been depicted as a train (to represent the state’s coal industry) moving to the top of a mountain. Among the organization’s learnings from its Baldrige journey, he mused, was that “it wasn’t much of a system.” So the organization “totally changed it,” he said. The improved leadership system (depicted below) puts patients in the middle, along with employees, the community, and the organization’s various partnerships. Ramsey pointed out that the organization also now focuses on communication, making it “a critical part” of the leadership system.
In addition to its leadership system, CAMC Health System considers its role-model practices to include communication and transparency, its performance improvement culture, its learning environment, and its “Grow Our Own” workforce development system. The organization’s performance improvement culture begins with strategic planning, with a goal cascade process in which the senior leadership team cascades corporate goals to every department and every employee.
Ramsey showed an example of a “Top 5 Board” that his organization uses to create transparency and communicate as part of the Transforming Care Together focus. Ramsey said that 198 of the boards are posted in public areas throughout the organization. The Top 5 Boards enable any patient, family member, or other visitor to see what each area of the organization is focused on improving, based on the strategic plan.
Mentoring and developing people within Ramsey’s organization is important, especially given that the demographics of its small, aging community make recruiting new workforce members difficult. CAMC Health System’s focus on cultivating a learning environment supports its system to develop leadership and clinical talent. “We have a philosophy of growing our own,” said Ramsey. “Half of our medical staff trained at CAMC, at least for some aspect of their clinical training.” He added that 30 percent of his organization’s pharmacists and nearly 100 percent of its nurses and nurse anesthetists are trained at CAMC.
As the largest charity-care provider in the state, CAMC Health System has taken steps to proactively address community health. The organization founded West Virginia’s Kanawha Coalition for Community Health Improvement (KCCHI) to promote community health in 1995, Ramsey said, with CAMC serving for more than 20 years as an incubator. In carrying out its core competency of improving the health and economics of the community today, CAMC Health System also works with a local community foundation to create jobs, said Ramsey.
Challenges and Results
The state of West Virginia’s challenges include an aging population; widespread poverty; high unemployment; and health risks such as tobacco use, obesity, and physical inactivity. CAMC Health System provides more uncompensated care than any other organization in the state, with 70 percent of its patients insured through Medicaid or Medicare and thus paying lower fees. Given its location in a state with an economy that is not growing, Ramsey said, the organization’s sustainability depends in part on ongoing cost reductions. “Every year we have to figure out how to take millions of dollars out of our operating budget to sustain the organization,” said Ramsey.
“We think our processes have really helped us take the expense out and improve our results as well.” “We’re in the top decile in the country” for mortality results as well as inpatient quality results, said Ramsey. He added that the organization has also achieved benchmark-level employee satisfaction results. Ramsey concluded his presentation by sharing an observation made by visitors studying the organization that made him proud: “They said that CAMC has a heart as big as the West Virginia mountains.”
The second blog in this series features the leadership presentation of Mary Searcy Bixby of the Charter School of San Diego. The third features the leadership presentation of Dean Kappel of Mid-America Transplant. The fourth features the leadership presentation of Larry Potterfield of MidwayUSA.