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The Official Baldrige Blog

Quality in Nursing Care Centers: the Impact of Baldrige

Results graph for 2013 showing data on organizations scoring high on quality metric

Used with AHCA permission.

Credit: ACHA

A few months ago, my family received a personal reminder of the importance of quality in the skilled-nursing care profession. It was delivered as my elderly father was transitioning from a hospital to a nursing home. With the advancement of his dementia and a few other vexing conditions, his health status had declined quickly.

It was obvious to doctors and family members alike that we were acting in his best interests in moving him to a care center where he could receive the support he needed. Yet I will never forget the spooked and bewildered look in his eyes as his stretcher was wheeled out of an ambulance in front of the nursing facility that was to be his new home. And I will never forget how reduced and vulnerable he looked, shivering in a hospital gown in the brisk autumn air, seemingly unable to even ask where we were going. “Dad, it’s OK. This is the right place for you,” I said more than once as we moved down the hall to his bedroom. 

Although I had enough objective information to support my assurances of the nursing care center’s high quality, I kept looking for any sign of less-than-stellar care. Fortunately, I found none. And I will never forget how relieved I felt.

If you’ve ever moved a loved one into a care center, you can fully appreciate my initial concern that day. And you might also appreciate my enthusiasm in reporting now on the excellent quality ratings and other beneficial results of nursing homes that have received top honors in recent years in the thriving Baldrige-based quality awards program of the American Health Care Association (AHCA).

Using the Baldrige Health Care Criteria for Performance Excellence as a basis for organizational assessments, the AHCA/National Center for Assisted Living (NCAL) National Quality Award Program draws applicants each year from some 12,280 long-term and post-acute care providers represented by the association. Between its inception in 1996 and 2012, the sector-specific award program received more than 8,000 applications and presented more than 3,000 awards at three levels: Gold, Silver, and Bronze (with 13, 256, and 2,856 awards issued at those levels, respectively). To be considered for the highest level of Gold, applicants must demonstrate “systematic quality performance and organizational effectiveness,” as stated in AHCA’s 2013 Quality Report (PDF file).

The 2013 Quality Report spotlights some impressive aggregated results of Silver- and Gold-level award recipients of the National Quality Award program from 2010 through 2012 (see pages 20 and 21). Consider the following two charts, which plot results data (provided by the Centers for Medicare and Medicaid Services) of AHCA/NCAL top-tier award recipients in comparison to aggregated results of all other industry peers:

As part of AHCA’s Quality Initiative launched in 2012, the association encourages its member organizations across the country to focus on the following four goals: (1) safely reduce hospital readmissions; (2) increase staff stability; (3) increase customer satisfaction; and (4) safely reduce off-label use of antipsychotics. Urvi Shah, quality improvement manager at AHCA, recently affirmed the importance of organizations’ use of the Baldrige Criteria as a framework for quality improvement—in general and in relation to achieving those four goals (for which AHCA has specific target dates and measures, as described in the 2013 report). “We tell our members that following the Baldrige Criteria will help them accomplish not only the four goals, but any goal they have,” said Shah.

The AHCA/NCAL National Quality Award program, like the Malcolm Baldrige National Quality Award program on which it’s based, also emphasizes that the improvements made during an organization’s quest for excellence are much more important than winning the award. “When organizations apply for the [AHCA/NCAL] award,” Shah said, “we say, ‘use your feedback report and see this as a journey of quality improvement.’”

Surely, the customers—and the family members of customers—served by nursing homes agree on this: we want to see every such organization achieving excellence!

About the author

Christine Schaefer

Christine Schaefer is a longtime staff member of the Baldrige Performance Excellence Program (BPEP). Her work has focused on producing BPEP publications and communications. She also has been highly involved in the Baldrige Award process, Baldrige examiner training, and other offerings of the program.

She is a Phi Beta Kappa graduate of the University of Virginia, where she was an Echols Scholar and a double major, receiving highest distinction for her thesis in the interdisciplinary Political & Social Thought Program. She also has a master's degree from Georgetown University, where her studies and thesis focused on social and public policy issues. 

When not working, she sits in traffic in one of the most congested regions of the country, receives consolation from her rescued beagles, writes poetry, practices hot yoga, and tries to cultivate a foundation for three kids to direct their own lifelong learning (and to PLEASE STOP YELLING at each other—after all, we'll never end wars if we can't even make peace at home!).

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I can strongly endorse the AHCA program. As a founding member of the California Culture Change Coalition I was seeking a robust indicator of nursing home quality. I became an AHCA examiner, senior examiner, master examiner and in the most recent cycle, judge. An AHCA Gold Quality Award recipient may not yet be a Baldrige winner, but is well on the way on the Baldrige journey. Lance Reynolds, Alameda, CA
I, too, support the AHCA quality award program. As a judge for the program (and as board chair for one of its very engaged members, the Benedictine Health System of Duluth), I have seen how the power of Baldrige can improve outcomes and service levels in long-term care. Kudos to the program and to the thousands of facilities and systems using this proven framework to achieve excellence!
As a Continuing Care Retirement Community invested in this award process, we can attest to how far it has moved us along our quality journey. That, coupled with the training and experience provided as an Examiner in this award series, raises the bar on performance and value. Kudos to all the AHCA National Quality Award participant facilities, and hats off to all who have earned honors. Get in the game!
I am glad an outside agency is checking on what is going on in our hospitals, care providers My mother just recently passed away. She was in the beginning stages of dementia. She had never been ill or a burden on anyone, our experience via the hospital system, care providers was an absolute nightmare. It is hard to believe that this country can produce so many incompetent ,arrogant people who deal with the most important people in the world, our parents and our children. All chasing the dollar bill. My mother stayed at home with me because my choices were non existent, my mother was entitled to her dignity and she had it up to the very end. Maybe these changes that are written about will be of assistance to others and if they can help one person I am glad
Barbara, I empathize with your dismay regarding your mother's hospital experiences--and I am very sorry for your loss. Based on the results and data I've seen, I feel passionately about the potential of the Baldrige Health Care Criteria to help all care providers improve how they address patients' needs and achieve better outcomes. To be clear, the Baldrige Criteria for Performance Excellence are not regulations, but rather, provide a framework comprising standards. Nonetheless, it seems to me that the growing use of these (optional) Baldrige Criteria in the health care sector today and the improvements being made as a result can only bode well for us all as American consumers of health care. Christine
I support the AHCA/NCAL quality award program. The program is helping long term care facilities improve their effectiveness and provide better care to residents. Contact the program director, Courtney Krier Bishnoi at 202-898-2857 or cbishnoi [at] (cbishnoi[at]ahca[dot]org) to learn more about this excellent program and how you or your organization can participate.

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