Sustaining Excellence in Rural Health Care the Baldrige Way—Hill Country Memorial’s Story

At annual Quest for Excellence^® Conferences, participants hear inspiring stories and results achieved by the U.S role-model Baldrige Award recipients. But some might wonder if after the pomp and circumstance, after the press and fanfare, do the recipients sustain their results and do they continue using the Baldrige Excellence Framework?

At the upcoming Quest conference, Jayne E. Pope, CEO of Baldrige Award-winning Hill Country Memorial (HCM) will explain that not only has the hospital continued to operate at the highest levels for its patients, other customers, stakeholders, and workforce, but its results remain “remarkable.”

I asked Jayne to help me understand how the hospital remains remarkable with Baldrige.

How would you define remarkable results?

A critical point in our Baldrige journey came when we challenged ourselves to take that word “Remarkable,” which we used so commonly, and make it measurable. We define “Remarkable Always” as performing in the top 10% of every national database metric—not just among small rural and community hospitals, but among all hospitals in the nation. This is our mission and our promise to our community—to achieve and sustain top-decile performance.

How have these remarkable results been important to your success?

Baldrige ensures a balanced or systematic approach to organizational improvement, with a focus on leadership, strategy, customers, measurement and knowledge management, workforce, operations, and results. This comprehensive approach reassured us; we wanted holistic organizational improvement, and we were not distracted by chasing trends. The Baldrige way became a guidebook to aid us on our climb.

We received our first Baldrige feedback report in 2010. It indicated that we were not really listening to our most important stakeholders; we were deciding what we thought were the expectations of our patients and the community, and implementing action plans that we thought would address their perceived issues. On the basis of that feedback, we formed a customer-focused improvement team that still functions today.

Through the team’s leadership and the work of our remarkable workforce, HCM has achieved and sustained the following:

• National top 10 percent performance on all Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) categories for the years 2012 through 2015
• National top 10 percent performance on overall patient satisfaction—as measured by Press Ganey—for inpatient care, ambulatory surgery, and emergency department experience for the years 2012 through 2015
• National top 2 percent of customer experience scoring in the Centers for Medicare and Medicaid Services Value-Based Purchasing Program

What are your top tips/suggested practices for using Baldrige to support results across an organization?

We took to heart a statement made by one of our board members: “The more complex it gets, the simpler we should get.”

We realized that integration of all we do was key to our ability to execute. We have worked to build systematic ways to empower others across our organization. Listed here are a few of the ways we support results.

• Align and integrate processes within the workforce. At HCM, we align all processes and our workforce to achievement of strategic goals. All processes support this alignment and integration. For example, when refining our workforce performance system, we asked ourselves how the redesign could integrate the system with our strategic plan. We developed quarterly coaching plans and an annual performance appraisal that align individual goals with strategic goals. After implementation of this refined system, we went from achieving approximately 45% of our strategic goals to 85–90%.

• Streamline processes and make them as easy to use and understand as possible. For example, we want individuals to be experts at their jobs, but we don’t expect them to be performance improvement experts, so we developed easy-to-use worksheets that walk them through process design and the Plan-Do-Check-Act (PDCA) methodology. Having these user-friendly tools allows every member of the workforce to be involved in performance improvement.

• Action plans and monitoring are key to achieving results. Just having goals is not enough. We must develop robust action planning and monitor processes. At HCM, we developed a Strategic Breakthrough Initiative (SBI) process. In this process, the executives identify those key short-term action plans that will move us toward achievement of our strategic goals. These are 90-day action plans, and the team reports out progress on a weekly basis to the executives. This weekly report-out supports accountability and ensures that team members have the support and resources needed to achieve their goals.

What else might participants learn at your conference session?

As a 2014 Baldrige Award recipient, we know that on your journey, the higher you get, the steeper the climb. By using the Baldrige concepts at HCM, we built a culture of execution. This has been so important for us because in the rapidly changing landscape of health care, we cannot linger long and look back at how far we’ve come—our climb continues. We execute to drive improvements, innovate, and achieve remarkable results.

Our vision “Empower others. Create healthy” means building a network of health services that always empowers patients, families, and workforce members to live holistically healthy lives with optimal community health outcomes. "Create healthy" inspires us as we envision our future, but it also guides how we live every day. We strive to create and sustain a healthy culture, a healthy community, healthy financials, and healthy patients. We believe that our Quest participants will benefit from hearing our systematic processes to pursue this vision. So at our breakout session, we will share the pillars of our newly updated strategy map, SBI process, and performance review cycle—some of the disciplined actions that may be helpful to others in pursuing the summits they strive to reach. In our case, our summit is a thriving health care system, partnering to create a community of people enjoying their highest level of health.

Visitors from Japan visit HCM.

 

Throughout 2015, HCM hosted more than 140 people from across the globe to share our award-winning processes and strategies at Baldrige Sharing Days. Guests from health care organizations, as well as other industries including education, banking, and government, came to our hospital in Fredericksburg, TX, to study our successes and lessons learned and to exchange ideas. During the Sharing Days, we not only helped others improve, our team members learned firsthand that the work they do every day was of great interest and benefit to others.

What are a few key reasons that organizations in your sector can benefit from using the Baldrige Excellence Framework?

Today’s health care environment is one of constant change. As a rural, nontax-supported community hospital, we continue to find our footing in the quest to achieve long-term sustainability. At HCM, we found the Baldrige Excellence Framework to be the field guide we needed to navigate the steep and often-obscured ascent to world-class performance. We found our core competencies, relationship building, values-based culture, and execution to be the footholds we need to support us in our climb. We continue to thrive while so many rural hospitals in the nation are struggling. Achieving high-performance health care is HCM’s stronghold.

Register now for the 28th Annual Quest for Excellence Conference to attend this session, “Sustaining Remarkable Results the Baldrige Way,” as well as other sessions from role-model Baldrige Award recipients, past and present, from every sector of the U.S. economy.

Visitors pose in front of HCM's Baldrige Award crystal.