What’s the latest on the initiative launched last year to create “an archipelago” of high-performing communities in the United States using a framework based on the Baldrige Criteria for Performance Excellence? I recently asked Stephanie Norling, managing director of Communities of Excellence 2026, for an update.
“The last year has been dedicated to planning and outreach,” said Norling. She then described the progress made in preparing the first two pilot sites for the initiative: San Diego County (California) and 18 counties of northwest Missouri.
Live Well San Diego
“Last year we signed a memo of understanding with San Diego County’s health and human services agency to pilot Communities of Excellence 2026 as the framework to support Live Well San Diego, the county’s vision for the region,” said Norling. “Live Well San Diego is celebrated as a national model” for supporting healthy communities, she added. Norling explained that the San Diego pilot, to be kicked off this spring, will involve collaboration by schools and cities as well as business, nonprofit, and faith-based organizations in the county.
According to Nick Macchione, County of San Diego Health and Human Services Agency Director, he became interested in working with Communities of Excellence 2026 because of his prior knowledge of the benefits of the Baldrige framework, particularly through his fellowship with the American College of Healthcare Executives.
“The College has placed a high importance on the Baldrige framework in their annual conferences and workshops, always using Baldrige as a model for operational excellence,” he said. “When I joined the College [early in my career], that was a strong imprint.”
Macchione also had exposure to the Baldrige Criteria for Performance Excellence in his graduate studies in health services administration and health policy. While earning dual master’s degrees from Columbia University and New York University in the 1990s, Macchione used Baldrige case studies in class and discussed related approaches to operational excellence while studying large health systems.
In describing how the Baldrige framework fits with his agency’s work, he said that from the start of his tenure with the San Diego County health and human services agency at its inception in 1997 (when he was deputy director), one of the agency’s key goals was to provide service excellence. When he became the agency’s director in 2008, “I had it clear in my mind that the framework we were going to use was the Baldrige framework,” he said. “We were going to bring out the best in what do for the San Diegans we serve.”
In 2014, Edgemoor Skilled Nursing Facility, which is part of Macchione’s agency, won a Silver Achievement in Quality Award from the American Health Care Association and the National Center for Assisted Living. (The award program is a member of the Alliance for Performance Excellence, a network of regional, state, or sector-specific programs that is a key partner of the national Baldrige Performance Excellence Program.)
Encouraged by the Edgemoor hospital’s achievement, Macchione said his entire agency is now preparing to apply for a Baldrige-based award as part of its Baldrige journey to excellence through continuous improvement. Given his belief in the benefits of pursuing a Baldrige improvement journey as an organization, Macchione’s first encounter with the budding Communities of Excellence 2026 initiative “was gratuitous,” he said.
“Communities of Excellence 2026 brings the core of the Baldrige framework to more organizations. I know we already have some organizations in San Diego that have been using the Baldrige framework and that have been on a journey to excellence, and this [initiative] will help bring out the best of what we each have to offer [to support community excellence].”
Macchione’s agency workforce of about 6,000 employees provides wide-ranging health and social services to a county that is as large as Connecticut, he said, and the agency has already served over 1 million of the 3 million diverse and far-flung residents. Using the adapted Baldrige framework, he said, will strengthen Live Well San Diego by ensuring a stronger impact on the health and well-being of county residents.
“We thought this would be a great opportunity to offer an amazing framework that helps organizations at any level. Our Live Well partners could use it to bring out their best of what they do to support the health and well-being of San Diegans,” said Macchione. (His agency currently has 176 Live Well partners, including for-profit businesses, local governments, health care and social service organizations, community-based organizations, and faith-based institutions.)
As an example of results achieved so far from his agency’s use of a Baldrige-based, collaborative approach, Macchione described how the Chula Vista Elementary School District reached out to the agency and its partners in 2010 for help with a serious problem related to student health. The district is the second-largest in California, with some 30,000 students enrolled, and many overweight children were missing school days due to poor health.
“We used the Baldrige framework to address the issue they were facing, particularly in the way we used data and measures,” said Macchione. “We required that they first get baseline data, measuring individual students’ body mass index, and we found that 40 percent of the district’s schoolchildren were obese at that time.”
The school system had been trying different interventions prior to 2010, Macchione added, but to effectively address the community health issue required a collective effort. “That’s what Live Well is about,” he said.
Over the next four years, his San Diego County agency worked with community-based organizations, a physician and medical group, businesses, schools, and the city and police department of Chula Vista to reduce student obesity. By 2014, the multisector collaboration had decreased the district’s student obesity rate by 17 percentage points, and Macchione emphasized that the work continues.
Learning from the Chula Vista district project led his agency to develop a toolkit that “we’re now sharing with all other school districts in San Diego,” he said. “That shows the power of bringing partners together and having an adaptive framework that all can work from to have a greater impact,” he said.
“It’s a wonderful illustration of the power of the work that can be done when you come together for collective impact, and you have a shared framework both in vision and values and mission and strategies, and you can operationalize it. You can do amazing things. We’re excited because Baldrige brings all of that together.”
According to Norling, the northwest Missouri pilot site of Communities of Excellence 2026 is in the stage of raising money to support the initiative in the rural region. The focus is “on getting the system in place first,” she explained, including fundraising to support leadership, a communication system, and a data platform. While Communities of Excellence 2026 will provide training and other support, the effort is being led locally by the Community Foundation of Northwest Missouri’s Regional Vitality Committee. Launched last fall, the nonprofit is chaired by Max Summers. A recent editorial in St. Joseph News Press presented a favorable perspective on the initiative to pursue “community performance excellence” in the region. The editorial pointed out the importance of “boosting the economy and employment opportunities … ; advancing the education and skills of the workforce; and improving residents’ health status, which notably lags behind other parts of the country.” “Communities of Excellence hopes we can become a national model for regional collaboration. We hope so, too,” concluded the newspaper editorial.
Baldrige Framework Adaptations
Norling also provided an update on the adaptations over the past year to the Baldrige Excellence Framework in order to support Communities of Excellence 2026 project sites. The effort has involved a series of edits from collaborators from the Baldrige Performance Excellence Program and the board of directors of Communities of Excellence 2026. Norling and collaborators have also sought input from focus groups of community members in San Diego and northwest Missouri.
“The framework has undergone multiple iterations,” said Norling. “The feedback has been very helpful in helping us see how Baldrige translates for communities—it helped us adapt the framework to community settings.”
“We made the decision last year to use the format of the [mid-level self-assessment booklet based on the Baldrige Criteria] Baldrige Excellence Builder,” Norling added. “We didn’t want something that would be overwhelming to those looking at it. Most won’t have any experience with Baldrige.”
Upcoming Presentation at Quest
At the Baldrige Program’s Quest for Excellence® Conference next week, Norling will join Max Summers, chairman of Northwest Missouri Regional Vitality, and Brian Lassiter, president and CEO of the Performance Excellence Network (and past president of the Alliance for Performance Excellence) as panelists at the session “Using Baldrige to Improve Community Outcomes: Communities of Excellence 2026.” Attendees will learn about the overall concept and pilot activities of Communities of Excellence 2026.
Like the newspaper editors in northwest Missouri, the Baldrige Program staff hopes to see those pilots continue to progress so they can become national models of how U.S. communities can effectively address pressing economic, health, and education issues with the support of the community-adapted Baldrige framework.