In a recent online video, Dr. Bill Neff, interim CEO and CMO at University of Colorado Health, for which 2008 Baldrige Award recipient Poudre Valley Health System (PVHS) is now part, shared PVHS's journey to excellence. In 1997, it was a single hospital with a 24% annual employee turnover rate and five CEOs in four years; by 2008, it was a Baldrige Award winner. What happened?
Dr. Neff, who was CMO at the time of the Baldrige Award, said that PVHS engaged over a 10–12-year period with the Baldrige Health Care Criteria for Performance Excellence in an effort to "get everybody running in the same direction."
In 1997, PVHS was in the midst of a changing health care market, but the largest challenge, said Neff, was the need for integration with very independent physicians. PVHS's fifth CEO in four years had been working with several organizations using the Baldrige Health Care Criteria, and the hospital decided to give the Baldrige process a try.
"If you participate in the process," Neff said, "one of the first thing you have to decide is who the heck are you and what do you want to do. . . . The [Baldrige] Organizational Profile really makes you do an internal assessment of what you are trying to do, and if you are good, what would that look like. You need to measure, analyze, deploy best practices. Everybody has to be in close alignment."
Between 1996 and 2000, Neff said the hospital had really become pretty impressive, even being an early adopter of Magnet in the United States. Applying for a Malcolm Baldrige National Quality Award, PVHS thought, "was a slam dunk." But the feedback written by Baldrige examiners from PVHS's first and second award applications let the hospital know that it might not be as good as it thought it was, he said.
From 2004 to 2008, Neff said that PVHS embarked heavily in the Baldrige process, trying to figure out how to get better. This included submitting applications to the Baldrige-based state award Rocky Mountain Performance Excellence (a member of the Alliance for Performance Excellence) and receiving feedback reports.
"In essence, we had to make [the Baldrige Criteria] the way we were doing our day-to-day work. It couldn't be an application that we filled in at the end of the year. It couldn't be about the award. It was about looking at all of those elements of the Criteria and talking about how are we really trying to be what we say we want to be and how do we ensure that is completely deployed across the entire organization," Neff said.
He added that it was especially important for Baldrige as a business model to be put into context for physicians; for example, PVHS conducted a Lean event that made patient processes more efficient and thus saved physicians time. The hospital had to translate the value of Baldrige into something that was real for the physicians.
"Before [Baldrige], there was a tendency to go to where it's easiest [to improve] and look right past or right over the areas where you're weakest and need to improve the most," he said. "The [Baldrige] process forced us to look in the mirror in those areas. Slowly, we started getting better."
One improvement started the day the PVHS board decided that the hospital would start measuring itself against top deciles, not just averages. "On that day, all of our scorecards went red," Neff said.
Between 2004 and 2008, PVHS received four Baldrige site visits—its applications scored high enough to send a team of Baldrige examiners to PVHS to take a closer look.
During this site visit week, Neff said, "folks who really, really know performance excellence are there to look at you really hard and say this is who you say you are but this is who you look like to us. You spend a week with [Baldrige examiners] who are really sharp, pointing out where you are doing well but then asking why aren't you doing it there, too." Neff said the examiners "look under every hood."
In 2008, PVHS received the Baldrige Award, the nation's highest honor for organizational performance excellence. "By the time we finally got to that point," Neff said, "everybody thought that was really cool but what they really wanted was the feedback report. Because you kind of become addicted to that level of interaction with folks who are trying to help you get better."
Treat physicians as partners, not competitors or customers. PVHS recognized that physicians needed to have input into strategic initiatives, the strategic plan, interdisciplinary teams, etc., but attendance at meetings needed to be as needed not mandatory. Physicians were also integrated into administrative leadership teams and given leadership development opportunities.
"The biggest thing about physician engagement from the administrative side of the house," Neff said, "they kept looking at physician engagement as how do we get them to see things our way, the trick is that at least 50% of the time it's how do we get to see things their way."
For physicians, build a culture of engagement one step at a time, he said; show them the results, do what you said you would do, and follow up to show you did it. Encourage engaged physician leaders to engage other physicians.
Constantly evaluate; performance excellence is not an instant fix. "We have a tendency to think that if we fix just one, two, three things then we'll be close to perfect, and then we can move on to a different project. That was not our experience with performance excellence," Neff said. "With performance excellence, it becomes your culture and . . . you are going to slowly get better. It might not be at lightning speed on some elements, but you're better today that you were yesterday, and you're going to be better tomorrow. You'll get there. . . . Once you've hardwired your systems, you just continue to get better."
Look for partnerships. Once PVHS received the Baldrige Award, Neff said that finding partners was much easier, as Baldrige winners are proven to be high performing. In 2012, a joint operating agreement was signed between PVHS and the University of Colorado Hospital.
"This is a testament to what you can accomplish with performance excellence," Neff said. "Remember we were that single, little bitty hospital up in Ft. Collins. To be able to come to the table with an academic system and be able to talk about an equal partnership was something that we would not have imagined in the mid-1990s."
Other hospitals also have been added into the system under management agreements. Neff advises starting small and building trust with these new partners.
Neff said the next steps at University of Colorado Health are to build the whole system by integrating each category of the Criteria—implementing the performance improvement program across the entire system. He said this implementation is being done incrementally; for example, first excel at customer focus, then workforce focus, then a focus on quality metrics, etc.
Neff said, "when [staff] tell me, I don't know if we can do Baldrige, I can say, actually you've been doing it for a couple of years."
The 2015-2016 Baldrige Health Care Criteria for Performance Excellence will be available in January 2o15.