This year, Kaiser Permanente’s Southern California region launched an initiative to drive operational improvements and excellence that is rooted in the Baldrige Excellence Framework. The initiative, called the Garfield Distinction, offers performance criteria and assessment to recognize operational excellence within Kaiser Permanente Medical Office Buildings (MOBs) in the region.
Marylynne Kelts, a leader and practice consultant for Kaiser Permanente’s Southern California Permanente Medical Group (SCPMG), leads the Garfield Distinction. Southern California is the largest of Kaiser Permanente’s eight regions nationwide, and 240 MOBs across 14 Southern California medical center areas are eligible to participate in the process.
The Garfield Distinction is named after the pioneering physician Dr. Sidney Garfield, who partnered with the industrialist Henry J. Kaiser in the 1940s to launch the health care organization that would become Kaiser Permanente. Describing Garfield as “an innovator who was always striving for improvement,” Kelts said the initiative was created in his name—“reflecting our commitment to continuous improvement and performance excellence.”
Kelts is a national Baldrige examiner who is familiar with both the Criteria for Performance Excellence (part of the Baldrige Excellence Framework) and the Baldrige Award process. Applying her knowledge of the Baldrige Criteria, Kelts led the development of criteria for the Garfield Distinction that reflect modification of the Baldrige Criteria—with inclusion of TJC (The Joint Commission) standards as well as Magnet and AAAHC (Accreditation Association for Ambulatory Health Care) guidelines, all adapted to the organization’s six focus areas: Leadership, Care Delivery, Member, Knowledge, People, and Operations. (The Baldrige Health Care Criteria’s seven categories are Leadership; Strategy; Customers; Measurement, Analysis, and Knowledge Management; Workforce; Operations; and Results.)
“Our criteria reflect what is important to us—the core principles of how Kaiser Permanente operates,” said Kelts. For example, modifications emphasize health care affordability, innovation, integration, community, and labor-management partnership. “It is a living document—reflecting how our organization continues to respond to the needs of our members and our learnings in applying highly reliable systems,” she said.
Kelts also explained that the Garfield Distinction criteria are designed to assess multiple departments that are providing services at a facility: “The [Garfield Distinction] criteria are designed not for a single department but, rather, for all the departments represented within a single MOB.” She added that “each leader of an MOB is required to be identified as part of the team that completes an initial self-assessment of the unit’s performance prior to the next phase of evaluation for the Garfield Distinction. This protocol was set up to ensure that the entire unit is represented in the application.”
According to Kelts, after completion of a pilot in April, the first official award cycle for the Garfield Distinctions is now under way. Applications were accepted from May 31 through July 7, site visits will be conducted in September and October, and final results (Distinctions) will be announced in November.
The cycle begins with a self-assessment completed by each MOB that elects to apply. Applicants use a self-assessment tool based on an organizational maturity model that was developed by the company. In future years, the self-assessments will be conducted from January through April.
Following the self-assessments, members of the Garfield Distinction Team assist each applicant MOB in responding to the criteria questions, creating a comprehensive document. The resulting set of facilitated responses become the completed application for the annual Garfield Distinction.
In the next phase of the process, an assessment of the MOB’s performance is conducted by a Kaiser Permanente team composed of multiple evaluators in each of the company’s focus areas. As described by Kelts, the 25 individuals serving as evaluators have differing content expertise and include physicians. Some of the evaluators also participate on the site visits.
After their evaluations, teams reach consensus on scores, which are used to determine whether an MOB qualifies as a “finalist” to receive a site visit. In November, recognition is granted to the applicants earning either “Silver” or “Gold” distinctions for operational excellence. MOBs receiving the Garfield Distinction will be reviewed in three years to determine their continued eligibility. “If their results are not sustained, a full application is needed the next year to sustain the Distinction,” Kelts shared.
Alice Fan, a project manager for SCPMG’s Consulting Services (and a volunteer Baldrige examiner for six years), worked with a San Diego MOB participating in the Garfield Distinction pilot earlier this year. Fan likened the experience to “a breath of fresh air” because she views the company-modified criteria for the Garfield Distinction as “more actionable for us, especially in categories 3 (Customers) and 5 (Workforce).”
Fan described the value of the self-assessment phase of the process as an “additional opportunity to reflect on … opportunities for us to improve… [which] gives us that pause to see if what we’re doing is driving the results that we want.”
“Seeing this at the MOB level gives us a different lens,” she added. She noted, for example, that the application process provides an opportunity to better appreciate employees’ contributions to the organization through their voices.
Asked about expected results of the initiative, Kelts said that the “immediate results we are seeing, even from the pilot” are “the connection and sharing of successful practices.”
“The Garfield Distinction Team is serving as a bridge for sharing these,” Kelts explained. “The other result we expect to see is continuous improvement … . Teams will be able to continually assess where they are, so we really expect a more systematic approach to continuous improvement, over a wide range of medical office operations. And in … improving our operations, we’ll have better outcomes.”
Kelts also pointed out that the identified “successful practices” that emerge from the process will eventually be made public on the organization’s website to be shared across Kaiser Permanente and with other organizations, too. “As we get better, we take the responsibility—just like Dr. Garfield did—to help others get better,” she said. “Kaiser Permanente is committed to improving the health of our members, our communities, and the nation.”
The Baldrige Excellence Framework has empowered organizations to accomplish their missions, improve results, and become more competitive. It includes the Criteria for Performance Excellence, core values and concepts, and guidelines for evaluating your processes and results.
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Ms. Fan’s concept of “a different lens” brings back fond memories of a key learning experience in my early Baldrige training days when Deborah Smyth explained the concept of the “Baldrige lenses” Examiners should always put on when reviewing an application. One lens is the Organizational Profile which helps Examiners focus on what is important to the applicant. The other lens is the Criteria which helps Examiners focus on the specific requirements that the application response is addressing and not be distracted by any extraneous prescriptions outside the assessment process.