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Creating Healthcare Managers #6: Must We Teach Baldrige?

By John Griffith, MBA, FACHE posted 05-03-2016 15:16

  

The only rigorous, audited description of excellence in healthcare delivery beyond the level of case studies is the set of “applications” of the 19 healthcare organizations (HCOs) that have won the Baldrige Quality Award. These are 54 page, single spaced documentations of proven work processes.  Excellence is strategically viewed, and extensively measured. Applications must follow the “Framework,” which systematically reviews leadership, strategy, customers, workforce, operations, and results. The process that identifies winners includes review by several trained analysts, each spending 20 hours, and a week-long site visit by 5 to 7 senior analysts.  Scoring assigns a 45 percent weight to results, expecting top quartile or better scores on standardized national measures of outcomes quality, patient satisfaction, worker satisfaction, and financial management.

The documented facts show that Baldrige winners give better care, at lower cost. Their patients are substantially more satisfied. Their workers, including their physicians, are happier and more loyal. Their business prospects and their credit ratings are excellent. They operate in 13 states, serve several large cities, include some challenging locations (Aleutian Islands, Detroit, Atlantic City, Tupelo, Charleston) and provide all kinds of patient care, from primary prevention to hospice.

The applications describe in depth how they do it. Because the Framework insists on benchmarking and best practice, they copy one another.  The model they have developed doesn’t look like the typical hospital.[1] It finesses a lot of the known points of contention that characterize mediocre HCO management, like inattentive or misled governing boards, physician and nurse dissatisfaction, compliance with rules, nursing shortages, cost-cutting, and malpractice. The winners basically do not have those problems. How they escaped them is not obvious, but becomes clearer on in-depth study.

The model not inconsistent with organization theory, but it pays no attention to it, either. It has had limited academic validation. A search for “Baldrige” in Articles Plus or Scopus reveals only 15 or 20 entries per year, worldwide. The recent analytic literature is in quality management publications. It acknowledges the winners’ excellence, and concludes that the components of the model must be taken as a whole, rather than attempted as free-standing concepts.

Charleston Area Medical Care is a $900 million four site, system providing extensive medical residency training. It is the largest health system in West Virginia. It won the Baldrige in 2015, and like all Baldrige winners, its application is public information, available at http://patapsco.nist.gov/Award_Recipients/PDF_Files/CAMC%20Health%20System%20Application%20Summary.pdf  CAMC implements the model: a complex, transformational, leadership system; reliable and valid measures of performance at structural, process, and outcomes levels; benchmarks; continuous improvement; rigorous use of evidence-based work processes for everything from handwashing to surgery to strategy; careful attention to strategic directions; and extensive celebration with cash and non-cash rewards. It is the reported state of the art: arguably how an excellent 21st century HCO must be run. Although other management will survive, it won’t thrive.

There is no ethical way a faculty member can ignore the Baldrige phenomenon.  Just as medicine, economics, and public health must teach the latest documented evidence, AUPHA members must teach the Baldrige model. Furthermore, under the “Competencies” accreditation, we must teach not just comprehension, but application. Our graduates need to be able to apply the model, and to analyze operations to identify how they depart from the model, and how to fix them. It will not be ethical to do otherwise. (Yes, I recognize that that is a strong statement. I also have learned that doing it won’t be easy.) In forthcoming blogs, and a version for peer review at JHAE, I hope to investigate how to use the CAMC application in the classroom. 

I’d welcome help: prior trials, willingness to analyze the application, willingness to experiment and report.



[1] Griffith, J.R., 2016 “The Baldrige: What We’ve Learned From The Most Rigorous Evidence-Based Management in Healthcare Organizations” in Kovner, A, D’Aunno T, Evidence-Based Management in Healthcare, forthcoming, Chicago, Health Administration Press. Preprint available on request, jrg@umich.edu



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