by Kennedy Smith
Overall satisfaction for inpatients, outpatients,
ambulatory surgery patients and home health care services
is near the 99th percentile
Positive morale among the staff has risen from 47
percent in 1996 to 84 percent in 2001. baptist Hospital
Inc.'s best competitor reported 70 percent staff morale.
The organization provides 6.7 percent of its total
revenue to indigent patients, compared to 5.2 and
4 percent for its competitors.
On March 9, President George
W. Bush and Commerce Secretary Don Evans presented seven
organizations with 2003 Malcolm Baldrige National Quality
Awards in recognition of their performance excellence and
quality achievements. One of the winners was Baptist Hospital
Inc., located in Pensacola and Gulf Breeze, Florida.
Baptist Hospital Inc., a subsidiary of Baptist Health Care,
includes three facilities: Baptist Hospital of Pensacola,
a 492-bed tertiary care and referral hospital; Gulf Breeze
Hospital, a 60-bed medical and surgical hospital; and Baptist
Medical Park, an ambulatory care complex that delivers outpatient
and diagnostic services.
Baptist Hospital Inc.’s Baldrige journey began in
2000 when the organization received its first site visit.
It has received site visits every year since, finally earning
the award in 2003.
What follows is an interview with John Heer, Baptist Hospital
What quality processes
were you using during your Baldrige journey?
Heer: As far as clinical quality,
we utilize total quality management; that initiative was
begun here back in the early 1990s. We still use the FOCUS
plan-do-check-act approach, which is derived from W. Edwards
When you talk about quality--especially in health care--people
automatically assume you’re talking about clinical
quality, which is the provision of service or the creation
of product. Under the Baldrige criteria, that mission of
quality is much broader. We’re more interested in
meeting all seven of the Baldrige criteria.
We started a cultural transformation back in 1996. It involved
a refocus of values within the organization and creating
a positioning statement. In 1998, we created the Five Pillars
of Excellence--five categories within which we have key
results that we use to manage the entire organization. These
five pillars are people, service, quality, financial and
growth--all of which are very much aligned with the Baldrige
When we applied for the Baldrige for the first time in
2000, we were pleased and excited because we didn’t
have to create any new initiatives to be in alignment with
the Baldrige criteria because we were already doing these
What was the most trying part of your journey?
Heer: The four site visits.
It’s a tremendous amount of work preparing for them,
getting everyone educated about what’s going on and
what’s to be expected, finding out when they’re
going to be here, and getting all the arrangements made.
Our last site visit was the shortest; it was only about
two and a half days. But in the prior three years, we’ve
had people here from four to four and a half days each time.
How important are
the feedback reports?
Heer: They’re valuable.
They didn’t cause us to change direction. It was more
tweaking--making minor adjustments. Instead of going north,
now we’re going northwest. It was just a matter of
making minor refinements to our systems.
How do you measure
each pillar of your Five Pillars of Excellence?
Heer: We monitor key indicators
in each category. With the “people” pillar,
for example, we monitor employee feedback from surveys,
and we also monitor our turnover rate. In addition, we survey
our employees three times a year during employee forums.
This gives us hard numbers that can be tracked over time.
In the “service” pillar, we survey inpatients,
outpatients, ambulatory surgery, billing, air/medical (our
helicopter), home health and emergency room patients.
The “quality” pillar has been more difficult
because hospitals monitor literally thousands of different
indicators every day. So we developed, and have since copyrighted,
a process called the Clinical Accountability Report of Excellence,
which is an aggregation of all the different quality monitoring
mechanisms we use. Now we have an index with a score that
is aggregated throughout the entire facility. We get a number
every month that we can track. Ninety and above is very
good; 80s and 90s are good but could probably use improvement;
80 and below is not good.
Are you working
with other health care facilities to improve quality?
Heer: VHA Southeast, a nationwide
cooperative of community-owned health care systems and their
physicians, has developed a report similar to CARE, with
comparisons of 44 different organizations within VHA Southeast.
They measure all kinds of key indicators, like congestive
heart failure, community-acquired pneumonia, etc. They also
provide an overall score that you can compare to your own.
VHA is still putting preliminary data together, so it’s
not rolled out yet. Right now, there’s no benchmarkable
data for health care, but we’re working with VHA to
develop that, at least for the 44 hospitals in the southeast.
Have many other
health care organizations contacted you expressing interest
in pursuing Baldrige?
Heer: It’s hard to answer
because, as an industry leader in patient satisfaction,
we’ve had about 6,500 people from organizations across
the country visit us over the past seven years. It’s
hard to tell how many of the people coming now are because
of the Baldrige. But there’s definitely an increase
in the interest because of the publicity associated with
Were there benchmarked
health care organizations out there when you started your
Heer: No. We actually relied
on information from those outside of health care.
Now that you can’t
apply again for another five years, how will you maintain
Heer: This organization is
very results-oriented, very outcome-oriented. We already
have our Five Pillars of Excellence in place, and we raise
the bar on each key indicator every year, so that’s
what we’re going to keep doing.
eligible, will you apply again?
Heer: I don’t know. When
the time comes, we’ll make a determination. If it
appears as something of value, then we will. It would be
hard not to, but we’ll just have to evaluate our organization
at that time.
It’s an incredible amount of work to apply for the
Baldrige. When you have so many processes like we do, it’s
easy to imagine spending all your time working the process
instead of trying to get the results. In other words, you
can spend so much time getting ready for the contest that
you don’t get the results.
What’s more important to us is providing great care
to our patients, having great leadership, being strategically
focused, focusing on our employees to make sure they’re
happy, and focusing on our patient satisfaction and high
quality. We’ll continue doing self-evaluations using
the Baldrige criteria along the way.
Kennedy Smith is Quality Digest’s associate