1999, SSMHC started a clinical collaborative program
with four teams to improve patient outcomes. By 2002,
85 teams had been involved in six clinical collaborative
projects. Physicians connected to an automated information
system have increased steadily from 3,200 in 1999
to 7,288 in 2002.
For four consecutive years, SSMHC has maintained an
“AA Credit Rating,” which is attained
by fewer than 1 percent of U.S. hospitals.
SSMHC’s share of the St. Louis market increased
over each of the past three years to 18 percent, while
three of its five competitors lost market share.
The turnover rate for all employees has reduced from
21 percent in 1999 to 13 percent as of August 2002.
On May 21, 2003, Vice President
Dick Cheney and Commerce Secretary Don Evans presented three
organizations with Malcolm Baldrige National Quality Awards
in recognition of their performance excellence and quality
achievements. Among the winners was SSM Health Care, the
first health care organization to receive a Baldrige Award.
SSM Health Care is a private not-for-profit health care
system based in St. Louis. It provides primary, secondary
and tertiary health care services through its 21 acute care
hospitals and three nursing homes.
With annual revenues of about $1.7 billion, SSMHC’s
5,000 physician partners and 23,000 employees provide health
care services through inpatient, outpatient, and emergency
departments, and ambulatory surgery settings. To support
its core hospital business, SSMHC offers additional services
that include physician practices, residential and skilled
nursing, home care and hospice, and information services.
What follows is an interview with Sister Mary Jean Ryan,
SSMHC’s CEO and president. This is the first of three
interviews with a representative from each 2002 Baldrige
Award winner that will be published in upcoming issues of
becoming the first Baldrige Award winner in health care.
How long have you been on your Baldrige journey.
Ryan: Our journey began somewhere
around 1995. That’s when we realized that the state
quality awards were patterned after the Baldrige criteria,
so we encouraged all of our facilities to apply for these
state awards. We decided we might as well begin looking
at the Baldrige criteria as it existed.
We soon learned that we didn’t understand the language
in the criteria. We decided to focus on trying to learn
as much as we could about the criteria itself. We put together
some teams structured around each category of the criteria.
Our purpose for doing that was to say, “This is what
the criteria says, and this is our reality.” We identified
a couple of major gaps in the very first category, leadership.
That led us to an important place in our journey because
it gave us the opportunity to rearticulate a mission statement
for the entire system. Prior to that time, each facility
had its own mission statement. We were also able to identify
the need for what became our seminal document on leadership,
expectations and quality. When we actually became eligible
for the Baldrige Award in 1999, we applied. We got a site
visit, and we’ve applied every year since.
Did you have any quality
processes before Baldrige?
Ryan: In 1990 we began continuous
quality improvement as a system in a very formal way to
shape our culture. Baldrige is really an extension of that.
It took our CQI efforts and gave us a discipline around
it and a focus. Instead of our quality efforts under CQI
being scattered, Baldrige turned it into a package. Now
we’re all aligned around a common focus, which comes
right out of our mission statement.
How important was the
Ryan: That’s the key.
In our earliest musings about Baldrige, we didn’t
see the award as part of our dream. We just knew we needed
to get better, which is where the feedback report came into
When we applied in 2001, we were pretty good. The feedback
we got, as we’ve done every year, was subjected to
a team from around the system to identify where the greatest
leverage points were and what we could put in place. I also
asked the team whether we should apply again. There was
talk of waiting another year so we could put some of the
feedback recommendations in place. In retrospect, we’ve
learned that if you give yourself two years to do something,
it’ll take two years. If you give yourself a year,
it’ll take a year. So, if for no other reason, applying
every year accelerated our efforts because we really utilized
You’re not eligible
to apply for another five years. Do you think that will
affect the way your business is run?
Ryan: In some respects it might,
but next year every facility has to apply for either the
Baldrige--which they can do individually--or a state quality
award. It will maintain the process of applying, getting
the feedback and implementing the feedback. So, hopefully
we’ll keep that momentum. That’s the thing I’m
most worried about: that we will lose momentum.
Are there aspects of
this year’s feedback report that you’re going
Ryan: Absolutely. It would
be foolish for us not to. One thing that’s a struggle
for health care is the comparative data, which is hard to
come by but critical. Some of our new information systems
will help us do so better than we’ve ever done before.
Another is CQI education. We’ve done QCI education
all along, but the curriculum has changed. We need to go
back into the mode of ensuring that as many employees as
possible are educated in CQI tools and techniques.
Are there any parts
of the Baldrige criteria that you couldn’t see matching
with your organization?
Ryan: If we couldn’t
match something to the extent the feedback might have suggested,
we would identify it and say it just doesn’t make
sense for us. The feedback we’re getting is all about
the pieces that we have to put a lot of effort into. There’s
no more low-hanging fruit.
What advice would you
give to a health care facility just starting to gain interest
Ryan: Start at the beginning.
Take the criteria and look through it. Somebody said to
me the other day, “We filled out an application, but
when we looked at it we didn’t think it was good enough.”
I said, “Big mistake.” It doesn’t matter
whether you think it’s good enough or not because
you’ll get a feedback report, and it’ll give
you a starting place. If you wait until you think you’re
ready, you’ll never do it. The likelihood that you’ll
get a Baldrige Award the first time you apply is pretty
small. But the application will provide the feedback you
can use the next time around.
Have you seen improvement
since the beginning of your journey?
Ryan: We are a different organization
today than we were five years ago and even more so than
in 1990 when we started our quality journey. It’s
been phenomenal. I’ve been here the whole time, and
I hardly recognize what we were then compared to what we
What was the catalyst
that prompted you to pursue the Baldrige Award?
Ryan: What we call “our
awakening” happened after our 1989 leadership conference.
We just knew that we weren’t nearly as good as we
could or should be. That really started us on our CQI journey.
Then Baldrige came into our line of sight. And when a couple
of our facilities won the state quality awards, we thought
the criteria might be the solution. So we decided to go
for it as a system.
Seeing results takes
time. Was it frustrating to not immediately see the results
of your quality efforts?
Ryan: Of course. It frustrated
everybody. It frustrated me in 1995 when somebody in one
of the facilities asked me, “Are we still doing CQI?”
We really were not focused enough at that time.
Your receiving the
Baldrige Award has garnered a lot of attention in the health
care industry. Have other organizations come to you for
Ryan: There have been some
companies that we’ve been involved in leadership and
information exchanges with. But it’s not exclusively
health care at all. When we were at the Quest for Excellence
conference, we had a mix of people from health care and
other companies. Some would come up and say: “We attended
your sessions, and frankly, we didn’t think we could
get anything out of them. We thought health care didn’t
have anything to do with us. But through Baldrige, we speak
the same language.”
We also have sharing days at our corporate offices, so
every other month we have people come in for small professional
interaction. We’ve had people from seven different
states at the last one.
What’s next for
Ryan: Getting better. With
40 pages of feedback, I don’t think we’re going
to be bored. What I’ve said to people is that we have
more of an obligation to improve because everybody is watching
us now. We have to be a model. This is not an endpoint;
this is a milestone.
This interview was conducted by Kennedy Smith, Quality
Digest’s associate editor. Letters to the editor regarding
this article can be sent to firstname.lastname@example.org.