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by Kennedy Smith

Quality Achievements

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 Quality Digest.

QD: Congratulations on 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.

QD: 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.

QD: How important was the feedback?

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 play.

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 the feedback.

QD: 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.

QD: Are there aspects of this year’s feedback report that you’re going after?

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.

QD: 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.

QD: What advice would you give to a health care facility just starting to gain interest in Baldrige?

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.

QD: 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 are today.

QD: 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.

QD: 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.

QD: Your receiving the Baldrige Award has garnered a lot of attention in the health care industry. Have other organizations come to you for advice?

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.

QD: What’s next for you?

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 letters@qualitydigest.com.