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by Kennedy Smith

Quality Achievements

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 Inc.’s president.

QD: 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 Deming’s methodology.

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 categories.

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 things.

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.

QD: 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.

QD: 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.

QD: 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.

QD: 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 the award.

QD: Were there benchmarked health care organizations out there when you started your Baldrige journey?

Heer: No. We actually relied on information from those outside of health care.

QD: Now that you can’t apply again for another five years, how will you maintain quality?

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.

QD: When you’re 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.

About the author

Kennedy Smith is Quality Digest’s associate editor.