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by Laura Smith

North Mississippi Medical Center, a 2006 Baldrige Award recipient, is the largest rural hospital in the country and Mississippi's largest community-owned hospital. Located in Tupelo, it serves 24 counties, employs 3,875 people and has annual revenues of $460 million. In 2006, NMMC provided a wide array of inpatient, outpatient and emergency services to 156,750 people. It also provides access to electronic medical records to every caregiver in its system.
Its Care-Based Cost Management approach has provided cumulative savings of $11.1 million since 1999, largely as a result of reducing practice variations and medical complications. The hospital had $56.5 million more in revenue than expenses in 2006--an increase of $29 million from 2005.

Patient and employee satisfaction with the hospital is similarly good: Physician overall satisfaction and ease of practice was measured at 99 percent, and almost 90 percent of patients said that they would recommend the hospital to a friend or relative, up from about 52 percent in 2002.

Here, Karen Koch, NMMC's research director, discusses how the hospital improved its processes and services enough to win the Baldrige Award.

Quality Digest : When and why did NMMC decide to pursue a Baldrige award?

Karen Koch: We initially began our Baldrige journey in 1998 by applying to our state's quality award program, which is based on the Baldrige criteria. Our administrative and governance leaders decided to objectively examine our focus, processes, and infrastructure and felt this was a good place to start. In 2000, we won the Governor's Award, which is the highest level of achievement in Mississippi's state quality program. The application preparation and site visit were challenging but a good overall experience. The feedback from the state examiners was meaningful, and our leaders decided to take it to the next level and pursue the Malcolm Baldrige National Quality Award. Our state quality award program was very supportive of this decision, and in 2002 our program director provided us with leadership training for the Baldrige Award application process.


QD : How much did you know about the process when you started?

KK: We knew relatively little about the Baldrige process, but, as noted, the state quality award experience was a good one, so we felt we would continue to benefit from the process. In addition, we attended the Quest for Excellence meetings and liked what we saw in the organizations that had won Baldrige Awards. Our leaders decided that the Baldrige process was the best way to get better faster and committed NMMC to the Baldrige journey.


QD : What were some of the challenges you faced when implementing the Baldrige criteria?

KK: The biggest initial challenge was to understand the criteria language. Our initial responses to "how" questions were "what" we did. We could always identify an example that seemed to fit the criteria. It was much more difficult, however, to identify a systematic process that met the criteria. In trying to describe how we systematically performed our functions, we identified gaps in our processes. With each application round we would identify and address more process gaps. It was challenging but the repeated exercise of asking how we do something has resulted in a culture change. We are now more systematic when we develop processes and integrate a timeline for objective assessment into every project. We often refer to the annual cycle of internal and external examination as the "Baldrige mirror." It isn't always flattering, but at least we have a realistic picture of our assets and flaws.


QD : How did you approach your challenges?

KK:Our feedback reports are very valuable to us. We enter each opportunity for improvement (OFI) into a matrix and determine the most significant issues we need to address. We typically identify four or five key OFIs in terms of best return and fit within our values and goals. We develop improvement teams and 90-day action plans for each OFI. Each action plan includes objective measures, and we work on the OFI until it is resolved.


QD : How has winning the Baldrige Award changed NMMC?

KK:The Baldrige Award has validated our employees' hard work and dedication to high-quality patient care. It has energized us to raise the bar for continued recognition as a role model in health care.


QD : What advice would you give to a company just starting the Baldrige process?

KK: Regarding the application process, we suggest that you engage in your state's quality award program and read the booklet Getting Started , available on the National Institute of Standards and Technology's Web site www.quality.nist.gov/Getting_Started.htm. Regarding your organization, we suggest that you analyze key drivers of employee satisfaction and hire the right leadership.


QD : Was it difficult to get your rank-and-file employees excited about the Baldrige process?

KK:The rank-and-file employees embraced the changes that the Baldrige process brought forth--more knowledge, transparency, access to leaders, alignment of goals and appreciation of effort--without necessarily realizing that the changes were due to the Baldrige process. Preparing for our Baldrige site visits helped our entire staff to understand how many of our processes and improvements were driven by the Baldrige process.


QD : Where do you think the quality movement is headed?

KK:Health care payers are moving toward a pay-for-performance reimbursement strategy which will link the quality of the care provided to the reimbursement received. This movement is an affirmation NMMC's Care-Based Cost Management approach to making the business case for quality. At NMMC, we've demonstrated that by examining each step of our care processes we can reduce variation, thereby achieving better patient outcomes and at lower costs.


About the author
Laura Smith is Quality Digest's assistant editor.