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Two Hospitals to Receive Nation's Highest Award for Quality, Performance

Cheryl A. Thompson

Baptist Hospital Inc., based in Pensacola, Florida, and Saint Luke's Hospital of Kansas City, Missouri, will receive the U.S. government's highest honor for quality and performance excellence—the Malcolm Baldrige National Quality Award—in a ceremony to be held early this year in Washington, D.C.

The hospitals' selection for the 2003 award was announced November 25 by President George W. Bush and Commerce Secretary Donald L. Evans.

Baldrige served as Commerce secretary from 1981 until his death in 1987. Later that year, Congress established the Baldrige award to promote quality awareness, to recognize quality and business achievements of U.S. organizations, and to publicize these organizations' successful performance strategies.

Applicants for the award must detail their achievements and improvements in customer and market focus, human resource activities, information and analysis, leadership, process management, results, and strategic planning.

Both winning hospitals' pharmacy directors described organizations whose entire structure, from the top level of administration down to the individual staff member, constantly has an eye on the quality of work performed by employees.

Quality as a mindset. Doug DeJong at Saint Luke's Hospital said the 467-bed facility had a vice president of quality when he started there in 1998.

"We have a very robust quality department," he said, noting that the group helps the pharmacy establish metrics and measurement systems, collect data, analyze data, and assemble process-improvement teams.

During his interviews for the director position, DeJong said, Saint Luke's impressed him with its lineup of quality-related awards, as if saying "Here is what we're about, here is how we define ourselves, and our goal is to have the highest quality care possible."

Saint Luke's, a three-time recipient of the Missouri Quality Award, adopted the Baldrige award's criteria for performance excellence as a business model in 1995.

Ken Richman, pharmacy director at Baptist Hospital, the larger of two hospitals constituting Baptist Hospital Inc., said his organization prides itself on its five "pillars of service operational excellence": people, service, quality, financial, and growth.

Proof of the organization's devotion to excellence can be found in recent surveys. Inpatients', outpatients', and home health care patients' overall satisfaction with services at the 492-bed Pensacola hospital since 1999 have been near the 99th percentile on the Press Ganey survey, a widely recognized measure of health care satisfaction. Positive morale among Baptist Hospital Inc. staff members increased from 47% in 1996 to 84% in the most recent survey.

Employees as a quality resource. Baptist in the 1990s started relying on teams of frontline employees—hospitalwide teams, multidisciplinary teams, and departmental teams—to improve patients' satisfaction.

"Those folks who really know what goes on every day are the folks who can solve our problems," he said.

It was the 2001 employee satisfaction survey that revealed pharmacy staff members' longing for better training of new personnel and reinstatement of the assistant director position, which had been eliminated with Richman's promotion from that position to director two years earlier.

Baptist's focus on employees includes the interview process, even for one's superior, Richman said. "We actually opened up the interview process to anyone in the department who wanted to interview" the three candidates for the assistant director position, he said. "Of course, we had to have several interview times" to accommodate up to four dozen people split among three shifts.

But making each assistant director candidate available for interview by as many staff members as possible was important, Richman said, "because this person was going to be so directly involved with their day-to-day activities."

One of the assistant director's first tasks, Richman said, was to devise a way to improve the training of new staff members. Now, the assistant director explains department policies and job functions to each new hire during that person's first two or three days. The staffing schedule is arranged so that the most experienced people in certain functions can instruct the new hire from the beginning in how the department works.

Process management. Saint Luke's has used clinical pathways—a means of streamlining patient care—for a long time, and pharmacy has been a vital part of that effort, DeJong said.

When it applied for the 2003 Baldrige award, St. Luke's had 134 clinical pathways in use covering the care of 60% of patients.

"I was very impressed when I came here at the level of involvement we had," he said. "These things weren't being done and created in a vacuum but were really being created across professions, across departments" and usually involved the pharmacists who worked directly with the patients whose care was being planned.

"It's not the clinical coordinator in an office meeting with manager from the different areas or the medical staff," DeJong said. "It's the pharmacists that are providing the care that we really rely on for the development of those pathways and the maintenance of . . . standing-order sets."

Walking the talk. Those efforts with clinical pathways, DeJong said, seemed to impress the examiners from the Baldrige award program, who not only wanted to see the organization's quality-improvement efforts but also wanted to determine how deep these efforts penetrated the hierarchy.

Each organization's onsite review by Baldrige examiners included conversations with staff members, similar to the recent move by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) to have surveyors question the people who do the day-to-day work, DeJong and Richman said.

"We were very confident," said DeJong, "that our staff members who would meet with [the examiners] would be walking the talk and demonstrating how they have contributed to the organization's area. For example, one of our pharmacists has been very involved in our vaccination program, and [the examiners] were very impressed speaking with her and [hearing about] the things she has been able to do in that program."

Contributing to DeJong's confidence, he said, was Saint Luke's Health System's heavy reliance on its employee evaluation process to take the system's overall goals down to the nine hospitals, including the flagship facility, then on to the departments, and eventually to individual employees.

Richman, who said his department participates in nearly all of his hospital's programs, had a similar experience. The Baldrige examiners made "a great point of trying to make sure that everything is integrated throughout the organization—top to bottom," he said.

Another contrast with previous visits by JCAHO surveyors, DeJong said, was the Baldrige examiners' eye toward how the health care organization ran as a business. For example, DeJong's pharmacy was asked how it manages suppliers and vendor relationships and how it partners with them.

"Oftentimes in health care, we don't stop and think of those partnerships . . . on a regular basis the way a Boeing would," he said, referring to Boeing Aerospace Support, a Missouri-based organization that is a 2003 Baldrige award winner for the service sector.

Employee appreciation. Baptist encourages employees to recognize each other's exemplary work through the organization's "wow" awards, Richman said.

"Any person on the staff can recognize another person for some outstanding contribution, something over and above their job" description, he said, such as working extra hours when a coworker is ill or doing something specific for a patient or coworker in another department.

Department leaders at Baptist are encouraged to send handwritten thank-you notes to staff members. Richman said he keeps a supply of the notes in his desk for such use and sometimes notifies his vice president of an employee whose work warrants a high-level thank-you note.

Baptist's third avenue of employee appreciation, he said, is its "champions" program to recognize outstanding service to patients, such as when a Spanish-speaking pharmacy technician served as an interpreter for a patient with a poor command of English. The champion is recognized before the department head for the outstanding service, and the deed is also recognized outside the department through the hallway display of a plaque and a brief summary of the service.

Quality as a staff retention tool. Not 1 of DeJong's 28 pharmacists has left "in essentially two years," he said. "I think that people enjoy being part of a team that is all on the same page, striving for the same thing."

In fact, Saint Luke's Health System had only one pharmacist opening among its nine hospitals at the end of 2003.

Richman said his hospital had no turnover in its pharmacist positions in the past fiscal year and about an 8% turnover rate for pharmacy technicians.

Whew, it's over. DeJong and Richman agreed that the interactions with and feedback provided by the Baldrige examiners were worth the preparations made by the hospitals.

All applicants for the award receive a detailed report of their organization based on the independent assessment conducted by the award program's panel of specially trained and recognized experts.

When the examiners left, DeJong said, "I think we all looked at each other and thought 'well, you know, win or lose, we've really done a lot of good work that we can be very proud of.' It was an extremely positive experience. . . . There wasn't a lot of window dressing that you're putting out to make [your hospital] look good."

Performance excellence in health care. Originally given to manufacturing companies, service organizations, and small businesses, the Baldrige award program was opened to education and health care in 1999.

SSM Health Care in St. Louis, Missouri, in 2002 became the first health care organization to receive the award. That year 17 health care organizations submitted an application and examiners visited 4 sites.

In the preceding three years in which health care organizations could submit applications, one or two of the organizations made the cut for a site visit but none received the award.

Nineteen health care organizations submitted an application in 2003.

Each year the award program publishes Health Care Criteria for Performance Excellence as a guide to applicants but also as a resource to health care organizations that want to assess their performance on health care outcomes, patient satisfaction, and operational, staff, and financial indicators. The 2004 criteria are not yet available, but the 2003 criteria (PDF) are available.

The Baldrige National Quality Program is administered by the National Institute of Standards and Technology, part of the Commerce Department.

Applicants for the award must pay an eligibility certification fee, an application fee, and, if selected for further review, a site-visit fee.