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Hospitals seeking to improve their performance increasingly are turning to the ambitious criteria established by the Malcolm Baldrige National Quality Award. Two years ago, health care was added as a category in that quality improvement program, and last year, Baptist Hospital in Pensacola, FL, became only the second health care organization to reach the level of site visit — a significant accomplishment.
Congress established the Gathersburg, MD-based Baldrige program in 1987 to raise awareness about the importance of quality and performance excellence. Many say the Baldrige criteria represent the most far-reaching quality improvement program now available. As many as three awards may be given each year in several categories — manufacturing, service, small business, education, and health care. But awards are not based on specific products or services. "There can be three awards given in each category, but we have never had a full complement in any of the categories," explains Jan Kosco, Baldrige public affairs specialist. She reports that in 1999, nine health care organizations applied for the award; last year, that number was eight. "We have been receiving numerous applicants in health care, but at this point, none of them have reached the final stage."
According to Kosco, it is not unusual for a relatively new category such as education or health care, both of which were added in 1999, not to receive an award. For example, she notes there was no award given in the service category until 1990, several years after it was added. Applicants receive anywhere from 300 to 1,000 hours of review conducted by an independent board of examiners, and at the site visit stage, and go through as many as six rounds of reviews. "It is a very tough process," says Kosco. "When you apply for the award, you have to provide great detail showing improvement in all seven areas."
Baldrige assesses hospitals and schools in the same light as for-profit companies. "They all have to go through the same application process and show achievement in seven areas that range from leadership to process management," she explains. However, the criteria are tailored somewhat for each specific environment. The seven categories that make up the award criteria are:
1. Leadership. Examines how senior executives guide the organization and how the organization addresses its responsibilities to the public and practices good citizenship.
2. Strategic planning. Assesses how the organization sets strategic directions and how it determines key action plans.
3. Customer and market focus. Examines how the organization determines requirements and expectations of customers and markets.
4. Information and analysis. Assesses the management, effective use, and analysis of data and information to support key organization processes and the organization’s performance management system.
5. Human resource focus. Examines how the organization enables its work force to develop its full potential and how the work force is aligned with the organization’s objectives.
6. Process management. Assesses aspects of how key production/delivery and support processes are designed, managed, and improved.
7. Business results. Examines the organization’s performance and improvement in its key business areas: customer satisfaction, financial and marketplace performance, human resources, supplier and partner performance, and operational performance. The category also examines how the organization performs relative to competitors.
While the basic purpose of Baldrige is similar to Japan’s Deming award, there are also important differences. According to Kosco, Baldrige focuses more on results and service, relies upon the involvement of many different professional and trade groups, provides special credits for innovative approaches to quality, includes a strong customer and human resource focus, and stresses the importance of sharing information.
The purpose, content, and focus of Baldrige also differ markedly from ISO 9000, a series of five international standards published in 1987 by the International Organization for Standardization (ISO) in Geneva. While health care organizations can use the ISO standards to help determine what is needed to maintain an efficient quality conformance system, those standards do not look at the entire organization in nearly the same fashion that Baldrige does. In fact, ISO 9000 registration covers less than 10% of the Baldrige Award criteria.
"What we are looking for is outstanding improvement and achievement across the board," Kosco asserts. "When you submit an application for a Baldrige Award, you have looked at every nook and cranny of your organization." In addition, organizations that submit an application receive very detailed feedback that cites areas where improvement is possible. In fact, it is precisely that feedback that organizations are seeking when they apply, she says.
[For more information on the Baldrige National Quality Award, contact: Baldrige National Quality Program, Gathersburg, MD. Telephone: (301) 975-2036. Web site: www.quality.nist.gov.]