I am sure that most of you heard the Baldrige news yesterday. What a great day! But this blog is not only about conveying congratulations to our newest role-model Baldrige Award recipients but giving a little perspective on the events of the past 10 days. The Meeting Begins On Monday, November 4th, the Baldrige judges met at the National Institute of Standards and Technology (NIST) for the final phase of a five-month effort to determine which organizations should be recommended for the 2013 Malcolm Baldrige National Quality Award—the highest Presidential honor for organizational performance excellence. They arrived around 7:30 a.m. and were quickly led to a secluded conference room in the maze-like basement of NIST’s administration building. The room had been prepped for their arrival: a large "U"-shape arrangement of tables with plenty of room to spread out; an entire back wall lined with additional tables holding boxes, crates, and file folders containing materials that represented thousands of hours of effort by Baldrige Award applicants, volunteer examiner teams, and the judges themselves; and a computer, projector, speaker phone, and one dinky little table with muffins, fruit, and coffee. After some procedural activities and a thoughtful review of the meeting purpose and processes, the fun began … three-and-a-half days later, the seal was broken, the door opened, and the judges staggered out with their final recommendations. Of course, I am only kidding, but to those who haven’t had the privilege to serve as a Baldrige judge or staff member, that might seem to be what happens. A Rigorous Process In reality, during this final meeting of the 2013 Baldrige Award process, the judges follow a very rigorous process for each applicant that received a site visit: Judges conflicted with a particular applicant receive none of its materials; conflicted judges leave the room for any and all sharing or conversation about that applicant. The lead judge for each applicant presents an overview of the organization, reviewing the examiner team’s overall findings, and reviewing the questions and issues the judges identified during their preliminary review of the application and detailed site-visit findings prior to the meeting. The lead judge then facilitates a conference call with the site visit team leader, exploring a standard set of questions asked of all team leaders. After the first call, the judges discuss what was conveyed and engage in dialogue to determine what issues and questions still remain to make a national role-model determination. A second call is held with the site visit team leader to probe very specific issues needing clarity or verification. After the second call, the judges debrief what they have learned, ensure that there are no further questions that need to be asked of the team leader, and identify the applicant’s key strengths and opportunities related to potential role-model status. Finally, a multilevel voting process occurs that requires a super-majority of judges to recommend a Baldrige Award recipient. After each applicant is discussed, a judge assigned as the process checker for that applicant leads a debrief, looking for opportunities to improve. The average cycle time for a given applicant is about three and a half hours, but since the judges’ motto is "it’s not over ‘til it’s over," further discussion later in the meeting is not uncommon. Final Recipients On Thursday, November 7th, around 3:30 p.m., it was finally over … or was it? The judging had been completed, with the three recipients and two additional organizations recognized for category-level best practices, but much remained to be done. Judges called team leaders to discuss suggested edits to the feedback reports that would be sent to applicants (yes, even award recipients receive feedback!). Press releases, recipient profiles, and talking points were finalized. Dr. John Jasinski, the chair of the Panel of Judges, and I met with Pat Gallagher, the acting deputy secretary of the U.S. Department of Commerce and director of NIST, to share the judges’ recommendations. The Department of Commerce was notified of the recommendations, and on Tuesday, November 12th, I traveled to D.C. to meet with U.S. Commerce Secretary Penny Pritzker and Pat Gallagher to call the recipients. Secretary Pritzker congratulated the winners, expressing her confidence that the three organizations will undoubtedly continue the Baldrige legacy and serve as role models for their peers in the health care and education sectors. I also have to share with you that Secretary Pritzker thoroughly enjoyed her conversations with each of the recipients. I hope you will join me in extending sincere congratulations to our recipients: three organizations with a deep commitment to excellence, driven by their desire to achieve outstanding results for the benefit of their stakeholders (students and patients, staff members and employees, families and communities). It’s a commitment that starts at the very top, is clearly a part of their culture, and anchors organizational decisions and directions. Pewaukee School District, Pewaukee, WI (education) Baylor Regional Medical Center at Plano, Plano, TX (health care) Sutter Davis Hospital, Davis, CA (health care) It is worth noting that each of these role model organizations has also won a top-tier award in the Baldrige-based program of its state (the Wisconsin Forward Award, the Texas Award for Performance Excellence, and the California Awards for Performance Excellence, respectively). Finally, I hope you will join me and applaud these two health care organizations for demonstrating excellence in leadership (category 1 of the Baldrige Criteria) as part of the 2013 Baldrige Award process: Duke University Hospital, Durham, NC Hill Country Memorial, Fredericksburg, TX Congratulations to all and a big thank you to all the many volunteer examiners and judges who make this program and the award process possible! To learn more about the best practices of these national role models, in addition to the best practices of other Baldrige Award recipients, attend the 26th annual Quest for Excellence Conference® April 7-9, 2014, in Baltimore, MD

We within the Baldrige Performance Excellence Program at NIST are delighted to share this news from today’s NIST Tech Beat: Fangmeyer Named as New Baldrige Program Director.  Congratulations, Bob! Robert (Bob) Fangmeyer, deputy director of the Baldrige Performance Excellence Program (BPEP) at the National Institute of Standards and Technology (NIST), has been selected to be the program’s new director. He will be only the third director to lead the BPEP since its establishment by Congress in 1987. Fangmeyer has served as acting director since his predecessor, Harry Hertz, retired in June, 2013. Fangmeyer started with the BPEP in 1997, holding multiple positions that increased in scope and responsibility over time: staff member, supervisory business specialist, team leader, senior staff-program analyst, deputy director and acting director. He has played a leading role in the development of the Baldrige Criteria, the creation of the program’s executive fellows program, and in Baldrige international activities. Fangmeyer has helped lead the Baldrige Program’s efforts to transform its business model, business plan and organizational relationships as the program has transitioned over the past year to be fully funded by the private sector. He also has represented the program as a speaker at national and international events, and is the primary liaison to the network of Baldrige-based state and local award programs. Prior to the BPEP, Fangmeyer worked for six years as a human resources specialist in NIST’s Office of Workforce Management. He holds a Bachelor of Arts degree in psychology from Villanova University and a Masters of Business Administration from the University of Maryland. BPEP is managed by NIST in cooperation with the private sector. The program raises awareness about the importance of performance excellence in driving the U.S. and global economy; provides organizational assessment tools and criteria; educates leaders in all types of organizations about the practices of national role models; and recognizes them with the Baldrige Award in six categories: manufacturing, service, small business, health care, education and nonprofit. BPEP also is a partner in the Baldrige Enterprise, which includes the private-sector Baldrige Foundation, the Alliance for Performance Excellence—a body made up of the 33-plus state, local, regional and sector-specific Baldrige-based programs serving nearly all 50 states; and ASQ, an international organization promoting quality. Thousands of organizations worldwide use the Baldrige Criteria to guide their operations, improve performance and get sustainable results. This proven improvement and innovation framework offers organizations an integrated approach to key management areas. The criteria are regularly updated to reflect the best practices from the latest validated management techniques. The Baldrige Award, named after Malcolm Baldrige, the 26th Secretary of Commerce, is not given for specific products or services. Since 1988, 96 organizations have received the award. For more information, go to www.nist.gov/baldrige.  

Posted by Dawn Marie Bailey A few months ago, Patient Room 2020 was unveiled, with more than 30 organizations kicking in technology and materials to produce a prototype for the patient room of the future, "a room designed to enhance both patient engagement and caregiver performance and efficiency." Among the contributors, Baldrige Award recipient Milliken customized antibacterial textiles for linens and scrubs. This "wholesale rethinking of the patient environment" began with a 2006 grant to produce the hospital room of the future that could improve health care outcomes. "Patient Room 2020 is designed to address some glaring shortcomings rife in the health care system today: a lack of patient engagement in his or her own treatment, hospital-acquired infections, caregiver inefficiency, and overall patient discomfort. . . . Each element was chosen for a reason and placed in the right location to enhance both patient engagement and caregiver performance and efficiency. It’s a systems approach-something that has long been employed to boost efficiency in other industries but has been sorely lacking in basic patient care, where things are often still done piecemeal with pen and clipboard." Talk of a systems approach and how the design of a room could actually impact health care outcomes led me to the Baldrige Health Care Criteria for Performance Excellence and the guidance within on taking into consideration patients’ expectations and requirements for their health care services-and in this case for their hospital rooms. Category 3 of the Criteria specifically relate to the voice of the customer and how to determine  patients’ and other customers’ satisfaction and engagement. According to the Health Care Criteria, voice-of-the-customer processes are intended to be proactive and continuously innovative so that they capture patients’ and other customers’ stated, unstated, and anticipated requirements, expectations, and desires. In order for a room design and the technology within to truly impact health care outcomes, I would assume that these patient requirements, expectations, and desires must be part of the design considerations. It all leads back to what a health care provider can do to ensure patient engagement in his or her own treatment. Listening to the voice of the customer is probably one of the best ways to start. And, of course, to me, it all leads back to the guidance in the Health Care Criteria on how to serve patients’ and other customers’ needs in order to engage them and build relationships. How would you design your patient room of the future?

Posted by Harry Hertz, the Baldrige Cheermudgeon Recently, I read a blog posting about the "Myths of Motivation." The point of the post is that motivating employees takes some time and energy and is not formulaic; one size does not fit all. The author then discusses four misconceptions about employee motivation: It is all up to the boss. No it isn’t! You can’t force employees to be motivated, but you can encourage them to be self-motivated by creating the appropriate environment. You know exactly what your employees want. No you don’t! Each employee is unique and what motivates each of them might not be the same that motivates you. Job satisfaction = motivation. No it isn’t! Satisfaction and engagement are not equivalent. You need an alignment between organizational goals and personal goals. Then you achieve engagement and motivation because your employee now identifies with the organization. How often have we heard, "It’s a job; I am satisfied." All you need is cash. No, not true! People want fair and adequate compensation, but beyond that they want to identify with their job and organization. They want to learn. They want a work culture that makes them look forward to coming to work and contributing. Is any of this surprising? It certainly isn’t if you have been using the Baldrige Criteria for Performance Excellence as a management systems framework. Workforce motivation has been a part of the Baldrige Criteria for many years and in 2007 we started a focus on workforce engagement, recognizing that workforce satisfaction alone did not lead to engagement and loyalty. Some of the key concepts in workforce engagement that are included in the Baldrige Criteria include: How do senior leaders communicate with and engage the entire workforce? How do they encourage frank, two-way conversation? How do you determine key elements that affect workforce engagement for different workforce groups and segments? How do you ensure that your organizational culture benefits from the diverse ideas, cultures, and thinking of your workforce? How does your learning and development system support the organization’s needs and the personal development of your workforce members? How do you manage effective career progression for your workforce members? How do you analyze key business results to identify opportunities for improvement in both workforce engagement and business results? How would your organization and its leaders answer these questions? Would their current answers lead to an engaged workforce? Let me know what you think!

Posted by Dawn Marie Bailey The value of organizational awards to engaging the workforce, driving business success, and sharing best practices is highlighted in a Pittsburgh Post-Gazette article that focuses attention on the number of "most-admired" companies with headquarters or major operations in Pittsburgh, PA—among them two Baldrige Award recipients. The May 16, 2013, article, entitled "Best Practices Make Perfect an Engaged Workforce and Commitments to Sustainability can Drive Business Success," describes the "most widely respected honor in business [as] the Malcolm Baldrige National Quality Award." The story begins with the description of a small business growing fast but without an entirely engaged workforce. So, the small business polls its workforce to identify critical issues to address, and after several years, addressing the issues leads to a national award for workforce engagement. The article quotes Aimee Kane, assistant professor of management at Duquesne University’s Palumbo Donahue School of Business: "Awards—whether they recognize an engaged workforce or best practices in safety, diversity or cutting-edge product development—can motivate employees and translate to employees feeling more responsible and invested." She adds, "If the award seems real and prestigious in the eyes of others whose opinions they care about or trust, it can lead [employees] to feel more proud that they belong to the organization . . . and they’ll act on behalf of that group. It feels good to have others think well of you." The article names a whole number of awards received by the elite companies of Pittsburgh—several of which have a connection to Baldrige. For example, a gentleman from Alcoa served as a judge for the Malcolm Baldrige National Quality Award, and local company and 2003 and 2010 Baldrige Award winner MEDRAD, Inc. is now Bayer HealthCare Radiology & Interventional, which has some U.S. headquarters in Pittsburgh. In addition, Westinghouse Electric’s nuclear fuel division, with a plant and headquarters near Pittsburgh, received one of the first-ever Baldrige Awards in 1988. So is there a link between employee engagement and other results and organizational awards? According to this article, those plaques and trophies of these elite Pittsburgh organizations sure make their employees feel good about their jobs.

On Thanksgiving, my husband and I volunteered at a local nursing home. We were not aware of our volunteer tasks before we arrived at the facility, but once we met with organizers, we were assigned to areas where help was most needed. As volunteers, we brought our own special skills and talents to completing these tasks.  Whether it was serving lemonade or tea to residents and their families in the dining hall, helping to set up dining room tables with tablecloths and dishes, wheeling residents from their rooms to the dining hall, serving plates of food to the residents and their families, feeding a resident who could not manage it for himself, or just visiting with residents who did not have family with them for the Thanksgiving meal—we were put to good use.   At one point, I looked across the room to see my husband with small beads of perspiration on his forehead as he was setting up tables while juggling conversations with patients who were just wheeled into the dining hall. He had a huge smile on his face and, later when we discussed our experiences, he said he had a great time engaging the residents in conversation. Everyone there knew that every task was an important one, and there was no shortage of help because we each contributed to making Thanksgiving a special occasion for the residents and their families. A couple of days after our volunteer experience, I read this quote: The highest reward for a person’s work is not what they get for it, but what they become because of it. — John Ruskin Giving your time and talent can be one of the most rewarding opportunities we will experience in our lifetime, and one unique volunteer opportunity is to become a Baldrige examiner.Baldrige examiners are an elite group of professionals who commit their knowledge, skills, and time to help evaluate applicants for the Malcolm Baldrige National Quality Award—the only Presidential award for organizational performance excellence. Their evaluations are used by organizations for improving not only their own systems but contributing to improving the entire U.S. economy.   Examiners have the unique opportunity to explore in-depth examples of best practices, innovation, planning strategies, and ways to engage customers and the workforce—learning that helps to build their own professional acumen. Please consider sharing your time and talent with U.S. organizations. The application process for appointment to the 2014 Malcolm Baldrige National Quality Award Board of Examiners will close at 6:00 PM on January 9, 2014. We hope to see your application in the pool for selection to the board. Please visit the Baldrige Web site to learn more about how to become a Baldrige examiner.

Posted by Harry Hertz, the Baldrige Cheermudgeon The selection of words used in the Criteria for Performance Excellence is by design, i.e., in general there is a deliberate intent with the words used and the order in which they are presented. While that intent is clear to the authors of the criteria, it is not always obvious to criteria users, for good reason. They can’t get inside the mind of those who create the criteria. With that realization in mind, I thought it might be good to write a periodic Blogrige post about some of those language nuances. This is the first blog in that series. It deals with language nuances in the results category. The most important category, from the perspective of criticality to organizational sustainability, is the results category with 45% of the total points in the Baldrige scoring system. With limited exceptions all the questions in that category begin with, "What are your current levels and trends in key measures or indicators of …(some aspect of organizational performance)." This is intentional to make clear that quantitative/numerical results are expected. Furthermore, not only is the current performance level expected, but also how that performance has changed over time to indicate improvements or challenges to good performance. It is a guide to decision-making for the future. However, there are a few results questions that do not ask for levels and trends, but have a more general request for "results." These questions are in item 7.1c on Supply-Chain Management Results and all of item 7.4 on Leadership and Governance Results. This choice of language is intentional because not all results in these areas are amenable to quantitative measures or trending. For example, in item 7.4 many of the results may be qualitative. It is not enough to say fines for violating law or regulation have gone down, but you want to know what caused the fines and how the problem was solved. As another example, results of intelligent risk-taking may not be trendable (# of risks over time?) because a significant risk that led to new product or that was aborted at the right time is by itself an important result. That said, this does not mean that numerical information should be avoided. Using the scoring guidelines, where a result is numeric and trendable that result should be reported. The lack of requirement for levels and trends should not be used as a directive to not include them when appropriate. I hope this helps clarify the intentionality of the language difference in some results item questions. If there other criteria language questions you would like to see addressed in Blogrige, please let me know. Thanks!  

Posted by Dawn Marie Bailey In late fall, Sri Lanka announced its national quality award winners for 2013 in the large- scale manufacturing category. Among them was Coca-Cola Beverages Sri Lanka Limited (CCBSL). The annual Sri Lanka National Quality Award is "based on the world-renowned Malcolm Baldrige model" and recognizes Sri Lankan organizations that excel in quality management and achievement. Although the number of U.S. business applicants for the Malcolm Baldrige National Quality Award, on which the Sri Lankan award is based, is not the sole measure for the value of the Baldrige Criteria (for example, we know of many organizations in the United States and around the world that adapt the Criteria for self-assessments and for their own internal quality programs), many of us have of course lamented the fact that more U.S. businesses have not applied for the award in recent years—not just for the recognition but for the objective feedback received on the organization’s strengths and opportunities for improvement. Perhaps one strategy to re-engage U.S. businesses in applying might be to remind them of the value that manufacturers in other countries are finding. Here are just a few examples: Proof of a Commitment to Quality and Top Standards "This award is a testament to our commitment," said Kapila Welmillage, country manager, Coca-Cola Beverages Sri Lanka. "I also want to take this opportunity to congratulate my team at CCBSL, who have worked very hard to maintain our top-quality standards and win us this award." Coca-Cola Sri Lanka ‘s production facility in Biyagama was also named by the Coca-Cola India & South West Asia Business Unit among the top-60 plants in The Coca-Cola System worldwide. "This award reinforces our commitment to high quality as we continue to build a world-class, sustainable business in Sri Lanka," added Abhishek Jugran, country manager—Sri Lanka & Maldives, Coca-Cola Far East Ltd. Better Production and Services, Costs Reduced, Performance Increased In an August 2012 article in International Business Research by Fariba Azizzadeh, Morad Shamsi, Seidmehdi Veiseh, and Farideh Kamari, we found that even businesses in Urmia, the 10th-most-populated city in Iran, are recommended the Baldrige Criteria as one model of improvement for "small industries" and "industrial estates." According to the authors, "quality improvement programs appear to be significant more than ever in order to achieve better production and services, costs reduction, and increasing the performance." One piece of research also noted in the study "Limitation and Difficulty Analysis of Quality Improvement Program Implementation in Urmia Small Industries" is that "manager’s support and commitment . . . play a significant role in quality improving programs." Customers Reward Quality In another example, we found a study called "Commitment to Service Quality in Automotive Dealerships: Results from an Australian Pilot Study" that stated "the importance of quality products and quality service to consumers cannot be overstated. . . . Customers explicitly reward quality." In the study, 2005 Baldrige Award recipient Park Place Lexus was recognized for receiving the "prestigious" Malcolm Baldrige National Quality Award and improving customer quality at its dealership. Challenges of implementing quality improvement systems at Australian dealerships are noted, among them lack of consistency in approaches and difficulties in developing quality cultures. The authors, Chihiro Watanabe, Hans-Henrik Hvolby, and Kym Fraser, lay out four factors for the success of quality improvement models, factors that are all embedded in the Baldrige Criteria: Top management commitment Customer focus and satisfaction Employee involvement Process management Conclusion Whether to apply for a Malcolm Baldrige National Quality Award (or a state- or sector-level Baldrige-based award), manufacturers, small businesses, and service organizations from around the world are seeing the value of the Baldrige Criteria. My hope is that this same value is clearly seen in U.S. business as well.

Posted by Christine Schaefer Last month in Missouri, the Governor’s Conference on Baldrige in Education kicked off a large-scale improvement initiative that has the backing of key education groups in the state. With a mission to "facilitate school districts’ deployment of the leadership and management principles that have been developed by the Baldrige Performance Excellence Program," the Missouri Network for Educational Improvement (MNEI) aims to support Missouri school districts’ use of the Baldrige Education Criteria for Performance Excellence to improve student learning, educators’ satisfaction, and other important results. "For Missouri to compete in today’s global economy, our students need to graduate from high school ready to succeed in college and careers," stated Missouri Governor Jay Nixon in announcing the conference. "To accomplish that goal we need a comprehensive approach that includes not just more resources, but also higher expectations, greater accountability and a commitment to excellence at every level." Nixon urged all school districts to implement the Baldrige Criteria. The MNEI represents a partnership of the University of Missouri College of Education (CoED), the Missouri School Boards Association (MSBA), and the Missouri Association of School Administrators (MASA). The network also is working in consultation with the Carnegie Foundation for the Advancement of Teaching and the Excellence in Missouri Foundation, among other organizations. Hosted by the University of Missouri, the early December conference was attended by superintendents from throughout the state, many of whom were accompanied by members of their leadership teams and boards of education. They heard from leaders of Baldrige Award recipients in education and business, among other experts, of beneficial impacts of using the Baldrige framework for performance excellence. Among key presenters was JoAnn Sternke, superintendent of the Pewaukee (Wisconsin) School District, a national 2013 Baldrige Award recipient. Sternke shared how, with adoption of a Baldrige systems approach to performance excellence, "the system drives the strategy." Innovation results from having systems in place, she said, and using the Criteria has freed schools to become more innovative. In reference to a popular claim from Baldrige-using hospitals that patients’ lives have been saved as a result of using the framework, Sternke pointed out that it "saves lives in education, too." Some schools see Baldrige as one more thing on their plate, acknowledged Sternke. But she stressed, "It’s not one more thing on your plate; it’s a way to organize your plate." Schools can save money from support services with improvements made as a result of using the Baldrige framework, she said, and they can funnel those funds to instruction. In her district, use of the Baldrige Criteria has provided for alignment of efforts, she added, with everyone talking the "same language of improvement." Also speaking at the conference, Menomonee Falls (Wisconsin) School District Superintendent Pat Greco shared how her district combines use of the Baldrige Criteria with resources from the Studer Education Group, Jim Shipley and Associates, and a local community college to improve and excel in leadership, strategic planning and deployment, and a focus on customers. Greco spoke enthusiastically about how use of the Baldrige framework aligns performance. Her district is now performing in the top 5% of districts in the state, she pointed out, whereas five years ago, it was labelled as needing improvement. Today district leadership teams check their progress on action plans every 45 days; at the classroom level, teachers and students benefit from 10- to 15-day cycles of improvement in teaching and learning processes. "We’re very excited about what’s happening in Missouri today with the push for excellence in schools using the Education Criteria and other Baldrige resources," said Sandra Byrne, a senior staff member and education specialist with the Baldrige Performance Excellence Program. "We hope to see Missouri school districts joining Pewaukee as Baldrige Award recipients in future years. Of course, the biggest winners will be the students, parents, teachers, and community members they serve." 

Posted by Dawn Marie Bailey "How will my investment in a criteria/award program impact my bottom-line?" is a question commonly asked by senior leaders. In other words, "What’s in it for my organization?" For 2014, French Brothers of Alamogordo, New Mexico, earned a Bronze NHQA award. For senior leaders in the home building industry who have invested in the National Housing Quality Award (NHQA), an award and education program modeled after the Malcolm Baldrige National Quality Award (MBNQA), such investment has led to growth in sales during the recession, expansion into new markets, and customer satisfaction, which has reached 100% for some builders. Developed in 1992 from a Department of Energy grant, NHQA’s goal is to inform and educate builders about the leadership needed to create customer- and quality-driven companies. It is now part of the National Housing Quality Program, sponsored by Professional Builder magazine. NHQA Director Serge Ogranovitch said that over 90% of NHQA’s 100 award winners are still in business, and he attributes this to quality management systems and well-managed companies. A study of NHQA winners from 1993 to 2009 showed metrics such as gross profits of 12-20%, construction costs vs. budgets of +/- 1%, cycle time reductions of 15-50%, zero defects at closing of 98%, defect reductions of 11-75%, referral rates of 30%, and trade satisfaction of 94%. NHQA uses criteria based on the basic concepts of the Baldrige Criteria for Performance Excellence, a management systems framework, but adapted to the home building industry. For example, instead of a focus on suppliers as in the Baldrige Criteria, the NHQA criteria focus on trade relationships and support. Like the Baldrige Criteria, the NHQA criteria are very customer focused, said Ogranovitch. Denis Leonard, who has been both an examiner for NHQA and MBNQA, said NHQA builders use the criteria with quality management tools and techniques to drive performance improvement. "[NHQA builders] have a strong focus on strategic planning, employee empowerment, trade relationships, and of course the customer," he said. "Evaluating your business against the Baldrige-based NHQA criteria can help you identify areas for improvement just as these builders have done. . . . [To be profitable in 2014, home builders] need to focus on . . . reducing waste, rework, warranty costs, improving cycle time, everything that can make us more effective and efficient in all aspects of our business and in every home we build, and quality management tools and techniques are how that can be achieved." Ogranovitch said he reviews the Baldrige Criteria every year to see what changes have been made and what new concepts should be adopted as improvements to the NHQA criteria. He said NHQA is now looking at adding the use of technology into its criteria, as technology is impacting every aspect of home building, including online checklists, details/specification sheets, payments, and tutorials. Ogranovitch added that he returns to the Baldrige Criteria when he "wants to see what’s going on. I truly believe that the people involved in doing Baldrige and helping to guide Baldrige are truly good thinkers in industries and quality management. If they have ideas and concepts that would be beneficial for [NHQA], I want to be aware of them. I want to stay current." Use of a criteria as a management framework has not been an easy concept for many home builders who tend to be entrepreneurial in nature, said Ogranovitch. Such builders were more used to taking notes and acting on their own experiences and instinct when making management decisions. But builders who have embraced the NHQA criteria like the standardization and the strengths and opportunities pointed out in feedback reports. "They like the idea of having an industry’s best practices there to help them," Ogranovitch added. The NHQA evaluation process is similar to the one used by the Baldrige Program. NHQA examiners are management and/or industry experts whose evaluation requires them to answer 147 questions gleaned from builders’ 17-page applications. The examiners score each application, and a high-enough score sends three NHQA examiners to a 1.5-day site visit of the builder to validate the content of the application and to find opportunities for improvement. A final phase of the site visit is a customer satisfaction survey given to the builders’ customers over the last 12 months to ensure that the builders’ customers are still satisfied. "Lots of builders really love [the NHQA process and criteria] because they see it as a process to improve their companies," said Ogranovitch. Builders often apply for the NHQA multiple times because of the feedback reports they receive after the process. Like Baldrige applicants, many builders use their NHQA feedback reports as "a guideline for marketing and strategic plans," he said, because the reports include hints and ideas on how to improve. Such feedback reports, Ogranovitch added, contain $30,000 worth of consulting for much less. "The value is wonderful." How would you adapt the Baldrige Criteria for your industry or organization?

Posted by Christine Schaefer A few months ago, my family received a personal reminder of the importance of quality in the skilled-nursing care profession. It was delivered as my elderly father was transitioning from a hospital to a nursing home. With the advancement of his dementia and a few other vexing conditions, his health status had declined quickly. It was obvious to doctors and family members alike that we were acting in his best interests in moving him to a care center where he could receive the support he needed. Yet I will never forget the spooked and bewildered look in his eyes as his stretcher was wheeled out of an ambulance in front of the nursing facility that was to be his new home. And I will never forget how reduced and vulnerable he looked, shivering in a hospital gown in the brisk autumn air, seemingly unable to even ask where we were going. "Dad, it’s OK. This is the right place for you," I said more than once as we moved down the hall to his bedroom. While I had enough objective information to support my assurances of the nursing care center’s high quality, I kept looking for any sign of less-than-stellar care. Fortunately, I found none. And I will never forget how relieved I felt. If you’ve ever moved a loved one into a care center, you can fully appreciate my initial concern that day. And you might also appreciate my enthusiasm in reporting now on the excellent quality ratings and other beneficial results of nursing homes that have received top honors in recent years in the thriving Baldrige-based quality awards program of the American Health Care Association (AHCA). Using the Baldrige Health Care Criteria for Performance Excellence as a basis for organizational assessments, the AHCA/National Center for Assisted Living (NCAL) National Quality Award Program draws applicants each year from some 12,280 long-term and post-acute care providers represented by the association. Between its inception in 1996 and 2012, the sector-specific award program received more than 8,000 applications and presented more than 3,000 awards at three levels: Gold, Silver, and Bronze (with 13, 256, and 2,856 awards issued at those levels, respectively). To be considered for the highest level of Gold, applicants must demonstrate "systematic quality performance and organizational effectiveness," as stated in AHCA’s 2013 Quality Report (PDF file). The 2013 Quality Report spotlights some impressive aggregated results of Silver- and Gold-level award recipients of the National Quality Award program from 2010 through 2012 (see pages 20 and 21). Consider the following two charts, which plot results data (provided by the Centers for Medicare and Medicaid Services) of AHCA/NCAL top-tier award recipients in comparison to aggregated results of all other industry peers: Reprinted with AHCA permission Reprinted with AHCA permission As part of AHCA’s Quality Initiative launched in 2012, the association encourages its member organizations across the country to focus on the following four goals: (1) safely reduce hospital readmissions; (2) increase staff stability; (3) increase customer satisfaction; and (4) safely reduce off-label use of antipsychotics. Urvi Shah, quality improvement manager at AHCA, recently affirmed the importance of organizations’ use of the Baldrige Criteria as a framework for quality improvement—in general and in relation to achieving those four goals (for which AHCA has specific target dates and measures, as described in the 2013 report). "We tell our members that following the Baldrige Criteria will help them accomplish not only the four goals, but any goal they have," said Shah. The AHCA/NCAL National Quality Award program, like the Malcolm Baldrige National Quality Award program on which it’s based, also emphasizes that the improvements made during an organization’s quest for excellence are much more important than winning the award. "When organizations apply for the [AHCA/NCAL] award," Shah said, "we say, ‘use your feedback report and see this as a journey of quality improvement.’" Surely, the customers—and the family members of customers—served by nursing homes agree on this: we want to see every such organization achieving excellence!

Posted by Dawn Marie Bailey It’s always an honor to highlight our nation’s heroes, especially during this holiday season when we should be thankful for so many blessings. Here’s one story of how our nation’s heroes in Texas are actively working to achieve and sustain high levels of performance using the Baldrige Criteria for Performance Excellence as a business model. I recently had the unique honor of a virtual conversation with Sergeant First Class Brenda Lopez, Organizational Excellence NCO, and Major Phil Kost, TXARNG Strategic Plans Branch Chief, of the Texas Army National Guard (TXARNG). TXARNG serves a dual state and federal mission, responding to both domestic emergencies and supporting active duty Army abroad. And just recently Texas guardsmen were called to duty to help local communities cope with the severe winter storms in the region. Tell me a little about the Army Communities of Excellence and the Texas Army National Guard. How do guardsmen use the Baldrige Criteria for Performance Excellence? The Baldrige-based Army Communities of Excellence (ACOE) program empowers Army organizations to achieve and sustain high levels of performance by using an integrated management approach based on the Baldrige Criteria. Although ACOE participation is voluntary, the program highly encourages Army organizations to participate and assess the overall health of their organizations, share best practices with other Army communities, and implement a continuous process improvement mindset. The Texas Army National Guard (TXARNG) utilizes the Baldrige Criteria as a business model to determine the current state of the organization through detailed self-assessments. To aide in this endeavor, TXARNG has created a cross-functional working group to create and analyze both individual and organizational processes in order to allow the organization to meet, exceed, and sustain established performance measures. This cross-functional working group has senior representatives from each key department of TXARNG with the organizational knowledge that is needed to better understand where TXARNG has been and where it should be going in the future. What has been the value of this process for the Texas Army National Guard? Participation in the ACOE program has brought great value to TXARNG and the way we conduct business from a management perspective. Through self-assessments and feedback reports, we are able to identify and share our best practices, take action on opportunities for improvement, and increase the overall performance of our organization. While there are other methodologies for process improvement, the Baldrige Criteria used in ACOE assist organizations, to include the TXARNG, align their strategic goals and objectives with organizational excellence through the established Criteria categories. An example of a process improvement came from feedback that led to an after-action review to address fiscal accountability and support for a key community. Prior to fiscal year 2012, requests for ACOE funds were submitted through an Excel spreadsheet, which caused delays in processing and tracking. Using the feedback and a Kaizen Rapid Improvement event, the Organizational Excellence Team created a Web site with instructions, user-friendly funds request, and response functions, as well as contact information. This improved the process to fullfil ACOE funding requests made by internal organizations, providing better tracking for fiscal accountability purposes. Other improvements derived through the ACOE process were the establishment of a new strategic planning process map to be used as a model for upcoming plans and new surveys to focus improvements in areas of importance to the workforce. What have the different departments learned about Baldrige, the Criteria, and process mapping? Why is this learning important? The TXARNG departments have learned that ACOE is more than just a competition; it is about providing a common vocabulary that facilitates an environment of excellence and continuous process improvement. They understand the importance of implementing a business model that will bring consistency to the organization’s management style through systematic and effective processes that drive innovation and improve performance. Although different departments have different duties and responsibilities, they have learned that each individual process is aligned and integrated with one another in order to achieve the overarching mission of TXARNG. Process mapping has helped our different departments identify how their workforce gets the job done, non-value steps or redundancy, and areas they can improve. They have also learned the importance of integrating our customers, partners, and workforce into organizational change processes that will have lasting impacts to our organization.

Posted by Harry Hertz, the Baldrige Cheermudgeon The results are in for the annual Best Places to Work In the Federal Government. The overall survey results are not surprising based on history, the current environment, and where many organizations (government and business) have been challenged over recent years in the area of workforce engagement. Government-wide job satisfaction dipped for the third year in a row. It dropped 7.2 points since 2010 to 57.8% in 2013. The largest drop in satisfaction was with pay; the second largest was with opportunities for training and development. And, in 2013 senior leadership received a government-wide satisfaction rating of 45.4%. According to Max Stier, president and CEO of the Partnership for Public Service, "In an environment where you are calling for more from your employees,  leadership has to do a better job of sharing information, recognizing good work and empowering the workforce to succeed in a challenging environment." The highest scoring agency was NASA. Jeri Buchholz, NASA’s assistant administrator for human capital said, "We talk about culture issues and employee engagement at every senior leadership meeting." She added that the agency has focused on leadership development. Both Stier’s and Buchholz’s comments should be music to the ears of all of us who have been guided by the Baldrige Criteria for Performance Excellence. Stier and Buchholz speak to key attributes of role model leaders contained in the Baldrige Criteria. The attributes are part of the Baldrige core value descriptor for visionary leadership. Item 1.1 on Senior Leadership asks how senior leaders create a sustainable organization through: creating an environment for mission achievement, performance improvement and leadership, and organizational and personal learning creating a workforce culture that focuses on customer engagement creating an environment for innovation, and participating in the development of future leaders It also asks how senior leaders engage in frank, open two-way communication with employees and how they focus the organization on action. The definition of performance excellence adopted by Bladrige has three components. The last component, learned from role model organizations (Baldrige Award recipients), is a commitment to organizational and personal learning. And in a study we did a number of years ago of Baldrige Award recipients, the highest scoring area across all sectors for role model organizations was Item 1.1,, Senior Leadership! It all sounds very logical. You now know how the federal government stacked up. How about your organization?

Posted by Dawn Marie Bailey Upon hearing of Baylor Regional Medical Center at Plano being named a 2013 Malcolm Baldrige National Quality Award recipient, U.S. Congressman Sam Johnson (TX-03) recognized the organization for receiving the nation’s highest Presidential honor for performance excellence through innovative practices and visionary leadership. On the floor of Congress, he said, "For nearly a decade, Baylor Plano has provided North Texas with high quality and compassionate care. Their superior patient satisfaction rate and dedication to training the best and the brightest go unmatched. Baylor Plano’s success and patient-centered care is a testament to . . . endless possibilities." Baylor, the first Texas hospital to ever receive the national award, also received the Texas Award for Performance Excellence in 2010. With the Health Care Criteria as a management framework/guide and numerous cycles of continuous improvement stemming from their use, the hospital posts role-model results; for example, Baylor Plano has consistently performed within the top 10 percent of hospitals nationwide for a variety of key health care measures. Patient satisfaction surveys for the past five years have rated Baylor Plano’s inpatient, outpatient, and ambulatory surgery services with scores of 90 percent or higher, exceeding national benchmarks. Baylor Plano maintained an above-90-percent retention rate for first-year employees and for all employees for the past three years. Baylor Plano currently stands at a 95 percent retention rate for new employees and at 94 percent for all employees. "Countless hours of work went into preparing the Baldrige Award application, and I am so proud to learn that the [Baldrige examiners] who visited Baylor Plano in October were impressed by the top-to-bottom quality they found at all levels," said Jerri Garison, president of Baylor Regional Medical Center at Plano. "This honor is a true reflection of the passion that our hospital staff, physicians, and board members have for our patients. I am so privileged to work with such dedicated staff members, and I would like to thank each of them for their hard work and contribution on this journey." "Receiving this award is a great honor for Baylor Plano and for our entire health care system," said Joel Allison, CEO of Baylor Scott & White Health, for which Baylor Plano is an owned/operated hospital. "[The Malcolm Baldrige National Quality Award] is one of the most prestigious awards given in America, and it is the first time any hospital in Texas has ever received this national honor. I want to extend my congratulations to the entire Baylor Plano team on this outstanding, well-deserved achievement." To learn more about how the Baylor Regional Medical Center at Plano used the Criteria  and about its best practices, consider attending the 26th Annual Quest for Excellence Conference®.

Posted by Christine Schaefer In education, as in other sectors, being a small organization is not an impediment to winning a Baldrige Award. With fewer than 3,000 students and 300 staff members, Pewaukee (Wisconsin) School District provides the latest example of this fact. As the district’s superintendent JoAnn Sternke recently stated, "We’re a small organization that has become very focused on using the Baldrige [Education] Criteria to help us improve. We’re the little engine that could." As noted before, no organization is too small to benefit from use of the Baldrige Criteria. Having used the Baldrige Education Criteria for Performance Excellence since 2007, Pewaukee School District was demonstrating excellence in wide-ranging processes and results by 2010, when it won the Wisconsin Forward Award of its state-level, Baldrige-based quality program. Pewaukee’s strong demonstration of excellence enabled it to win the national Baldrige Award in 2013, becoming the seventh school district in the history of the program to win the national award. The district boasts one of the highest graduation rates in its state, despite also having a relatively tough graduation requirement (28 credits), as well as very low truancy and dropout rates. What’s more, the rate of college attendance among the district’s graduates has increased from 78.8 percent in the 2006-2007 school year to 91.9 percent in the 2011-2012 school year, compared to a state rate of 74.1 percent. While having added Advanced Placement (AP) course offerings in recent years, the district achieved an AP exam passing rate (76 percent, as of 2011-2012) that is eight percentage points higher than the statewide rate. And on ACT college-readiness tests, district students have outperformed both state and national comparisons with their aggregate score of 23.4. Sternke has noted that "leveraging the Baldrige Criteria helped us look at improving all the processes in our organization and streamline spending. We had to be very good and strategic about setting achievement goals." With strategic planning processes in place that reflect the Baldrige Criteria and best practices, her district develops action plans to ensure the accomplishment of its strategic objectives and reviews them every 90 days. The district boasted a completion rate of 98 percent for action plans during the most recent school year. Perhaps not surprisingly, Pewaukee schools also have engendered high levels of satisfaction among parents and staff members. In fact, parent satisfaction rates (between 91 and 95 percent) at all district schools last year outperformed the national average rate of 74 percent. To learn more about this district’s inspirational results and journey to excellence, check out the profile of the organization on our Web site and attend the Quest for Excellence® conference this coming April, where district leaders will be on hand to share their story and best practices.

Posted by Dawn Marie Bailey Janet Wagner, CEO of Sutter Davis Hospital (SDH), the smallest hospital ever to receive a Baldrige Award and the first in the Sacramento area, was recently profiled in a Sacramento Bee article about the ten-year journey in which the hospital adopted, implemented, customized, refined, and eventually integrated Baldrige Health Criteria for Performance Excellence principles into its operations. "When we started, we really had to do some self-reflection and say, ‘What is it that we do best? What’s our core competency?’" Wagner said. "And my managers and the doctors and my employees said, ‘Our core competency is our culture of caring; how we take care of each other, our patients, our doctors, our community.’" The 2013 Malcolm Baldrige National Quality Award winner found that by engaging its staff and integrating Baldrige principles into how it provides care-in a customized way that led to specific behaviors and a training module-SDH employees moved from simply satisfying patients to giving them a "remarkable customer experience." In a Digital Journal article, Wagner explained how patients have been impacted by the Baldrige win. "Winning the Baldrige says something to your community. It tells them that you’ve got one of the best hospitals in the country, and that the people there are working very hard to provide the very best care. When patients receive care at Sutter Davis Hospital, they know that the team here really does care about their welfare and is doing the very best for them. The Baldrige Framework for Performance Excellence works," said Wagner. "The Baldrige Award has brought interview requests from media outlets around the nation and a number of speaking engagements . . . but the reward is what [SDH's leaders] learned and [are] learning about connecting with employees’ belief systems, establishing a framework for continuous improvement, and ensuring that every patient is embraced by a culture of caring," Wagner added. The results that the nonprofit, 48-bed acute care hospital has achieved make the point: SDH performance scores for specific patient groups such as acute myocardial infarction, congestive heart failure, and pneumonia have ranked in the top 10 percent nationally since 2010. SDH exceeds the top 10 percent benchmarks nationally for readmission rates and average length of stay for pneumonia, heart failure, and acute myocardial infarction, as well as average length of stay for both Medicare and overall inpatient care. SDH demonstrates high standards for work and process efficiency. For example, the average door-to-doctor time in emergency has decreased from 45 minutes in 2008 to 22 minutes in 2012, well below the California benchmark of 58 minutes. An organizational focus on people is reflected in SDH’s employee satisfaction and engagement scores, which exceed the top 10 percent of marks in a national survey database. SDH has been named a 100 Top Hospital by Truven four times, including for the past three years. "In spite of the struggles that health care finds itself in today, there is great care being delivered every day to every patient at Sutter Davis Hospital," said Wagner. "This recognition from the Baldrige Foundation may seem like the end to a long journey; however, it is just a springboard to executing the many innovative ideas and processes that this complex health care environment demands." Part of SDH’s journey was its engagement with the California Awards for Performance Excellence (CAPE)-part of the Alliance for Performance Excellence, a network of Baldrige-based state and sector programs. Prior to its national Baldrige recognition, from CAPE, SDH received three Eureka Gold-level awards, as well as the Governor’s Award for Excellence in California. Both the Baldrige Award and CAPE processes include volunteer examiners who provide expertise through feedback reports that SDH and other award applicants receive and use to address opportunities for improvement. To learn more about SDH’s improvement journey, best practices, and results, attend the 26th Annual Quest for Excellence Conference®. Also, watch a Quality Digest two-part video interview with CEO Janet Wagner and a live video webcast with Wagner and Baldrige Program Director Robert Fangmeyer on Quality Digest Live, February 14, at 11 a.m. Pacific.

Posted by Christine Schaefer Ever read about a business failure and felt passionate about ways the organization could have avoided it? Consider the case of a large company that suffered a huge loss after a major customer switched to a competitor for future business. Reading the details in the news, I quickly became convinced the company would not have made key decisions that preceded the failure had its leadership embraced the Baldrige Criteria for Performance Excellence as a management framework. Before I delve further into this case, let me be clear that I do not intend to publicly criticize a particular organization here. Therefore, I will not name it, and I will blind its identity by avoiding specific descriptors and the time frame. I am, however, outlining a few key elements of the story because they highlight performance lacks that need not be permanent and process failures that need not be repeated. After all, Baldrige Award winners of every size and sector over the years have shown that full adoption of the systems perspective at the heart of the Baldrige Criteria can dramatically improve organizational leadership and results. Surely, the Baldrige framework could yet help the company in question (and many others) steer clear of costly blunders in the future. Here are salient details of the story: prior to its large-scale customer and market share loss, the organization experienced significant problems with product quality and delivery results. A root cause named by a sector expert was the leadership’s cost-cutting in a key area impacting product quality (apparently harming one of the company’s most important core competencies, in Baldrige Criteria terms) in order to benefit the company’s stock price. While we usually use this space to describe the inspirational achievements of organizations that have used the Baldrige Criteria to improve and excel, we have heard that spotlighting opportunities of improvements can also promote learning. (For example, in response to a Blogrige post last year, some readers suggested that negative case studies are indeed instructive.) So, using the story above as such a negative case study, let’s pretend the organization is fictitious; call it Americawidgets. Now, let’s consider a few sample questions provided by the Criteria for Performance Excellence that Americawidgets could use to assess its processes and improve its performance in relation to its customer focus (category 3 of the Criteria): How do you seek immediate and actionable feedback from customers on the quality of products, customer support, and transactions? How do you determine customer satisfaction and engagement? How do your measurements capture actionable information to use in exceeding your customers’ expectations and securing your customers’ engagement for the long term? How do you obtain information on your customers’ satisfaction relative to their satisfaction with your competitors? How do you determine customer dissatisfaction? How do your measurements capture actionable information to use in meeting your customers’ requirements and exceeding their expectations in the future? Of course, Criteria self-assessment questions on leadership (category 1), strategic planning (category 2), and operations focus (category 6), among other areas, also could help strengthen Americawidgets to recover from and prevent more customer, financial, and market losses. All the Baldrige questions are designed to work together as an integrated framework for managing performance. Answering them could help Americawidgets deliver greater value to its customers, contributing to its sustainability; improve its overall effectiveness and capability; and improve and grow as an organization.  

Posted by Dawn Marie Bailey How to Boil the Ocean In 2012, Lockheed Martin Missiles and Fire Control (MFC) participated in the Baldrige Executive Fellows Program. As part of the program, John Varley and the other Fellows were given homework: identify a significant challenge in their organizations and use the principles of the Baldrige Criteria for Performance Excellence to achieve significant improvement. Varley, vice president for Quality and Mission Success-at the 2012 Baldrige Award recipient that designs, develops, manufactures, and supports advanced combat, missile, rocket, and sensor systems for the U.S. and foreign military-knew that MFC’s most significant area of improvement was the supply chain. Over the past year, the economy had hit the U.S. Department of Defense (DOD) and its contractors hard, and as spending became tighter, the smaller subcontractors in the industry-those who support the large contractors-were hit the hardest. According to Steven Sessions, supplier quality director and deputy, Quality Mission and Success, MFC has a multitier supply chain, with suppliers who have subcontractors and so forth, so there are several tiers of suppliers that support MFC. Sessions says when the economy began to squeeze the lower-level, smaller contractors, the tendency was not to lay off the person who created the parts but the person who was in charge of checking the quality of the parts. MFC has contractual relationships with the first line of its supply chain, but how do you assess the risk with lower-level tiers that farm out parts of their work? Sessions said that MFC was already working on strategies to address supply chain issues when his colleague came back from a Baldrige Executive Fellows session with the idea for a project that "was pretty startling to colleagues." Varley’s project focused on how to improve the entire DOD supply chain. "[Such a project] was closer to boiling the ocean," Sessions says. "We have 2,000+ suppliers, and now we would be taking on a project to help companies that are competitors improve their own organizations." "John’s premise was that we either all improve together or all decline together because we are so integrated," Sessions says. "It was an interesting insight. We tried to figure out how to use the Malcolm Baldrige [Criteria] model to open up doors to companies that five years ago you would never have thought would open their doors to share processes, tools, and techniques on how to improve the DOD supply chain." Sessions added that years ago, the top DOD suppliers like Lockheed Martin were very distinct entities, but now they often act as partners in some programs, competitors in others, and suppliers in still others. Based on the Baldrige Criteria, a strategy called Senior Leadership Engagement and Benchmarking was developed by MFC, and MFC’s senior leaders set out to meet with the senior leaders of the other top DOC contractors, getting their commitment around the strategy that we all go up or down together. The sharing-ideas strategy really took off, with more than 18 major DOD suppliers and others standing in line to take part, Sessions says. "The Malcolm Baldrige Award has made the whole effort take off to the point now where we’re having to leverage seasoned people with more people in the organization in order to keep up with requests," Sessions says. "The interesting part is that we started out thinking that we are going to be . . . helping [other DOD contractors] improve, and we’ve been able to do that. But out of it, we gained a lot of insight into areas in which we can improve our journey as well. What started out as boiling the ocean, materialized into a real partnership and relationship with some significant companies that are coming up with ideas on how to improve the supply chain that any one of us by ourselves probably would not have been able to achieve." Sessions says that MFC is working on other strategies to improve the overall DOD supply chain in the long term; for example, staff members are working on how to prevent counterfeit parts from getting into its systems. In close alignment with its customer, MFC is teaming with others in the industry to solve this complex, difficult problem. Benchmarking Against the Best "The Malcolm Baldrige model is a very structured approach to improving your business," Sessions says, but MFC didn’t turn to the Baldrige Criteria because it needed a framework for improvement. MFC had already won a host of awards, including awards from the Baldrige-based Sterling Award in Florida and Texas Quality Award. MFC decided that we wanted to get a good, solid, independent benchmark of where MFC was relevant to its performance, Session says. As they decided whom and how to benchmark, they brought forward the "world-class" Baldrige Criteria. "We had several ideas of how to benchmark," he says. "But we wanted to be benchmarked by the best of the best. Our focus was to [apply for the Baldrige Award and] get a site visit and get the outcome of where we stood and where we could improve some more." Sessions says, "As we began to understand the [Baldrige Criteria], we found that it was very similar to our own vision for improvement that we had been using over the past 10 years. . . . The reason people model themselves around the Malcolm Baldrige model is to get that kind of proven, world-class performance. . . . We’ve seen dramatic achievements across the business because our senior leaders had the right premises to line up with the Malcolm Baldrige model." Frank McManus, senior quality leader, MFC, says that when MFC chose to begin using the Baldrige Criteria, "Our leaders wanted us to get not so much the award but the feedback. Having the site visit, with examiners coming to various facilities [and those examiners] representing many different industries and experiences and getting that kind of view [became a] vantage point of how we’re operating and continuously improving." "The examiners were the carrot," he added; receiving their feedback was incredibly valuable. The Right Metrics and Why the Baldrige Criteria Sessions said the MFC business model was structured very similarly to the Baldrige Criteria-very focused on the customer and aligned with leadership and every aspect of the organization. A Strategic Enterprise Leadership Counsel reviews the MFC business model to ensure that it aligns with both customer and business needs. Key to the MFC business model is having the right metrics to drive performance that align with customers and are tied to every level of the workforce. Similarly, Session says, the Malcolm Baldrige model focuses on customers, with each operational focus tied into a metric system that is aligned with strategic planning and customer needs. "That’s the beauty of [such a model]," says Session. "It’s very easy for our leadership team to see where areas for improvement are needed because of the instrumentation we have from the smallest of teams to 16 sites, and it rolls up from all of those organizations to the top. . . . We are very process focused with data-driven decisions, and our customer is the primary focus area. We know if we get it right for the customer, our business will follow. The Malcolm Baldrige model follows all these same tenets-always focusing on the customer with robust processes and data-driven decisions. It was a natural fit." For other organizations, Sessions says the value of the Baldrige Criteria is the structured framework and focus on the customer. "Sometimes companies get too inwardly focused and end up losing sight of [what the customer really needs]. Comparing yourself with other industries and what’s considered the best of the best brings insights." Sessions said that when MFC started with the Baldrige Criteria, "We literally had to flip all of our metrics upside down." Its performance had gotten so good that it was focusing on just the 1% of parts that were coming in bad, for example. To complete its application for the Malcolm Baldrige National Quality Award, MFC had to flip its model to show the good parts of its supply chain, and this led to interesting observations. "When you start to benchmark yourself, it makes you look at metrics differently," Sessions says. "The whole organization was pretty astonished when it started to pull together metrics in one place [for its Baldrige Award application]. It makes you look back and forward in how you have been performing on your journey and where it would take you. That’s the value [of writing a Baldrige Award application]-that reflection and insight on where we go next." For more information, attend MFC’s special presentation, "Improving the Supply Chain Using Baldrige," at the Baldrige Program’s Quest for Excellence® Conference in Baltimore, Maryland.

Posted by Christine Schaefer  Next week in Tennessee, one city, two government agencies, and 11 units of a third agency will be among the organizations receiving state-level Baldrige awards for the results and improvements they’ve achieved in recent years using the Criteria for Performance Excellence as a management framework. Those awards will be bestowed at the annual award ceremony of the Tennessee Center for Performance Excellence (TNCPE), a member of the Alliance for Performance Excellence network that provides a feeder system for the Malcolm Baldrige National Quality Award. (Similar Baldrige-based quality award programs can be found around the country.) One of the state agencies that will be honored next Wednesday with a TNCPE award is the Tennessee Department of Human Resources. "We are proud to participate in what TNCPE is doing to help organizations across Tennessee move forward in creating a culture of performance excellence," said Rebecca Hunter, commissioner of the Tennessee Department of Human Resources (DOHR). "While the most important part of this application and award process for us is the outstanding feedback we receive from the examiners, we can also say that since we began to focus on the [Baldrige] Criteria, we have more clarity around our mission, vision, and values. We find that the daily work of our entire team is more focused on our strategic plan and key success factors." "DOHR has fewer than 100 employees whose work serves more than 43,000 state employees and ultimately reaches the more than 6 million residents of Tennessee," added Hunter. "Everyone benefits from the greater efficiency and effectiveness of our department’s key processes." TNCPE’s president and CEO Katie Rawls noted that in the organization’s first year of submitting an award application, DOHR already has earned a Level 2 award among the four levels in TNCPE’s tiered award program. Next Wednesday TNCPE will also present a Level 3 award to the City of Germantown (for the second year in a row) and a Level 2 award to the state’s Bureau of TennCare. In addition, the Tennessee Housing Development Agency, nine county health departments, and two other departments under the auspices of the state health department each earned Level 1 TNCPE awards in the 2013 program. In 2012, state agencies that received TNCPE awards included the Tennessee Department of Children’s Services (Level 2), the Department of Environment and Conservation (Level 1), and the Department of Health (Level 1). In 2012 TNCPE also recognized two public-sector organizations for achieving the highest, Level 4, of excellence: the (municipally owned) Bristol Tennessee Essential Services and the Metropolitan Nashville Airport Authority (a unit of the metropolitan government of Nashville and Davidson County, Tennessee). How did these wide-reaching Tennessee government entities become involved with the Baldrige program in their state? According to Rawls, since its creation as a public/private partnership 20 years ago, the TNCPE "has always had a connection to state government, though it has ebbed and flowed." In recent years, she explains, a major catalyst for state government involvement in the Baldrige program has been John Dreyzehner, Tennessee’s commissioner of health. Dreyzehner has been leading his department in use of the Baldrige Criteria since becoming state commissioner of health in 2011. He also now serves on the board of directors of TNCPE. Rawls credits the participation of two state commissioners on TNCPE’s board with greatly boosting use of the Baldrige framework in the Tennessee government. Dreyzehner has been particularly helpful, said Rawls, in explaining how the Baldrige framework can help people in government. She said he coached her in how to frame the Criteria for Performance Excellence in presenting it to government organizations, in particular, by not leaving the impression that use of the Criteria is something beyond other performance improvement tools that adds a lot more work. Instead, Dreyzehner has characterized the Baldrige framework as being "like the plastic thingy that helps you hold together a six-pack of beer" in relation to other improvement tools and plans and priorities for work processes. To illustrate this value, Rawls worked with Emily Passino, a Lean expert in the state, to create the crosswalk graphic shown below (and linked here as a PDF file: TNCPE Lean Crosswalk) that depicts the Baldrige Criteria framework in the context of the state government’s vision and work processes. Completed and presented at a Lean roundtable in October 2013, this tool was designed to help state employees see how the Criteria categories and questions complement Lean improvement methodology and support all areas of their work. Created by Emily Passino and Katie Rawls. Used with permission. Interviewed separately, Dreyzehner credited TNCPE for being "a model, high-performing state Baldrige organization." He said Rawls was helpful from the start when he contacted her years ago to learn more about the TNCPE program and resources to promote improvements and excellence in Tennessee’s local health departments’ performance. Dreyzehner had first learned about the Baldrige Criteria as a young Air Force captain and flight surgeon in the early 1990s. "The Air Force was very interested in performance excellence," he recalled, "and was looking at and beginning to use the Baldrige Criteria as a framework." Later, as a district health director in Virginia working with counties in Tennessee, Dreyzehner became intrigued by the use of the Baldrige framework in Tennessee’s Sullivan County, which had been initiated by the county’s public health director, Gary Mayes. Today, Dreyzehner takes pride that 11 subunits of his state health department will receive Level 1 TNCPE recognition at the ceremony next week. He says that his organization will apply at the next level in 2014. At the same time, he stresses, "We’re about the journey, not the award."   "What this is about is empowering employees in public service. We’re trying to foster this framework throughout the organization in order to get everybody engaged," he said. "We’re looking to encourage a posture in everybody . . . so that they’re in a position to make the customer’s experience transformative rather than just transactional."   "We want customers to feel that they’re getting really good value," he added. "A lot of times people are coming to us not because they want to, but because they have to. It is a privilege to be in public service. We really want to delight the people we serve if we can." Dreyzehner’s agency provides direct services to 1 in 5 Tennesseans, while also touching on the lives of all residents through its regulatory role. "This is one of the reasons having [the Baldrige] framework is so important: so everybody [providing government services] can have a common approach," he said. To that end, more than a dozen employees in his agency have been trained as TNCPE examiners and are helping to lead their units in the health department, according to Dreyzehner. In addition, he said, more than 500 employees have been trained in the Baldrige Criteria over the last few years. Among other Tennessee organizations helped by their involvement with TNCPE is TRICOR, a quasi-governmental organization (self-funded with a board of directors appointed by the governor) that provides job training for individuals incarcerated in the state. TRICOR sent its first employee to become trained as a TNCPE examiner in 2008; by 2011 it had earned a Level 2 TNCPE award. When preparing an organizational profile for its first (Level 1) TNCPE award application, TRICOR leaders and employees had an epiphany. According to TRICOR CEO Patricia Weiland, as they were discussing the elements of their organizational profile, they realized the mission needed to be restated to make clear TRICOR’s core purpose of preparing people for employment. "We got involved with Baldrige and TNCPE for our sustainability," said Weiland. "Until we got involved with Baldrige process, we’d always recognized as our key customers those individuals who purchased our products and services. Once we were going through the TNCPE application as well as our strategic planning process we realized that we had missed a key customer—the offenders who were working in our training programs. We had to change our mission and vision statement, and one of our performance indicators became reducing recidivism." She added, "It was amazing. It has changed the culture and direction of our organization. It has brought clarity to where we need to spend our time and our resources. Being involved in the Baldrige process has placed us as a national leader in the field of reentry." As Dreyzehner suggested, with the number of organizations in his state using and benefitting from Baldrige resources, the momentum of performance improvement and excellence has been building across the public and private sectors alike: "It’s an exciting time in Tennessee state government. The state government started the TNCPE, and it’s really benefitted our private sector. And I see more and more people are seeing the value of it. Our governor, Bill Haslam, is really interested in management and alignment and seeing that we’re delivering the best service for the lowest cost." "More and more of the [state government] departments are using the TNCPE and the Baldrige framework to help us do that," he added. "It’s one of the things that gives our state a competitive advantage."  

Posted by Dawn Marie Bailey  Innovation, intelligent risking, sustainability, and visionary leadership are all concepts that appear in the Baldrige Health Care Criteria for Performance Excellence. And in today’s health care environment, a culture that embodies these concepts may be just what is needed for the health care organization of the future—both in conforming to the Affordable Care Act and in delivering the highest-quality patient-centered care. In southeastern New Jersey, one health care system is looking at the difficult journey to that future and has been evolving its business model-with the Criteria as a framework for its success. Recently, 2009 Baldrige Award recipient AtlantiCare, a nonprofit health system, the largest provider in its region, announced that it had signed a letter of intent to partner with Geisinger Health System, an integrated health system in rural Pennsylvania. "Following a thorough year-long search process to find the right partner to continue our transformation of health care, we are pleased to move forward with a letter of intent with Geisinger Health System, a national model for innovation and value," said AtlantiCare President and Chief Executive Officer David P. Tilton. "We believe that together, AtlantiCare and Geisinger can broaden innovation and improve the quality, experience, and value for our patients and the communities we serve." In a conversation with Mr. Tilton, he elaborated on how AtlantiCare has been planning for this transformation of health care and the future. What do you mean when you say "transformation of health care" and what does this letter of intent mean for AtlantiCare? Over the last decade, we began developing new models of care aimed at providing more value to our community. Over the last 18 months, we have used Category 2 [the strategic planning category of the Criteria] to evaluate our readiness to be accountable for the health of populations in our region and to develop and implement our population health strategy. We looked at the needs of our community, the evolving roles of our care team, and the ever-changing national health care environment. We made a strategic decision to focus on population health management and determined the need for a partner in order to succeed. We looked for a partner with a proven track record whose culture is compatible with AtlantiCare’s. Geisinger Health System proved to be the most likely candidate. Population health management is a significant strategic shift in the health care model from fee-for-service, in which the greater the volume, the more the health care organization is paid. We believe that the fee-for-service model is becoming obsolete. Instead, we plan to create greater value for health care patients and other customers with a value-based business model, one in which the organization is compensated for services provided and outcomes achieved. The health care organization becomes accountable for services. How is this move beneficial, especially in terms of innovation and value, for AtlantiCare and its patients, other customers, and stakeholders? Consider that the health care field in America is like a strong running river, and we are trying to shift the river’s flow to a different direction. What customers and businesses are saying and the Affordable Care Act is signaling is that health care must move in a different direction. Across the nation, the challenge is that health care is not always affordable or producing the outcomes required. The overall population and business community demand a new approach. Episodic care is not producing major value. AtlantiCare decided to take an intelligent risk to change our business model. It’s kind of strange because we are a very strong organization. We continue to perform solidly. All of our measures are solid. This was a big, thoughtful shift in how we deliver care. Did AtlantiCare use the Baldrige Health Care Criteria during this opportunity? Does it still use the Criteria? The Criteria still live strongly at AtlantiCare. We think about what our future Organizational Profile will be and that fuels our vision. The Criteria are not something we occasionally use; they are embedded in our culture, our work, in all we do. We use the Criteria to determine our path to the future, as well as to design and evaluate our key services and daily operations. All of our work and planning are targeted toward our vision of building healthy communities well into the future, and all of our work is rooted in the Criteria. This is especially important because we believe that AtlantiCare and all health care organizations will experience some choppy waters with the transformation of the entire field of health care. What has AtlantiCare learned and/or implemented during its Baldrige journey that led to improvements? One of the things that came out of AtlantiCare’s Baldrige improvement journey was more effective strategic planning.That discipline is serving us well. What we have also learned is the importance of real-time communication with our board, physicians and staff, and community so that they can all connect with the work we do and with our goals. We continue to enhance communication-even more so this past year. Be it internally or externally, with traditional or new media, face-to-face or other venues, we know we have to successfully communicate in many ways to reach the various communities we serve. We invite feedback, thoughts, and observations. We have been studying this transformation in health care over the past four years and sharing information and what we’ve learned throughout AtlantiCare, so that all stakeholders can prepare for and participate in our future.  This communication is an important part of AtlantiCare’s incredible engagement work with staff, resulting in top-box employee engagement scores. How we relate to people is essential to our work in health care. Workforce engagement continues to be important in achieving goals, fostering innovation, and creating an outstanding patient experience. Given the current health care climate, how do you think that the Criteria might help or be used by other organizations? The Criteria are incredibly valuable. I think one of the things that has really helped us a great deal and could help other organizations is taking a look at writing an Organizational Profile and assessing your category one [leadership category of the Criteria] position. This helps you really think about who you are as an organization, how visionary your leaders are, where you want to be three-to-five years down the road, what relationship you want to have with your staff, customers, community, etc. The future is not going to be an extension of the past. Difficult journeys require innovation, agility, and the ability to pivot quickly. Having the Baldrige framework surrounding and guiding you and using it as a way to improve performance, is extremely effective. The language and thinking that the Baldrige Criteria bring to you really can provide great overall benefit for any organization.

Posted by Dawn Marie Bailey Faced with limited resources, many health care administrators ask themselves whether to invest in Magnet or in the Baldrige Health Care Criteria for Performance Excellence. Is one more dispensable than the other? Magnet designation, now operated by the American Nurses Credentialing Center, was approved for creation by the American Nurses Association in 1990. Today, Magnet is used as a way of recognizing hospitals that offer both excellent nursing care and an environment supportive of nurses-based on the characteristics of health care organizations that excel in recruitment and retention of registered nurses. In 1998, Congress authorized the participation of health care organizations in the Malcolm Baldrige National Quality Awards, the nation’s highest Presidential honor for organizational excellence. With funding originally from the Veterans Administration, the Health Care Criteria were published to provide a framework for organizations to examine all parts of their management systems and improve processes and results, from results related to leadership and the workforce to customers, operations, and strategies. The Health Care Criteria were based on the best practices and ideas learned from business organizations that had contributed to the Baldrige Award since 1987. I asked Donna Poduska, chief nursing officer of Poudre Valley Health System, who is speaking at the 26th Annual Quest for Excellence Conference, and Priscilla Nuwash, system director for performance excellence of University of Colorado Health, about their presentation that focuses on using Baldrige and Magnet together. What are three reasons that a hospital might find value in implementing both Baldrige and Magnet principles? Baldrige and Magnet complement each other in creating a successful organization. Both are based on quality, innovation, and the pursuit of areas for improvement, and Magnet has components that integrate with the areas to address in the Baldrige Criteria. Although they complement and integrate with the other, each also addresses areas that the other does not. Together, they can create an exceptional organization. At times, different parts of the organization may not work together as a system; the value of using the Baldrige Criteria and Magnet together is that you are able to identify the best approach from each and deploy that throughout the organization. The Baldrige Criteria and Magnet succeed through engaging the workforce. Differing segments of the workforce have differing key elements that engage them. The value of using Magnet and the Baldrige Criteria together is that they produce professional work environments that address key elements for engaging everyone in the workforce.  What are some tips for using them together? Emphasize that both are grounded in what is best for the patient, which creates purpose and pride in the workforce. Focus on the concept that both the Baldrige Criteria and Magnet are based on evidence-based practice; they learn from each other. Both the Baldrige Criteria and Magnet are based on a foundation of having structure, process, and outcomes. Those three premises work together for both the Baldrige Criteria and Magnet. When developing committee structure, capitalize on your existing committees. Use one process improvement methodology when making improvements identified by the Baldrige Criteria and by Magnet. Then involve nursing and non-nursing staff in both to get the benefit of differing perspectives. Crosswalk your responses in applications for both Magnet and the Baldrige Award. Crosswalks are cost effective and are an additional way to identify best practices. What else might folks learn at your Quest for Excellence session? Donna will present a crosswalk visual of Magnet and the Baldrige Criteria and show how the components of Magnet and the Criteria are indispensable for an organization’s performance excellence journey. For more information, attend Poudre Valley Health System’s special presentation, "How Baldrige and Magnet Are Successful Together," at the Baldrige Program’s Quest for Excellence® Conference in Baltimore, Maryland.

Posted by Dawn Marie Bailey Recently, the publishers of Quality Digest conducted a live interview with Janet Wagner, CEO of Baldrige Award-winning Sutter Davis Hospital, and Bob Fangmeyer, director of the Baldrige Performance Excellence Program. The interview brought out some behind-the-scenes reflections and insights on the use of the Baldrige Criteria for Performance Excellence, including why the Criteria are so suited to health care organizations but also to other organizations that have a strong sense of purpose and mission. Wagner also shared some "ah-ha" moments for the nonprofit, 48-bed acute care hospital. Following are some highlights of questions discussed and answered. Why are the Baldrige Criteria of such interest in the health care industry? Wagner said she sees a natural link between hospitals who want to improve and sustain world-class results and use of the Baldrige Health Care Criteria. "Baldrige offers a framework for sustainable results and a sustainable organization, and health care right now is in the news every day and our results are being looked at," she said. "Consumers are getting smarter, so this framework offers a lot to a leadership team in terms of being successful and competitive." She added that the Baldrige Criteria offer questions in a framework format that allows leadership teams to self-assess their own organizations. "[The framework] leads to a path of focus for the leadership team and that has served us at Sutter Davis Hospital at staying on track, focused, and getting results." Fangmeyer acknowledged that health care organizations have three-often conflicting-goals: improving patient safety, improving health care outcomes, and reducing costs. "It’s the application of our framework that lets organizations manage themselves from a systems perspective rather than sub-optimizing these areas," he said. "Hospitals in particular have seen a lot of improvement in their outcomes." What about use of the Baldrige Criteria in other industries? Fangmeyer said that organizations with a strong sense of purpose and mission tend to do better when applying an improvement strategy and are naturally more attracted to the Baldrige Criteria. "The framework and processes of Baldrige help an organization stay focused and really achieve their goals and their mission. When you have that strong focus and strong sense of purpose, Baldrige really does fit well within the organization’s efforts," he said. What did you learn during your Baldrige journey? Wagner said that year after year, Sutter Davis Hospital applied for Baldrige feedback at either state or national levels and "learned very quickly how to improve results, how to course correct, and then how to sustain results. And for me as a leader, I would say that’s probably one of the most important things. That framework, along with the site visits and the feedback, really focuses you on narrowing down and being able to prioritize those things, those behaviors, those systems, those processes that lead to consistent results. For us, [Baldrige] was a very good fit and energized us to do better." Wagner added that while learning to course correct rapidly was very valuable, one of the most beneficial parts of Sutter Davis Hospital’s journey was getting leadership team members comfortable in being transparent in getting and discussing results, and then having the Baldrige examiners come in and validate that they were on the right track. Sutter Davis Hospital also sent staff members to examiner training, either at state or national levels,  giving them an opportunity to view management from different vantage points. "When we sent them to examiner training, they had to step back and look at the Criteria from a different view point and that was insightful," Wagner said. Staff members learned "a different skill set, and this gave us a chance to look at our own organization without being defensive." Wagner said the biggest "ah-ha" moment for Sutter Davis leadership team members was when they learned the Baldrige "ADLI" and "LeTCI" approaches to reviewing processes that considered approach, deployment, integration, and learning and reviewing results that considered levels, trends, comparisons, and integration. "When [leadership team members] started to look at mature results through the Baldrige process, we added some depth and breadth to our own results and how we trended results, correlated, and segmented them. . . . [This approach] really propelled them to a different level of leadership." What’s the value of a Baldrige journey? "Oftentimes, leaders have blind shots that they don’t realize that they’re not paying enough attention to and that’s one thing that the Criteria do for organizations," Fangmeyer said. "[The Criteria] help ensure that you are paying attention to all of those things that will [lead to] sustainability, that [lead to] outstanding results. . . . Having your leadership team review the Criteria questions really can open your eyes, even at a very basic, self-assessment level." Mike Richman, publisher of Quality Digest, added, "Baldrige has become a highly sought-after prize. Naturally for the winners, recognition as a world-class organization for performance excellence and quality is a great reward, but any organization that has ever pursued the Baldrige at the national level or even one of the many state quality awards based on the Baldrige Criteria will tell you that it’s the journey that counts. Organizations that take the lessons of continuous improvement to heart will reap the true rewards of that journey. Customers and the American economy in general are the ultimate beneficiaries." The complete 30-minute interview can be found on YouTube.

Posted by Christine Schaefer Baldrige Award winners receive a lot of attention every year, but did you know that two health care organizations earned recognition for category-level best practices as part of last year’s award process? Both organizations—Duke University Hospital of Durham, North Carolina, and Hill Country Memorial, of Fredericksburg, Texas—were chosen for their leadership practices in category 1 of the Health Care Criteria for Performance Excellence. As noted before on Blogrige, to be considered by the Baldrige judges for Category Best Practice recognition, organizations must have received a site visit as part of the annual Baldrige Award process and demonstrated outstanding practices in one or more of the first six categories of the Baldrige Criteria for Performance Excellence. Such recognition requires strong processes and results related to those processes as well as good performance across the other items. The Panel of Judges noted that both organizations have strong leadership systems. They noted that Duke University Hospital’s leadership system was tied to its performance management system and that Hill County Memorial has both strong leadership development and a strong community connection. Along with the 2013 Baldrige Award winners, these two organizations are expected to present on their recognized best practices at the Baldrige Program’s Quest for Excellence® conference in Baltimore in April. So if you really want to learn what is so great about these organizations, mark your calendar and attend their presentations. Let their examples inspire organizations of every size and sector to begin charting or continue trekking on a path to excellence.

Posted by Dawn Marie Bailey 2012 Baldrige Award recipient North Mississippi Health Services (NMHS) is now inviting its physicians to apply for NMHS’s 2014 Physician Leadership Institute to provide an opportunity for the physicians to gain a greater understanding of the health care system, its mission, and its actual operation. Along the way, the physicians will also acquire additional skill sets in the areas of leadership, finance, strategic planning, operations, and the medico-legal aspects of health care. Such training, which will be held over two evenings per month for six months, is no small investment in resources for the system or in time for the physicians. So what’s the value for the system and physicians? Might such an investment be valuable for other health systems, too? I asked Dr. Brian Condit, director of NMHS’s Physician Leadership Institute, who will be speaking on such training at the upcoming Quest for Excellence Conference, and Beth Frick, director of NMHS’s Education Department, what they have learned from leadership training for physicians. What does your physician leadership training accomplish? Develops engaged, informed, and connected physicians for leadership roles Creates a hothouse for innovative ideas for care improvement Builds a group of positive change agents for clinical integration What are three tips to inspire physicians to invest time in leadership training? Have a physician champion who is a trusted peer recruit physicians within the organization. Emphasize the mission of improving patient care and the increased personal effectiveness of the leadership-trained individual to make a positive difference. Have physicians see that previously trained physicians behave differently and have demonstrated success and recognition as a result of their training. What else will folks learn at your session? How to develop an excellent curriculum at minimal cost by leveraging internal assets rather than expensive external resources For more information, attend NMHS’s special presentation, "Physician Leadership Training," at the Baldrige Program’s Quest for Excellence® Conference in Baltimore, Maryland.