An Organizational Model for Excellence in Healthcare Delivery: Evidence From Winners of the Baldrige Quality Award.

Winners of the Baldrige National Quality Award in healthcare have documented top quartile clinical outcomes and patient satisfaction across a variety of American communities and a full spectrum of care. Their results also show high levels of satisfaction among physicians, nurses, and other workers, as well as effective financial performance. The managerial methods they use-collectively, the Baldrige model-are consistent with organizational theory literature and are found across all winners.

Is It Time to Abandon Hospital Accreditation?

Hospitals contracting with the Centers for Medicare & Medicaid Services (CMS) must comply with Conditions of Participation (CoP), enforced by 4 certified independent accrediting organizations (AOs) or individual state survey. Recent work documents that the system fails to achieve consistent clinical outcomes, allowing several-fold variation in mortality and patient safety. Other publicly reported evidence shows weaker clinical performance by state-surveyed hospitals, inexplicable variation in individual state surveys, and recurring disagreement between initial and audit surveyors.

Understanding High-Reliability Organizations: Are Baldrige Recipients Models?

Chassin and Loeb argue persuasively that healthcare organizations (HCOs) can and should be "high-reliability organizations" (HROs) seeking zero defects in outcomes quality. They suggest that the Baldrige model is a sound platform for achieving high reliability. This article analyzes the similarity of the HRO concept to the Baldrige model using a recent Malcolm Baldrige National Quality Award recipient's application.

A positive deviance perspective on hospital knowledge management: analysis of Baldrige Award recipients 2002-2008.

Knowledge management (KM) is emerging as an important aspect of achieving excellent organizational performance, but its use has not been widely explored for hospitals. Taking a positive deviance perspective, we analyzed the applications of nine healthcare organizations (HCOs) that received the Malcolm Baldrige National Quality Award from 2002 to 2008. Baldrige Award applications constitute a uniquely comprehensive, standardized, and audited record of HCOs achieving near-benchmark performance.

Transforming the dominant logic of hospitals.

Substantial and sustained change is inevitable for U.S. hospitals, driven by the Medicare and Medicaid cost inflation curve and embodied in regulatory initiatives and reforms.

Finding the frontier of hospital management.

The frontier of demonstrated high-performance community hospital management is a valuable guide to the potential of this important healthcare sector. The best documented frontier cases are recipients of the Malcolm Baldrige National Quality Award, a varied set of 34 U.S.

Development of an interprofessional competency model for healthcare leadership.

During the past decade, there has been a growing interest in competency-based performance systems for enhancing both individual and organizational performance in health professions education and the varied healthcare industry sectors. In 2003, the Institute of Medicine's report Health Professions Education: A Bridge to Quality called for a core set of competencies across the professions to ultimately improve the quality of healthcare in the United States. This article reviews the processes and outcomes associated with the development of the Health Leadership Competency Model (HLCM), an evidence-based and behaviorally focused approach for evaluating leadership skills across the professions, including health management, medicine, and nursing, and across career stages.

Improving preparation for senior management in healthcare.

Noting the historical and practical relationship of management education in healthcare to business generally, this paper reviews and analyzes four recent criticisms of management education by Pfeffer and Fong, Ghoshal, Mintzberg, and Bennis. It concludes from that analysis that increased effort on assessing and improving healthcare education efforts is essential, and proposes a model for a national program of continuous improvement of educational practice. It reviews existing competency assessment tools in the light of needs, and suggests next steps for educators and practitioners.

Is anybody managing the store? National trends in hospital performance.

Nine standardized measures compiled from Medicare data show trends in the safety, quality, financial management, and efficiency for more than 2,500 community hospitals over five years ending in 2003. Although much public attention has been given to hospital performance, along with exhortations to improve, few measures show substantial positive trends, either in variance reduction or overall improvement. The authors conclude that environmental forces are not stimulating improvement and that the overall picture is one of randomness rather than management.

The revolution in hospital management.

Five healthcare systems that have either won the Malcolm Baldrige National Quality Award in Health Care or been documented in extensive case studies share a common model of management: they all emphasize a broadly accepted mission; measured performance; continuous quality improvement; and responsiveness to the needs of patients, physicians, employees, and community stakeholders. This approach produces results that are substantially and uniformly better than average, across a wide variety of acute care settings. As customers, courts, and accrediting and payment agencies recognize this management approach, we argue that it will become the standard for all hospitals to achieve.

The impact of evidence on teaching healthcare management.

As healthcare management becomes more responsive to market demands, healthcare management education must prepare a more sophisticated and effective product. The author reviews the barriers to change in education and suggests that education will evolve to a new business model emphasizing "small bites" that are directly related to work needs and often learnable at the worksite, as well as integrative materialbest learned in a university environment. The ultimate model will have the following characteristics: 1.

Toward an understanding of competency identification and assessment in health care management.

Given the revolutionary changes occurring in the health care industry, there is increasing agreement that academicians and practitioners must collaborate to identify and prioritize major educational outcomes for health care management. Several competency initiatives have been undertaken or completed in health care and health care management in the last 5 to 7 years. Health care leaders who have undertaken such endeavors reveal that the task is most formidable.

A framework for evaluating and continuously improving the NCHL transformational leadership initiative. National Center for Healthcare Leadership.

The National Center for Healthcare Leadership transformational leadership project is a broad and ambitious initiative that seeks to bring to the table top leaders from industry and academe. Their charge is to accomplish nothing short of resetting the course for health management education and practice in the coming decades. Four councils were recruited to launch the four major interventions: (1) recruitment and diversity, (2) core competencies, (3) the advanced learning institute, and (4) accreditation and certification.

A new approach to assessing skill needs of senior managers.

Management of health care organizations must improve to meet the well-documented challenges of quality improvement and cost control. Other industries have developed the tools--entry education, mentoring, planned mid-career formal education and experience, and special programs for senior management. The purpose of this paper is to pilot test an alternative method to identify competencies and performance of health care executives.

Measuring comparative hospital performance.

Leading healthcare provider organizations now use a "balanced scorecard" of performance measures, expanding information reviewed at the governance level to include financial, customer, and internal performance information, as well as providing an opportunity to learn and grow to provide better strategic guidance. The approach, successfully used by other industries, uses competitor data and benchmarks to identify opportunities for improved mission achievement. This article evaluates one set of nine multidimensional hospital performance measures derived from Medicare reports (cash flow, asset turnover, mortality, complications, length of inpatient stay, cost per case, occupancy, change in occupancy, and percent of revenue from outpatient care).

Structural versus outcomes measures in hospitals: a comparison of Joint Commission and Medicare outcomes scores in hospitals.

Outcomes performance measures are increasingly important in health care. The Joint Commission on Accreditation of Healthcare Organizations (Joint Commission) continues to rely on structure and process measures based on accepted good practice. One of the first tasks in moving to a more outcomes-oriented approach is to compare the two measurement approaches.