By Jessica Clark
In Spring 2019, the organization of which I was a part was only beginning to apply the notion of performance excellence as a strategic consideration, so when I was introduced to the Baldrige examiner experience at that time, I anticipated that I was unqualified to take part in evaluation of performance excellence at any level. I’m a little embarrassed to admit to my naivete in thinking Baldrige an elitist practice or label that could never apply to organizations like mine or growing professionals like me. I certainly did not understand how it could impact my learning and professional development. I now, without reservation, admit just how wrong I was in those early assessments.
I attended a day-long class at last Spring’s iPEX where we simulated the months-long examination process over the course of one day. I was struck by the diversity of industry represented in the room that day--from manufacturing and insurance to education, health care, and government to financial services and human services. The simulation and accompanying Q&A and discussion provided context for each step in the evaluation process and a roadmap for the months ahead.
Over the next several months, I enjoyed the process and came to understand that the Baldrige framework for performance excellence is not only about organizations already on the path to organizational health or with expressed and very public commitments to performance excellence; it is also a framework for implementation of such a commitment. When stumbling over how to codify a commitment to performance excellence where it had not previously existed, going through the examiner experience and seeing the application of the Baldrige framework provided a “how to get started” toolkit when getting started seemed overwhelming.
The examination process is designed for success and for learning. At the start, I was assigned to a team for application review--that actually amounted to the opportunity to work with others committed to performance excellence in varied industries, which I found a rare and awesome experience. Our initial meeting was spent on in-depth review of the applicant’s Organizational Profile and identification of Key Themes that we used as guideposts through the examination process.
The initial months were devoted to independent review, during which we independently read and provided comments on the sections of the application that demonstrated the applicant’s implementation of each of the principles.
In early Fall, the teams reconvened for Consensus Week, during which we reviewed comments and questions and learned from one another in discussions, formulated structured comments, and planned for site visit. Learning from seasoned examiners on the team and learning from team members from other applicant organizations enhanced my experience as an examiner and a critical thinking professional.
The deep-dive during site visit was the culmination of the examiner experience. The opportunity to see in practice what we’d read and talked about for months by that point, talking with leaders and staff throughout all tiers of the organization and validating descriptions throughout the application affirmed that performance excellence really is a commitment and discipline and does not just happen.
One of my favorite, most important takeaways was the engagement with many other dedicated professionals and how those engagements verified for me the universality of the principles of Baldrige and performance excellence -- regardless of industry, the application of the principles results in better organizational health; employee engagement, attraction and retention; operational excellence; and results.
In my previous work, the Baldrige framework and my experience as an examiner provided a way to organize strategic thinking around performance excellence and to help the organization start on the Baldrige journey. As I looked to shift my career, I used the principles and tenets identified in my own Baldrige journey to clarify the qualities of an organization I aspired to move into. Experience showed me that I wanted to be part of a value-driven organization with committed leadership, as evidenced by strategic attention to customers, workforce development, operational excellence, and a drive toward results, culminating in organizational health and growth. I’ve since joined such an organization, and still my examiner experience is reminding me that Baldrige is a journey. Knowing the framework enables me to see in my current organization what is working well and why; illuminates opportunities for improvement; and reinforces how the integration of those principles is essential for success.
Now that I have familiarity with the framework and examination process and have experience in different industries and in different places on the spectrum of organizational health and commitment to performance excellence, I look forward to a new year and a new team and applicant.
By Scott Burgmeyer
2020 has been a year of change and disruption we haven’t likely seen in our lifetime. This anxiety, stress, and forced innovation comes with learning. Looking back at 2020, the key learnings we have walked away with so far include:
Innovation and Change: Through the great disruption, we have been forced to change and work in ways we haven’t before. The question is, how do we support our organizations and employees to continue to be ready for change AND manage the anxiety that comes with it? The research supports the premise that the more change ready an organization is, the more sustainable and successful it will be.
We are bigger than just ourselves: Many events remind us of the unfairness and need for change and respect. The learning is that each of us can make a difference. Respect each other, look for opportunities to learn about organizations, people, and cultures that are different, and apply that learning to grow.
Time to Focus: We all have had more time working by ourselves, assessing how we work, and completing projects that were on the back burner. This attention raises a question: how do we remain this focused on execution while still maintaining relationships?
Your learnings may be different. My challenge to you is to take the time to reflect, gather what you have learned--the good, the bad and the ugly--and determine how you can move forward on the journey. This reflection is what makes the journey worth it.
By Angie Bowen
Being a Baldrige Examiner for the Iowa Recognition for Performance Excellence was a lot of hard work, but extremely rewarding. It has often been mentioned that being an Examiner is like getting an MBA in four months due to the range and amount of knowledge being processed. I know my brain was mush after I completed my independent review of the application. I can only imagine the mindset of those applicants who have implemented all the processes to achieve performance excellence, crafted and polished their application, and sent it off for review.
While going through the 55-page application (and not one page more) and comparing it to the Baldrige criteria during Independent Review, I not only gained a much better appreciation of quality, but also what it takes to achieve performance excellence. The application I reviewed was in a field with which I was not familiar, something I could not say by the time I was done with the Independent Review. For each item, I had to note 4-6 of the most relevant strengths or opportunities for improvement (OFI), (including at least one strength and one OFI). Sometimes it was necessary to drill down into the item notes to find something in the criteria to reference, then write the feedback-ready comment noting the nugget (criteria), then an example of the nugget in the application, and why the example was relevant. Only then could I move on to the next item. Repeat this over 70 times, writing over 280 feedback-ready comments in under four weeks, and one has Independent Review down pat. By the end of Independent Review, I felt I knew the applicant well and had a good feel for who they were as an organization.
After each member on my team independently reviewed the application and wrote their comments, we came together for Consensus Week. During Consensus, the members of each team gathered to compare what everyone noted during Independent Review, came into agreement on how we viewed each item as a team, then either prepared for the on-site visit or generated the final report of the review of the application.
It was interesting to see not only what each of us wrote up during Independent Review, but also where we agreed and disagreed. At this point (where the week gets its name from), we were tasked to come to consensus on each of the items. This meant going through all the feedback-ready comments we individually wrote, deciding which ones best captured what we felt as a team about the application, then either tweaking or rewriting comments noting strengths and OFIs. It was interesting to see where someone captured a key factor that others didn’t necessarily see during Independent Review, only to have it become a key point. This also emphasized why Independent Review must remain independent, guided by our team lead. Despite hearing stories of previous years where there have been knock-down-drag-out fights over a point of view on a comment, this was not the case with our group. As our applicant was not eligible for a site visit, we spent the second half of Consensus Week crafting our final report, walking the wall of the feedback comments to be included, noting grammar, word usage and the like.
At the end of Consensus, we realized what our little group of three newbies and a team lead had accomplished. I say “little” as there are usually twice as many people on a team than what we had. This didn’t mean the application was easy, but it allowed those overseeing the iPEX program to see what could be accomplished.
Being an Examiner was an outstanding experience. I had a great team, even if we were all first-time Examiners. It allowed us to journey together the very steep learning curve of being an Examiner. We were fortunate to have help from an experienced team lead who helped guide us through the process. Independent Review of the application made me use my brain in ways it had not been used for many, many months. The process gave me not only an appreciation for all the work these applicants do when writing up the 55-page application to determine if they have met performance excellence, but also a better appreciation for quality. While I did not get my MBA diploma, I did receive a certificate of recognition of my hard work and dedication, and as a result I am looking forward to the next opportunity to become an Examiner.
Examiner Training starts in September! Details here.
By Katie Freeman, IQC
Many people assume that you can only benefit from implementing a management system if you are (or become) ISO certified. GOOD NEWS!! Any organization in any industry can benefit from implementing a management system.
A management system is a set of policies, processes, and procedures used by an organization to ensure fulfillment of the needs and expectations of the customer. This is a key part of our Audit Fundamentals course!!
Want to take the next step? If you take time to plan, implement, and sustain a management system within your organization – here are some considerations for you:
The best outcome of a well implemented management system is happy customers because their needs are always met. One of the most important key elements is the review and improvement of the processes and the overall system. Perhaps the best way to achieve this review and improvement is through auditing.
Auditing may sound daunting, but it is really quite simple, and fun! When you are auditing, you simply are comparing what you are observing to what is “supposed” to be happening and finding the gaps. Once the gaps are identified, then you can work to close the gaps and improve the process.
By Karen Kiel Rosser, Mary Greeley Medical Center
In 2008, Mary Greeley Medical Center began looking for a system of evidence-based quality principles. Every accountant knows the Generally Accepted Accounting Principles, or GAAP, as the evidence-based best practices for finance. We knew we needed something like that for Quality and Performance Excellence at Mary Greeley. It was during a presentation on the Baldrige program at an ACHE conference in 2008 that we realized we had found what we were looking for.
From the start, we decided our process to document performance improvement would be a long-term priority and not simply an annual goal. Our decade-long journey began not in a single moment, but as a culmination of several. In the over ten years that ensued, this focus on quality has resulted in Mary Greeley Medical Center becoming the first organization in Iowa to receive the prestigious Malcolm Baldrige National Quality Award. It also helped us earn Magnet Designation, the nation’s top recognition of nursing quality. We are one of only 12 hospitals in the country to have both honors.
Here are some of the lessons we’ve learned along this journey.
Early on, we made the decision not to house our Baldrige efforts in a single department, but rather to expose as many departments as possible to the framework and criteria. We enrolled staff as examiners in the Iowa Recognition for Performance Excellence (IRPE) program. Becoming examiners exposed our staff to the criteria as well as gave them firsthand experience to other organizations striving to radically improve.
Learning from other Baldrige organizations as well as using the IHI’s improvement philosophy, we developed what we call our Big Dot goals. There are four of them: reducing patient harm; improving patient experience; improving workforce engagement; and achieving a positive operating margin. These goals are on wallet-size cards on which employees can describe how they contribute to these goals. Each goal has a measurement that is tracked both organization-wide and in individual departments.
We track our progress on our Big Dot Goals on huddle boards displayed in every department across the hospital. Daily huddles are routinely held near these boards during which we stress operations issues, process improvement, and current performance. Using the vernacular of 4DX, a formula for executing on important strategic goals laid out in the book, “The 4 Disciplines of Execution,” departments create lead measures that align with the Big Dot Goals so each staff member understands how their individual work contributes to the organization’s goals.
CREATE ONGOING IMPROVEMENT AND INNOVATION MECHANISMS
Our improvement philosophy is that everyone at Mary Greeley has two roles: Do Our Work and Improve Our Work. To support this, we encourage staff to present improvement ideas through an online system. Additionally, we challenge our leaders to think of innovative ways to reduce costs or generate revenue through the 100-day workout concept.
We created a quality improvement unit which, among other things, oversees rapid improvement projects designed to literally break down our processes, develops ideas to improve them, and then executes these ideas. Each of these projects involves cross-sections of staff, which further hardwires a culture of improvement throughout the organization.
LISTEN TO YOUR CUSTOMERS … AND ACT ON WHAT YOU HEAR
We get feedback from our customers in a variety of ways, including hourly rounding, patient surveys, a patient and family advisory council, social media, letters, unsolicited phone calls, and through informal interactions with patients and families. We collect and track these comments through a customer listening system and complaint management process, which enables us to address problems in an efficient and timely manner. It also enables us to monitor trends that indicate larger opportunities for improvement.
SUSTAIN THE FOCUS
During our IRPE journey, we received Gold-level recognition in 2014 and 2017. We remain the only Iowa organization to reach this top level twice. We have continued to submit our application to the IRPE program even when we are not award-eligible because we receive valuable feedback that helps us remain focused on the process. We also continue to recruit staff to be IRPE examiners. To date we have over 80 years of combined examiner experience!
While we take pride in the honors received for our quality, the real impact of our efforts can be seen in the measurable quality of our care and the opinions of our patients and employees.
Our key measurements are in the Centers for Medicare and Medicaid Services (CMS) top decile, including 30-day readmissions, 30-day mortality, incidence of preventable blood clots, and compliance with sepsis practices, influenza vaccinations, stroke bundle, and outpatient imaging measures.
Inpatient satisfaction, as measured by HCAHPS, has been at or above top-decile performance since 2016. More than 75 percent of inpatients and outpatients would recommend Mary Greeley to others, representing top-decile or near-top-decile levels.
Close to the National Research Corporation top decile, 75 percent of employees “talk up” the organization as a great place to work. Meanwhile, physician engagement ranks in the 82nd percentile.
Our ten-year journey has had a significant impact on our patients and families and staff, and it does not end. The Baldrige framework has become the standard practice for how we do our work – and improve our work. It has allowed us to document, standardize, and improve some of the most complex and seemingly impossible-to-document processes in our healthcare system. Most importantly, it has enabled us to provide continually improving care to our patients.
Many people ask me about continuous improvement and what the best method is, how they should approach it, when, etc. My answer is ALWAYS – it depends. There are several methods – Six Sigma, Lean, Toyota Production System, Lean Sigma, make your own, and so many more.
If you are thinking it’s time to start, here are some key questions you need to ask:
The last two questions are the most important. If you were not successful before, what prevented success? What will you do to change that this time? If you haven’t done it before, what will make you successful this time?
Evolution is crucial to think about. Getting stuck in one method and set of tools will create CI Confusion as you evolve. One key role for the CI professional is to, as JoAnn Sterke says, “support people to get better at getting better.” Understanding what you are trying to solve, the history of what has or hasn’t been tried, and visioning the future is a key step to starting CI, and realizing success in the end.
Coaching is not just for sports anymore!!
For any of you who have had a great coach in the past--in sports or in business--congratulations!! Years ago an organization invested in me by hiring an executive coach. This experience was grueling, reflective, fun, and it developed me well beyond what I realized I could do. When people ask me what coaching is – it is hard to explain. There are sooooooo many perspectives out there, and I want to share mine.
In the simplest of definitions, a coach is someone who supports you from getting from point A to point B. This can be in your personal, fitness, or business life. From my perspective, the key components of a great coach are:
The most powerful aspect of coaching is when the coach holds the mirror up to you and CHALLENGES your thinking and perspective. The value of this expansion of your mind, perspective, and talent is priceless.
Welcome to our first IQC blog. It’s very exciting to take our next step of offerings and connecting with fellow Iowans.
As we rounded out our strategic plan for 2020 and 2021, one of our goals was to become more visible and connect with IQC members and organizations. Through the use of virtual mediums, classes, and new offerings, we have taken a strong step forward.
Our next step in our strategy is to expand our website to include enhanced member content, blogs, vlogs, and resources for you on your journey.
I am excited to share this next step with you. Let’s Journey Together!!
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