In 2020, GBMC HealthCare, Baltimore, and Wellstar Paulding Hospital, Hiram, Ga., received the Malcolm Baldrige National Quality Award in healthcare for posting industry-leading performances, despite the ongoing pandemic.
Accomplishing this feat required a multiyear commitment to system design and a formalized leadership framework that helped the organization swiftly move toward its vision. However, achieving the Baldrige Award is not a testament to the work of the CEO, but to every member of the organization.
Embrace System Design and Foster Continual Improvement
Healthcare is a newcomer to system thinking, which the Baldrige journey promotes using to design and implement processes that achieve high reliability and reduced error, thereby saving lives.
Achieving system thinking requires leadership to establish clear goals and objectives and to empower every team member to work daily to improve the organization. This leads to best-in-class performance in safety and quality. Error reduction and high reliability are key.
By pursuing the Baldrige criteria, a health system or hospital also commits to acknowledging imperfections and learning from them in a systematic way. Deficiencies are addressed when there is an obvious negative outcome, and initiatives to solve problems are celebrated even when they do not necessarily lead to a positive outcome. A transparent culture in which people feel comfortable speaking up is crucial to recognizing areas of improvement.
Realize Connection Between Front Office, Front Line
The GBMC and Wellstar leadership teams are committed to speaking with employees daily in a meaningful way. They ask staff members during morning huddles and other similar settings what processes or changes they are implementing to get the organization closer to its vision.
It takes a great deal of executive rounding for team members to be comfortable with the regular presence of senior leadership. Once that culture matures, employees feel more secure, and that’s when the necessary, organic discussions take place.
At GBMC, senior management visits units and departments daily with three roles:
- Say “thank you.”
- Foster problem-solving, rather than solving the problems.
- Remove barriers.
By regularly communicating with staff, leadership models the level of communication needed with patients. As a result, GBMC’s rating for communication with physicians is consistently in the top 10% of national hospitals, with patients feeling they are heard by their medical team.
It’s also important to engage with staff beyond their job duty. Senior leaders at Wellstar practice different types of rounding. During informal rounding, they check in with staff and ask how their families are doing. During structured rounding, leaders sit in on visual management processes, for example, and ensure the processes align across the organization.
Wellstar also implemented rounding software and hosts daily voice-of the-customer huddles, in which staff share stories of their “neighbors-caring-for-neighbors” culture.
These efforts led to Wellstar Paulding Hospital achieving 91% on the Great Place to Work Trust Index Survey in fiscal year 2019 and Wellstar Health System earning a place on the Fortune 100 Best Companies to Work For list.
The conversation continues outside hospital doors, where Wellstar Paulding Hospital’s senior executive leads biannual town hall meetings to reinforce the hospital’s culture and mission. GBMC also continually touches base with the community through earned and paid media opportunities, weekly blog posts, biweekly COVID-19 video updates along with comments posted on social media and feedback from its Patient and Family Advisory Council, among other avenues.
By implementing a tiered rounding approach and fostering open communication, leaders gain helpful insights and actionable data, and employees feel valued. The senior leaders of both organizations regularly remind their employees, “I only exist to make sure you have what you need to get the job done.”
Stay Focused as Leaders
Leadership teams should be intentional and consistent in how they lead and steadfast in what they consider to be important. Keeping the organization focused on its goals is key.
GBMC and Wellstar use the Lean management approach, which is embedded through the strategic planning process and in how goals are cascaded throughout the hospital. The result is that their people are working daily to improve what’s happening in the hospital and to be transparent about what is working.
Throughout the Baldrige journey, GBMC senior leadership reinforced the goal of being a community-based system that could deliver the care they would want for their own loved ones to every patient, every time. This was then distilled down to four aims used to unify the team:
- The best health outcome.
- The best care experience.
- The least waste of resources.
- The most joy for those providing the care.
GBMC and Wellstar senior leaders believe the process of pursuing the Baldridge Award is more important than the award itself. It’s not necessary that all team members know the Baldrige criteria. More important is putting practical, systemic strategies in place and that CEOs and senior management are consistent and disciplined in execution.
Allowing for Nimbleness
The Baldrige process teaches organizations to look at their core competencies and consider what makes them strong and different, and what would be hard for competitors to emulate. GBMC decided its core competency was redesigning care.
When the pandemic hit, previously reliable systems were gone or overwhelmed. Clinical changes, staffing challenges and mounting fear were synonymous across the healthcare management field, and health systems had to quickly redesign care.
GBMC ramped up its telemedicine offerings and opened a COVID-19 testing center with a centralized drive-through. Additional safety measures for staff and patients were put in place, and employees used technology to enable patients to communicate with loved ones.
Leadership immediately helped to address the childcare needs of staff and offered emotional and financial support. The organization also preserved time-off benefits.
At Wellstar, having systematic approaches in place allowed the organization to be nimble and reallocate staff where necessary. Because employees already knew how to communicate and engage the front-line team, they were able to maintain strong nursing retention in comparison to their peer group and leverage support agency staff. Leadership continued to foster employee engagement and maintain the company culture.
The Baldrige process equipped both organizations with the flexibility to not only meet the demands of a sudden, global health crisis but also post industry-leading performance.
The First Steps of an Ongoing Journey
When an organization begins its Baldrige journey, two key factors will set a path for success: First, understand your “Why.” If it’s to achieve an award, you likely won’t be successful. Second, it is important that the CEO leads the process and sets the priorities for the organization.
To begin, have senior leadership study the Baldrige criteria and create an organizational profile per the Baldrige instructions. By answering those questions, the team will come to understand its “Why,” and how it is tied to its mission, vision and values.
Next, ensure all staff members know the organization’s mission and vision statements. Reinforce these at new employee onboarding sessions and during interviews.
Mission, vision and value deployment, like everything else, needs a systematic approach that includes knowing where and when you’re going to communicate these statements and how you’re going to use and support them. As with all aspects of the organization, a disciplined, intentional approach establishes the foundation to do the important work.
Earning the Baldrige Award does not mean an organization has achieved perfection. It means that it has embraced system design to become more highly reliable, and the results show it, but there is still much work to be done. The search for perfection is never-ending.
John B. Chessare, MD, FACHE, is president/CEO, GBMC HealthCare, Baltimore (jchessare@gbmc.org). John Kueven, RN, FACHE, is senior vice president/president, Wellstar Health System/president, Wellstar Cobb Hospital, Austell Ga. (John.Kueven@wellstar.org). Kueven was the president of Wellstar Paulding Hospital at the time of the Baldrige recognition.