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Performance Management Excellence Among the Malcolm Baldrige National Quality AwardWinners in Health Care
Abstract
When carefully constructed, performance management systems can help health care organizations direct their efforts toward strategic goals, high performance, and continuous improvement needed to ensure high-quality patient care and cost control. The effective management of performance is an integral component in hospital and health care systems that are recognized for excellence by the Malcolm Baldrige National Quality Award in Health Care. Using the framework in the 2011-2012 Health Care Criteria for Performance Excellence, this article identifies the best practices in performance management demonstrated by 15 Baldrige recipients. The results show that all of the recipients base their performance management systems on strategic goals, outcomes, or competencies that cascade from the organizational to the individual level. At the individual level, each hospital or health system reinforces the strategic direction with performance evaluations of leaders and employees, including the governing board, based on key outcomes and competencies. Leader evaluations consistently include feedback from internal and external stakeholders, creating a culture of information sharing and performance improvement. The hospitals or health care systems also align their reward systems to promote high performance by emphasizing merit and recognition for contributions. Best practices can provide a guide for leaders in other health systems in developing high-performance work systems.
... In 2006, further aspects of the position were identified by Kagan et al. 18 and Cadmus et al. 19 In 2007, Sherman et al. 20 -by-step approach for identifying and implementing properly focused systems for the continuous improvement of hospital organizations and the synergy required within the six major process-oriented parts of the hospital -leadership; strategy; clients; measurement, analysis, and knowledge management; workforce; and operations -that lead to excellent performance results. [23][24][25] In Vietnam, job descriptions have been the new thing in government health facilities, including the definition of competency for pharmacy department managers for different qualification levels, varying significantly among hospitals. With the aim of better defining managerial competency, this study used a self-administered questionnaire to conduct a study of pharmacy department heads in hospitals in southern Vietnam. ...
... One option to (re)organize the care process is the implementation of a quality management system (e.g., ISO 9001, European Foundation for Quality Management (EFQM), Malcolm Baldrige National Quality Award) [9][10][11]. ...
Objective
The objective of the current study was to evaluate the effect of a quality management system on treatment and care delivery of proximal femoral fractures. Specifically, our hypothesis was that the “plan–do–check–act (PDCA)” philosophy of the ISO 9001 quality management system results in a continuous improvement process.
Methods
1015 proximal femoral fractures were prospectively included into a hip fracture database over a 5-year period, after a restructuring process with implementation of clinical pathways and standard operation procedures. A close and structured ortho-geriatric co-management (certified ortho-geriatric center) was the basis for treatment. ISO 9001 certification was granted for the first time in 2012. Procedural and patient outcome parameters were analyzed by year and evaluated statistically using SPSS 25.0.
Results
In both categories (procedural and outcome) significant changes could be detected during the 5-year period, e.g., significant reduction of time to surgery for the first 2 years, improvement in discharge management, and reduction of surgical complications. However, no significant changes could be demonstrated for mortality or internal complications such as pneumonia, urinary tract infections, or postoperative delirium. However, the incidence of the latter was already on a very low level at the onset of the quality improvement process.
Conclusion
We could show a relevant and continuous improvement of several quality indicators during a 5-year period after implementation of a quality management system based on the PDCA philosophy for the treatment of proximal femoral fractures in elderly patients. However, other parameters (internal complications, cost-effectiveness, etc.) need our close attention in the future.
... In complex organizations like hospitals, it is crucial for goals to be shared by different management levels if positive outcomes are to be reached (Anantatmula, 2008). Leaders need to define priorities clearly, make everyone aware of them, and ensure that the efforts of everyone are aimed at reaching them (Duarte, Goodson, & Arnold, 2013;Manion, 2005). ...
Leadership plays a decisive role in improving the quality performance in healthcare organizations. Research examines how Italian hospitals generate conditions to support leadership, at both top management and department/unit level, in improving quality. It focuses on the role of the management in processes for the delegation of responsibilities, and tools implemented to facilitate clinical leadership. Data show that: mandate is linked to full accountability; top management supports leadership for reinforcing outputs; and evaluation processes are systematically implemented. Furthermore, data show that leaders require performance systems to enhance clinical professionalism and to commit to improving performance.
... Patient experience orientation included 5 items assessing whether the practice assesses patient needs and expectations, resolves patient complaints promptly, and uses data from patients to improve care. The Malcolm Baldrige National Quality Award criteria 24 were used to develop the measure. Each PCMH composite was scored as the unweighted average of responses to items and then rescaled to range from 0 to 100 to facilitate comparisons across composite measures. ...
Background:
Strategies to enhance appointment access are being adopted by medical practices as part of patient-centered medical home (PCMH) implementation, but little is known about the use of these strategies nationally.
Objectives:
We examine practice use of open access scheduling and after-hours care.
Research design:
Data were analyzed from the Third National Study of Physician Organizations (NSPO3) to examine which enhanced appointment access strategies are more likely to be used by practices with more robust PCMH capabilities and with greater external incentives. Logistic regression estimated the effect of PCMH capabilities and external incentives on practice use of open access scheduling and after-hours care.
Subjects:
Physician organizations with >20% primary care physicians (n=1106).
Measures:
PCMH capabilities included team-based care, health information technology capabilities, quality improvement orientation, and patient experience orientation. External incentives included public reporting, pay-for-performance (P4P), and accountable care organization participation.
Results:
A low percentage of practices (19.8%) used same-day open access scheduling, while after-hours care (56.1%) was more common. In adjusted analyses, system-owned practices and practices with greater use of team-based care, health information technology capabilities, and public reporting were more likely to use open access scheduling. Accountable care organization-affiliated practices and practices with greater use of public reporting and P4P were more likely to provide after-hours care.
Conclusions:
Open access scheduling may be most effectively implemented by practices with robust PCMH capabilities. External incentives appear to influence practice adoption of after-hours care. Expanding open access scheduling and after-hours care will require distinct policies and supports.
Performance is the most important aspect of hospital operations. Bed Occupancy Rate (BOR) shows the productivity of using inpatient beds and can also show the performance of the hospital staff. The BOR rate in the inpatient unit of RS X in 2020-2022 was below the ideal rate of 60-85%. This study aims to measure the performance of the inpatient unit of RS X based on the seven Malcolm Baldrige criteria. This type of research is descriptive research with a cross-sectional approach. The population in this research is all nurses of the inpatient unit of X Hospital which amounted to 201 people. The sample was taken using simple random sampling method and calculated the proportion of each room with a sample size of 138 people. Data were collected using a questionnaire consisting of 49 statements. The results of the study obtained a percentage of achievement based on the Malcolm Baldrige score on leadership criteria of 85.25%, strategic planning criteria of 84.0%, customer focus criteria of 86.94%, PAMP criteria of 82.89%, human resource focus criteria of 84.94%, operational focus criteria of 85.88%, and results criteria of 83.58%. Overall performance achievements based on the seven Malcolm Baldrige criteria are in the excellent level 2 category, except for the measurement, analysis, and knowledge management criteria which are in the excellent level 1 category. So, efforts still need to be made to improve performance in the inpatient unit, especially in the measurement, analysis, and knowledge management categories.
Amaç–Bu çalışma, covid-19 pandemi sürecinde, sağlık çalışanlarının performans değerleme sistemine ilişkin görüşlerinin değerlendirilerek bu görüşlerin kişisel ve mesleki özelliklere göre farklılaşıp farklılaşmadığının tespiti amacıyla gerçekleştirilmiştir. Yöntem–Çalışmada veri toplama tekniklerinden anket yöntemine başvurulmuştur. Anket uygulaması sonucunda, elde edilen verilerin normal dağılıma uygunluğu için Skewness ve Kurtosis değerlerine bakılmıştır. Çalışma modeli olarak sağlık çalınalarının kişisel faktörleri ile performans alt boyutları arasında ilişkiyi içermektedir.Bulgular–Çalışmada, ölçek ifadelerine verilen cevapların güvenilirlik düzeyleri için Cronbach’s Alpha değeri ortaya konmuş olup bu değer 0,95 olarak tespit edilmiştir. Çalışmada, sağlık çalışanlarının performans değerleme sistemine ilişkin görüşlerinin karşılaştırılmasında ikili değişkenler için Bağımısz Örneklem t-testi, ikiden fazla değişkenler için Tek Yönlü Varans analizine başvurulmuştur. Tartışma–Elde edilen sonuçlarda, cinsiyete göre performans değerleme sistemine yönelik görüşlerin anlamlı düzeyde farklılaşmadığı tespit edilmiştir. Buna karşın, medeni durum, kurumdaki çalışma süresi, eğitim düzeyi, covid-19 kaynaklı yatan hastaya hizmet verme durumu ve covid-19 kaynaklı ölüm senaryosu yaşama durumu ile performans değerleme sistemine yönelik görüşler arasında 0,05 düzeyinde anlamlı bir farklılık olduğu tespit edilmiştir
The United States Congress in 1987 voted to enact the Malcolm Baldrige National Quality Award (MBNQA) with the goal of encouraging U.S. businesses and other types of organizations to approach and deploy effective quality processes in the delivery of their products and services. The MBNQA provides a framework of internal assessment for companies to use in their planning and implementation of quality initiatives. Through this internal assessment process, company leadership gains a better understanding of the alignments/linkages within its operations to modify its processes for meeting or exceeding customer expectations and requirements.
The purpose of the research is to examine the extent of the alignment between strategic planning processes and human resource processes. Eleven manufacturing companies were selected for a site visit. Each of these eleven companies represents a different industry sector, geographical location, and organizational size. A survey, documents search, and personal interviews were used to collect the data.
The observations of the alignment between the two construct categories show mixed results and are dependent upon the specific statistical analysis used. Therefore, research questions R1 and R2 are not confirmed.
This research aimed to analyze nursing education excellence in 54 nursing schools in East Java, Indonesia, using Baldrige Criteria for Performance Excellence (BCFPE) to evaluate competitive advantage on an international level. Data were collected through interviews; questionnaires; and documentation from heads of departments, lecturers, and students. Data obtained using the Baldrige modified questionnaire were analyzed with descriptive statistics and then classified using the BCFPE score. Results showed that these schools of nursing were still in the early growth stages in all areas measured. Their overall achievement scores were below 50%. The schools of nursing could achieve world-class performance and competitive advantage in nursing education, emerging as industry leaders, by improving leadership; customer focus; strategic planning; measurement, analysis, and knowledge management; human resources focus; and learning process.
: A capable workforce is central to the delivery of high-quality care. Research from other industries suggests that the methodical use of evidence-based management practices (also known as high-performance work practices [HPWPs]), such as systematic personnel selection and incentive compensation, serves to attract and retain well-qualified health care staff and that HPWPs may represent an important and underutilized strategy for improving quality of care and patient safety.
: The aims of this study were to improve our understanding about the use of HPWPs in health care organizations and to learn about their contribution to quality of care and patient safety improvements.
: Guided by a model of HPWPs developed through an extensive literature review and synthesis, we conducted a series of interviews with key informants from five U.S. health care organizations that had been identified based on their exemplary use of HPWPs. We sought to explore the applicability of our model and learn whether and how HPWPs were related to quality and safety. All interviews were recorded, transcribed, and subjected to qualitative analysis.
: In each of the five organizations, we found emphasis on all four HPWP subsystems in our conceptual model-engagement, staff acquisition/development, frontline empowerment, and leadership alignment/development. Although some HPWPs were common, there were also practices that were distinctive to a single organization. Our informants reported links between HPWPs and employee outcomes (e.g., turnover and higher satisfaction/engagement) and indicated that HPWPs made important contributions to system- and organization-level outcomes (e.g., improved recruitment, improved ability to address safety concerns, and lower turnover).
: These case studies suggest that the systematic use of HPWPs may improve performance in health care organizations and provide examples of how HPWPs can impact quality and safety in health care. Further research is needed to specify which HPWPs and systems are of greatest potential for health care management.
Balanced scorecards became a popular strategic performance measurement and management tool in the 1990s by Robert Kaplan and David Norton. Mainline companies accepted balanced scorecards quickly, but health care organizations were slow to adopt them for use. A number of problems face the health care industry, including cost structure, payor limitations and constraints, and performance and quality issues that require changes in how health care organizations, both profit and nonprofit, manage operations. This article discusses balanced scorecards generally from theoretical and technical views, and why they should be used by health care organizations. The authors argue that balanced scorecards are particularly applicable to hospitals, clinics, and other health care companies. Finally, the authors perform a case study of the development, implementation, and use of balance scorecards by a regional Midwestern health care system. The positive and negative aspects of the subject's balanced scorecard are discussed. Leaders in today's health care industry are under great pressure to meet their financial goals. The industry is faced with financial pressures from consumers, insurers, and governments. Inflation in the industry is much higher than it is within the overall economy. Employers can no longer bear the burden of rising group health insurance costs for its employees. Too many large companies have used bankruptcy law as a shield to reduce or shift some of their legal obligations to provide health insurance coverage to present or retired employees. Stakeholders of health care providers are demanding greater control over costs. As the segment of un- or underinsured within the United States becomes larger as a percentage of the population, voters are seriously beginning to demand some form of national health insurance, which will drastically change the health care industry.
Performance management consists of significantly more than periodic evaluation of performance. It is the art and science of dealing with employees in a manner intended to positively influence their thinking and behavior to achieve a desired level of performance. It is essential for the manager to always model positive behavior concerning performance; what one does or says as a manager always has an influence on others. The kinds of employee behavior most likely encountered relative to performance management efforts stem from resistance to change and lack of complete understanding of what is expected. Employee participation must be elicited whenever possible for performance improvement; as far as the inner working details of a specific job are concerned, there is no one who knows the job better than the person who does it everyday. For each task to be done, an employee needs to know what output is expected, how this output will be measured, and what standards are applied in assessing the output. Managing employee performance requires ongoing contact with each employee, regular feedback, and whatever coaching, counseling, and training are necessary to bring an employee back on track when a problem appears. Sustaining efficient and effective employee performance requires the manager's ongoing attention and involvement.
The clinical operations and programs division at the University of Texas M. D. Anderson Cancer Center undertook an initiative, as part of a new performance management system, to determine the effectiveness in aligning individual performance goals to institutional goals and linking performance to rewards (i.e., distinguishing high performers from low performers). The initiative was completed in two phases--the first involved a pilot group of administrators and managers, and the second encompassed the entire clinical area of the institution. Progress was monitored using a survey specific to the performance management initiative, an institutional employee opinion survey, and employee performance review and merit data. We demonstrated support for both goals in the findings from our performance management survey and for our second goal with the institutional employee opinion survey results. Our correlation analysis of the linkage between performance and merit data provided further evidence that the initiative's implementation affected our goal of better distinguishing high performers from low performers. Although our results indicate that we made significant progress toward meeting our goals, we outlined limitations and implications of our results for other organizations to consider as they embark on their own performance management initiatives. Thinking of performance management as a complete system that encompasses goal alignment, education, communication, and continuous feedback can lead to the recognition of top performers. This recognition is important as organizations try to retain their top talent and improve the performance of all employees in an effort to positively influence the patient experience.
Le management est confronté au défi lancé aux organisations quand elles doivent définir, mesurer et stimuler la performance des salariés avec pour objectif ultime d’améliorer la performance organisationnelle. La gestion des performances implique différents niveaux d’analyse et est manifestement reliée à l’évaluation des performances et aux thèmes relevant du management stratégique des ressources humaines (MRH). Cet article présente un modèle convenant à la gestion des performances qui combine des perspectives issues du MRH stratégique et des psychologies organisationelle et du travail. Le modèle intègre des éléments de différents niveaux et enrichit les modèles antérieurs en prenant explicitement en compte la perception des salariés, le rôle des supérieurs directs et une causalité qui peut être inversée. On présente enfin les défis que les futures recherches devront affronter.
Performance management deals with the challenge organisations face in defining, measuring, and stimulating employee performance with the ultimate goal of improving organisational performance. Thus, performance management involves multiple levels of analysis and is clearly linked to the topics studied in strategic human resource management (HRM) as well as performance appraisal. This paper presents a model for performance management combining insights from strategic HRM and work and organisational psychology. The model incorporates multi‐level elements, and adds to previous models by explicitly incorporating employee perceptions, the role of direct supervisors, and possible reversed causality. Challenges for future research are also presented.
Baldrige applica-tion summary
- Advocate Good
Advocate Good Samaritan Hospital. Baldrige applica-tion summary. 2010. http://www.baldrige.nist.gov/ PDF_files/2010_Advocate_Good_Samaritan_Award_ Application_Summary.pdf. Accessed May 7, 2012.
Performance management systems: from strategic planning to employee productivity.
- Addams