WU Initiatives in Strategic Health Care Organizations Essay

  • The old adage, “form follows function” describes considering the importance of what you are trying to accomplish before you decide how to get there. It is important to remember that you have to have the will to improve, ideas about alternatives to the status quo, and make it real—execute (Nolan, 2007).

    In this Discussion, you will describe strategic health care quality initiatives in two organizations attempting to accomplish their goals and objectives in quality improvement. You will also examine the purpose of the initiatives(s) and share the issues and opportunities for improvement, as well as address any elements crucial to improving quality in your health care organization or one you are familiar with.

    To prepare:

    Read and review the resources in the Learning

  • Resources
  • section as they relate to initiatives in strategic health care organizations.

    SelectONE organization from each of the TWO groups listed:

    Group I:

    • Agency for Healthcare Research and Quality (AHRQ)
    • Institute for Healthcare Improvement (IHI)
    • Institute for Safe Medication Practices (ISMP)

    Group II:

    • ANCC Magnet Recognition Program
    • Baldrige Performance Excellence Program
    • The Leapfrog Group

    The Assignment:

    In a 3- to 4-page paper (excluding title page and references):

    • Describe strategic health care quality initiatives in two of the organizations. Compare and contrast the purposes of the initiatives.
    • Analyze strategic quality issues and opportunities for improvement within the two organizations.
    • Evaluate which elements of the initiatives are crucial to the quality-improvement opportunities of your health care organization or an organization with which you are familiar
    • Resources

    • https://www.nursingworld.org/organizational-progra…
    • https://www.nist.gov/baldrige
    • http://www.ihi.org/resources/pages/ihiwhitepapers/highimpactleadership.aspx
    • https://www.leapfroggroup.org/

    Understanding High-Reliability
    Organizations: Are Baldrige
    Recipients Models?
    John R. Griffith, LFACHE, professor emeritus, Health Management & Polity University
    of Michigan, Ann Arbor
    E X E C U T I V E
    S U M M A R Y
    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 applica­
    tion. The analysis suggests that neither high reliability nor Baldrige criteria are easily
    achieved, but the two have strong similarities. The principal difference is in Baldrige’s
    emphasis on strategic independence versus the HRO commitment to “zero patient
    harm” and quality as “the organization’s highest-priority strategic goal.”
    Based on this analysis, the article reviews data on the actual performance of
    Baldrige recipients as recorded at WhyNotTheBest.org. The data show that the
    Baldrige approach is an effective method of generating above-average performance.
    Award recipients have made substantial strides in safety, reductions of infections,
    immunizations, and patient satisfaction, but receipt of the award has not translated
    as effectively to reduced readmissions, mortality, and costs.
    The pattern of results suggests that Baldrige recipients have exploited the right to
    establish their own strategic goals and are likely to respond to strengthened financial
    rewards for quality. The Baldrige model has documented successes in quality
    improvement and should be the standard of excellence in managing all HCOs.
    For more information about the concepts in this article, contact Mr. Griffith at
    U nderstanding H igh -R eliability O rganizations: A re Baldrige R ecipients M odels?
    Only award recipients’ applications
    are made public; the names and all
    other information about other appli­
    cants are held in strict confidence. The
    award selection process is based on
    scoring by multiple reviewers and
    heavily weighted to quantified results,
    including measures of patient care
    outcomes and processes, patient satisfac­
    tion, workforce satisfaction, and finan­
    cial and market performance (NIST,
    2014d; Evans & Mai, 2014). Award
    recipients typically report top-quartile
    and often top-decile performance.
    Recipient organizations are exten­
    sively audited by the Baldrige Board of
    Overseers (NIST, 2014b). Thus, there is
    no comparable source of documented
    best practice descriptions for healthcare
    Chassin and Loeb (2013) argue persua­
    sively that healthcare organizations
    (HCOs) can and should be “highreliability organizations” (HROs). They
    outline a series of 14 steps, which they
    call Robust Process Improvement (RPI;
    discussed in more depth later), that
    form “a practical framework that indi­
    vidual healthcare organizations can use
    to evaluate their readiness for and
    progress toward the goal of high reliabil­
    ity” (Chassin & Loeb, 2013, p. 461). This
    article compares the practices of one
    group of high-performing HCOs—
    recipients of the Malcolm Baldrige
    National Quality Award—to Chassin
    and Loeb’s 14 steps and reviews their
    performance using data assembled by
    WhyNotTheBest.org, an online resource
    operated by The Commonwealth Fund.
    H ig h -R e lia b ility O rg a n iza tio n s
    Chassin and Loeb (2013, p. 461) define
    high-reliability organizations as having
    an environment of “collective mindful­
    ness” in which all workers look for, and
    report, small problems or unsafe condi­
    tions before those issues pose a substan­
    tial risk to the organization and when
    they are easy to fix (Weick & Sutcliffe,
    2007, paraphrased in Chassin & Loeb,
    2013, p. 461).
    Working from the Weick and
    Sutcliffe research, Chassin and Loeb
    (2013, p. 461)
    The B a ld rig e A w ard in H e a lth c a re
    The Baldrige National Quality Program
    (now known as the Baldrige Performance
    Excellence Program) began as a congressionally sponsored effort “to identify and
    recognize role-model businesses, estab­
    lish criteria for evaluating improvement
    efforts, and disseminate and share best
    practices” (NIST, 2010). With the begin­
    ning of the Baldrige Awards in Health
    Care in 2002, the applications of award
    recipients have become a unique
    resource from which to understand the
    operation of successful HCOs. The
    applications are densely written, 50-page
    documents following rigorous seven-part
    criteria addressing leadership, strategy,
    customer relations, human resources,
    knowledge management, operations, and
    results (NIST, 2014c).
    developed a conceptual and practical
    framework for assessing hospitals’
    readiness for and progress toward high
    reliability. By iterative testing with
    hospital leaders, we refined the
    framework and, for each of its fourteen
    components, defined stages of maturity
    through which we believe hospitals
    must pass to reach high reliability.
    J ournal of H ealthcare M anagement 60:1 January/ F ebruary 2015
    They note that seeking high reliabil­
    ity, as through the Baldrige criteria, is a
    journey and that “we know of no
    hospitals that have achieved high
    reliability across all their activities”
    (Chassin & Loeb, 2013, p. 472). The
    highest stage of maturity of the 14
    components in the Chassin-Loeb
    model, Approaching, is described in
    Table 1, with an assessment of whether
    North Mississippi Health Systems
    (NMHS), a recent Baldrige award
    recipient, meets the standard. Our
    judgment is based on specific wording
    in the NMHS application, cited by
    application section number. Other
    recent applications are generally consis­
    tent as to both practice and the section
    Chassin (2013, p. 1761) argues:
    Perspectives has also compared perfor­
    mance at NMHS, the 2012 Baldrige
    healthcare award recipient, to outcomes
    desired in the high reliability concept
    (“Together, Joint Commission,” 2013).
    In short, the Baldrige Health Care
    Criteria and recipients’ practices are fully
    congruent with 11 of the 14 ChassinLoeb standards. The major difference
    lies in strategic emphasis. Baldrige
    explicitly leaves strategic priorities to the
    corporate governance; Chassin and Loeb
    (2013) ask for a commitment to “zero
    patient harm” and quality as “the
    organization’s highest-priority strategic
    The financing of HRO and RPI is a
    critical matter. Noting that virtually
    every transition in Table 1 implies extra
    expenditures, one key issue is the
    dynamic by which best practice becomes
    a sustainable business model. Baldrige
    recipients’ data suggest that they are
    performing quite well in a wide variety
    of situations. Their success appears to be
    attained through the power of service
    The service excellence model
    assumes that an HCO operates in a
    competitive market and thrives because
    it produces a superior product. It
    changes the focus of strategic decision
    making from inputs to outputs. It moves
    managerial conversations and activities
    from cost control to process improve­
    ment. The HCO application of the
    concept is shown in Figure 1. The
    massive investment in knowledge
    management, training, and performance
    improvement teams (PITs), coupled
    with deliberate empowerment, senior
    management rounding, consultative
    support, and a focus on measured
    Desired progress will not be achieved
    unless substantial changes are made to
    the way in which quality improvement
    is conducted. . . . Newer and much
    more effective strategies and tools are
    needed to address the complex quality
    challenges confronting healthcare.
    Tools such as Lean, Six Sigma, and
    change management are proving highly
    effective in tackling problems as
    difficult as hand-off communication
    failures and patient falls. Finally, the
    organizational culture of most
    American hospitals and other
    healthcare organizations must change.
    Chassin calls the Lean-Six Sigmachange management tool set Robust
    Process Improvement.
    The Joint Commission (2013) has
    published a detailed review of its
    criteria, the Baldrige criteria, and Magnet
    Recognition Program (ANCC, 2014)
    criteria on its website. Joint Commission
    U nderstanding H igh -R eliability O rganizations: A re Baldrige Recipients M odels ?
    T AB L E 1
    One Baldrige Recipient’s Practices and High-Reliability Organizations
    Chassin-Loeb Component and Approaching Standard3
    NMHS Practice11
    Board commits to the goal of high
    reliability (i.e., zero patient harm)
    for all clinical services.
    Met, except commitment to zero
    harm. Balanced scorecards
    routinely address outcomes
    quality (l.la .3 ), but the board
    sets goals based on its strategic
    priorities (l.lb ( l) ) .
    CEO leads the development and
    implementation of a proactive
    quality agenda.
    Partially met. The agenda is
    based on the strategic priorities
    set by the governing board
    rather than “proactive quality”
    ( l.lb ( l) , 7.1).
    Physicians routinely lead clinical
    quality improvement activities
    and accept the leadership of other
    appropriate clinicians; physicians’
    participation in these activities is
    uniform throughout the
    Met (6.2b). Uniform compliance is emphasized in the
    criteria and judging process
    (see “Scoring,” NIST, 2013,
    pp. 28-33).
    Quality strategy
    Quality is the organization’s
    highest-priority strategic goal.
    Not met. The board retains the
    right and the obligation to
    establish locally relevant goals.
    Quality measures
    Key quality measures are routinely
    displayed internally and reported
    publicly; reward systems for staff
    prominently reflect the accomplishment of quality goals.
    Met. Measures are now reported
    by CMS and private organizations such as WhyNotTheBest.
    org. Recipients emphasize
    internal review (P. la(2),
    Safely adopted IT solutions are
    integral to sustaining improved
    Met. (Section 4 of the applications details IT strategies.)
    Safety Culture and High Reliability
    High levels of (measured) trust
    exist in all clinical areas; selfpolicing of codes of behavior is
    in place.
    Met. Communication, trust, and
    associate satisfaction are
    routinely measured and studied
    for improvement (see Section 5,
    especially 5.2a(2)).
    J ournal of H ealthcare M anagement 60:1 January/ F ebruary 2015
    c o n tin u e d
    All staff recognize and act on their
    personal accountability for
    maintaining a culture of safety;
    equitable and transparent disci­
    plinary procedures are fully
    adopted across the organization.
    Met. Processes are described in
    Section 5 of the application.
    Results are reported in Section
    7, especially NMHS figures
    Identifying unsafe
    Close calls and unsafe conditions
    are routinely reported, leading to
    early problem resolution before
    patients are harmed; results are
    routinely communicated.
    Met. NMHS reports a patient
    safety program promoting “An
    environment of trust & fairness
    where it is safe to report and
    learn from mistakes” (l.la(3),
    P.2). It encourages reporting
    “any variance that results in
    harm or risk of harm to a patient
    or visitor” (p. 58) and studies
    these reports closely (6.1b(2)).
    Strengthening systems System defenses are proactively
    assessed, and weaknesses are
    proactively repaired.
    Met. NMHS documents a
    sophisticated continuous
    improvement program (6.2).
    Met. NMHS documents 22
    quality and safety measures
    tracked and benchmarked (7.1
    and 7.3).
    Safety culture measures are part of
    the strategic metrics reported to the
    board; systematic improvement
    initiatives are under way to achieve
    a fully functioning safety culture.
    Adoption of RPI tools is accepted
    fully throughout the organization.
    Met (6.2a(l)).
    Training in RPI is mandatory for
    all staff, as appropriate to their
    Met. NMHS invests more than
    80 hours/FTE-year (l.la(3);
    5.2c; figures 7.3-7.23).
    RPI tools are used throughout the
    organization for all improvement
    work; patients are engaged in
    redesigning care processes, and
    RPI proficiency is required for
    career advancement.
    Met. Systematic continuous
    improvement is a core concept
    of the Baldrige criteria.
    aSource. Chassin & Loeb (2013, table 1, p. 471; table 2, pp. 474-475; table 3, pp. 478-479).
    bSummary of material describing NMHS performance, identifying the relevant application section(s) and figures. (The
    applications are publicly available. See NIST, 2014b).
    Note. NMHS = North Mississippi Health System; CMS = Centers for Medicare & Medicaid Services; IT = information technology;
    RPI = Robust Performance Improvement; FTE = full-time equivalent.
    U nderstanding H igh -R eliability O rganizations: A re Baldrige R ecipients M odels ?
    outcomes, creates a workforce that is
    substantially more effective than the
    norm and delivers a product that costs
    less and is more attractive in the
    congruence of recipient processes and
    the Chassin-Loeb high-reliability model,
    the profile of recipient performance
    should be exceptional.
    Many of the measures used by recipients
    have become public through the Centers
    for Medicare & Medicaid Services (CMS,
    2014) Hospital Compare program and
    voluntary efforts such as WhyNotThe
    Best.org, a website operated by The
    Commonwealth Fund (2014). Using
    It is understood that, as Chassin and
    Loeb (2013, p. 459) claim, there are no
    high-reliability HCOs. Receiving the
    Baldrige award is not equal to achieving
    perfection; recipients’ scores are usually
    around 60%. However, given the
    FIGURE 1
    The Service Excellence Chain in H ealthcare
    Satisfied Associates
    Associates who know they can rely
    on each other and will have the
    resources they need will be loyal to
    the organization and effective in
    patient care.
    Satisfied Patients
    Patients and families will be
    favorably impressed by caring and
    effective associates and will leave
    Strong Demand
    Well-planned services and high patient
    satisfaction will keep demand high,
    providing a foundation for lower costs
    and higher quality.
    Operational Support
    Day-to-day and strategic needs are
    met; a culture of commitment to the
    mission and respect for individuals
    and evidence prevails.
    Financial Support
    A strong demand and efficient
    production generate profits that
    support up-to-date equipment and
    supplies and other strategic needs.
    Source. White & Griffith (2010, p. 48).
    J ournal of H ealthcare M anagement 60:1 January/ F ebruary 2015
    these data allows a comparison of
    recipients to the larger population of
    healthcare organizations.
    We assembled the list of award
    recipients from the Baldrige website,
    which are as follows (NIST, 2014a)
    (asterisk denotes an application from a
    multihospital system):
    set contained 44 hospitals, but not all
    data are reported for each hospital. We
    collected the WhyNotTheBest.org
    benchmarks—national means and
    top-decile measures—posted as of
    January 2014. We grouped the measures
    to reflect similar characteristics, as
    follows (definitions and sources of the
    measures may be found at http://www.
    1. *SSM Health Care, 2002
    2. Saint Luke’s Hospital of Kansas City,
    Outcomes of acute care
    Readmission rates
    Mortality rates
    Healthcare-associated infections
    Inpatient quality indicators
    Patient safety indicators
    3. Baptist Hospital Inc., 2003
    4. Robert Wood Johnson University
    Hospital Hamilton, 2004
    5. Bronson Methodist Hospital, 2005
    Prevention and population health
    6. North Mississippi Medical Center,
    2006 (see also system award, 2012)
    Prevention quality indicators
    Population health/utilization and
    County health rankings
    7. *Mercy Health System, 2007
    8. *Sharp Healthcare, 2007
    9. *Poudre Valley Health System, 2008
    Customer service
    10. *AtlantiCare, 2009
    Hospital Consumer Assessment of
    Healthcare Providers and
    Systems (HCAHPS)
    Emergency care
    11. Heartland Health, 2009
    12. Advocate Good Samaritan Hospital,
    2010 (system not included)
    13. *Henry Ford Health System, 2011
    Spending per Medicare beneficiary
    Healthcare costs
    14. *North Mississippi Health Services,
    Process of acute care
    Recommended care (CMS Core
    Composite measures of
    recommended care
    Health information technology
    We excluded Southcentral Foundation
    (2011) from the above list, as its acute
    care hospital was not part of its
    Seven of the 15 recipients applied as
    systems. In those cases, we collected
    data on all hospitals identified with the
    system on WhyNotTheBest.org as of
    January 2014. In cases where the appli­
    cation was for a single hospital, we
    collected data only on that hospital. The
    The measures are taken from data
    submitted to The Joint Commission and
    CMS, with the exception of some health
    information technology measures from
    the American Hospital Association
    (AHA) Annual Survey and the inpatient
    U nderstanding H igh -R eliability O rganizations: A re Baldrige R ecipients M odels ?
    quality, safety, and prevention measures
    from the Agency for Healthcare Research
    and Quality.
    We were unable to use the following
    measures offered byWhyNotTheBest.org:
    differences are not significant. Recipients
    excel on five of six infection measures,
    but only two are significant. Patient
    safety results and pneumonia immuni­
    zation rates are significantly better than
    the national average.
    The magnitude of some of the
    significantly superior performance is of
    interest. WhyNotTheBest.org’s compos­
    ite safety index is 13% better than the
    national average, central line infections
    are more than 40% better, and colon
    surgery infections are almost 50% better.
    Baldrige recipient organizations
    perform significantly better on most of
    the CMS Core Measures than the
    national average, while their emergency
    service measures are not significantly
    different. Response counts are low for
    most of the six Joint Commission
    Recommended Care measures, and
    recipients are significantly better in
    only two.
    WhyNotTheBest.org’s cost per case
    index of Medicare spending does not
    indicate a significant advantage for
    The recipients excel on patient
    satisfaction. They are clearly superior on
    two important summary measures:
    “highly satisfied” and “would recom­
    mend.” (They also excel on all of the
    eight detailed measures WhyNotThe
    Best.org reported, but their measures did
    not reach significance on physician
    communication, nighttime quiet, or
    clean bathrooms.)
    Recipient performance is consistent.
    The median coefficient of variation is
    only 0.11, although high variation
    occurs in several important measures,
    most notably the infection rates and
    the composite patient safety score,
    Early elective delivery rates: checked
    February 2014; no data for set
    Surgical care improvement: national
    mean of 97.5 compliance; too
    compressed to use
    Healthcare costs: no national values
    Health information technology: process
    measure with no national
    standard (most recipients had
    top score)
    County health rankings: no national
    The available measures cover many
    elements important in high reliability.
    Compared to the usual balanced scorecard (White & Griffith, 2010, p. 27), one
    dimension—worker satisfaction and
    retention—is noticeably lacking. There
    is no public source for national data on
    this dimension.
    We compared recipients to national
    means. For each measure, we report the
    mean, standard deviation, and standard
    error of the recipient set, the national
    mean, the difference, and significance.
    Results are shown in Table 2. Overall,
    Baldrige award recipients’ performance
    is good and sometimes, but not consistendy, exceptional. On five mortality
    measures, recipients are superior to
    national averages on all but one, but
    only The Joint Commission nonsurgical
    composite is statistically significant. On
    readmissions, recipients perform better
    than the national averages, but the
    J ournal of H ealthcare M anagement 60:1 January/ F ebruary 2015
    ( ft
    ( ft

    How to place an order?

    Take a few steps to place an order on our site:

    • Fill out the form and state the deadline.
    • Calculate the price of your order and pay for it with your credit card.
    • When the order is placed, we select a suitable writer to complete it based on your requirements.
    • Stay in contact with the writer and discuss vital details of research.
    • Download a preview of the research paper. Satisfied with the outcome? Press “Approve.”

    Feel secure when using our service

    It's important for every customer to feel safe. Thus, at HomeworkGiants, we take care of your security.

    Financial security You can safely pay for your order using secure payment systems.
    Personal security Any personal information about our customers is private. No other person can get access to it.
    Academic security To deliver no-plagiarism samples, we use a specially-designed software to check every finished paper.
    Web security This website is protected from illegal breaks. We constantly update our privacy management.

    Get assistance with placing your order. Clarify any questions about our services. Contact our support team. They are available 24\7.

    Still thinking about where to hire experienced authors and how to boost your grades? Place your order on our website and get help with any paper you need. We’ll meet your expectations.

    Order now Get a quote