Academic journal article Frontiers of Health Services Management

Can Baldrige Build Learning Organizations?

Academic journal article Frontiers of Health Services Management

Can Baldrige Build Learning Organizations?

Article excerpt

Recognizing the enormous magnitude of change urgently required of American healthcare over the next several years, the Institute of Medicine (IOM) convened the Committee on the Learning Health Care System in America to identify potential strategies to accelerate healthcare organizations' capabilities for continuous learning and improvement. In its final report, Best Care at Lower Cost: The Path to Continuously Learning Health Care in America the committee concluded, "Health care can lag behind many other sectors [of the economy] with respect to its ability to . . . adapt, to improve-in short, to learn" (IOM 2013, 6). Indeed, the task of fundamentally changing any organization's capacity to learn and adapt to shifting customer needs and requirements, in any sector of the economy, has long challenged renowned business leaders and thinkers. As Harvard Business School's Clay Christensen concluded, "It's not that managers in big companies can't see disruptive changes coming. Usually they can. . . . What managers lack is a habit of thinking about their organization's capabilities as carefully as they think about individual people's capabilities" (Christensen and Overdorf 2000, 66).

Having spent 30 years as a healthcare and insurance executive starting with managed care in the mid-1980s, I share the IOM committee's conclusion about the limitations on capability for learning and change in the healthcare sector. Pick any major topic challenging healthcare today-population health, disparities, safety, or cost control-and we find a plethora of articles lamenting the lack of progress (Berwick, Nolan, and Whittington 2008; Chassin and Loeb 2013; Kindig and Isham 2014; Siegel 2014). Yet transformational change based in agility and true organizational learning is possible. As a member of the panel of judges for the Malcolm Baldrige National Quality Award (MBNQA) from 1999 to 2002, with the responsibility and privilege of evaluating the applications and final examination reports of approximately 30 superior organizations from all industries, I studied organizations that had demonstrated a capacity for learning. The MBNQA judges determine which of the site-visited finalists deserve to be named a role-model organization by the president of the United States. Through this effort, I came to appreciate that profound change is indeed possible with an effective and systematic approach. Many of these organizations started out as rather mediocre, so understanding exactly what they did to lead transformational change is beneficial.

Start with the Results

The feature articles in this issue of Frontiers of Health Services Management represent two such organizations that have been recognized as national role models in learning and improvement. In both cases, the evidence is compelling with regard to their comprehensive and significant performance improvement, and their capabilities are noteworthy. Both articles refer to a systematic process or journey, highlighted by words such as "perseverance," "transparency" regarding their true comparative performance, and "execution," or the capability to move from aspirations to measurable results. Pope, Padula, and Wallace-Dooley describe how Hill Country Memorial went from average to the national top 10 percent in performance on a broad set of organizational metrics, such as patient experience, quality, and financial performance. Forgey and Dye offer an impressive array of financial, workforce engagement, and quality metrics at high levels of performance. For readers interested in the details of these or any MBNQA recipients' results, their applications are available to the public (http:// patapsco.nist.gov/Award_Recipients/ index.cfm). Although recipients have the opportunity to remove proprietary or confidential information, their application summaries generally include 80-100 graphs and charts of data with comparisons and trends over at least three years. The results speak for themselves. Although some individual metrics may tend toward being merely above average, generally these organizations demonstrate wide-ranging top-quartile or top-decile performance across all key dimensions. …

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