Since the 1999 release of the Institute of Medicine’s landmark study, “To Err is Human,” hospitals and health systems around the country have been working hard to reduce costs and improve patient care.

Improving patient outcomes has proven to be a tall order, with recent research from the Institute for Healthcare Improvement showing that 1.5 million medical errors occur annually, and the National Patient Safety Foundation showing that one out of 20 hospitalized patients contracts a health care-associated infection. In addition, the United States has seen total health care expenditures per capita nearly double to $8,915 in 2012, from about $4,900 in 2000, according to the Centers for Medicare & Medicaid Services.

Yet, there is hope because many organizations are achieving success in improving patient safety outcomes and controlling costs. A common trait among many of these organizations is their commitment to performance excellence, systematic process improvement and learning from evidence-based practices. Further, there is growing evidence that leadership can impact improvement efforts by not only providing direction and focus, but also by shaping the behaviors and actions required to achieve high-quality care. When leaders deliberately engage all employees, strong results can be achieved.

To reduce variation, developing more highly reliable organizations must be the top priority. Although there is no panacea, one approach is gaining ground for good reason.

How Baldrige Can Help

Thousands of organizations have turned to the Baldrige Criteria for Performance Excellence, with its established framework for improvement and innovation that builds on core values and concepts, including: patient-focused excellence; organizational and personal learning; agility; and focus on results and creating value. The program has been around since the late 1980s and, in 1999, the award was expanded to include health care organizations. Since then, there have been 17 winners in the health care category. Baldrige hospitals (those that have won an award or have been an award finalist) are six times more likely to receive 100 Top Hospitals national recognition, according to a 2011 study from Truven Health Analytics (then known as Thomson Reuters). What’s more, Baldrige hospitals are also more likely to be cited for marked performance improvement over a five-year span.

Rulon F. Stacey, president of Fairview Health Services in Minneapolis, spoke before the U.S. House Committee on Veterans’ Affairs in July about the value of the Baldrige approach to performance improvement. Stacey highlighted data on improvements in health care outcomes and other measures achieved by U.S. hospitals that have used the Baldrige Health Care Criteria for Performance Excellence.

“The program initially revolutionized manufacturing in the United States, and it is now having the same effect on health care,” he said. He cited research from Truven Health: In 38 hospitals that were Baldrige Award finalists, the overall risk-adjusted mortality rate was 7.5 percent lower, the patient safety index was more than 8 percent better and the risk-adjusted complications index was 1.4 percent better than in 3,000 peer hospitals. Stacey formerly served as president and CEO of Baldrige Award recipient Poudre Valley Hospital in Fort Collins, Colo., and is chair of the board of overseers of the Malcolm Baldrige National Quality Award.

“Using the program as an improvement road map at Poudre Valley, we improved patient satisfaction for 10 straight years,” he added. “Our risk-adjusted mortality rate improved to rank among the top 10 percent nationally. … While driving these improvements, we also created efficiencies, freeing up resources to further reinvest in our clinical care and services.”

It is clear the Baldrige framework can be useful in enhancing systemic performance and achieving better results. It is used in many industries, and its impact on health care will continue to grow, with more than 68 percent of the applicants to the Baldrige Award from the health care sector in 2013. A key component is the importance of sharing best practices and learning from those who have achieved systematic results. All Baldrige Award applications are posted to and contain detailed descriptions of hundreds of best practices and successful solutions.

Through their efforts, organizations may find best practices from these winning organizations, adapt them to their environment and then share their cycles of learning and measurable results with other organizations.

Leadership Must Change

ACHE is on its own Baldrige journey of systematic improvement. In 2011, we received the Bronze Award for Commitment to Excellence from Illinois Performance Excellence, or ILPEx, the state-based Baldrige program. Since then, we have been using the ILPEx feedback report to more clearly define and articulate systems, and to embed cycles of continuous learning, improvement and innovation into our organization. ACHE also is studying successes of other organizations.

The increase in attention to performance excellence and creating highly reliable organizations is changing the culture of health care and the way executives lead. The old leadership hierarchy is being replaced with collaborative, team-based thinking and implementing best practices. Doing something the way we’ve always done it is no longer acceptable.

Moving forward, the focus on improvement must be ongoing. Boards can play an important role in these efforts by ensuring that a culture of continuous improvement exists in their organizations and by holding themselves accountable to the same standard for governance. Boards also can encourage their organizations to learn from others and adopt performance improvement processes using such resources as the Baldrige Health Care Criteria for Performance Excellence, because there is still much work to be done to improve the outcomes of health care for patients, families and our communities. 

Deborah J. Bowen, FACHE, CAE (, is president and CEO of the American College of Healthcare Executives, Chicago.