Baldrige performance program cited as cure for what ails VA hospitals

By KEVIN MCKENZIE | The Commercial Appeal, Memphis, Tenn. | Published: July 4, 2014

MEMPHIS, Tenn. — It could have helped avoid the scandal rocking the U.S. Department of Veterans Affairs over wait times, bonuses and cover ups at medical centers serving the nation’s veterans, said Donald C. Fisher.

Wider, mandatory use of the secretary of Veterans Affairs’ own Robert W. Carey Performance Excellence Award Program could be the cure for what ails the VA, said Fisher, executive director and chief executive officer of the Mid-South Quality/Productivity Center in Memphis.

The program is a voluntary assessment used to spotlight the best performers among the VA’s 152 hospitals and some 800 clinics, but it only attracts a handful each year, he said.

The VA Medical Center in Memphis, a facility scaled to serve 67,000 veterans in four states, hasn’t been among the hospitals using the VA award program. In June, Memphis VA made headlines when Veterans Affairs officials disclosed the 2,275-employee center was among 81 VA hospitals in the nation selected for further review of scheduling problems.

Like scores of others around the globe, the VA award program uses the criteria honed for the national Baldrige Performance Excellence Program. The Baldrige was born in 1987 as a public-private partnership with the goal of improving U.S. business competitiveness.

From standards for integrity and whistleblower policies to demands for evidence that systems and processes are truly in place to serve customers as they want to be served, the Baldrige criteria could have exposed and perhaps prevented what amounts to a colossal failures of customer service at the VA, Fisher said.

“We look under the carpet, not just over,” he said. “We would have found some discrepancies in the data.”

Furthermore, “I would think that it shouldn’t be a choice,” he said. “I would think that all VA hospitals would be on notice that within a year or two years you will have a Baldrige-based assessment,” Fisher said.

He’s in a good position to know. Since 2012, Fisher has served as one of six judges for the VA’s performance excellence program. He was among the earliest national examiners for the Baldrige program, helped judge the U.S. Air Force Quality Award and the Presidential Quality Award, has written 10 books based on using the Baldrige criteria and has traveled around the globe helping others embrace it.

Joe Webb, a former chief executive officer for Methodist South Hospital during an 18-year career with Methodist Le Bonheur Healthcare, is another Memphian sold on the value of the Baldrige, and puzzled by its limited use at the VA.

As board chairman for the Mid-South Food Bank, Webb is leading use of the Baldrige criteria and an assessment to guide plans to provide more pounds of food in three states.

“There’s not a tool out there that has the overarching effect of strategic guidance and direction that the Baldrige does,” Webb said. “If we had been using that to provide care or deliver care to one of our largest health care delivery components, the VA system, wow, think of what could have been happening, instead of us being where we are now.”

Managed by the U.S. Department of Commerce’ National Institute of Standards and Technology, the Baldrige program grew to include education, health care, government and nonprofit organizations.

It requires senior leaders to take a systems, or holistic, approach, Fisher said. It lays out criteria, core values and tools for assessing key areas including leadership, strategic planning, customer focus, management by fact and results.

The annual Malcolm Baldrige National Quality Awards are intended to spotlight organizations that serve as role models and supply troves of “best practices” that others can adopt. Congress named the award for a U.S. Commerce Department secretary who championed quality management and was killed in a rodeo accident in 1987.

In Memphis, interest in the Baldrige has waned in years since FedEx Corp., then called Federal Express, in 1990 became the first service company to achieve the award. There are local pockets of interest, Fisher said. One of those is the city of Germantown.

“It’s one thing to set lofty performance goals; it’s another to figure out exactly what has to be done to make those numbers, fulfilling those recommended actions and then assessing whether there was true cause and effect,” said Germantown Mayor Sharon Goldsworthy.

The VA secretary who resigned in May, Eric Shinseki, wasn’t a “systems thinker,” Fisher said. He said the retired Army four-star general mandated that new patients be seen within 14 days, but did not ensure that the infrastructure was in place to support the policy.

“I think you can have a heart for it, but if you don’t have a systems mentality as a senior leader, you may not be able to have an impact on the organization,” Fisher said.

However, he finds ample evidence that President Obama’s pick for a new secretary, Bob McDonald, has a firm grasp of the Baldrige concepts. McDonald is a graduate of the U.S. Military Academy at West Point as well as a former chief executive of Procter & Gamble Co.

Still, Fisher said the VA could quickly find “opportunities for improvement” by benchmarking all of its medical centers using the Baldrige criteria. He thinks the 37 state and local awards programs based on it, including the quality center he directs that is supported by the Greater Memphis Chamber and Southwest Tennessee Community College, could be contracted to supply the boots on the ground.

“To me it would be a fast way of looking at these and putting them on guard that you are going to be assessed by an outside group,” and the world’s most widely used standard for performance excellence, Fisher said.


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