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Quality Line – Spring 2005 Return to Newsletters Table of Contents   Baldridge National Quality Program Malcolm Baldrige was Secretary of Commerce from 1981 until his death in a rodeo accident in July 1987. Baldrige was a proponent of quality management as a key to this country’s prosperity and long-term strength. He took a personal interest in the quality improvement act that was eventually named after him and helped draft one of the early versions. In recognition of his contributions, Congress named the award in his honor. The Baldrige Award is given by the President of the United States to businesses—manufacturing and service, small and large—and to education and health care organizations that apply and are judged to be outstanding in seven areas: leadership; strategic planning; customer and market focus; measurement, analysis, and knowledge management; human resource focus; process management; and results. The Baldrige performance excellence criteria are a framework that any organization can use to improve overall performance. Seven categories make up the Health Care Criteria for Performance Excellence Framework: Leadership— Examines how senior executives guide the organization and how the organization addresses its responsibilities to the public and practices good citizenship. Strategic planning— Examines how the organization sets strategic directions and how it determines key action plans. Focus on Patients, Other Customers and Markets— Examines how the organization determines requirements and expectations of all customers and markets; builds relationships with customers; and acquires, satisfies, and retains customers. Measurement, analysis, and knowledge management— Examines the management, effective use, analysis, and improvement of data and information to support key organization processes and the organization’s performance management system. Human Resource Focus— Addresses key human resource practices—those directed toward creating and maintaining a high-performance workplace and toward developing staff to enable them and your organization to adapt to change. Process Management— Examines aspects of how key production/delivery and support processes are designed, managed, and improved. Organizational Performance Results— Provides a results focus for meeting the organization’s mission as a health care provider. It encompasses the objective evaluation by its customers of the organization’s health care outcomes and service delivery results, the overall financial and healthcare market performance, the leadership system and social responsibility results, the staff and work systems results, and the results of all the key processes and process improvement activities. Health Care Criteria Health Care Criteria are the basis for organizational self-assessments, for making Awards, and for giving feedback to applicants. In addition, the Health Care Criteria have three important roles in strengthening US competitiveness: to help improve organizational performance practices, capabilities and results to facilitate communication and sharing of best practices information among health care organizations and among US organizations of all types to serve as a working tool for understanding and managing performance and for guiding organizational planning and opportunities for learning Health Care Criteria for Performance Excellence Goals The Health Care Criteria are designed to help organizations use an integrated approach to organizational performance management that results in: delivery of ever-improving value to patients and other customers, contributing to improved health care quality improvement of overall organizational effectiveness and capabilities as a health care provider organizational and personal learning Core Values and Concepts The Health Care Criteria are built upon the following set of interrelated Core Values and Concepts: visionary leadership patient-focused excellence organizational and personal learning valuing staff and partners agility focus on the future managing for innovation management by fact social responsibility and community health focus on results and creating value systems perspective These values and concepts are embedded beliefs and behaviors found in high-performing organizations. They are the foundation for integrating key organizational requirements within a results-oriented framework that creates a basis for action and feedback. Need some useful tools to meet the Baldrige challenge? Try using: Getting Started with the Baldrige Criteria for Performance Excellence E-Baldrige Organizational Profile found on the Baldrige website at: http://www.baldrige.nist.gov/eBaldrige/Step_One.htm Are We Making Progress? and Are We Making Progress as Leaders? Contact the Baldrige National Quality Program or visit the Baldrige Web site at http://www.baldrige.nist.gov for these and other educational material. PARETOS! “Long ago and far away, an Italian economist named Pareto spoke of an 80/20 rule. Loosely translated, his rule says that if all items or tasks are listed, 80% of the value, satisfaction, or results will come from 20% of the list. For example, 80% of the sales come from 20% of the customers, 80% of the sick leave is used by 20% of the employees, 80% of the prescriptions repeat 20% of the drugs, and my own personal favorite, 80% of the dirt is on 20% of the floor.” Quote from the Pro-Nurse Handbook By Melodie Chenevert   The Pareto Chart is a wonderful legacy from the work of that Italian economist. These are tools that are useful when we have “unordered categorical” data, or unrelated buckets of data that don’t have an inherent rank of any sort. When you look at a Minitab Pareto like the one below, you will see there is a scale on both the left and right side of the graph. The left side (y axis) is usually a simple count of the number of “things” in the “bucket”. In the graph below, that is a count of the reason the people in the sample fell. The right side is always a scale from 1 to 100 %. The line above the bars on the graph starts with the percent of total falls (the phenomenon of interest) that are in the first bucket. The dot above the second bar marks the total % of the falls that are in the first two buckets. This line will then track a cumulative total of the % in each bucket until it reaches 100% of the falls (phenomenon of interest). The table below the graph lists the counts, individual percents and a cumulative percent. While a Pareto chart is a very useful tool to use for prioritizing where to target your change energy and resources, it does have some limitations. A concept you will need to keep in mind when using the Pareto is that of looking at both the scope and the severity of an issue. Scope has to do with how widespread or common an occurrence is. The severity on the other hand, addresses how much harm the thing you are looking at can cause. An application of the concepts of scope and severity would be in regard to medications and adverse drug events (ADE’s). A Pareto of the kinds of errors will tell you that missed drug doses is typically the most frequently reported medication error. When we look at harm related to errors, we find that the missed dose seldom results in perceivable or noticeable harm. With ADE’s, we probably would find on a Pareto that severe nausea and vomiting is the single most frequent ADE. While the literature tells us this adds about a half day of stay and $800 additional costs, most people would not consider this as serious harm to the patient. If the goal of the improvement is to reduce costs, this would be a valuable place to target energies. If our goal is making patient care safer, we may wish to target another kind of ADE such as respiratory depression with pain management. Even though it occurs in a smaller per cent of patients, the potential for harm to the patient is much more serious than for nausea and vomiting. Using the falls Pareto as an example, lets look at the buckets of confused/forgetful and syncope/vertigo. Confusion and forgetfulness is the most frequent reason for a fall. If we look at percent of the patients with confusion that fall and percent of patients with syncope that fall, we might find only a small percent of the confused patients fall while a high percent of the patients with syncope fall. Knowing this may impact how you think about the scope of the problem. This additional data may alter how you begin to address a fall reduction program. Any time you have data that is unordered categorical, or different buckets with no inherent way to rank them, a Pareto is one of the tools you need to use to look at the data. Just as you wouldn’t set out to build a house with just one tool, you shouldn’t set out to analyze your data with just one tool. You need to use data analysis and data tools with a clear understanding of the purpose you are collecting and analyzing the data so it can effectively support improvement. Respectfully submitted by: Trisch Beilke, MA, RN, CPHQ, Immanuel St. Joseph’s – Mayo Health System   It is important that all members of MHQP know you are invited to attend Board Meetings. If you have questions, feel free to contact the Board Members. Quality Line and Between the Lines are designed to provide members information on vital issues in Minnesota healthcare, trends, CQI methodologies, legislation and news about our organization. Published quarterly in Spring, Summer, Fall, Winter. Editor: Patricia Beilke Beilke.Patricia@mayo.edu