Thomson Reuters Finds Baldrige Hospitals Outperform Peers

Posted by Zara Brunner

Thomson Reuters just released a report finding that Baldrige hospitals (those that either received a site visit or the Baldrige Award at the national level) outperformed non-Baldrige hospitals on nearly all of the measures of performance used in the Thomson Reuters 100 Top Hospitals.  It's great to have this outside study to validate what Baldrige applicants, winners, examiners, state programs, and other community members have known for so long: Baldrige really does make a difference in improving health care outcomes, accelerating organizational performance, and in saving lives. 

You can see the full report, but in the meantime let me highlight some of the findings:

• Baldrige hospitals were six times more likely to be counted among the 100 Top Hospitals, which represent the top 3% of hospitals in the United States
• Baldrige hospitals outperform the 100 Top Hospitals on the following Thomson Reuters measures:
  • risk-adjusted mortality index
  • risk-adjusted complications index
  • patient safety index
  • CMS core measures score
  • severity-adjusted average length of stay
  • adjusted operating profit margin
• Baldrige hospitals were significantly more likely than peers to display faster five-year performance improvement

"The results of the Thomson Reuters study confirm what we've known for years: using the Baldrige Criteria and the earnest pursuit of the Baldrige evaluation will improve your organization by nearly every measure of success, be it in outcomes, safety, customer and employee satisfaction, or profitability," says the Baldrige Cheermudgeon, Harry Hertz. 

If you were thinking about getting started with the Baldrige Criteria, are in the early stages of assessing your organization with the Criteria, or applying for the Baldrige Award, this new study should bolster your reasons for doing so.  To all those organizations, health care and otherwise, that just completed their Baldrige site visits: congratulate your staff on their accomplishments.  And to all the Baldrige Examiners who make site visits and the Baldrige process possible: thank you for the difference you make to improving U.S. performance across all sectors!

Comments

[selwyn becker]

Why were there no data collected regarding case load severity adjusted cost of care?

[Barry Johnson]

My 2 cents

Selwyn, the TR database does not use that data point. The detailed TR100 report explains why each of the 10 measures is used and why others are not. This study compared the data available in both databases. It was not an exploratory research project to identify additional data points of potential interest. One of the significant findings of the study is the capability of high performance on the Baldrige balanced data set (Category 7 less 7.3) to PREDICT superior performance relative to other facilities not using the Baldrige data set to demonstrate superior performance on the TR data set and earn recognition through the TR100. Although not mentioned, the TR100 are selected based two dimensions- (1) ranked relative current performance level and ranked relative improvement trends, thus encompassing 3 of the LeTCI Baldrige scoring dimensions. The overall composite ranking of all 10 elements which is how TR100 winners are selected is analogous to the Integration scoring dimension in Baldrige. This validates the Baldrige "holistic" assessment process although it is not as statistically rigorous as the TR assessment process. Adding additional measures to the assessment process would require demonstration of higher predcitability.

[Toni Kfuri, MD,MPH,CMQ.]

The judges decision to add CMS Value Based Purchasing (VBP)standardized metrics, when reviewing site visited health care applicants ,comparative data for 7.1 A & 7.2 ,is establishing a level playing field for that "common" set of measures that all hospitals are required to report ,and establish from this year's SVs, a baseline to compare against. The new Thomson Reuters research paper has shown that Baldrige Hospitals outperformed their peer hospitals on nearly all the measures used in their 100 Top Hospitals reports, and that they were six times more likely to be listed in that report.The most important finding is that Baldrige Hospitals showed a statistically significant difference in core measures when compard to their peers.
This kind of information is very important for dissemination among the health care industry. The judges' decision to add the VBP measures is a "pre-emptive strike" and more importantly, because it adds value to mandatory reporting for CMS VBP and would be a large financial incentive for hospitals to use Baldrige if they want to have "statistically significant" better core measures that will allow them to recover funds from a 'budget neutral" CMS VBP program.

[bill boyt]

Before we broadcast these results too widely it might be worth considering that they a correlated while not being causal. Of course Hospitals chosen for site visits or to receive the award perform better than their peers. 45% of the score used to determine site visits are given for results. If you do not show exceptional results you are not chosen for a site visit and certainly not for the award. To say those chosen out performed those not chosen or not participating is circular and proves nothing.

[Eric]

FWIW: Juran's comments from 1995 (See: Malcolm Baldridge National Quality Awards Program: An Oversight Review From Its Inception):
I have been especially gratified by the steps being taken by N-I-S-T, NIST, to extend the Baldrige Award to three of our giant industries of health care, education, and government.
Those industries have been late getting into quality improvement, but now they are on the move. Making them eligible for the Baldrige Award will be a welcome stimulus, and I strongly urge this Committee to help bring this about.
We also face the need to explain to the leaders in certain sectors of our economy the fact that quality has moved to center stage.
In my view, the Japanese Revolution in quality is an historic event of enormous importance. It enabled Japan to emerge as an economic superpower. That would not have happened without their quality revolution.
Yet, this fact has not been grasped by many of our economists hnancial experts, national legislators, senior government adminis- trators, the media, and still others.
We do need a counter-revolution, and the Baldrige Award has been a significant aid to that. We should not abolish the Baldrige Award; we should support it to help that counter-revolution.

[Eric]

Regarding Bill's comment, above. I'd argue he makes the right observation then draws the wrong conclusion. Correlation is fine between the two award criteria. But the Baldrige winners can add this:
"Not only are our results worthy of recognition, but our governance system creates value for our stakeholders, including our community and our nation. We ensure our approaches have linkages to our results. Our entire team understands we pursue continuous improvement and seek to institutionalize excellence. You can read about these efforts in our application and our scorebook."

[Blood Testing Centers]

Well, this is not very surprising.
It's pretty obvious that hospitals that were chosen for site visit will invest much more effort and time in order to prove better performance.

[Reuccislisold]

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