In our work with the Rural Quality grantees over the past year,
Kap Wilkes and I set out to discover how key sustainability success factors are
integrated into such programs. We hypothesized that these success factors would
be closely aligned with the Baldrige Performance Excellence Framework, so that
became our starting point in designing our approach. We conducted an online assessment
and several key informant discussions with grantees from the current and
previous years’ grant cycle. We also facilitated a workshop for grantees to
discuss key activities specific to sustaining a quality program. In talking with their peers, grantees
identified lessons learned, including challenges of implementation and
successful results.
Not surprisingly, we found the grantees are already doing many
of the components of the Baldrige Performance Excellence Framework, but we did
not see much evidence of a systems approach to the grantees’ efforts. Following are brief descriptions of the key
sustainability success factors and findings from our recent work with the rural
quality grantees.
Leadership: enhancing leadership awareness, alignment and
capabilities
This is a time of dramatic
change in health care, and it appears that the Rural Quality Program and other
health care leaders are paying attention to the changes and looking for ways to
adjust to the developing health care landscape. This is a critical part of
leadership awareness and one of the key sustainability success factors.
What we heard from the
grantees is that their quality program goals are very much in line with health care
reform. For example, the disease registries they created and their focus on
chronic disease management meet all three criteria of the triple aim: better
health, better care, lower cost.
Strategic Planning: planning and aligning vision, strategy, and
initiatives
Grantees were using strategic
planning methods to align their vision and strategies with their initiatives
and action plans. They were also regularly
communicating about this strategy with leadership, striving for alignment with
the mission of the overarching organization.
Patients, Partners, and Communities: engaging patients,
partners, and community for improved population health
This criterion guides in the
examination of how an organization engages customers to attain long-term
success in the marketplace. This includes how to listen to the “voice of the
customer,” build customer relationships, and use customer information to identify
opportunities for improving their communities’ wellness.
Many grantees said they keep
in touch with their patients, partners, and communities by using mailings, phone
calls, newsletters, websites, social media, patient portals, meetings, health
fairs, free educational events, and especially face-to-face communication as
much as possible. They were effectively partnering with many other kinds of
organizations and working together toward the health of their communities.
Measurement, Feedback, and Knowledge Management: evaluating
progress, managing knowledge, and utilizing tools and resources
Although technology advances
quickly and can be challenging to learn and use, the implementation of
electronic health records has made it much easier to track and measure all
kinds of data. This, in turn, has allowed rural quality grantees to use the
feedback to spot areas that need improvement. Technologies, such as webinars
and intranets have made it easier to share information with each other, learn
new things, and help organizations manage their knowledge.
Workforce and Culture: developing workforce capacity and a
quality-focused, change-ready culture
When asked to describe the
culture of their organizations, grantees responded with some long pauses and
some laughs. We noticed that their intentional focus on patient safety and
quality was obvious. Also, many described an ever-changing workplace. Some
talked about those that were resistant to change and how they have fallen by
the wayside. Being change-ready is crucial in today’s health care environment.
Part of success is tied to responding quickly and being prepared for anything. Some
grantees also shared that the new methods of measuring data have created a
healthy competition among their care providers.
Operations and Processes: continuously improving processes,
services, and products
Several of the Quality
Improvement methodologies mentioned by this group of Quality grantees included Plan/Do/Study/Act,
Chronic Care Model, and Lean. Using technology is also a very important part of
improving operations and processes, including electronic health records and patient
portals. Continuously improving
processes is a mindset that supports sustainability.
Impact and Outcomes: calculating and communicating value and
impact
There are many benchmarks to
use, including national standards like Healthy People 2020, as well as
regional, state, local, and internal standards. The important thing is to use
benchmarks to show progress is being made and then communicate that success to
as many audiences as possible. Grantees said demonstrating the value of their
programs to funders was helping their programs to continue and grow.
In talking with the Rural Quality grantees, it is obvious to us
how passionate they are about the important work they are doing, and we are
excited about the successes within each of the components. However, we do not see much evidence most of
them are thinking in terms of a systems approach. Our hope is that as the
grantees continue to implement aspects of each Baldrige component, they begin
to see the integrated nature of the activities and consider them as a system. Using a “systems thinking” approach such as
the Baldrige Performance Excellence Framework, we believe, is the key to
sustainability of rural quality programs.
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