Baldrige Award Research Articles

Relationship between quality management and organizational performance in the healthcare industry

ABSTRACT This study investigates how Quality Management (QM) programmes, particularly the Baldrige excellence framework, provide an approach to enhance healthcare organisational performance. Two independent methods were used to examine the short-term and long-term effects of winning the Baldrige award and the specific influence of common QM practices on results. The first method assesses the Baldrige Award’s impact on hospital performance by examining patient survey data and shows that initial quality improvements are not sustained in the long term. The second method uses confirmatory semantic analysis (CSA), a text-mining method, to analyse 22 Baldrige award-winning applications to determine the relationship between QM practices and organisational results in healthcare settings. The results show that only three QM practices – measurement, analysis, and knowledge management (MAKM), leadership, and operations focus – significantly contribute to organisational performance. Furthermore, CSA findings highlight the dominant role of leadership in driving performance outcomes, with other factors in the framework showing nonsignificant mediation effects. By exploring both the overarching effectiveness of QM programmes across different time lengths and specific practices that contribute to performance, this research provides academic insights with practical application in the healthcare industry. Importantly, the findings highlight the nuanced relationship between QM initiatives and organisational excellence.

Assessing the Performance Value of the Baldrige Journey: A Comparison of Baldrige Applicants and Nonapplicants.

The national Baldrige program has supported performance excellence in healthcare since 1999. Previous studies have compared the performance of Baldrige hospital recipients to nonrecipients. This study, however, sought to address the question of whether the mere pursuit of the Baldrige award provides value. This study used propensity score matching with linear and quantile regression techniques to understand the impact of hospitals applying the Baldrige Excellence Framework across a comprehensive set of standardized industry performance measures, regardless of award recognition. The analysis demonstrated that Baldrige applicants outperformed non-Baldrige applicants in select operational measures of efficiency (such as inpatient average length of stay), patient experience, and financial measures (including return on net assets, days in accounts receivable, and expenses as a percentage of patient revenues). However, there was no statistically significant difference in clinical performance between Baldrige applicants and nonapplicants. The findings from this study suggest that hospital leaders can realize significant gains with select operational and financial measures without compromising clinical outcomes when applying the Baldrige Excellence Framework to their organizations.

The importance of information technology to organizational results within the Baldrige award

Information technology (IT) is considered as a key to business success by academia and industry. Notably, IT has evolved to an organization-level role that is far beyond previous technology supports and information storage functions; rather, it serves as a core analytics tool, combined with machine learning and artificial intelligence, to facilitate quality management (QM) and communication among business units. The authors derived their research model through literature and the Baldrige framework, and tested the hypothesized research model through partial least squares – structural equation modeling using cross-sectional survey data. This study investigates how IT integrates with QM practices to affect organizational performance. The results show that IT makes a considerable difference to the function of QM by interacting with business operations and leadership, resulting in improved organizational performance. The implications of the results bring IT and other business functions together and shape an ecosystem of IT-enabled organizational frameworks in the Big Data era.

The Baldrige Award’s falling fortunes

PurposeThe purpose of this paper is to explore two explanations for the Baldrige Award’s decline. The management fashion literature suggests that it is a waning management fad, and the marketing choice literature suggests the likely presence of an ISO 9000 substitution effect.Design/methodology/approachThis exploratory study utilizes data collected on Baldridge Award applications, publications, ISO 9000 certifications and economic indicators. These data are contrasted to explore patterns and trends, and correlation analyses conducted to reveal the plausibility of the fad and substitution effect explanations for the Baldrige Award’s decline.FindingsData analysis confirms the Baldrige Award’s prolonged decline and strongly suggests it is in the final stage of a management fashion life cycle with support provided for the presence of an ISO 9000 substitution effect.Research limitations/implicationsMany organizations have shifted their attention away from the Baldrige as a means to quality and performance excellence, and there is evidence that the ISO 9000 standards are a viable substitute.Practical implicationsThe Baldrige Program has served its purpose with the Baldrige Award being the pinnacle of recognition for performance excellence achievement. However, the Award is in decline and the Baldrige Program is on a path to financial exigency. The Baldrige must be reframed to recover its role as the preeminent approach to performance excellence.Originality/valueThe paper satisfies the need to examine potential causes for the diminishing role of the Baldrige Award and challenges both academicians and practitioners to reexamine the Baldrige Program.

Quality management in healthcare organizations: Empirical evidence from the baldrige data

The purpose of this paper is to investigate the determinants of customer satisfaction and quality results in the healthcare industry using the Baldrige data. We use publicly available data on quality assessment of healthcare organizations that applied for the Baldrige award to examine two research questions: 1) whether the Baldrige model is a reliable and valid model for assessment of quality practices in healthcare organizations, and 2) to determine the relationship between quality practices and their impact on quality results in the healthcare organizations. Using structural equation modeling, the findings suggest that the Baldrige model is a valid and reliable quality assessment model for healthcare organizations. Consistent with previous studies, the findings suggest that the main driver of the system is leadership, which has a significant effect on all quality practices in the healthcare industry. Controlling for the applicants’ year, the findings indicate that 1) Information analysis and knowledge management has a significant impact on Quality results, 2) Workforce development and human resource management has a significant impact on both Customer focus and satisfaction and Quality results, and 3) Strategic planning for quality has a significant impact on Customer focus and satisfaction. The study provides insights and suggestions for healthcare organizations on how to improve their quality systems using the Baldrige model.

Integration of supply chain management and quality management within a quality focused organizational framework

A paucity of research has explored the integration of supply chain management (SCM) and quality management (QM) within an overall organizational context. The investigation of integrating SCM and QM within an organizational framework has the potential to foster theory development of SCM and QM and to strengthen SCM and QM practice. The Baldrige Award promotes organization performance excellence and the associated framework has evolved into a notable quality focused organizational framework. Prior studies have focused on validating the effectiveness of the Baldrige framework. In this research, we integrate SCM and QM within the context of a quality focused organizational framework by proposing a modified version of the Baldrige framework and validate the proposed framework. We use cross-sectional survey data to test the hypothesized research model through partial least squares – structural equation modeling. The results support the effectiveness of the proposed framework. The research shows the importance of SCM as a major organizational construct with a significant positive direct influence on organizational results. The research also shows that SCM is a mediator for leadership and measurement, analysis and knowledge management that influence organizational results. This work discusses theoretical and managerial implications as well as implications for future research.

An empirical investigation of the Baldrige framework using applicant scoring data

PurposeThe purpose of this paper is to overcome evaluative limitations of previous studies to provide a more decisive test of the causal relationships implied in the Baldrige Criteria for Performance Excellence (CPE) using a unique data source.Design/methodology/approachThe authors employ partial least squares path modeling on blinded scoring data from Baldrige Award applicants. In addition, the authors conduct multi-group analysis to examine whether the hypothesized causal model is universal across different industry sectors.FindingsThe path analysis provided strong support for the CPE framework in its entirety. However, analysis of sector-specific subsets of the data did not confirm all relationships, suggesting the possibility of industry-dependent performance excellence frameworks and raising new research questions to be explored.Practical implicationsThis research offers several pertinent implications for managers who seek to translate the theoretical CPE framework to actionable quality-improvement efforts.Originality/valueCPE operationalizes many total quality management (TQM) concepts and provides guidelines to TQM programs. This study validates the CPE framework using the most relevant data set to date – the applicant scoring data. The authors are also the first to investigate the cross-industry differences in the relationships between the CPE constructs.

Differences in TQM Performance of Small Enterprises

This research investigates how small enterprises differ from large enterprises in adopting and using TQM practices. This comparison of performance in TQM practices is based on the items in the Baldrige criteria. The scores of 86 applicants to a state quality award were statistically analyzed to look for any significant differences in the scores based on the size of the applicant. The feedback reports provided by the examiners were used to explain the significant differences in scores. The analysis indicates that the scores of small enterprises were significantly lower than medium and large enterprises. The lower scores reflect a lack of sustained, formal quality strategy and a lower priority given to continuous improvement. Information management in benchmarking and determination of employee and customer satisfaction also contribute to the lower scores. 
 This study alerts consultants and managers to the possible areas that small enterprises need to focus on to get the best out of their TQM implementation. The study also indicates that the formality of the criteria in assessment tools such as the Baldrige award criteria may not be very suitable for small enterprises. Past research about the use of TQM in small and medium enterprises for the most part use self-reported data and rarely provide comparison to large enterprises. The study compares the performance of small enterprises with large enterprises and provides objective data to confirm the differences in performance of small enterprises in TQM practices.

Strategic lean actions for sustainable competitive advantage

PurposeThe purpose of this paper is to add to the quality management body of knowledge by solidifying the connection between operational and strategic aspects of lean transformation. Previous research has examined these issues in isolation, demonstrating mixed results in financial and operational efficiencies. The authors show that when operational and strategic changes are jointly considered the likelihood of success for lean transformation increases.Design/methodology/approachThe authors provide a literature review of 109 peer-reviewed papers on lean manufacturing and qualitative analysis of 23 Baldrige award winners (2000-2014) that implemented lean to assess the importance of strategic actions in achieving a sustainable competitive advantage through lean transformation.FindingsThe authors find that lean transformation yields mixed results unless strategic actions are taken by senior management. These strategic actions include but are not limited to knowledge management, human resources, and business growth and can result in performance heterogeneity by improving the output/input ratio of the firm. This performance can then manifest as either doing the same level of business with fewer resources (a profit play) or doing more business with the same resources (a growth play). As specific examples, the authors analyzed Baldrige award winners for evidence of lean strategic action to drive performance gains. The authors suggest further model validation through directed interview and/or survey research.Originality/valueThis paper clarifies the need for jointly implementing lean tools with strategic actions. The findings provide more deliberate strategic actions for organizations wishing to increase the likelihood of success of lean transformation and ultimately improve quality.

Spiritual leadership as a model for performance excellence: a study of Baldrige award recipients

Issues regarding workplace spirituality and spiritual leadership have received increased attention in the organizational sciences. The implications of workplace spirituality for leadership theory, research, and practice make this a fast growing area of new research and inquiry by scholars. The purpose of this research was to test a dynamic relationship between the revised spiritual leadership model, consisting of inner life, spiritual leadership (comprised of hope/faith, vision, and altruistic love), spiritual well-being (i.e. a sense of calling and membership), and key organizational outcomes in a sample of Baldrige Performance Excellence Program award recipients. With structural equation modeling, results revealed a positive and significant relationship between spiritual leadership and several outcomes considered essential for performance excellence, including organizational commitment, unit productivity, and life satisfaction. These relationships were explained or mediated by spiritual well-being. Implications for research and practice are discussed.

A Relational Study on Quality Parameters of Baldrige Award with Stable Performance Outcome in Indian Star Hotels

Malcolm Baldrige national quality award is pioneer among both manufacturing and service sectors internationally. Many other awards given by various organizations and governments also use Baldrige's quality criteria and parameters to evaluate industries. A few papers attempt to find actual relationship between the parameters with actual performance of the company. However, financial performance is very difficult to obtain and to measure. This paper tries to use stability as the performance measure which was originally used in age-old practices of US Training within Industry (TWI) program. A set of structural relationship models have been analyzed in a scenario of hotel industry to validate the relationship. Primary data collected through a structured questionnaire in southern parts of India is used.

Does a Good Workforce Influence Restaurant Performance or Does Good Restaurant Performance Influence the Workforce?

Workforce focus is one of the Baldrige Award's criteria, and it consists of two factors: workforce environment and workforce engagement. This study develops unit-level measures of workforce environment and workforce engagement and tests whether they affect two important outcomes, namely, intent to quit and unit sales per customer. Using a time-lagged research design, the results show that workforce environment and workforce engagement lead to unit results.

Sharing Leadership Insights on Our Baldrige Journey to Excellence

CONGRATULATIONS TO THE feature article authors and their teams for their pursuit of excellence, the perseverance to achieve it, and the well-earned recognition from the Baldrige Performance Program.The driving forces for the Baldrige Award recipients on their journey to excellence are twofold:1. Healthcare is a dynamic industry that requires leadership focus.2. Using a systematic and proven leadership framework to deliver highquality care and remain competitive is a worthwhile pursuit.Both Hill Country Memorial Hospital and Schneck Medical Center experienced the joys, enlightenments, and professional fulfillment in rising to world-class status by the best care to the communities they serve. In winning the Malcolm Baldrige National Quality Award, both organizations earned the highest level of national recognition for performance excellence.Like athletes, leaders who pursue this level of excellence realize that both mental and physical preparation are needed to pursue an organization's goals, improve results, and become more competitive. An athlete depends on his or her coaches for training and inspiration. The same is true for management teams pursuing excellence. Organizations on the Baldrige journey seek feedback from coaches, high performers, their workforce, and key internal and external stakeholders. The leaders at Hill Country Memorial and Schneck realized that their journeys would take years to complete. Pope, Padula, and Wallace-Dooley wanted to take their organization from average to the national top io percent of performance. Forgey and Dye knew that maintaining the status quo was not an option for the future of Schneck.The leaders in these organizations exemplify role modeling that begins with commitment to a goal and follow-through on the vital few objectives in an industry with many distractions. Perseverance is necessary to stay the course and dare to achieve what few have accomplished. To date, only 103 organizations in all industries have received the Malcolm Baldrige National Quality Award. At speaking engagements about the Baldrige journey of Sutter Davis Hospital in Davis, California, I am frequently asked, How do you sustain the journey, year after year? The answer lies in leadership and the strength of the commitment to be the best and to earn the recognition.LEADERSHIPOrganizations that receive the Baldrige Award are led by seasoned, tenacious, highperforming leaders who have a vision and a passion to fulfill that vision. The Baldrige journey cannot be delegated. As Jack Welch has been quoted as saying, Excellence is not a spectator sport. Everyone's involved. The CEOs at Hill Country Memorial and Schneck had a vision about how they would set their care delivery systems apart from those of average hospitals. For Hill Country Memorial, this meant providing remarkable care and service, and for Schneck, being a healthcare organization of excellence-every person, every time. My experience at Sutter Davis was the same; after years of dialogue with the team, we defined our unique position in healthcare as a culture of caring.At both Hill Country Memorial and Schneck, the leaders set the strategic direction and the expectation that everyone in the workforce execute the vision through their behaviors and choices to achieve success. Therein lies a key quality of senior leaders-direction. They also must be able to communicate that direction to their team and follow up by holding everyone accountable for the direction they have set. This is how the journey begins. Forgey and Dye note that each employee must maintain the values set forth by the organization. Pope, Padula, and Wallace-Dooley explain that members of the workforce must understand their roles in achieving the organization's goals.The vision, mission, and values of an organization are translated into expectations that lead to sustained results. Achieving sustained results over time is one of the more difficult outcomes to achieve and probably the key reason most organizations do not achieve a high level of success. …

Healthcare Performance Excellence: A Comparison of Baldrige Award Recipients and Competitors

Hospitals today face pressures from a variety of stakeholders to improve performance across a comprehensive scorecard, which has become the basis for value-based purchasing and reimbursement. This study investigates relationships between the effective application of the Malcolm Baldrige Health Care version of the Criteria for Performance Excellence (HCPE) and healthcare organizational performance. There have been many studies on the value of implementing the Criteria for Performance Excellence, but due to the lack of comparable contexts and common performance measures, analysis of the differences in performance between Baldrige Award recipients and nonrecipients has been limited. This study focuses on the common context of healthcare organizations in the same geographic region along with common metrics to analyze the impact of effective HCPE application. This study compares 34 Malcolm Baldrige National Quality Award Health Care recipients (2002–2011) to 153 competitors in their geographic markets using standard Centers for Medicare & Medicaid Services (CMS) performance measures to determine if there is a relationship between the effective use of the HCPE as an organizational excellence framework and the performance of healthcare organizations. Three categories of performance were explored including the process of care (23 measures), patient experience using the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey (10 measures), and outcome of care (six measures). Process of care and patient experience data included performance from October 2009 through September 2010, and the outcomes of care measures covered performance from July 2007 through June 2010. While there was no significant difference in process of care results or outcomes between Baldrige recipients and their competitors, there was a significant difference in patient experience results. The most important finding in this study was that Baldrige recipients provided care equal to or better than competitors while at the same time providing a better patient experience. These results add to the growing evidence that the HCPE are a valid framework to align organizational design, strategy, systems, and human capital to create long-term effectiveness in an institutionalized high-performance culture.

An Information Processing Perspective of Process Management: Evidence From Baldrige Award Recipients

This study employs an information processing perspective to advance the understanding of the relationship between process management and performance. Process management is viewed as a means for coping with information processing requirements under conditions of uncertainty. The central proposition is that as the amount of uncertainty surrounding an organization's task environment increases, performance evolves from managing processes to progressively higher degrees of maturity. The authors explore the validity of their conceptual framework using data from feedback reports of 11 past recipients of the Malcolm Baldrige National Quality Award that included each of the award categories except manufacturing. Their analysis found that the processes of Baldrige recipients generally fell short of full integration and alignment sought by Baldrige and other frameworks. Because the sample organizations generally operate in stable contexts, these findings are consistent with the notion that high-performing organizations limit process management efforts to a degree that meets their information processing needs. Because this study constitutes one of the first to use primary data from the Baldrige Award process, a secondary contribution demonstrates how Baldrige data can be employed to advance both scholarship and practice.

Identifying Critical Factors That Predict Quality Management Program Success: Data Mining Analysis of Baldrige Award Data

This study identifies the critical factors that predict quality management program success using the Malcolm Baldrige National Quality Award (MBNQA) Criteria for Performance Excellence framework as a measurement proxy. Success is measured based on MBNQA applicant scores that qualify for award recipient consideration. Use of the MBNQA system as a proxy for success is supported by prior research. This study performs longitudinal and cross-sectional data mining analyses using ANOVA, multiple regression analysis, discriminant analysis, and decision tree analysis to compare 1,098 independent review process cases and 486 consensus review process cases drawn from the MBNQA item-level applicant scoring data from 1991 to 2006. The data are drawn from the MBNQA item-level blinded applicant scoring data released in 2011 by the National Institute of Standards and Technology (NIST). The analyses use an MBNQA “award” threshold score of 608 points that is stable for the 1991 through 2006 reporting period. This score is the approximate lowest winning score of the 66 award recipients for the reporting period, and is a function of the component scores that are being modeled. This study contributes to the quality management literature by empirically identifying the factors that matter the most when predicting quality management program success as measured by qualifying for an MBNQA award. The author found that MBNQA Category 4 (Measurement, Analysis, and Knowledge Management) and Category 1 (Leadership) MBNQA criteria (factors) are the only contributing factors—none of the other MBNQA factors matter. This finding suggests that quality management practitioners should consider focusing on leadership development and informatics-related interventions as a strategy for improving organizational performance and achieving MBNQA award status as measured by MBNQA criteria and financial outcomes.

Benchmarking award winning health care organizations in the USA

Purpose – The purpose of this study is to benchmark the use of process improvement techniques among US health care organizations that won the Malcolm Baldrige National Quality Award. Design/methodology/approach – The applications from 13 Baldrige award winning health care organizations were researched to determine which process improvement techniques were used most frequently to guide their operations. Findings – The results from this study identify several best practices in process improvement techniques. Furthermore, the study pinpoints in which aspect of performance that a process improvement technique is most likely to be used. Research limitations/implications – Only applications from organizations winning the Baldrige award have been studied. The identity and application for organizations that do not win the award are not released to the public. Statistical analysis of the data is limited to the relatively small number (13) of award winners. Practical implications – The results clearly show that there are certain process improvement techniques used by a majority of the Baldrige winners. It is not possible to guarantee that the use of these same techniques by other health care organizations will result in performance improvement, only that the winners used the techniques and have achieved a high level of performance. The results identify processes for further benchmarking studies. Originality/value – The process improvement techniques identified in this study have been used by successful health care organizations. This information may be useful to other health care organizations when deciding on which process improvement techniques to pursue in order to improve their own performance. While the Baldrige award process has driven benchmarking efforts, this study uses the Baldrige process to identify benchmarking opportunities for process improvement in health care organizations.

Winning the Baldrige Award: How the Henry Ford Health System Undertook a Five‐Year Improvement Process

AbstractHenry Ford Health Systems (HFHS) won the 2011 Baldrige Award, a major accomplishment. This achievement resulted from a systemwide focus on minimizing and controlling medical errors, a cultural shift to stimulate innovation and creative problem solving, and service excellence at every level. The five‐year effort centered on meeting Baldrige Award criteria, typically utilized in the for‐profit setting. When applied to the nonprofit sector, HFHS managed to reduce costs, reduce medication and treatment errors, introduce multiple creative clinical programs, and launch a new Ritz Carlton‐quality, hotel‐style service.

A study of the Baldrige Award framework using the applicant scoring data

The purpose of this research is to take an in-depth look at the Baldrige Award framework by analysing the nature and strength of relationships between the Baldrige criteria. This study facilitates the prominent role that quality awards such as the Baldrige play in the implementation of total quality management (TQM) systems. We aim to fill a gap in the literature by utilising the original independent review scores of the Baldrige Award applicants obtained from the National Institute of Standards and Technology. In addition, canonical correlation analysis is applied in order to evaluate the Baldrige Award framework from a new perspective. The findings confirm previous research that there is a strong relationship between all the Baldrige criteria. This paper specifically stresses the strong role of leadership in the Baldrige framework and provides managers with useful implications regarding the implementation of TQM practices. Companies need to bear in mind that concentrating on specific sections of the model is not adequate to attain excellence; instead a systematic approach that includes all elements of the framework should be adopted.

A Positive Deviance Perspective on Hospital Knowledge Management: Analysis of Baldrige Award Recipients 2002-2008

Knowledge management (KM) is emerging as an important aspect of achieving excellent organizational performance, but its use has not been widely explored for hospitals. Taking a positive deviance perspective, we analyzed the applications of nine healthcare organizations (HCOs) that received the Malcolm Baldrige National Quality Award from 2002 to 2008. Baldrige Award applications constitute a uniquely comprehensive, standardized, and audited record of HCOs achieving near-benchmark performance. Applications are organized around leadership, strategy, customers, information, workforce, and operations. We find that KM is frequently referenced in all sections, and about two thirds of each application addresses KM-related issues. Many specific KM activities, such as strategic and action plans, communications, and processes to capture internal and external knowledge, are addressed by all nine applications. We present examples illustrating these frequently appearing KM concepts. Baldrige Award-recipient HCOs apply continuous improvement to KM processes, as they do to their organizations as a whole. We conclude that these HCOs have developed sophisticated, comprehensive KM processes to align both culture and specific procedures throughout the organization. KM in these organizations is a deliberate effort to keep all relevant knowledge at the fingertips of every worker, characterized by frequent communication, careful maintenance of content accuracy, and redundant distribution. We also conclude that the extent and rigor of their KM practice distinguish them from other U.S. hospitals.