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Baldrige Landmark Case Study

Baldrige Landmark Case Study

Over the last decade, there has been a growing importance in evaluating the healthcare system’s performance through various deliverables. Health organizations have made tremendous efforts in improving the quality of their healthcare services. The management of health organizations strives to improve the performance of their institutions. The management has developed values and institutional policies that will guide them in achieving the vision and missions of their institutions. Institutional success takes the inputs of the top-level and middle-level management, employees, and staff commitment (Hobcraft, 2017). The inter-professional collaboration of these departments creates an organizational culture of performance and commitment to success. Health organizations have developed a strategic team to guide the institution in the strategic planning process. This process will help in the attainment of strategic goals. Consequently, leadership, governance, strategic planning, customer focus, and process management are the areas that need improvements. Health organizations need to adopt reforms in the industry in order to improve the quality of the health services they offer to patients.

Senior Leadership

Areas of strengths

Senior leadership is central to healthcare success and reform. The top-level management has developed a unique vision, mission, and values for the company. The senior leadership creates an enabling environment that helps the employees to reach the goals and objectives of the health organization. According to Hobcraft (2017), senior leaders must show commitment to the values of the organization, embrace a communication process, create reinforcement, and serve as role models to the employees.

Opportunities for improvements

Although the management has embraced a communication process it is still not clear how to bring on board the various categories of employees (part-time, contract, permanent and casual) and how they all can take part in the communication process. Additionally, although there is a commitment by the senior leadership in identifying the talented and potential employees that need to be mentored, the organization does not spell out clearly the criteria for selecting such employees.

Governance and Social Responsibility

Areas of strengths

The organization uses the top-level advisory board made up of the chief executive and the departmental heads. Management and senior leaders’ performance is reviewed on a 360 degrees feedback system (Latham, 2013). The feedback process runs from all of the lower-level employees to subordinate staff to supervisors and middle-level managers as well as the departmental heads all through to the CEO. The feedback from the various departments is reviewed and the necessary actions are taken to improve the management and the functions of the health facility. A special open meeting is held where the results from the action plan are discussed. As a value and a condition for employment ethical behavior are paramount in the organization. As a sign of its commitment to ethical and legal requirements, the organization conducts annual ethical training of employees. Health institutions are registered and comply with all the relevant legal requirements by the Centers for Medicine and Medicaid Services (CMS), such as the IOM and APHA, and Health Insurance Portability Accountability Act (HIPAA) (Hobcraft, 2017). Supporting key communities is an integral part of the organization which is enjoined in its mission vision and values statement. The organization has a serious commitment to improving the community’s health by improving the health status of the general population of the surrounding community and delivering effective and efficient healthcare services. To achieve this goal the organization is dedicated to helping the less fortunate in the community, people with disabilities, promoting a healthy lifestyle within the community, supporting the growth and development of employees in the health industry, and offering support for the history of the community (Latham, 2013). There is a need for the organization to recognize the necessity for managers to have decision-making power so that they can increase the efficiency and effectiveness of healthcare services (Hobcraft, 2017). Such power ensures the involvement of the immediate community.

Improvement opportunities

Although the organization has expressed its commitment to ensuring that ethics and legal compliance are addressed, there is no clear definition of what measures and processes that can be used to monitor compliance from the employees at an individual level. Health organizations are organizing annual training sessions to enhance the development of ethics and career growth within the organization. However, it is not expressly stated how health organizations can promote ethics within the organization’s governance structure.

Strategic Planning and Development

The organization has a unique strategy mix that enables it to plan for its short and long-term strategic directions. An annual SWOT analysis is conducted as a part of the strategic planning process. The strategic process brings on board the CEO and all the heads of the departments and creates room for external stakeholders, such as community members, suppliers, and other participants. Such external inputs play a key role in identifying grey areas that need to be improved. The CEO and the heads of departments gather data within the year. This data is analyzed during the annual data review and strategic planning process. The organization and its strategic goals are clear, and each strategic goal has been given a specific timeline for accomplishment. The strategic aim of the organization is in line with the overall strategic goals of the health care system.

Opportunities for improvements

Although the senior management is involved in the strategic planning process, how the employees are brought on board during the strategic planning process is not clear. Additionally, how the information and data collected during the year will be used in defining the long and short-term goals of the firm is also unclear. The process does not stipulate on who is assigning and allocating the role of the resources during the action plan and implementation. Finally, the strategic objectives of the organization are not clear on how to meet the various needs of the different players in the healthcare industry.

Strategy Deployment

Health organizations make use of the main performance and measures indicators and compare them against past performance. Health organizations make both long and short-term projections guided by short and long-term strategic goals. They have automated their health records and make use of the Electronic Health Record (EHR) system which helps in improving their efforts of offering efficient and effective health services.

Opportunities for improvements

The establishment, deployment, and execution of strategic action plans are not clear. In case there are changes in plans such as the supply of medical equipment and medicines. The organization fails to put clear how it can involve its main partners, such as the suppliers.

Patient, Customers, and Markets Focus

Health information provided by the patients during their first visits to the health organizations is used to identify patients in the future. The patients are classified according to their needs and their area of residence. Customer satisfaction is measured based on the relative contentment that the patients would get from other main competitors within the industry. From the obtained feedback health organizations are able to learn what the customers’ future expectations are, and they are able to learn what the health market looks like and the nature of the services that the competitors do provide. Health organizations also engage the patients and other stakeholders in several platforms which undergo annual improvements. These platforms include the company’s website, a mobile application that customers can download and install on their phones, and social media platforms, such as Facebook and Twitter. Knowledge about the healthcare market is obtained from the employees, customers, patient feedback, and industry. All these are some of the strategies that health organizations make use of in order to maintain and monitor the voice of the customers as well as to learn about the healthcare market.

Opportunities for improvements

Although health organizations have clearly devised ways of obtaining feedback about the organization’s services and satisfaction level, their means of obtaining information about the level of customer satisfaction relative to other competitors are unclear. According to Marsh et al. (2016), having a clear way of how the organization may obtain information about competitors can give the organization an upper hand in developing a future strategic plan.

Patient, Other Customer Relationships, and Satisfaction

Healthcare organizations form strategic alliances with customers and patients in order to maintain a strong relationship between other stakeholders, patients, and health organizations. They use the information desk to strengthen the patient and customer relationship as well as to evaluate the level of satisfaction or dissatisfaction. Health organizations use customer and patient satisfaction surveys to identify another health facility that they have visited or used previously within the last year. These surveys enable the organization to identify and analyze its main competitive strengths and weaknesses. Another source of information about customer satisfaction is various local publications that provide information that helps in strengthening customer relationships and focus on improving the patients satisfaction. Strategies for improving customer satisfaction and relationship have to be in line with the vision, mission, and values of the organization (Latham, 2013). The organization also makes use of a call center that helps in providing feedback and solution to customers’ and patients’ dissatisfaction.

Improvement opportunities

Although there are numerous ways of determining and assessing customer satisfaction, it is not clear how the various categories of employees are assessed so as to derive customer satisfaction or dissatisfaction. Feedback by customers sometimes may involve negative feedback or complaints. There is no clear definition of how the CEO and the departmental heads can make a follow-up screening of complaints and take action. This may jeopardize the commitment of the organization to improving customer satisfaction and strengthening the relationship.

Measurement, Analysis, and Improving the Organization Management

Operation data is gathered and reviewed by the departmental heads and the CEO together with the progress of the action plan. Reviews are conducted during the meeting with the staff and in a monthly review. These operational data are aligned with the strategic direction of the organization and areas of improvements are also identified. Weekly, monthly and annual reviews are the measure of the organization’s performance against the strategic direction. The management also conducts a detailed analysis which involves SWOT analysis, correlational analysis and other tools in order to help determine the level of performance for the organization as guided by the strategic objectives and the action plan. The analysis is aimed at evaluating and determining the trend in the healthcare industry and in health organizations and making projections regarding technology (Latham, 2013). The analysis is based on various sources of data related to healthcare outcomes, customers, and patients.

Opportunities for improvement

Even though operational and performance measures are easily recorded and selected, their support of decision-making in the organization is not clear and this may hinder the evaluation of the processes and its effectiveness. It is not clear how the organization selects data from surveys that can be used to support its operation and strategic decision. This may hamper the monitoring of measures and the effectiveness of the operation. Finally, it is not clear from the organization’s measures and analysis system how the organization prepares for unanticipated changes (both internal and external changes).

Knowledge, Information, and Information Technology Management

The organization has an internal network system where employees can have access to EHRs according to the nature of the job one is doing and this aids in decision-making and, hence, in improving the health services offered. The internal system is connected to the external networks through the website so that customers and patients could have access to the kind of services offered at the facility. However, the website does not give access to the private EHRs of patients since it is secured and this ensures the security privacy, and confidentiality of EHRs. The data and information systems are in line with the strategic business directions and technological needs. The technical and support team makes a review and system maintenance as well as provides backups to guarantee the security and privacy of the health information of the patients stored in the EHRs. During the data entry process, data is counterchecked to ensure the accuracy of the information and its entering into the EHRs system. The customer’s and patients’ knowledge is managed through Electronic Health Record System (EHRs) which provides historical data about the patient and customer as well as helps in the decision-making process. Through the website, the organization provides a system that supports the customers, patients, and other external stakeholders, such as the suppliers to make their opinions and recommendations and this gives the organization a chance to learn the external stakeholders’ expectations and helps in making future projections and strategic goals.

Opportunities for improvement

The system is not clear on how health information is continuously provided in case of emergency. Sharing the knowledge alone is not enough. The organization should identify the importance and use of the knowledge in implementing the best healthcare practice. Knowledge and information should not only be used during the meetings and reviews but also for developing and implementing the best healthcare practice.

Process Management and Work Systems Designs

Health organizations are using customers’ feedback systems to provide information necessary for devising a unique process that is customized and tailored in order to meet the needs of employees, customers, owners, and other stakeholders. Healthcare organizations pioneered the adoption of some unique innovations and inventions that are now being considered as the industry standards, hence, giving the organization a competitive advantage. Health organizations have developed a unique work system that promotes the corporation of the internal systems, such as the employees with the external systems, and stakeholders, such as the patients, customers, and suppliers of both medical and non-medical supplies. Such external elements are vital in offering qualitative and affordable health services. Health organizations have disaster and emergency preparedness units which headed by the chief of the disaster management and preparedness team. Hospital policies are guided by the national requirements for disaster and management preparedness requirements. The leader of this department offers directions to the health organization in making annual reviews which helps to incorporate new technology and make the necessary updates to the organization’s systems.

Opportunities for improvements

The hospital does not identify ways of implementing various processes that promote and ensure design requirements. It is also not openly stated how the organization incorporates the effectiveness and efficiency factors into the work system and process for easier process management. The organization is not directly on how daily operational processes ensure that the key process requirements are met. Setting out and making clear how these requirements are met will help to easily improve the system where needed.

Process Management and Improvement

The key support process is identified during the annual strategic planning. The hospital does not make outsourcing it process competencies. The CEO and the hospital management are responsible for determining the requirements to support the process. Such requirements are customized but in line with the general requirements in the processes for providing healthcare services.

Improvements areas

In most of health organizations, the major key process that supports the work process of the hospital is not expressly stated. Lack of clarity about the main key processes that support the organizational work system may hinder the improvement of the overall organization and operations and performance. The hospital does not explain well how it uses effectiveness and efficiency in the operation of the process.


Health organizational leaders play a critical role in directing healthcare organizations. Senior leadership is responsible for encouraging and stimulating staff for attaining the highest standards of performance. Compliance with established rules and regulation is also key to the success of any healthcare provider. The senior leadership also engages in strategic planning through strategic development and deployment. Strategic planning plays a critical role in helping health organizations to attain their strategic goals and objectives. Customer satisfaction is essential for the success of the organization. Healthcare organizations focus on effectiveness and efficiency. To fully satisfy customers health organizations have to focus on process management through work systems, designs, and process improvement. This is achieved by the implementation of the Electronic Health Records system.

Action Plan

Senior leadership makes use of both formal and informal communication processes to communicate, empower and motivate employees. Some of the used methods include a daily briefing with the employees, weekly reviews, and monthly meetings with employees. The senior management holds confidential meetings with the team leaders that provide feedback on the challenges and areas that need senior management’s input. In order to improve the organization’s performance in terms of efficiency and effectiveness in offering quality health services, employees are encouraged to offer innovative inputs on how to improve the process in the organization. Senior leaders also engaged in talent building and mentorship programs to develop employees that show high potential in their work.

Suggested Strategies

To improve the quality and transform the healthcare system, numerous strategies can be adopted. They include; primary care coordination and the adoption of Health Information Technology (HIT) which will help in the automation of keeping the health information of patients (Latham, 2013). Intervention strategies that target a specific category of patients would help in improving the quality of healthcare services and reducing of costs of healthcare. To improve results and bring about the accountability of health care practitioners, the leadership team should be at the forefront of reforming the health care delivery system. Such delivery reforms must be implemented together with other tools and resources needed, such as incentives to patients and health care providers, and thus provide better patient outcomes.


Baldrige Criteria help in the assessment of levels of commitment of health organizations in providing quality, reliable, responsive, accessible, effective, and efficient healthcare services. It also helps in identifying areas of improvement that will guide health organizations in improving their services. The health sector is one of the industries that require constant review. The healthcare service provider has to keep on changing to provide and meet the changing needs of the industry. The senior leadership team of health organizations needs to build on the weak areas of improvement in order to help the organization in refining the quality of their services.