The Malcolm Baldrige National Quality Award (MBNQA) is an award that was established in 1987 by the U.S. Congress to promote awareness of the importance of quality management and recognise companies in the U.S. that have been able to implement quality management systems successfully. The award was named after the late Malcolm Baldrige, who once served as the Secretary for Commerce. He was known to be a proponent and an ardent supporter of quality management. The President of the United States presents this annual award to organisations which have demonstrated excellence both in quality management and performance. This award is typically awarded to organisations that fall in categories such as manufacturing, non-profit, small business, healthcare, education and service company. The organisations that apply for the prestigious Baldrige award usually are judged based on their achievements and improvements in seven key areas that include leadership, customers, strategy, workforce, operations, measurement, analysis and knowledge management and results. This report will apply the MBNQA to Duke University Hospital.
Organisational Profile of Duke University Hospital
Organisational Description
Duke University Hospital is a 932-acute bed full-service quaternary and tertiary care hospital found in Durham, North Carolina. Since the first day it opened its doors in 1930 as a small regional hospital, Duke University Hospital has grown by leaps and bounds to become an academic medical centre that is renowned worldwide.
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Organisational environment
Product Offerings
The offerings by Duke are defined by the speciality care that they offer to the patients. These specialities include endocrinology, ear, nose and throat, urology, gastroenterology, endocrinology, lung disease, cardiology, oncology, spine and back care, primary care, transplant and ophthalmology. All of these services are tailored to ensure that the patient receives excellent care which translates into patient satisfaction. Most of these services are delivered by a team of dedicated medical practitioners working at the Hospital.
Mission, Vision and Values
Duke’s mission reads "Advancing Health Together". The Hospital hopes to achieve its purpose through the following means as contained in its vision (Duke Health, 2018):
Delivering tomorrow’s healthcare today
Creating education for healthcare practitioners that is transformative
Building healthy communities
Accelerating the discovery of medical techniques and technologies and their translation in modern practice
Collaborating with others to improve health on a global scale.
Duke University Hospital’s values include excellence, integrity, teamwork, innovation and respect (Duke Health, 2018). These values are applied across the various areas in the larger organisation. Duke's core competencies include forward-thinking and patient service. These two competencies relate well with the mission in that through forward-thinking, Duke can engage in research aimed at coming up with innovative medical solutions that will solve present and future medical challenges faced by its patients. Similarly, by focusing on delivering services that satisfy their customers, Duke can fulfil its mission of advancing health together as it listens to other stakeholders for their input.
Workplace Profile
The Workplace profile for Duke Hospital University comprises of Doctors, Managers, Nurses, health workers and support staff. Academic qualification for these employees varies with the group or segment to which an employee belongs. For instance, doctors and advanced nurses have degrees in medicine and nursing respectively with additional certifications from their regulators. Managers and directors have degrees in fields such as ICT and accountancy. Relationship with co-workers, managerial support and meaningful work are some of the drivers that the management at Duke University Hospital uses to engage employees in meeting the organisation's mission and vision. The employees are unionised meaning that they enjoy union representation which can help them in organised bargaining.
Unique health and safety requirements for Duke Hospital University include the provision of disposable medical items to be used by medics, provision of protective clothing for employees, provision of a quarantine unit for infectious diseases. Additionally, all employees are required to take charge of their safety and health while on the premises and report any safety or health concerns to a responsible officer.
Assets
Duke has a critical power management system which manages its over 50 electric generators that serves its over 90 buildings spread over 210 acres of land. Additionally, Duke has campuses, parking lots, housing, dining and residence areas and n expansive Duke Forest. The Hospital has wards, theatres, pharmacies, office suites for doctors. Duke has a forward-thinking IT department whose role is to design, deploy and maintain IT solutions developed to help the organisation in its operations.
Regulatory Requirement
The Joint Commission has accredited Duke University Hospital on Accreditation of Healthcare Organizations. The regulation is aimed at ensuring that Duke University Hospital commits to improving the safety and quality of healthcare that is provided to the public. Duke has subscribed to Compliance 360, a compliance management software that ensures all of its subscribers are regularly updated with the changes in the regulatory environment and by so doing ensure that they stay compliant.
Organisational relationships
Organisational Structure
Duke University Hospital is headed by a president who is assisted by five senior executives that include a chief operating officer (COO), a chief medical officer (CMO), a chief financial officer (CFO), a chief human resources officer and chief nursing and patient care services, officer. The president reports to the Chancellor and CEO of Duke University Health Services (DUHS), who in turn reports to the board of directors. The governance board is tasked with formulating policies which are communicated to the president of Duke University through the CEO of DUHS who doubles as the secretary to the board.
Customers and Stakeholders
Duke University Hospital segments its patients (customers) into two main groups- adults and children. These segments are further broken down based on common characteristics such as the medical condition that the patients present. These patients expect the healthcare providers to attend to their needs and help them get better or enjoy an improved quality of life. Some patients are admitted for hospice care whose desire is to have services that will help them manage the symptoms of their terminal illnesses.
Suppliers and Partners
Duke University Hospital does not deal with vendors directly. Instead, it deals with them through an elaborate supply chain management system that is managed by DUHS. Many vendors supply both products and services to the hospital through DUHS. These include medical device representatives, consultants, pharmaceutical representatives and restaurants. The two-way communication is handled through the supply chain management system. DUHS has a procurement and supply chain management department which handles all the issues related to vendor management.
Organisational Situation
Competitive environment
Competitive position
Duke University Hospital competes favourably with its closest rival UNC Healthcare. These two have their headquarters located less than 20 miles from each other. Duke is ranked at the top in the state with UNC Healthcare coming third. These two organisations compete for customers as well as for administrative and clinical talent.
Competitiveness Changes
The fundamental changes affecting my firm's competitive situation include the fact that healthcare organisations are consolidating their operations in mergers to increase their competitiveness. Innovations coming to the industry are also likely to change the way in which firms compete.
Comparative data
Comparative and competitive information is not readily available. One has to dig through the internet to first figure out who the competitors are then based on these findings move on and check the websites of the individual competitors to figure out how they compare regarding their competitiveness.
Strategic Context
Duke University Hospital operates a complex system which makes it somewhat resistant to change. Organisations with simplified systems can quickly respond to change just because there are no too many parts in the system that needs to be moved. Therefore, a piecemeal approach will not work. In these systems, doctors play a pivotal role in meaning that if they fail to embrace the change, then the chances are that the change initiative will fail. Two of the critical strategic advantages include (i) the move to maximise the value that patients receive by delivering best outcomes at reduced costs; and (ii) shifting the organisation from being physician-centred to being patient-driven with the emphasis being placed on providing patient-centric services that will enhance patient satisfaction.
Performance improvement system
Cognisant of the fact that patients’ needs keep changing, Duke University Hospital has positioned itself to anticipate and react to these changes in the best way possible. The organisation uses its patient satisfaction university to train its employees on the new developments in the field of medicine and specifically on how to tailor these to meet the varying needs of its customers who are the patients.
Leadership
Senior Leadership: How do senior leaders lead the organisation
The visions and values for Duke University Hospital were set by the senior leadership guided by the mission of the larger Duke University Health Systems. The top leaders communicate with the staff in their various departments to get insight on what they would like to be notified to the board, which they relay to the president who then communicates it to the CEO who is the secretary of the board. Although the organisational structure is hierarchical, employees’ input in decision making is highly encouraged by the senior management. The senior management demonstrates its commitment to ethical and legal behaviour by formulating policies aimed at barring its employees from receiving gifts from vendors and subscribing to compliance 360, a system which ensures that all operations in the organisation are compliant with the regulatory requirements.
The senior leadership build an organisation that is successful now and in the future by being forward-looking. This means that the organisation can look ahead and innovate solutions that will address the needs of its patients both in the now and in the future. The senior leadership communicates to its workforce through departmental heads and supervisors. They interact with their key customers through press releases and message boards. They create a focus on action by creating teams whose activities align with the mission, encouraging employees to weigh in on purpose and by supporting the mission from the top.
Governance and societal responsibilities
Duke ensures responsible governance in three ways; defining roles and functions of different levels of management and for the staff, emphasises on ethical dealings and integrity and building an active board of directors that holds the administration accountable. Performance of the senior management and the board is best analysed by looking at how the organisation performs across different departments. Public concerns touching on products and operations are addressed through timely press releases. Ethical behaviour is promoted by using a code of conduct that requires all employees to adhere to the system that supports the values of honesty and integrity. Societal well-being is ensured by the firm trying as far as possible to embrace clean energy and other environmentally-friendly measures in its operations. Key communities are strengthened through projects, activities and programs aimed at addressing their needs.
Strategy
Strategy Development
Duke conducts its strategic planning process by collaboratively engaging the entire community that include trainees, staff, faculty, board members, alumni among others. The strategic planning process is guided by a combination of population health, academic and clinical priorities. The process stimulates innovation by allowing all stakeholders to participate and table their ideas through their working groups. Data is collected through interviews and focus groups discussions and analysed using the qualitative methods of data analysis. Key work systems include suppliers, partners and employees. The key objective is to improve patient satisfaction by the end of 2019. This strategic objective supports the meeting of the needs of the organisation.
Strategy implementation
The critical short- and longer-term action plans are all aligned towards achieving the mission of advancing health together.
Short-term action
Train all stakeholders on their role in advancing healthcare
Long-term action
Ensure that all operations comply with the regulatory framework established for healthcare practitioners.
The action plans are typically deployed through working groups. All resources will be made available through budgeting which would make sure that resources are made available. The main workforce plan to support the action plan revolves around training and continuous learning for the staff so that they can be equipped for the action plan. The effectiveness of the action plans is measured based on feedback received from patients. According to the feedback, it is estimated that the envisioned goals and objectives will be met within the time frame stipulated in the plan. Modified action plans will only be implemented if there is a need to do so and this will be done following the same process used in performing the original plans.
Customers
Voice of the customer
Duke listens to the voice of the customer through feedback given via suggestion boxes, online surveys, social media platforms and reviews on the official website. Patients are also asked to fill a form detailing whether they were served well or not. The firm listens to potential customers through forums and social media. Satisfaction, dissatisfaction and engagement are all determined by looking at feedback received across different platforms. Discussions are a nice place to compare satisfaction levels of customers with your services versus those of other organisations.
Customer engagement
Duke's products offerings are standard and are determined by the board based on an analysis of needs presented by patients. Patients are encouraged to seek information and support by being directed to the hospital's resource centre. The hospital's groups and segments are determined by age and the medical condition they present. Customer relationships are built and managed through the customer management system, and complaints are dealt with speedily by the physician or nurse on duty.
Measurement, Analysis and Knowledge management
Measurement, Analysis and Improvement
Data is necessary, the data collected across the organisation is used to see areas that need to be improved on. Information is selected based on its usefulness and relatedness to the organisation's action plan. Market data and voice-of-the-customer data are used to innovate offerings and align operations to meet patient needs. The performance measurement system is part of the broader system that runs the organisation. Therefore, any changes recorded in any area or department is quickly picked up by the system and a response plan is devised and implemented. The performance and capabilities are reviewed on a bimonthly basis and variances investigated. Best practices are shared as part of the policies that govern the organisation. The performance measurement system can forecast future performance. Performance reviews are essential, and they are all used to modify action plans for best outcomes.
Knowledge management, information and Information Technology
Organisation knowledge is managed through a knowledge management system which ensures that tacit knowledge is passed down to trainees and new hires. Knowledge and resources are deployed in such a way that continuous learning is made part of the organisation culture. A checklist is used to verify the quality of organisational data. Sensitive and privileged data is password protected and only available to authorised personnel. Hardware and software are under the watchful eye of the IT department which assigns access rights to employees. The data is backed up to the cloud ensuring that in the event there is an emergency, the firm can shift and run the cloud-based system until such a time that the physical order will be restored.
Workforce
Workforce Environment
Workforce capability and capacity needs are determined by using an incremental approach which looks at where the firm is and where it needs to be. This helps to determine the skills required to meet the developmental goals. The HR department does Hiring, recruitment and replacement of the workforce through a competitive process. The workforce is organised and managed by departments, but the HR department handles all workforce-related matters. The workforce is prepared for changes in capability and capacity needs through workshops, seminars and continuous learning opportunities. Workplace health, security and accessibility are ensured by following the guidance of OSHA policies in designing a good working environment for all. The workforce has access to health cover paid by the employer and other perks on top of their basic salaries.
Workforce engagement
Workforce engagement is fostered by having management that is approachable. The HR determines key drivers to workforce engagement. Participation is assessed based on feedback received from them. The workforce performance management system supports high performance and workforce engagement by recognising top performers and rewarding them. Learning and development system is tailored to equip the workforce with capabilities needed to do their jobs. Effectiveness and efficiency of the learning and development system are evaluated based on how best the employees understand what they are trained on. The HR department determines career progression.
Operations
Work Processes
The mission of the firm determines key product and work process requirements. Offerings are designed to meet requirements based on patient's needs. Day-to-day operations are part of the critical process of delivering patient-centric care. Key support processes are determined based on the needs of the essential work processes. The work process is improved through continuous innovation. Duke's manages change by the senior management setting the right example for the rest to follow.
Operational effectiveness
Overall cost is controlled by using a budget. The supply chain is managed by the use of a robust supply chain management system. The safe operating environment is provided by designing the workplace following the OSHA guidelines. Disaster and emergency preparedness by training employees on how to respond to such and backing up all critical files to the cloud.
Results
Product and Process Results
Results for products and customer service providers is 85%
Process effectiveness and efficiency results are 90%
Emergency preparedness results are 95%
Supply chain management results are 90%
Customer-focused results
Customer satisfaction results are 80%
Customer engagement results are 75%
Workforce-focused results
Workforce capability and capacity result is 80%
Workforce climate result is 85%
Workforce engagement result is 85%
Workforce leader development is 55%
Leadership and Governance results
Senior leaders’ communication and engagement with workforce and customers 45%
Governance accountability 75%
Legal and regulatory consequences 80%
Ethical behaviour 85%
Societal responsibilities and support for critical communities 85%
Achievement of organisational strategy and action plans 90%
Financial and Market Results
Financial performance results are 90%
Market performance results are 90%
Reference
Duke Health (2018). Mission, Vision and Values . Retrieved from https://corporate.dukehealth.org/who-we-are/mission-vision
