2009

Award Recipient

National Institute of Standards and Technology • U.S. Department of Commerce

Baldrige National Quality Program

 Highlights

• Heartland Health has achieved 90 percent ratings in overall 

outpatient satisfaction and in key drivers of outpatient 

satisfaction between 2006 and 2009.

• Members have rated HH’s Community Health Plan above 

the National Committee for Quality Assurance (NCQA) 

90th percentile for health care and specialists’ care.

• HH is ranked in the top 15 percent of hospitals nationally 

for patient safety according to the HealthGrades (an 

independent health-care-ratings organization) “Best 

Hospital Scores.” 

• In promoting quality improvement and deploying its core 

competencies as part of the organizational culture, HH 

applies Six Sigma methods within its Process Improvement 

Model to control costs; prevent rework and errors; and 

minimize the costs of inspections, tests, and audits. Cost 

savings as a result of process improvements have increased 

from approximately $8 million in fi scal year 2005 to more 

than $25 million by fi scal year 2009.

Heartland Health

Based in St. Joseph, Missouri, Heartland Health (HH) is 

a not-for-profi t, community-based integrated health system 

serving the residents of northwest Missouri, northeast 

Kansas, southeast Nebraska, and southwest Iowa. With more 

than 3,200 caregivers (employees, volunteers, and health 

care practitioners), HH is the region’s largest health system 

and employer. HH was developed out of the merger of two 

prominent St. Joseph’s hospitals with the commitment to 

create an exceptional health care system, contribute to the 

economic vitality, and improve the overall health of the region. 

The system is governed by a community board of directors.

A Lasting Impact 

on Community Health

Heartland’s Health Pyramid was created to illustrate how 

the system distinctly impacts community health and drives the 

actions of all HH business units. This visual reminder shows 

that the underlying cause of death and disease (the tip of the 

pyramid) is often the result of individual lifestyle choices 

(the middle of the pyramid). These behaviors (e.g., tobacco 

use or poor diet) have a signifi cant and costly effect on the 

patient as well as the health system. The underlying drivers 

of these individual behavioral choices are a variety of root 

causes (e.g., stress or poverty) represented at the bottom of 

the pyramid. By spending time and resources on the middle 

and bottom of the pyramid, HH expects to see fewer acute 

illnesses and injuries at the tip of the pyramid.

The three-level Health Pyramid also depicts the structure 

for HH’s business entities. At the top, acute illness and injury 

are focuses of Heartland Regional Medical Center (HRMC), 

a 353-bed tertiary care hospital. It provides physician and 

hospital care services, including cardiac, women’s, children’s, 

and primary care; oncology; surgery; orthopedics; and 

neurosciences. Heartland Clinic, a group practice of 107 

physicians, also prevents and treats disease. In the middle of 

the pyramid, Community Health Improvement Solutions 

promotes individual health and provides disease management. 

Heartland Foundation is the organization’s outreach arm to 

help build a healthier, more livable community and to address 

root causes (at the bottom of the pyramid) by offering lifestyle 

and civic programs.

The Health Pyramid aligns all HH entities to further 

its mission to “improve the health of individuals and 

communities located in the Heartland region and provide the 

right care” and its vision to make the area “the best and safest 

place in America to receive health care and live a healthy and 

productive life.” 

How well does it work? HH has achieved 90 percent 

ratings in overall outpatient satisfaction and in key drivers of 

outpatient satisfaction between 2006 and 2009.

Actions Speak Louder Than Words

Senior leaders use the framework of the Malcolm 

Baldrige Criteria for Performance Excellence to take action 

on the organization’s mission and strategic objectives. 

Among the tools used to achieve these objectives are an 

integrated, organization-wide strategic planning process, 

balanced scorecards, and a fully deployed performance 

management system.
Called “Heartland 2020,” the organization’s strategic 

planning process ensures sustainability, allowing HH to 

anticipate health care industry changes in time for course 

corrections, as well as to plan for major capital, building, and 

strategic projects.

The balanced scorecard is an important tool in both shortand long-term strategic planning that aligns performance 

measures with organizational strategies. The scorecard 

measures are driven down to team leaders and individuals 

through entity, service line, department, and process 

performance measurement scorecards.

The People Plan ensures that every element of the caregiver 

(employee, volunteer, and health care practitioner) life cycle 

is carried out according to industry best practices and aligns 

with the HH mission, vision, and strategic framework. The 

performance management program cascades organizational 

goals to individual goals, supports caregiver performance 

through evaluations and individual education plans, and 

acknowledges caregivers with a rewards program.

The HH culture includes a strong focus on patient 

satisfaction. HH builds and manages relationships with 

patients through various tools and processes, including:

 • RESPECTcounts: standards developed by employees

 • HEART Standard: Hear — listening to the voice of 

the customer, both internal and external; Excellence— 

performing work in a professional manner; Appearance— 

taking pride in both personal appearance and that of the 

facility; Responsibility— doing all that is expected to meet 

customer needs and respecting the privacy of patients/

customers; and Teamwork— supporting each other to 

improve customer service, quality, and safety

 • AIDET: Acknowledge, Introduce, Duration, Explain, 

and Thank, the script given to each caregiver to meet service 

excellence behavioral standards 

The Best and Safest

Patient safety is driven by the vision “to be the best 

and safest” as a key element of the organizational culture. 

Senior leadership establishes and monitors patient-safety 

measures through the use of the patient-safety scorecard. 

When scorecard measures fail to reach goals, leaders make 

improvements as necessary.

In 2009, HRMC received the HealthGrades’ Patient 

Safety Excellence AwardTM. An independent health care 

rating organization, HealthGrades presents this award to 

hospitals with overall patient safety records in the top 5 

percent of the nation. 

HH also received the following recognitions:

 • HRMC is among 75 acute-care hospitals nationwide to 

receive the Superior Quality Merit Award from the 2009–

2010 Hospital Value IndexTM study by Data Advantage, LLC.

 • The Commonwealth Fund, a nonprofi t quality rating 

system, ranked HRMC the 19th-best hospital in the nation 

in 2009, based on measures of evidenced-based care, patient 

experience, readmission, mortality rates, and costs. In 2008 

and 2009, it ranked in the top 1 percent of hospitals.

 • HH consistently maintains its Moody’s and Fitch bond 

ratings of A and A2, respectively. In fi scal year 2009, the 

organization exceeded the Moody’s and Fitch current bond 

rating requirements for days cash on hand and achieved 

performance in both rating agencies’ top 10 percent for total 

margin and operating margin.

 • HH was recognized with the Missouri State Quality 

Award in both 2000 and 2005. 

Contributing to the Vitality 

of the Community

Heartland Foundation is the catalyst for building 

partnerships that develop community support initiatives. It 

researches national and state health policy data to identify 

community-specifi c health priorities that address root causes 

of public health issues. With this information, it identifi es 

partnerships and programs for HH’s participation. Ongoing 

initiatives include the Healthy Communities Program to 

foster healthier, more livable communities; the Youth Health 

Partnership with schools to improve health, attendance, and 

learning; and Circle of Hope to create a system of care for 

the mental health needs of youth. The Project Fit America 

Program addresses physical fi tness in 43 area schools with 

10,800 students participating.

In 2007, the Heartland Foundation partnered with the 

Environmental Protection Agency to clean up and restore 

a warehouse in a federally designated “Brownfi eld” district 

(blighted/polluted real estate). In its place, the foundation 

opened a state-of-the-art technology learning center called 

EmPowerU. This center engages middle- and high-school 

students in a hands-on curriculum that focuses on civic 

education, critical thinking, team building, community 

problem solving, technological skill building, leadership 

development, and workforce readiness skills. 

 For more information:

 Monica Ray

 Process Leader Quality, Safety and Risk

 Heartland Health

 5325 Faraon Street

 St. Joseph, MO 64506

 Telephone: (816) 271-6782 

 E-mail: monica.ray@heartland-health.com

 Web site: www.heartland-health.com/baldrige