Achieving and Sustaining Quality in Healthcare

SUMMARY * SSM Health Care (SSMHC), the first healthcare recipient of the Malcolm Baldrige National Quality Award, has been cited by both Baldrige and the Joint Commission on Accreditation of Healthcare Organizations as having a culture of continuous quality improvement (CQI). SSM Health Care began to implement CQI systemwide in 1990. CQI provided the foundation for other strategies that served to further weave quality improvement into the fabric of the organization's culture. It gave SSMHC's people the tools and techniques to make improvements, created an environment of teamwork, and introduced the concept of improving processes. Using the Baldrige Criteria for Performance Excellence as a business model helped SSMHC to see how various organizational functions should link and to discover gaps in the linkage within its own organization. Baldrige feedback reports identified opportunities that could then be prioritized and the resulting improvements implemented. Overall, the Baldrige model gave a focused approach to what had been scattered improvement efforts. SSM Health Care considers the Baldrige model the best way for an organization to get better faster. ON MAY 2i, 2003, SSM Health Care (SSMHC) was awarded the 2002 Malcolm Baldrige National Quality Award, becoming the first recipient in healthcare to be selected. Since that time, we at SSMHC have been fulfilling our responsibility as a national role model in healthcare by sharing our best practices and our lessons learned with other organizations. We shoulder this responsibility eagerly because we believe that it is through an exchange of knowledge that, together, we can make healthcare breathtakingly better. In this article, I focus on the primary strategies that SSMHC has used during the past 14 years to achieve and sustain a culture of continuous quality improvement (CQI). From the beginning we considered CQI to be a journey, not a destination. The Baldrige award is for us an awesome milestone on this journey, but we are keenly aware that we have not reached perfection and that we must continue to improve. OUR MISSION SSM Health Care's mission is "Through our exceptional health care services, we reveal the healing presence of God." This mission statement evolved from a year-long process that involved 3,000 employees from every one of our entities and at every level. Its call for "exceptional health care services" echoes the historic commitment of my congregation, the Franciscan Sisters of Mary, which sponsors SSMHC. Our values are compassion, respect, excellence, stewardship, and community. Our quality journey really began in 1872 when our founder, Mother Odilia Berger, a German nun, came to St. Louis, Missouri, with four other sisters and began to nurse people with smallpox. Later, the sisters established hospitals that would become the foundation for our system. These sisters and those who followed in their footsteps were all strongly committed to excellence. It is critical for an organization to have a mission that inspires and energizes people. But that is not enough. An organization must also have clearly defined processes to achieve that mission. People in an organization need to see exactly how their quality-improvement work contributes to the organization's mission. CQI SSM Health Care committed to continuous quality improvement system wide in 1990 and was among the first healthcare systems in the nation to do so. When we began to explore CQI in 1989, SSMHC was not in the midst of a crisis; it was stable and doing fairly well. But as those of us in system management brainstormed that summer, we found that we were discontented with the status quo. We believed we could do better in advancing our mission and values. Our research into CQI showed strong parallels between SSMHC's values and quality principles. We thought that in CQI we had found the structure we were looking for to improve our healthcare services and to put us on the path to excellence. …