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In our work with the Rural Quality grantees over the past year, Kap Wilkes and I set out to discover how key sustainability success factors are integrated into such programs. We hypothesized that these success factors would be closely aligned with the Baldrige Performance Excellence Framework, so that became our starting point in designing our approach. We conducted an online assessment and several key informant discussions with grantees from the current and previous years’ grant cycle. We also facilitated a workshop for grantees to discuss key activities specific to sustaining a quality program. In talking with their peers, grantees identified lessons learned, including challenges of implementation and successful results.
Not surprisingly, we found the grantees are already doing many of the components of the Baldrige Performance Excellence Framework, but we did not see much evidence of a systems approach to the grantees’ efforts. Following are brief descriptions of the key sustainability success factors and findings from our recent work with the rural quality grantees.
Leadership: enhancing leadership awareness, alignment and capabilities
This is a time of dramatic change in health care, and it appears that the Rural Quality Program and other health care leaders are paying attention to the changes and looking for ways to adjust to the developing health care landscape. This is a critical part of leadership awareness and one of the key sustainability success factors.
What we heard from the grantees is that their quality program goals are very much in line with health care reform. For example, the disease registries they created and their focus on chronic disease management meet all three criteria of the triple aim: better health, better care, lower cost.
Strategic Planning: planning and aligning vision, strategy, and initiatives
Grantees were using strategic planning methods to align their vision and strategies with their initiatives and action plans. They were also regularly communicating about this strategy with leadership, striving for alignment with the mission of the overarching organization.
Patients, Partners, and Communities: engaging patients, partners, and community for improved population health
This criterion guides in the examination of how an organization engages customers to attain long-term success in the marketplace. This includes how to listen to the “voice of the customer,” build customer relationships, and use customer information to identify opportunities for improving their communities’ wellness.
Many grantees said they keep in touch with their patients, partners, and communities by using mailings, phone calls, newsletters, websites, social media, patient portals, meetings, health fairs, free educational events, and especially face-to-face communication as much as possible. They were effectively partnering with many other kinds of organizations and working together toward the health of their communities.
Measurement, Feedback, and Knowledge Management: evaluating progress, managing knowledge, and utilizing tools and resources
Although technology advances quickly and can be challenging to learn and use, the implementation of electronic health records has made it much easier to track and measure all kinds of data. This, in turn, has allowed rural quality grantees to use the feedback to spot areas that need improvement. Technologies, such as webinars and intranets have made it easier to share information with each other, learn new things, and help organizations manage their knowledge.
Workforce and Culture: developing workforce capacity and a quality-focused, change-ready culture
When asked to describe the culture of their organizations, grantees responded with some long pauses and some laughs. We noticed that their intentional focus on patient safety and quality was obvious. Also, many described an ever-changing workplace. Some talked about those that were resistant to change and how they have fallen by the wayside. Being change-ready is crucial in today’s health care environment. Part of success is tied to responding quickly and being prepared for anything. Some grantees also shared that the new methods of measuring data have created a healthy competition among their care providers.
Operations and Processes: continuously improving processes, services, and products
Several of the Quality Improvement methodologies mentioned by this group of Quality grantees included Plan/Do/Study/Act, Chronic Care Model, and Lean. Using technology is also a very important part of improving operations and processes, including electronic health records and patient portals. Continuously improving processes is a mindset that supports sustainability.
Impact and Outcomes: calculating and communicating value and impact
There are many benchmarks to use, including national standards like Healthy People 2020, as well as regional, state, local, and internal standards. The important thing is to use benchmarks to show progress is being made and then communicate that success to as many audiences as possible. Grantees said demonstrating the value of their programs to funders was helping their programs to continue and grow.
In talking with the Rural Quality grantees, it is obvious to us how passionate they are about the important work they are doing, and we are excited about the successes within each of the components. However, we do not see much evidence most of them are thinking in terms of a systems approach. Our hope is that as the grantees continue to implement aspects of each Baldrige component, they begin to see the integrated nature of the activities and consider them as a system. Using a “systems thinking” approach such as the Baldrige Performance Excellence Framework, we believe, is the key to sustainability of rural quality programs.
