In 2000, Joel Allison assumed the leadership role as president
and CEO of Baylor Health Care System in Dallas. The system,
which has 15 hospitals and 16,000 employees, was a large player
in the area’s health care arena and was functioning well. But
Allison and others at Baylor began to ask an important question:
How could it be better?
The conclusion they reached was the organization could
improve if it focused on quality.
Allison, previously the health care system’s chief operating officer, wanted everything in the health care system to be the best it
could be, all the way from the meals that are served to patients
to the cleanliness of the floors to ensuring surgeons operated on
the correct leg.
The nonprofit health care system, with $2.9 billion in operating
revenue for fiscal 2007, implemented a new vision and mission statement that pushed every staff member to focus on quality, and it found
a way to encourage its employees to care about how the hospital was
perceived in the community.
It put forth the vision of “To be trusted as the best place to give and
receive safe, quality, compassionate health care.” Around this vision
is a flywheel of four major initiatives to implement that vision: people, quality, service excellence and stewardship/finance.
“We wanted to go to the next level with our commitment to quality,” Allison says. “Our board actually passed a resolution on our
commitment to quality and said not only will we meet, but we will
exceed all benchmarks on quality.”
Allison says you don’t improve quality by mentioning it during orientation and letting it go at that.
“It’s through communication, communication, communication,
and it’s through constantly living that message and walking the talk,”
Allison says. “I truly believe that what you have to do is continue the
message to your health care team and to your employees. We do
everything we can to reinforce our vision statement, our values, our
mission and why we are here. … (Employees) make up the culture
of your organization, and, at the end of the day, they sustain it. We
want to be very much in touch with our health care team.”
Quality at the top
Baylor officials started by hiring someone to be in charge of quality.
“We wanted to have a very focused approach to quality and have
someone identified as a chief quality officer to help us evolve in that particular space for the long term,” Allison says.
The candidate they wanted would have to come from a strong
health care system with a good reputation for quality care. Dr. David
Ballard was recruited to Baylor to become the organization’s chief
quality officer in 1999.
Ballard helped Baylor set up measurements for quality, which helped
employees know what the goals were and how to achieve them.
Baylor officials looked for industry standards, and then set the bars
even higher.
Allison says the key to quality is making sure that every
employee in every department cares about the quality of the work
that he or she does. To send this message, Baylor added quality into
the components measured and discussed during its performance
awards program offered to upper-level managers. The annual performance awards are incentives given to managers who meet certain
performance goals in the areas of finance, patient satisfaction and
now quality, with all three areas getting equal weight in the evaluation
process.
Also, three times a year, Baylor gathers its top 1,000 managers from
across the company for its Leadership Development Institute, which
has as its ongoing goal to revisit the four major emphases of Baylor:
people, quality, service and stewardship/finance. In the most recent
leadership development meeting, Baylor brought in an outside consultant to discuss behavioral interviewing with managers to help
them hire the right people.
Overall, the institute strives to emphasize quality in every aspect of
the organization. Allison personally attends each Leadership
Development Institute.
“We have actual matrix, and we talk about measuring them,
and we talk about how we can motivate and encourage people
to make that daily commitment to delivering safe, quality, compassionate care,” Allison says. “… We want to have a cascading
of a very common message that engages the employees.
Everyone wants to know, ‘What does that mean to me?’ The
engagement of your team is important because it’s the combination of your employees’ motivation or commitment and their
ability to know how to make an organization successful by
having this clear line of sight. They really are committed to
help the organization succeed. It’s how you treat people and
how you sustain relationships that helps build your culture.”
Communicate at all levels
Baylor emphasizes listening just as much as talking with its employees, and executives are encouraged to listen to concerns of employees. Also, employees are surveyed every other year, with some 79
percent taking part in the most recent survey in 2006. Baylor also has
focus groups with employees and also has an ethics hot line, in which
employees can anonymously report violations of company policy.
The calls are routed to a third-party vendor who handles the calls to
assure the review is objective. Every call is reviewed by Baylor’s chief
compliance officer, who reports directly to Allison.
“That helps us to find out if there are any issues or concerns about
any problems or early warning signals to pay attention to,” Allison
says. “It’s all back to quality. It’s all back to service. It’s about commitment to patient care and value of integrity and openness that we
want to be the best organization we can be and to be trusted as an
organization that is delivering the highest quality of service.”
The two-way nature of the conversation engages employees in contributing to quality. Allison’s own e-mail address is made available to
all employees, and he tries to answer every e-mail he receives, even
if it is just to let the employee know he’s forwarded his or her question to another manager. Surprisingly, employees aren’t abusive of
having it, and they often have valid points or concerns that they bring
to his attention.
Employees have to feel valued, and one of the ways to do that is to
be responsive.
“They are critical to you being successful,” Allison says. “They are
the ones who are out there, 24 hours a day, seven days a week, taking care of patients. I think it’s a CEO’s and management’s responsibility to stay in touch with your employees. You have to engage them.
You have to know what they are thinking and what they can do to
help you, how they can make it better for the patient. I’m a big believer in building strong employee relationships and being out with the
people. We encourage all of our senior executives and the presidents
of our facilities to do that.”
Rewarding quality also helps motivate employees to keep quality
standards high. When a patient writes a letter of thanks, Allison
makes a point to share it with the company leadership, and he and
the leaders also take the time to thank the employees who delivered
that great service.
“We share stories of grateful patients who write back to tell us how
their care was delivered,” Allison says. “We reinforce to our people the
good work that they are doing. We write thank-you notes. When anyone does a great job or delivers great service, we have our leaders
write thank-you notes to them.”
In 2007, Baylor held its first Quality Summit. Employees submitted
quality programs for awards, and prizes were given for the best initiatives. The first place winners were invited to give a presentation on
their quality programs. Many of those initiatives became best practices throughout the health care system. Allison says the program was
a big hit with employees. Some immediately began talking about next
year’s contest, which shows their enthusiasm for the program.
“It’s a message from top management that we’re putting a focus on
quality, such that we will recognize quality and reward it by saying,
‘You have achieved a level of quality that is recognized by your peers
and a panel of judges,’” Allison says.
Future quality goals
Future goals toward raising the bar of quality even higher include
reducing turnover, which is a goal for 2008. He plans to accomplish
this by adding a people portion to the performance awards program
for managers, which will measure retention of employees.
“We want to make sure we are hiring the right people and retaining
the right people,” Allison says.
The right people, he says, make all the difference in the organization’s success. He tries to be one of those right people himself.
“I believe very strongly in surrounding myself with the best and
brightest people, empowering them and letting them do their job, and
being of service to them and help them find the necessary resources
to accomplish their tasks,” Allison says. “I try to be available and visible. I try to really continue to communicate the message and live the
values of the Baylor Health Care System.”
He says creating a program that concentrates on quality can
change your organization, but only if you practice it and believe it
yourself.
“Create a vision around quality for your organization, and communicate that to everyone in your organization,” Allison says. “You need
measurements. How are we going to achieve the vision and set milestones on how your employees will be recognized on achieving quality? Make it very much a part of your every day conversation, and
make it a part of your culture. Really emphasize that quality is important and anything short of less than excellence in quality is not
acceptable. You want only the best. Your patient or customer truly
deserves the best.” <<
HOW TO REACH: Baylor Health Care System, www.baylorhealth.com