Strong medicine Featured

7:00pm EDT January 29, 2008

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,