Quality of Care and Patient Experience: You Don’t Have to Choose!

You shouldn’t have to choose between quality healthcare and a great patient experience. And now you don’t have to. Hospitals and Healthcare Systems that have successfully used the Healthcare version of the Baldrige Criteria for Performance Excellence (HCPE) provide as good or better quality of care and outcomes of care while at the same time providing a better patient experience than their competitors. While some have suggested that you have to make “trade-offs” and give up quality of care to improve patient experience and satisfaction, it turns out that is simply not true. If you take a holistic, systems thinking, approach to designing and improving the processes of care and the patient experience as an integrated system you can have both, as the Baldrige Award recipients in this study demonstrate.


Ron Schulingkamp, Sc.D. of Loyola University New Orleans and John Latham Ph.D. of Organization Design Studio, Ltd. addressed this issue in a 2015 paper titled, Health Care Performance Excellence: A Comparison of Baldrige Award Recipients and Competitors. Ron Schulingkamp Sc.D. recently presented this research on high-performing hospitals at the 28th Annual Quest for Excellence® Conference, Marriott Baltimore Waterfront, Maryland (April 5, 2016).

Value-Based Purchasing

Hospitals today face pressures from a variety of stakeholders to improve performance across a comprehensive scorecard, which has become the basis for Centers for Medicare & Medicaid Services (CMS) Value-Based Purchasing (VBP) program. The VBP program is part of the Affordable Care Act (ACA) and is important in a practical sense because it has an effect on the hospital’s financial performance. The ACA created the VBP program to transition Medicare toward integration and alignment between payment and quality. The performance measures in the study are part of the VPP program (See Table in Presentation). The VBP program rewards hospitals for improving the quality of care by redistributing Medicare payments so that hospitals with higher performance in terms of quality receive a greater proportion of the payment than do the lower performing hospitals. The VBP program goal is to transform Medicare from a passive payer of claims based on the volume of care to an active purchaser of care based on the quality of services its beneficiaries receive.

Comparing Baldrige Recipients and Their Competitors

This study investigates relationships between the effective application of the Baldrige HCPE and healthcare organizational performance. There have been many studies on the value of implementing the Baldrige Criteria for Performance Excellence, but due to the lack of comparable contexts and common performance measures, analysis of the differences in performance between Baldrige Award recipients and non-recipients has been limited. This study focuses on the common context of healthcare organizations in the same geographic region along with common metrics to analyze the impact of effective HCPE application. This study compares 34 Malcolm Baldrige National Quality Award Health Care recipients (2002–2011) to all 153 competitors in their geographic markets using standard CMS performance measures to determine if there is a relationship between the effective use of the HCPE as an organizational excellence framework and the performance of healthcare organizations.

Dr. Ron Schulingkamp at Quest 2016

The study included 39 measures from three of five VBP program categories:

  1. Process of care (23 measures);
  2. Patient experience using the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey (10 measures); and
  3. Outcome of care (6 measures).


The results identified Baldrige Award recipient hospitals had higher mean values representing higher performance than the non-Baldrige Award recipient hospitals in 37 of the 39 (95 percent) study measures.

The HCAHPS patient survey measures results were the most significant findings in this study. Hospitals that used the HCPE had higher means and lower standard deviations than the non-HCPE hospitals in all HCAHPS patient survey 10 measures, and 9 of the 10 measures were statistically significant. The final HCAHPS patient survey question, “Patients would definitely recommend the hospital”, was perhaps the most critical performance measure in the study and is considered a critical question relating to customer loyalty, which is an important aspect of the profitability and sustainability of any organization. The hospitals using the HCPE have transformed their organizations from a narrow focus on clinical outcomes to a more holistic approach to healthcare quality in all respects, including the patient experience.

Dr. Ron Schulingkamp at Quest 2016
The most important finding in this study was that Baldrige recipients provided care equal to or better than competitors while at the same time providing a better patient experience.

These results combined with previous research provide leadership with evidence that the HCPE serve as a valid framework to create both clinical process of care results and outcomes along with quality patient experiences. Additionally, these results add to the growing evidence that the HCPE are a valid framework to align organizational design, strategy, systems, and human capital to create long-term effectiveness in an institutionalized high-performance culture. While an HCPE transformation is not an easy task, it is possible with the leadership system, style, and individual leadership characteristics identified in previous research on CEOs who led successful transformations resulting in recognition as Baldrige Award recipients.

Download Presentation (PDF)

Download Paper — The results of this study were published in the Quality Management Journal.

Schulingkamp, R. C. & Latham, J. R. | 2015 | Healthcare Performance Excellence: A Comparison of Baldrige Award Recipients and Competitors | Quality Management Journal | Vol 22 Issue 3

Enjoy the journey,

Originally published at Organization Design Studio™.

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