EXPERT SOLUTION: The Health Care Manager Volume 34, Number 3, pp. 177–186 Copyright # 2015 Wolters Kluwer Health

The Health Care Manager
Volume 34, Number 3, pp. 177–186
Copyright # 2015 Wolters Kluwer Health, Inc.
All rights reserved.

Workforce and Leader
Development
Learning From the Baldrige Winners in
Health Care

Edwin W. Arnold, PhD, SPHR; Jane R. Goodson, PhD;
Neville T. Duarte, PhD

It is ironic that perhaps the only constant in health care organizations today is change. To compete
successfully in health care and position an organization for high performance amid continuous
change, it is very important for managers to have knowledge of the best learning and development
practices of high-performing organizations in their industry. The rapid increases in the rate of
technological change and geometric increases in knowledge make it virtually imperative that
human resources are developed effectively. This article discusses the best learning and develop-
ment practices among the Malcolm Baldrige National Quality Award winners in the health care
industry since 2002 when the industry had its first award-winning organization. Key words:
learning and development practices, Malcolm Baldrige National Quality Award, management

practices, organizational change

MANAGERS IN THE health care industry face important challenges in workforce
and leader development as they prepare their

organizations for continuous change while seek-
ing to achieve a sustainable competitive advan-

tage in their markets. Health care organizations

striving to become facilities of choice need to elicit

high performance to operate effectively in an en-

vironment undergoing arguably the most signif-

icant changes in the history of the industry. As

managers endeavor to strengthen their organiza-

tions and position them for competing in the fu-
ture, few strategies will be more important than

fostering employee learning and development for

continuous improvement and adaptation to change.

Author Affiliations: Department of Information

Systems and Management, Auburn University at

Montgomery, Montgomery, Alabama.

The authors have no funding or conflict of interest.

Correspondence: Edwin W. Arnold, PhD, SPHR,

Department of Information Systems and Management,

Auburn University at Montgomery, PO Box 244023,

Montgomery, AL 36124 ([email protected]).

DOI: 10.1097/HCM.0000000000000067

One instance of rapid change and growth in-

volves projected changes in the health care labor

force. The Bureau of Labor Statistics reported

that there were approximately 145.4 million
jobs in the United States in 2012, with the

number projected to increase to approximately

161 million in the subsequent decade, includ-

ing nearly 22 million in the health care and

social assistance industry.
1

Significantly, the

health care and social assistance industry was

expected to add the largest number of jobs,

nearly 5 million of the almost 16 million projec-
ted or about one-third of the national increase,

making it the largest industry in terms of jobs.
2

This important increase in job opportunities

in health care will require industry organiza-

tions to select and develop a large number of

new employees, and the results of this effort

will be critical for long-run success. Managers

will have to orient and onboard a large num-
ber of new employees while developing their

current workforces continuously to sustain high

performance and deal with rapid changes in

technology in the dynamic environment.

To meet the difficult competitive challenges

facing the health care industry today, managers

Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved

177

178 THE HEALTH CARE MANAGER/JULY–SEPTEMBER 2015

will need to establish a culture that fosters work-

force and leader development. The culture will

need to be reinforced with management prac-

tices that prepare people for implementing or-

ganizational strategies, including the need to

adapt to change. Emphasis on learning and d-
evelopment will be a critical success factor for

health care organizations seeking to blend peo-

ple and technology for high performance.

An important question for managers in the

health care industry will be: What management

practices should be implemented to develop and

sustain workforce and leader development to

ensure higher levels of performance? To help
address the question, this article provides ex-

amples of the best practices in workforce and

leader development in hospitals and health

systems using the framework of the Malcolm

Baldrige National Quality Award (MBNQA).

THE MALCOLM BALDRIGE NATIONAL
QUALITY AWARD

History

The MBNQA was established in 1987 and

named after the former US Secretary of Com-

merce who had been a champion of quality and

competitiveness for organizations in the United

States. The MBNQA Program is located in the

National Institute of Standards and Technology
in the US Department of Commerce. Organiza-

tions in manufacturing, small business, and ser-

vice industries were eligible to be considered

when the award was initially instituted; organi-

zations in health care and education became

eligible for consideration in 1998, and those in

nonprofit, including governmental agencies,

in 2007.
3

There were 17 award winners in the health

care industry between 1998, when health care

organizations first became eligible, and 2013.

Health care accounted for 17 of the 69, or 25%,

of the MBNQA winners since the industry be-

came eligible, although a health care organiza-

tion did not win an award until 2002. From

2002 through 2013, health care organizations
won 17 of 53, or 32%, of the Baldrige Awards

granted.
4

Competition in health care has been

significant, as only 17 of the 397 health care

applicants since 2002, or 4.3%, won an award.

Baldrige Award interest appears to have been

quite high in health care when compared with

the other eligible industries because health care

organizations accounted for 51% of the total

applicants for a Baldrige Award from 2002

through 2013.
5

The Table includes the MBNQA
winners in the health care industry.

BALDRIGE AWARD HEALTHCARE
CRITERIA FOR PERFORMANCE
EXCELLENCE

The 2013-2014 Health Care Criteria for Per-
formance Excellence

6
for industry organiza-

tions applying for the Baldrige Award include

leadership; strategic planning; customer focus;

measurement, analysis, and knowledge man-

agement; workforce focus; operations focus; and

results. An important component of the workforce

focus criterion is workforce and leader develop-

ment, which includes the learning and devel-
opment system, the effectiveness of learning

and development, and career progression. This

article presents examples of best management

practices implemented by the MBNQA winners

to foster effective learning and development in

their organizations.

WORKFORCE AND LEADER
DEVELOPMENT

The learning and development system

The MBNQA criteria for assessing the learn-

ing and development system in health care orga-

nizations include core competencies, strategic

challenges, and achievement of short- and long-

term action plans; organizational performance

improvement and innovation; ethical health care
and ethical business practices; focus on patients

and other customers; transfer of knowledge

from departing or retiring workforce members;

and reinforcement of new knowledge and skills

on the job. (Note: To enhance the analysis, we

combined the criteria of ethical health care

and ethical business practices and focus on

patients and other customers into 1 criterion
entitled ethics and patient centeredness.)

6

The following analysis presents examples of

the best management practices implemented

by the MBNQA winners to establish effective

Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved

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Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved

Baldrige Winners in Health Care 179

180 THE HEALTH CARE MANAGER/JULY–SEPTEMBER 2015

learning and development systems in their

organizations.

Core competencies, strategic
challenges, and achievement of
short- and long-term action plans

The MBNQA award winners have emphasized
developing and sustaining core competencies to

meet strategic challenges and achieve both short-

and long-term action plans. As a result, they care-

fully construct their learning and development

goals to reflect the strategic goals of the organiza-

tion. The following are some examples of their

successful efforts.

Advocate Good Samaritan Hospital
7

analyzes
core competencies, strategic challenges, and

action plans annually to develop learning needs

for all leaders and associates throughout the

hospital. Educational curricula are designed spec-

ifically to reflect these strategic needs. For exam-

ple, the hospital addresses the core competency

of building loyal relationships through the ‘‘Five

Fundamentals of Service, a PCA Enrichment
Series, and Sensitivity Training.’’ They implement

similar specialized programs to address the strate-

gic challenge of recruitment and retention of

talent, including ‘‘Peer Interviewing, the Rota-

tional Nurse Residency Program, and All Aboard

Training.’’ Long- and short-term action plans are

supported with specific programs and training

emphases, including those aimed at leadership
competencies to accomplish strategic plans.

At Bronson Methodist Hospital,
8

under the

Strategic Performance Management System, edu-

cation and training initiatives also are tied to the

accomplishment of the organization’s action plans.

The hospital’s Workforce Development Plan

includes an annual educational plan that is devel-

oped during strategic planning and is designed to
be aligned with the organization’s strategic needs.

Similarly, Baptist Hospital
9

has a comprehensive

system for both short- and long-term education

and development to build core competencies,

meet strategic challenges, and implement action

plans. Through a corporate-wide leadership

development program, Baptist University, the

hospital trains and develops its leaders in key
core competencies and skills needed to ensure

strategic success.

The development of leaders to meet the orga-

nization’s strategic challenges is also the focus at

Henry Ford Health System.
10

It has a New Leaders

Academy that focuses on ‘‘system integration and

modeling the leadership competencies,’’ a Lead-

ership Academy that emphasizes ‘‘the strategic
pillars and completing innovative improvement

projects,’’ and an Advanced Leadership Academy

with concentration on ‘‘higher-level leadership

competencies and completing strategic sys-

tem improvements with business unit CEOs

as sponsors.’’

Organizational performance
improvement and innovation

Baldrige winners gear their learning and devel-

opment systems to improve organizational effec-
tiveness through performance improvement and

innovation. All have some form of training that

provides employees and leadership with tools to

improve individual and/or team performance

and move the organization forward. As is the

case with most Baldrige winners, employees and

leaders at AtlantiCare,
11

Advocate Good Samaritan

Hospital,
9

Henry Ford Health System,
10

and
Poudre Valley Health System

12
are trained in per-

formance improvement processes early in their

onboarding with the hospital. Employees at all

levels are involved in the performance improve-

ment process and in the development of in-

novative strategies, including gathering best

practices information from organizations inside

and outside health care. These health systems
train employees and leaders on the Baldrige

framework of performance improvement and

innovation. Poudre Valley Health System
12

goes

even further to provide financial support for

employees to be trained as Baldrige examiners

to sharpen their skills in performance improve-

ment and identification of innovative best prac-

tices. Mercy Health Systems
13

also utilize best
practices to encourage performance improve-

ment and innovation and has developed a Best

Practice Sharing Program to support this effort.

While the specifics of the learning and de-

velopment programs vary, MBNQA winners im-

plement a system-wide learning approach to

performance improvement, innovation, and

change. They all focus on ongoing and continuous

Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved

Baldrige Winners in Health Care 181

improvement. Beginning with orientation, all

employees at SSM Health care
14

are required to

participate in continuous improvement train-

ing designed to stimulate innovation and im-

provement in work systems. Likewise, North

Mississippi Medical Center
15

approaches edu-
cation and training as an intensive, system-wide

process, and employees are encouraged to pub-

lish innovative processes and improvement

methods so that ideas can be shared through-

out the organization. Other winners develop

specific initiatives to encourage performance

improvement and innovation. For example,

Schneck Medical Center
16

has a simulation lab-
oratory, and Advocate Good Samaritan Hospital

7

has workout sessions for employees to develop

innovative strategies. Henry Ford Health Systems,
10

which focuses on performance improvement and

innovation across its learning and development

curriculum, developed ‘‘renewal’’ training to em-

phasize innovation and change management.

Future physician leaders also attend the Phy-
sician Leadership Institute to learn to encourage

organizational improvement and innovation.

Baldrige winners train leaders, advisors, and

teams to lead and support performance improve-

ment and innovation. Leaders at Advocate Good

Samaritan
7

receive specialized training in facilitat-

ing and sustaining change (Change Acceleration

Process Training). Henry Ford Health Systems
10

uses a similar training, called Influencer training,

to prepare leaders to lead innovative change and

manage system-wide performance teams. A team

focus on improvement and innovation is practiced

at AtlantiCare,
11

and consulting services are pro-

vided for teams to improve performance or en-

courage innovation. Southcentral Foundation
17

also identifies performance improvement advisors
who work specifically with projects that promote

improvement and innovation. At SSM Health

Care,
14

managers and supervisors are trained

to reinforce employees’ use of performance

and quality improvement tools in their jobs.

Ethics and patient-centeredness

Baldrige winners recognize the need to create
learning and development systems that empower

employees to make decisions that reflect the

highest level of ethics and patient centeredness.

All of the Baldrige winners train employees in

ethical health care and business practices and

institute continuous learning and development

in this area. In addition to training, Robert Wood

Johnson University Hospital
18

has ethics and

diversity committees to ensure that these initia-

tives are integrated throughout the hospital.
The MBNQA winners also ensure that learn-

ing and development initiatives promote the

value of the patient and other stakeholders and

hold employees accountable for excellence in

patient care. For example, SSM Health Care
14

conducts competency assessments of patient

care that are reported to the board on an annual

basis. At Henry Ford Health System,
10

new em-
ployee orientation is focused on patient-centered

care. This emphasis is continued on the job with

assessments, training, practice, and demonstra-

tion of patient care. Leaders, including physicians

and other clinicians, are trained to communicate

more effectively with patients and can practice

these skills through interactive role play in the

‘‘Simulation Center.’’ Schneck Medical Center
16

integrates patient care throughout the orga-

nization by developing organization and de-

partment plans that focus on its ‘‘patient first’’

core competency. An organization-wide training

program is developed according to this empha-

sis on patient care. Several Baldrige winners also

tie their individualized patient care efforts to

their diversity efforts, recognizing that care must
be tailored to reflect the diversity of the patient

population.

Reinforcement of new knowledge and
skills on the job

The MBNQA winners recognize the impor-

tance of utilizing current talent and multiple

methods in reinforcing new knowledge and
skills on the job. A systematic approach to rein-

forcement fosters continuity in job performance

and contributes to organizational effectiveness

in the long run. The following are a few exam-

ples of how the award-winning health care orga-

nizations accomplish new knowledge and skill

reinforcement.

All of the MBNQA winners use mentor pro-
grams and supporting organizational processes

to reinforce new knowledge and skills in the

organization. At Baptist Hospital,
9

for example,

leaders who have demonstrated particular

Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved

182 THE HEALTH CARE MANAGER/JULY–SEPTEMBER 2015

competencies, as rated by their coworkers,

mentor employees in these areas. In addition,

the hospital considers reinforcement to be very

important in establishing and maintaining their

culture of learning, and a number of approaches

including performance evaluation and Baptist
University sessions are used to reinforce learn-

ing. In Southcentral Foundation’s
17

learning and

development system, employees learn from for-

mal and informal mentors as well as through

job shadowing and demonstration of compe-

tencies. The knowledge and skills required on

the job have been reinforced previously during

employee orientation, and mentoring is used
during these early stages as well. When new

managers are selected, they participate in a

90-day program with individual learning mod-

ules that are led by current managers.

Other hospitals also utilize a variety of ap-

proaches to reinforce knowledge and skills on

the job. For example, Saint Luke’s Hospital of

Kansas City
19

uses mentoring, coaching, and
learning through observation during adminis-

trative rounds. Furthermore, their performance

management process reinforces training and

ensures that employees achieve commitments

and acquire appropriate knowledge. At North

Mississippi Medical Center,
15

preceptors assist

new clinicians in developing job-specific skills.

Learning also is reinforced with written pro-
cedures and information sharing regarding suc-

cessful, innovative methods. Likewise, Robert

Wood Johnson University Hospital Hamilton
18

utilizes the direct observation of job incumbents

to reinforce development and maintenance of

skills. Employee application of learning from

education programs is enhanced by ‘‘just-in-

time’’ training in which the tools learned in
education programs can be immediately applied

to projects in the workplace.

Nine of the award winners use formalized pre-

ceptor programs to encourage continuous learn-

ing and development on the job. Typically, these

programs involve assigning employees, includ-

ing physicians, to highly trained preceptors

who mentor employees as they apply new knowl-
edge and skills. Such a process ensures that em-

ployees continue to learn and develop on the job,

contributing to organizational effectiveness in the

long run.

Transfer of knowledg

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