COLLEEN HUEBNER: We now have a half an hour to reflect on Judy's presentation, and ask her and the other panelists questions about the Baldrige framework and how it might fit or parts of it might fit to our endeavor. So what I'd like to do is ask Joel Berg to begin. Joel, you've seen this framework function in business and now you work in university settings. Could you tell us a little bit about its application to graduate training or this as you referred to it yesterday, our new product line strategy.
JOEL BERG: Well, as I, is this on?
COLLEEN HUEBNER: No.
UNIDENTIFIED SPEAKER: Now it is, yes
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JOEL BERG: As I mentioned yesterday I think that the business, not from Baldrige, the third components, education, I'll converse into the hybrid with business and education. And the business (inaudible) with Baldrige has nine criteria I believe. Those are similar and I guess what I want to talk about is the similarities, what I've learned, and I really like Malcolm Baldrige and I'll tell you why. I make three comments, three comments today as it relates to education and business. One is, sometimes things are going right and they go right for a long time and suddenly they're not going right. You don't know why. So one of the best, purpose of one the most important purposes of Malcolm Baldrige is a few scanned individual components of the process. Still when things start to not go right, you can make (inaudible) action. An example was given to me once, which is simplistic but I think accurate, so I'm on call for it but I know how difficult it is and they said Tiger Woods has a coach or several coaches who break down his swing in 12 different elements. And he practices each of those 12 elements, meticulously everyday, the way he stands, the way he holds the club, you know, everything. So when things start, don't go right he can actually go right through the particular elements and fix that part and not go for somebody on the result and say, oh, it's not going right. And I think in any kind of work (inaudible) for the same thing. Things are going right, things are going right, you don't know why they're not going right suddenly, so support (inaudible) Malcolm Baldrige is a way to identify individual components so you can see what's making this machine work.
This Malcolm Baldrige is nothing more than identifying a set of processes, which lead to the result. So it's a matter of determining which point in the process you can tweak. And the other side of that, of course, is if you want to improve, what's the most likely point in the process where you can tweak something to make it even better. Do I put investments here, or do I put investments there. Without understanding the individual elements, you don't know what to do. So that's my first point. The second, and that applies with us as well, because we focus on results and I think it's interesting to note that only 450 points out of a thousand are on results. Five hundred and fifty are on what are sometimes called enabling objectives. They are enabling objectives or enabling criteria and results criteria and it's important, it's interesting to note that more of them are on the enabling side because we can't just look at results. We have to look at what leads us to that because to a certain extent one could argue that you shouldn't have to look at results at all because the only reason you do that is to make sure it really is working. But if the processes are working correctly, they meet your results and that's all you should have to do. So I think it's important from that perspective but the second point is that it's easy to go into Malcolm Baldrige seeing this as a process, which is external to the organization. And when Judy goes in to look at that, I'm sure one of the things you look at is, is this really engrained into the organization. Is the management living this every day?
This can't be something that's a process, it's an exercise, a workshop, a symposium, its got to be something that is the way you do business. These processes actually are the elements of how you run the organization. You know in the case of our training programs, I thinks there's an incredible opportunity to break it down using the Baldrige, Baldrige elements, the criteria, and then to adopt them as the way we do business. Without that, it's not going to work and that's really important. This is not a superficial layer superimposed upon what we do. It actually is what we do. That can be very different without making an attempt to do that. The third thing, the last thing I want to mention, which I is I think is the same in business and I think it's made even more true in educational or healthcare side, is if you go back and it's interesting if you haven't done this, to go look at it. Look at a couple of the self-assessments. Go online and look at some of the ones that have won the award. A couple that I'll give as examples that I've seen are Nokia, Volvo, and 3M Dental Products won it in 1997. And if you look at what's common amongst all those, it's the people part. And a big part of the Malcolm Baldrige is how do you develop your people? And Judy, you talked about the satisfaction of the people and one part of satisfaction of course, is how are they developed, how do they perceive their role. And the development process of course, I mentioned yesterday, the transparency in the organization. Are they aware? And that's something that the examiners look at. Does everybody really know about the mission vision? Can you walk down the hall and stop somebody in the hall and say, what's the mission of the organization? What are we here for? So this transparency, the people aspect and are they really involved in the organization as something that's critical for success. I think you'll see that in the winners, very clearly. And they're nice, they're actually nice papers to read because those are my comments and I think I didn't really respond specifically to the education, but I didn't do than intentionally because I think there is no difference. I think, you know, the criteria is slightly different, you know, the business side focuses a little bit more on the market but in our case its patience instead of customers. There's no real difference.
COLLEEN HUEBNER: Any obvious response to Joel's comments or questions for Joel? Questions for Judy?
UNIDENTIFIED SPEAKER: What is the most important fact that, the chief officer or the head of the department is really covered with and then stimulates everybody else. (Inaudible). (Inaudible).
JUDY MORTON: That's a great, can you hear, is this working? Oh right there it is. Is that working? I'll just, it is working, great. That's a great question. I think that I've seen it happen both ways, however, I don't think that it's possible to achieve without a senior leader that is totally committed. And then, but the reality is, and I just sort of really reinforce what Joel said. I've had the privilege of doing some site visits for organizations that eventually did become winners and you will see that level of commitment, but it's not just at the senior leader level. It is like every single one of those direct reports and all the way through the organization. I mean, it almost gives me the shivers. Where I've gone, there've been where, no matter who you interview in the organization, large organizations, a janitor can tell you what he or she is doing that is contributing to their departments success, their goals, that is contributing to the organizations success. So that level of alignment with the mission and commitment is felt across the organization. But it does require major senior leadership commitment and support and that daily living of it as Joel was saying.
UNIDENTIFIED SPEAKER: I think it's years to lead up to this.
JUDY MORTON: Yes, and they, I've heard it said that it takes usually between, that this is not, this is not a quick fix. This is sort of a never, ending journey. And many of the organizations that have actually achieved the level of winning the award, most of them have been applying for the award and using it as a way of improving four, five, six, seven, eight years, before they actually achieve that level of performance. And it's interesting, many of the winners, now they can't apply again at least officially for the award. Often times, we'll continue using that as an assessment because again, they have integrated it into the way they do their work. It's just how they get better.
Unidentified Speaker: Is it possible for a component on an organization to do this. I mean, most of our training programs exist within the module of institutions:
JUDY MORTON: Absolutely. It, the criteria can apply to any size group. Different divisions of organizations have applied before, for example, the airplane part of Boeing has applied. But here within MCH like an individual program could apply or-
Unidentified Speaker: Is that true Judy? I think it said, at least when I reviewed the educational criteria, the institution as a whole had to apply.
JUDY MORTON: Really.
UNIDENTIFIED SPEAKER: Because it talked about Pediatric Dentistry versus the Dental School, remember that whether we could-
JOEL BERG: I'm not sure about the actual educational side. There may be a way of interpreting it so that an organization within a larger institution could do it. I don't know. But in the business side, clearly an element of an organization can, as I mentioned 3M Dental, okay, which is a pretty small part of 3M, won the award. And they're obviously, they obviously have the same issues. They're connected to the infrastructure of a larger organization. Their finance department is not in that organization, you know, their, do you know what I mean? All those other infrastructures are external yet they isolate themselves for the purpose of their quality management system. So I think it could be done. I don't know whether it's allowed.
JUDY MORTON: Well and in hospital systems as well. Like for example, Baptist Hospital is a smaller subset of a larger entity. And they have shared support services. And so different like elements have, but we may need to check that.
JOEL BERG: I think that actually speaks to just a quick comment on that. That speaks to a very important point for managing our systems and looking at the outcomes of our people is that it's easy for us to see ourselves within the scope of this gigantic institution and therefore not manage our part because we leave it up to this organization. And it speaks to the point of actually isolating ourselves, not isolating in the sense of separating, but isolating from a management perspective and looking at what we can manage and what we can't and focusing on excellence within that organization. And I think that's credibly important as we look at outcomes.
Judy Morton: One of the things too, just to mention sort of to piggy back on that is SSM, for example, with the 21 hospitals. They were all required each, each of the 21 hospitals was required to do their own self-assessment every years and they were applying for State Baldrige Awards essentially to get that feedback. And so they were doing it individually and then when they put it all together, they were able to achieve a phenomenal level of achievement across the board.
GREG BORSE: How have you seen the Baldrige awards meshing with other-
UNIDENTIFIED SPEAKER: I wonder if you could identify who you are on this.
GREG BORSE: Okay. I'm Greg Borse from the University of South Dakota Lung Program. How do you see the Baldrige awards meshing with other accrediting activities that Universities or Schools or Hospitals have to deal with?
JUDY MORTON: I'm not as familiar with the educational crediting. I think it's something different. You clearly need to go through accreditation. Often times I think it can be very supportive because it does essentially contribute to further excellence, which is I think the intent of accrediting entities. I know in the healthcare setting where any of you who've been involved with healthcare are very familiar with joint commission. And we, it's a very demanding kind of accreditation process. We see that as being, those two working together very well.
COLLEEN HUEBNER: There was another hand up near you. Yes?
JIM BADGE: I'm Jim Badge from Effective Arts and it's, the idea of being conflictive void that was brought up yesterday. I think the only thing more avoidant than we are is assessment avoidance. And so, you know, to get this kind of award it really seems like people have to embrace the power of assessments. So what have you seen about how to actually get people to embrace, like I want to know what's going on. How have you seen that actually happening?
JOEL BERG: I think that speaks to first of all, and that's an excellent point, it speaks to the issue of is the analysis of these processes integral to the way you do business versus a superficial air as I mentioned. And if it's the latter, then we're going to have an aversion to it forever. Why would we do extra work for no reason? It's just something maybe fun but we're not going to continue it, it's not going to have sustainability. But if there's transparency in terms of how everybody believes this is actually helping us. That's the key is that it has to be presented from the perspective, this is going to bet he way we do business. This is our management system. And when people first started hearing about quality management systems, they were often viewed as something external to me. And it really needs to be something that's integral to the way we live, our business life every day. And once it's perceived as that, it's perceived as a system that allows to identify processes that can be improved to make our results better, measuring the way our graduates are trained in the performance of society, then people will buy into it. And that's why that's a key element is it has to be integral to the way we work. If not, then you're right. Then it's superficial and we're not, it's not going to have sustainability.
JENNY REID: I'd like to make a comment about that too. I can't speak to it from the Baldrige point of view but if you look at the notion of feedback in general, our brains are built to learn. And learning is supposed to be pleasurable. And it was for all of us at one point. It's a lot of; formal education tends to sort of beat the pleasure out of learning in a lot of ways. But that doesn't mean that we can't recapture that. Instead of thinking of assessment as focusing on what we aren't doing that we should do, if we can focus on what we're doing well that we should do more of. What we're doing now that we may not need to do in the future. We can change the environment in which we give feedback and we can make it pleasurable and something that people want to be involved in.
UNIDENTIFIED SPEAKER: I'm from the University of North Carolina (inaudible), I'm curious because I see that you can shift the performance measures and to look at exactly what your organization must look at, but in a time when state budgets are declining rapidly, and I recognize that. Resources are often dependent on these budgets. How do you find that as a indicator of success or (inaudible) of success?
JUDY MORTON: I'm sorry, how do you find thee-
UNIDENTIFIED SPEAKER: Well, as you look at institutions that are using this (inaudible), organizations that are using this funnel that might be state funded versus those that are privately funded or whose revenue seems to be rising or at least level, I'm curious how that plays out in terms of, you know, the success, using the-
JUDY MORTON: I think many of the winners actually come from those kinds of organizations and I think sometimes being able to have documented results can be very helpful with enlightened state governments or federal governments or grantors or whatever. I think the other thing is, is in resource constrained organizations potentially getting really clear about what are the absolute key measures of success that allows you to do some of the things that Jenny was talking about is maybe not being able to do everything but doing those things that are really the most important in whatever the limited budget may be. There may be others-
COLLEEN HUEBNER: You know, I would concur what, I did have the good fortune of going to a Baldrige training and hearing the people from the rural school district in Alaska. Honestly, they fly their students in for some of their educational programs. And when I saw that work across such a difficult situation, I thought surely our problem might be able to fit inside this solution some how. But I think if I came away from that meeting with one, one gem, it was alignment, alignment, alignment. And if you can get clear from point A and point Z and are always working to ask yourself how are these things aligned? Then in the face of budget constraints, you've got a framework for prioritizing and decision-making. And sometimes that's to say, we really can't do that now. And that you need to put some things on the back burner to stay focused on vision and a strong alignment. Does anyone else have anything to add to that?
GREG REDDING: I just wanted to pick up on that theme because I think as we look toward the rest of this meeting, it pertains in the sense that as you were talking about the Baldrige review of an organization, I was trying to ponder exactly which organization I would like to respond to and whether it's me division, the center, the categories, training in general, MCH, HERSA, you can get pretty broad here in terms of how we evaluate and what part of that segment are we. And I think it will pertain specifically in terms of how aligned are we as categories? How aligned are we as training programs? And frankly, what's the product? I'm not so sure we're training the same product among our different categories. And I'm not sure we should be. And that's going to kind of fly in the face of what you're describing. So I actually think it's not much of a nice system that brings a lot of important questions about what we do, what our products are, what are organization is, and do we see ourselves collectively or do we see ourselves individually as we go through this process.
COLLEEN HUEBNER: Yes?
SUE SWANSON: Hi, I'm Sue Swanson from (inaudible) Medical School and I wondered from (inaudible) program, for those programs that might be interested in attempting to raise the bar to this level, are there, is there a way already established for those MCH programs that are already striped for this to be able to come together and or at least a way of communicating together trying to help do some of this.
UNIDENTIFIED SPEAKER: Yes, there are ways. We just need to figure out what they are.
COLLEEN HUEBNER: This is the first time this conversation has happened to my knowledge. So one of the products of this conference could be establishing a forum for that discussion and follow on. So please hang on to that thought and lets not let it get lost.
COLLEEN HUEBNER: Wendy.
WENDY: I just want to make a, open up a (inaudible) here. One of the things that we heard in the halls and in discussions from a couple of different places yesterday was people's anxiety about the fact that we are in fact looking at assessment and outcome and fearing that as we tie ourselves down to any kind of measurement indicators or even begin to go in that direction that we're leading ourselves off to the slaughter. So, you know, I'd just like maybe Laura to respond to that because I believe that this really needs to be looked at and it needs to be looked at positively and embraced for the fact that, if the outcome is improved leadership at MCH, we can't stick our heads under the pillows and say I don't want to know how I'm doing because somebody's going to measure me because I will never get better if I can't do that. So can you reassure us so people can be a little bit freer about thinking?
LAURA KAVANAGH: I think you have to look at this from a variety of different levels. One is a process for improvement at, I mean it's the same, it's just that Greg brought up. One is you have to-
COLLEEN HUEBNER: Do you want to come up, please?