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
Tab
le.
Malc
olm
Bald
rige H
ealt
h C
are
Aw
ard
Win
ners
Ho
sp
ital
or
Healt
h C
are
Syste
m (
Ab
bre
via
tio
n),
A
ward
Year,
Web
Sit
e
Typ
e
No
. o
f E
mp
loyees
Lo
cati
on
s
SSM
Healt
h C
are
(SSM
HC
), 2
00
2,
ww
w.s
smh
c.c
om
Fait
h b
ase
d,
no
t fo
r p
rofi
t 2
4 0
60
M
isso
uri
, Il
lin
ois
, W
isco
nsi
n,
Okla
ho
ma
Bap
tist
Ho
spit
al, I
nc (
BH
I),
20
03
, P
rivate
, n
ot
for
pro
fit
22
70
Flo
rid
a
htt
p:/
/ww
w.e
bap
tist
healt
hcare
.org
/Ho
mep
age/
Sain
t Lu
ke’s
Ho
spit
al
of
Kan
sas
Cit
y (
SLH
), 2
00
3,
Fait
h b
ase
d,
no
t fo
r p
rofi
t 3
18
6
Mis
sou
ri
htt
ps:
//w
ww
.sain
tlu
kesh
ealt
hsy
stem
.org
/ R
ob
ert
Wo
od
Jo
hn
son
Un
ivers
ity H
osp
ital
at
Ham
ilto
n (
RW
JUH
H),
P
rivate
, n
ot
for
pro
fit
15
00
N
ew
Jers
ey
20
04
, h
ttp
://w
ww
.rw
jham
ilto
n.o
rg/P
ages/
ab
ou
t_M
ain
.asp
x
Bro
nso
n M
eth
odis
t H
osp
ital
(B
MH
), 2
005, htt
p:/
/ww
w.b
ron
son
healt
h.c
om
/ P
rivate
, n
ot
for
pro
fit
31
82
M
ich
igan
N
ort
h M
issi
ssip
pi
Med
ical
Cen
ter
(NM
MC
), 2
00
6,
htt
p:/
/ww
w.n
mh
s.n
et/
P
rivate
, n
ot
for
pro
fit
38
75
M
issi
ssip
pi
Merc
y H
ealt
h S
yst
em
(M
HS),
20
07
, h
ttp
://w
ww
.merc
yh
ealt
hsy
stem
.org
/ P
rivate
, n
ot
for
pro
fit
40
00
W
isco
nsi
n,
Illin
ois
Sh
arp
Healt
hC
are
(SH
C),
20
07
, h
ttp
://w
ww
.sh
arp
.co
m/i
nd
ex
.cfm
P
rivate
, n
ot
for
pro
fit
14
00
0
Califo
rnia
P
ou
dre
Valley H
ealt
h S
yst
em
(P
VH
S),
20
08
, h
ttp
, h
ttp
://p
vh
s.o
rg/
Pri
vate
, n
ot
for
pro
fit
42
00
N
eb
rask
a,
Co
lora
do
, W
yo
min
g
Atl
an
tiC
are
(A
C),
20
09
, h
ttp
://w
ww
.atl
an
ticare
.org
/ P
rivate
, n
ot
for
pro
fit
51
00
N
ew
Jers
ey
Heart
lan
d H
ealt
h (
HH
), 2
00
9,
htt
p:/
/ww
w.h
eart
lan
d-h
ealt
h.c
om
/ P
rivate
, n
ot
for
pro
fit
32
00
M
isso
uri
, K
an
sas,
N
eb
rask
a,
Iow
a
Ad
vo
cate
Go
od
Sam
ari
tan
Ho
spit
al
(GSA
M),
20
10
, Fait
h b
ase
d,
no
t fo
r p
rofi
t 2
72
7
Illin
ois
h
ttp
://w
ww
.ad
vo
cate
healt
h.c
om
/gsa
m/d
efa
ult
.cfm
?id
=1
H
en
ry F
ord
Healt
h S
yst
em
s (H
FH
S),
20
11
, h
ttp
://w
ww
.hen
ryfo
rd.c
om
/ P
rivate
, n
ot
for
pro
fit
24
33
2
Mic
hig
an
Sch
neck M
ed
ical
Syst
em
(SM
C),
20
11
, h
ttp
://s
ch
neckm
ed
.org
G
overn
men
t–lo
cal,
no
t fo
r 8
00
In
dia
na
pro
fit
So
uth
cen
tral
Fo
un
dati
on
(SC
F),
20
11
, A
lask
a n
ati
ve o
wn
ed
, n
ot
for
14
87
A
lask
a
htt
ps:
//w
ww
.scf.
cc/i
nd
ex
.ak?C
FID
=1
56
81
87
&C
FT
OK
EN
=1
19
27
70
7
pro
fit
No
rth
Mis
siss
ipp
i H
ealt
h S
erv
ices
(NM
HS),
20
12
, h
ttp
://w
ww
.nm
hs.
net/
P
rivate
, n
ot
for
pro
fit
65
57
M
issi
ssip
pi
Su
tter
Davis
Ho
spit
al
(SD
H),
20
13
, h
ttp
://w
ww
.su
tterd
avis
.org
/ P
rivate
, n
ot
for
pro
fit
38
5
Califo
rnia
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 Hospital7
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 Hospital9
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 System12
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 Systems13
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 care14
are required to
participate in continuous improvement train-
ing designed to stimulate innovation and im-
provement in work systems. Likewise, North
Mississippi Medical Center15
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 Center16
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
Samaritan7
receive specialized training in facilitat-
ing and sustaining change (Change Acceleration
Process Training). Henry Ford Health Systems10
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 Foundation17
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 Hospital18
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 Care14
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 Center16
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’s17
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 City19
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 Hamilton18
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 knowledge from departing or retiring workforce members
The MBNQA winners each ensure that knowl-
edge is transferred from departing or retiring
employees. This management practice will be
especially critical in the coming years with the
impending retirement of millions of employees
in the baby-boom generation. Here are some
examples of how the award winners secure
knowledge retention when people leave the
organization.
Poudre Valley Health System12
utilizes several
approaches for making sure that job knowledge
is not lost because of departure of employees.
Their cross-training program, which gives em-
ployees opportunities to become proficient in
multiple jobs, includes job rotation, ‘‘secondary
job codes’’ to allow employees to do more than
1 job, and job placements on an interim basis.
Furthermore, it is the hospital’s goal to hire a
replacement prior to the exit of any employee,
allowing for on-the-job training from the incum-
bent employee. When their new Medical Center
of the Rockies opened and almost 300 employees
were transferred to the new facility, they imple-
mented a comprehensive staffing plan to allow
transfer of knowledge to occur prior to the change.
Similar to Poudre Valley Health System, Heart-
land Health20
retains the knowledge of departing
or retiring employees through cross training, de-
briefing meetings, and work shadowing. These
practices ensure that knowledge is retained and
transferred to new employees. Other Baldrige
winners gather information from departing em-
ployees during the exit interview process in
addition to cross training, mentoring, and other
on-the-job methods for transfer of knowledge.
For example, North Mississippi Health Services21
implements a formal exit interview to obtain
information from employees who are departing
the organization. Any helpful information ac-
quired can be incorporated into the mentoring
program for transfer to the new incumbent. Mercy
Health System13
also improved its exit interview
process ‘‘to more systematically retain knowledge
from partners departing from key positions.’’ The
partner assists in the development of a plan to re-
tain knowledge so that services can be maintained.
They may also participate in a ‘‘Work-to-Retire’’
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved
Baldrige Winners in Health Care 183
program that allows them to work reduced
or flexible work schedules and locations. This
program allows the hospital to retain partners
and their knowledge for longer periods.
EFFECTIVENESS OF LEARNING AND DEVELOPMENT
All of the Baldrige winners utilize multiple
criteria for assessing the effectiveness of work-force and leader development efforts. In addi-
tion to using direct methods for measuring
effectiveness, all of the winners include perfor-
mance indicators and/or organizational outcomes
in their assessments. The following examples
demonstrate the extensive efforts that Baldrige
winners undertake to conduct comprehensive
analyses of their workforce and leadership development initiatives.
In addition to employee and leader evalua-
tions of training and development programs,
Sharp HealthCare22
statistically analyzes clini-
cal data, financial results, and other organi-
zational outcomes to gauge improvement from
its workforce development efforts. Individual
performance on action plans and variance from desired outcomes is analyzed to determine if
training and development efforts succeeded in
moving employee performance in the desired
strategic direction. Bronson Methodist Hospital8
also uses multiple levels to analyze education
and training effectiveness. They measure pro-
gram reaction and direct learning through
testing but also assess postprogram skills and organizational effectiveness.
More than half the Baldrige winners utilize
the Kilpatrick model to evaluate the effective-
ness of their training and development effort.
This is a specific method that assesses 4 levels
of effectiveness including reaction to courses
through participant feedback, measurement of
course learning through pretests and posttests, transfer of knowledge to performance or skills
on the job, and analyses of organizational or busi-
ness results. At the fourth level, most Baldrige
winners tie the effectiveness of their development
efforts to their strategic success. For example,
North Mississippi Medical Center15
ties its per-
formance indicators to their critical success fac-
tors of people, service, and quality; Henry Ford
Health Systems10
focuses on action plan accom-
plishment; and Baptist Medical Center9
ana-
lyzes its financial return on investment in learning.
CAREER PROGRESSION
While training employees to be successful in
their current position is a critical human resources
function, it is equally important for hospitals/health
systems to pay attention to the development of
employees across their careers. Career manage-
ment is not only a powerful employee motivational
tool, but it also ensures the long-term vitality of
organizational well-being.23
Section 5.2(c)(3) of the Health Care Criteria for Performance Excel-
lence framework requires hospitals/health systems
that apply for the Baldrige award to address how
they manage ‘‘effective career progression’’ for
their employees as part of workforce develop-
ment.24
While the field of career planning and
career management covers the complex inter-
action between an employee’s individual career goals and the organization’s career management
programs, 25
the emphasis will be on the orga-
nization’s responsibility for the effective career
development of its employees. In this section,
the variety of career management activities and
programs of the Baldrige winners are highlighted.
Every Baldrige winner reported having com-
prehensive career development processes in place, typically as part of its overall performance
management system. Employees are most likely
to be interested in the career opportunities
available in the organization through job post-
ing systems and career paths.25
Advocate Good
Samaritan Hospital9
has a 13-step approach to
career progression. Henry Ford Health Systems10
has well-defined career paths/ladders as do most of the other winners. Southcentral Foundation
17
uses specific tools such as progression check-
lists and promotion pathways that define the
competencies required to advance to the next
level. Some of the hospitals/health systems give
employees the opportunity to progress via mul-
tiple career pathways. For example, at Sharp
HealthCare,22
technical and leadership career paths are distinct for all clinical areas, whereas
at Schneck Medical Center,16
the nursing staff
may choose among leadership, research, or
clinical tracks.
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved
184 THE HEALTH CARE MANAGER/JULY–SEPTEMBER 2015
Another factor that contributes to employee
motivation is when an organization has a clear
policy to hire internally, whenever possible,
and the majority of Baldrige winners indicate
a strong preference for internal recruitment.
SSM Health Care14
was proud of the fact that 49% of its executives and 1064 employees were
promoted from within in 2001. Similarly, more
than 80% of Saint Luke’s Health System’s19
Executive Council has been promoted from
within. Special attention is also paid to physicians’
career advancement at Heartland Health,20
Henry Ford Health Systems,10
Mercy Health
System,13
and Sutter Davis Hospital.26
Instead of leaving employees to their own
devices in managing their careers, the Baldrige
winners have a number of assistive programs
that employees can utilize when making career
choices. Baptist Hospital, Inc,9
offers career
coaching sessions. North Mississippi Medical
Center15
holds an internal job fair, which is
helpful for sharing career opportunities across departments. Career counselors are available
at Mercy Health System,13
and several other
winners have career planning programs, semi-
nars, and other related career guidance services.
Taking it a step further, Baptist Hospital, Inc,9
integrates information from the Baldrige Feed-
back Report in its career development activities.
Central to career advancement in health care is the extent to which a hospital/health system
provides educational assistance internally or
externally to help employees and managers
acquire critical skills necessary for effective pa-
tient care. There are numerous ways such sup-
port can be provided, but the most common
practice is tuition assistance to employees to
enhance their education. All the Baldrige win-ners provide scholarships and/or tuition assis-
tance in some way or the other. Notably, North
Mississippi Medical Center15
gives employees
the benefit of flexible scheduling and educational
leave; Bronson Methodist Hospital8
and Robert
Wood Johnson University Hospital Hamilton18
reward employees for advanced degrees and
certifications with special bonuses. A unique initiative by Heartland Health
20 allows students
to place scholarship dollars earned through
volunteering into an escrow account, which
they can later apply to a field of study in health
care. Poudre Valley Health System12
and
Schneck Medical Center16
strongly encourage
continuing education by sponsoring attendance
at various conferences related to an employee’s
discipline. Internally, Baptist Hospital, Inc,9
Henry Ford Health System,10
and Robert Wood Johnson University Hospital Hamilton
18 have
in-house universities that provide a wide range
of educational offerings.
In addition to the key programs discussed,
there are a few other initiatives that the Baldrige
award recipients use effectively to develop their
employees’ careers. Work enrichment arrange-
ments, which have been referred to as methods to reinforce and retain job knowledge and inno-
vative approaches, as well as reinforce perfor-
mance improvement and change, also broaden
employees’ perspectives across the health care
domain and create opportunities for employees
to transition to other areas to enhance their
careers. More than two-thirds of the Baldrige
winners use methods such as cross training, job shadowing, and job rotation that expand
job scope and responsibilities. Baptist Hospital,9
for example, practices ‘‘cross providing,’’ which
is cross training of employees so that they can
learn performance improvement and innova-
tive strategies in other departments. Advocate
Good Samaritan Hospital9
encourages job
shadowing as part of its ‘‘Look Before You Leap’’ program wherein registered nurses can
evaluate their choices before moving to another
program. Poudre Valley Health System12
created
secondary job codes that allow employees to
develop in other jobs while still in their cur-
rent positions. At Sutter Davis Hospital,26
even
volunteers are given the opportunity to be cross
trained, which often results in their employment at the hospital.
Succession planning is a formal process that
identifies employees who will be developed
to replace personnel in key critical positions.27
The process involves the identification of criti-
cal positions and associated competencies, the
assessment of employee interest and potential,
and providing professional development mech-anisms that meet the organization’s strategic
human resource needs. The advantages of establi-
shing a succession planning process include hav-
ing an adequate supply of competent individuals,
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved
Baldrige Winners in Health Care 185
the ability to deal with organizational and environ-
mental changes, and providing career paths and
plans for employees, which aids in employee
retention and motivation. The imminent mass
retirement by ‘‘baby boomers’’ makes succes-
sion planning all the more necessary, and the Baldrige organization has recognized its impor-
tance by including it in the award criteria.24
Every Baldrige winner clearly identified suc-
cession planning as being part of its human
resource development strategy. Although suc-
cession planning should be implemented at all
levels in an organization, the focus, most often,
is on leadership development. As a starting point, many award winners begin by assessing lead-
ership potential systematically as part of their
performance management process. Formal as-
sessment methods such as aptitude testing, in-
terest inventories and/or skill-based testing are
used by North Mississippi Health Services21
;
leadership readiness self-assessment, manager
leadership readiness assessment, and 360-degree leadership assessment at Southcentral Founda-
tion17
; and a variety of psychometric assessment
tools such as Calipers at SSM Health Care.14
The next step in the succession planning pro-
cess comprises a variety of development activities
that enhance employees’ skill to enable them to
take on additional responsibilities and/or adopt
leadership roles. Leadership institutes/academies exist at many of the Baldrige winners includ-
ing AtlantiCare,13
Bronson Methodist Hospital,8
Henry Ford Health System,10
North Mississippi
Medical Center,15
and Schneck Medical Center,16
whereas the other winners have other forms of
intensive leadership development programs. Robert
Wood Johnson University Hospital Hamilton18
(founding member) and Heartland Health20
use the Healthcare Advisory Board Academy
Fellowship leadership development program.
Some leadership development occurs in partner-
ships with universities. For example, AtlantiCare11
REFERENCES
fully sponsors high-potential candidates to an
executive masters in business administration,
Mercy Health System13
partners with the Uni-
versity of Minnesota Masters in Health Adminis-
tration Program and the Notre Dame MBA
program, and Schneck Medical Center16
has an on-site program that grants managers and super-
visors the Certified Healthcare Manager from
the Indiana University School of Environmental
and Public Affairs. Advocate Good Samaritan
Hospital7
allows employees in nonsupervisory-
positions to attend leadership training programs
to gauge their potential and interest. Finally, all
the Baldrige winners have formal mentoring pro-grams to help protégés navigate through their
careers. The Career Mentor Program at Mercy
Health System13
includes financial assistance as
part of the mentoring, and the Diversity Mentoring
Program at SSM Health Care14
ensures upward
mobility for minority employees. In summary, all
the Baldrige award winners, in keeping with their
reputation for quality, pay particular attention to the career development of their employees and
invest considerable time and effort in succession
planning activities.
CONCLUSION
Managers in health care organizations today
seek continuous improvement in their work-forces and leadership in efforts to improve their
positions in the highly competitive health care
industry. To adapt well to continuous change,
they will need to stay abreast of the best man-
agement practices in the industry and implement
innovative approaches to improve the learning
and development systems in their organizations.
They also will need to monitor the effectiveness of their learning and development systems and
evaluate career progression with effective suc-
cession planning to prepare their organizations
for even greater challenges in the future.
1. The Bureau of Labor Statistics, Employment Projections. http://www.bls.gov/opub/ted/2014/ted_20140110.htm.
http://www.bls.gov/emp/ep_table_201.htm. Accessed Accessed August 3, 2014.
August 3, 2014. 3. Baldrige Frequently Asked Questions. http://www.
2. The Bureau of Labor Statistics, Health care and social nist.gov/baldrige/about/baldrige_faqs.cfm. Accessed
assistance expected to add 5 million jobs, 2012 to 2022. August 4, 2014.
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved
186 THE HEALTH CARE MANAGER/JULY–SEPTEMBER 2015
4. Baldrige Performance Excellence Program, Baldrige
Award recipient information. http://patapsco.nist.gov/
Award_Recipients/index.cfm. Accessed August 4, 2014.
5. Baldrige FAQ’s: Baldrige Award Recipients. http://
nist.gov/baldrige/about/faqs_recipients.cfm. Accessed
August 4, 2014.
6. Baldrige Performance Excellence Program. 2013.
2013–2014 Health Care Criteria for Performance
Excellence. Gaithersburg, MD: US Department of Com-
merce, National Institute of Standards and Technology.
http:www.nist.gov//baldrige. Accessed August 21, 2014.
7. Advocate Good Samaritan Hospital. Baldrige applica-
tion summary, 2010. http://patapsco.nist.gov/Award_
Recipients/PDF_Files/2010_Advocate_Good_Samaritan_
Award_Application_Summary.pdf. Accessed August 26,
2014.
8. Bronson Methodist Hospital. Baldrige application sum-
mary, 2005. http://patapsco.nist.gov/Award_Recipients/
PDF_Files/Bronson_Methodist_Hospital_Application_
Summary.pdf. Accessed August 26. 2014.
9. Baptist Hospital, Inc. Baldrige application summary, 2003.
http://patapsco.nist.gov/Award_Recipients/PDF_Files/
Baptist_Hospital_Application_Summary.pdf. Accessed
August 26, 2014.
10. Henry Ford Health Systems. Baldrige application sum-
mary, 2011. http://patapsco.nist.gov/Award_Recipients/
PDF_Files/2011_Henry_Ford_Health_System:Award_
Application_Summary.pdf. Accessed August 26, 2014.
11. AtlantiCare. Baldrige application summary. 2009.
http://www.baldrige.nist.gov/PDF_files/AtlantiCare_
Award_Application_Summary.pdf. Accessed August 26,
2014.
12. Poudre Valley Health System. Baldrige application sum-
mary, 2008. http://patapsco.nist.gov/Award_Recipients/
PDF_Files/2008_Poudre_Valley_Application_Summary.pdf.
Accessed August 26, 2014.
13. Mercy Health System. Baldrige application summary.
2007. http://patapsco.nist.gov/Award_Recipients/
PDF_Files/2007_Mercy_Application_Summary.pdf.
Accessed August 26, 2014.
14. SSM Health Care. Baldrige application summary. 2002.
http://patapsco.nist.gov/Award_Recipients/PDF_Files/
SSM_Application_Summary.pdf. Accessed August 26,
2014.
15. North Mississippi Medical Center. Baldrige applica-
tion summary. 2006. http://patapsco.nist.gov/Award_
Recipients/PDF_Files/NMMC_Application_Summary.pdf.
Accessed August 26, 2014.
16. Schneck Medical System. Baldrige application summary.
2011. http://patapsco.nist.gov/Award_Recipients/PDF_
Files/2011_Schneck_Award_Application_Summary.pdf.
Accessed August 26, 2014.
17. Southcentral Foundation. Baldrige application summary.
2011. http://patapsco.nist.gov/Award_Recipients/PDF_
Files/2011_Southcentral_Foundation_Award_Application_
Summary.pdf. Accessed August 26, 2014.
18. Robert Wood Johnson University Hospital at Hamilton.
Baldrige application summary. 2004. http://patapsco.
nist.gov/Award_Recipients/PDF_Files/RWJ_Hamilton_
Application_Summary.pdf. Accessed August 26, 2014.
19. Saint Luke’s Hospital of Kansas City. Baldrige applica-
tion summary. 2003. http://patapsco.nist.gov/Award_
Recipients/PDF_Files/Saint_Lukes_Application_Summary.
pdf. Accessed August 26, 2014.
20. Heartland Health. Baldrige application summary. 2009.
http://patapsco.nist.gov/Award_Recipients/PDF_Files/
Heartland_Award_Application_Summary.pdf. Accessed
August 26, 2014.
21. North Mississippi Health Services. Baldrige application
summary. 2012. http://patapsco.nist.gov/Award_
Recipients/PDF_Files/2012_North_MS_Application_
Summary.pdf. Accessed August 26, 2014.
22. Sharp HealthCare. Baldrige application summary.
2007. http://patapsco.nist.gov/Award_Recipients/PDF_
Files/2007_Sharp_Application_Summary.pdf. Accessed
August 26, 2014.
23. Callahan GA, Godshjalk VM. Career Management.
3rd ed. Fort Worth, TX: Harcourt College Publishers; 2009.
24. The National Institute of Standards and Technology
(NIST). 2013-2014 Health Care Criteria for Performance
Excellence. http://www.nist.gov/Baldrige/publications/
upload/2013_2014_Health_Care_Criteria.pdf. Accessed
August 24, 2014.
25. Werner JM, DeSimone RL. Human Resource Develop-
ment. 4th ed. Mason, OH: Thomson South-Western; 2003.
26. Sutter Davis Hospital. Baldrige application summary.
2013. http://patapsco.nist.gov/Award_Recipients/PDF_
Files/2013_Sutter_Davis_Application_Summary.pdf.
Accessed December 1, 2014.
27. Fried BJ, Fottler MD. Fundamentals of Human Re-
sources in Healthcare. Chicago, IL: Health Adminis-
tration Press; 2011.
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved