Understanding High-Reliability Organizations: Are Baldrige Recipients Models?

Chassin and Loeb argue persuasively that healthcare organizations (HCOs) can and should be "high-reliability organizations" (HROs) seeking zero defects in outcomes quality. They suggest that the Baldrige model is a sound platform for achieving high reliability. This article analyzes the similarity of the HRO concept to the Baldrige model using a recent Malcolm Baldrige National Quality Award recipient's application. The analysis suggests that neither high reliability nor Baldrige criteria are easily achieved, but the two have strong similarities. The principal difference is in Baldrige's emphasis on strategic independence versus the HRO commitment to "zero patient harm" and quality as "the organization's highest-priority strategic goal." Based on this analysis, the article reviews data on the actual performance of Baldrige recipients as recorded at WhyNotTheBest.org. The data show that the Baldrige approach is an effective method of generating above-average performance. Award recipients have made substantial strides in safety, reductions of infections, immunizations, and patient satisfaction, but receipt of the award has not translated as effectively to reduced readmissions, mortality, and costs. The pattern of results suggests that Baldrige recipients have exploited the right to establish their own strategic goals and are likely to respond to strengthened financial rewards for quality. The Baldrige model has documented successes in quality improvement and should be the standard of excellence in managing all HCOs.