Journal of Healthcare Management - May/June 2013 - (Page 189)

H oS P I tal K nowledge M anageMent : a naly SIS The Baldrige review and award process fulfills this methodology. It relies on a detailed 50-page application in which applicants address about 30 questions in each of six dimensions of the organization (leadership, strategy, customers, human resources, information, and operations), plus a seventh section documenting performance against benchmark in each dimension (Baldrige Performance Excellence, 2009–2010). All applications receive comments and scoring from several trained examiners. Outlier scores are eliminated and the remaining scores are averaged. Finalround qualifiers receive a site visit to audit their application. The site visit team, composed of seven experienced examiners, spends five days on-site contributing a total of about 420 hours of effort and interviews with at least 10% of HCO staff to validate the results and the process described in the application (Baldrige Performance Excellence, 2012). The authors know of no comparably rich, rigorous, or validated source of information on the practices of highperforming HCOs. We note that identifying organizational processes within high performers is often the first step in other research that explores firm-based strategic competitive advantages (e.g., Cremer, Garciano, & Prat, 2007) and the development of evidence-based management practices over time (e.g., Rousseau & Barends, 2011). In previous positive deviance studies, researchers have pursued narrow clinical areas, such as performance in care of patients with acute myocardial infarction, services for pregnant women, and preventive services for childhood nutrition (e.g., Bradley et al., 2009). of B aldr Ige a ward r ec IPIentS In this study, we apply the positive deviance method at a broader level, seeking to understand how successful HCOs use knowledge to align, deploy, integrate, and improve these specific processes. The next step in a positive deviance approach is to test for the importance of these characteristics in achieving quality outcomes in larger population-based samples. While we plan to conduct this next step, it is beyond the scope of this article. MEtHodS data Sources We identified common KM strategies using qualitative analysis of the applications of nine HCOs receiving the Baldrige Award between 2002 and 2008 (Table 1). The recipients operate a total of 39 acute care hospitals across a range of locations, from extremely rural to densely urban communities, generally in competitive situations, with extensive ambulatory and post-acute operations. In total, they expend about $8 billion annually. The recipient set is small, which may reflect some advantageous environmental factors, such as monopolies or particularly supportive economies. However, we argue that the characteristics described in Table 1 fairly reflect a broad spectrum of American communities and hospital market conditions. Baldrige applications devote four pages to a general description of the business, its location, and its unique characteristics and about 35 pages to addressing the organization’s work processes in the areas of leadership, strategy, customer focus, human resource focus, information management, and 189

Table of Contents for the Digital Edition of Journal of Healthcare Management - May/June 2013

Journal of Healthcare Management - May/June 2013
Contents
Interview with Thomas C. Dolan, PhD, FACHE, CAE, President and CEO, American College of Healthcare Executives
Equity in Care: Picking Up the Pace
How Might a Reforming U.S. Healthcare Marketplace Threaten Balance Sheet Liquidity for Community Health Systems?
Assessing the Productivity of Advanced Practice Providers Using a Time and Motion Study
A Positive Deviance Perspective on Hospital Knowledge Management: Analysis of Baldrige Award Recipients 2002–2008
How to Improve Breast Cancer Care Measurement and Reporting: Suggestions from a Complex Urban Hospital
The Fear Factor in Healthcare: Employee Information Sharing

Journal of Healthcare Management - May/June 2013