The 1995 pilot criteria of the Malcolm Baldrige National Quality Award (MBNQA) in Health Care have generated great interest from the health care sector in the award itself and in using the criteria as a self-assessment tool. The MBNQA in Health Care is a model of Total Quality Management specifically designed for health care organizations. This study evaluates the causal linkages and performance relationships among the seven categories of the Baldrige model in U.S. hospitals.
A questionnaire is developed to empirically measure the 28 dimensions (subcategories) of the Baldrige Health Care criteria. Fifty-one hospitals participated in a pilot test, and the 28 dimension measurement scales were thoroughly evaluated for reliability and validity. For the main study, the questionnaire was mailed to 814 community hospitals across the U.S., and 228 responded (28 percent).
Twenty-three research hypotheses test relationships among the categories of the Baldrige Health Care model. Following is a summary of the major findings:
1. Baldrige theory that Leadership drives the System which causes Results is supported in hospitals. Results include Organizational Performance Results (Baldrige Category 6.0) and customer satisfaction (Category 7.0).
2. Hospital Leadership has a direct causal influence on Information and Analysis, Strategic Planning, Human Resource Development and Management, Process Management, and Organizational Performance Results. Leadership also indirectly, through the Baldrige System, influences Organizational Performance Results and customer satisfaction.
3. Within-System linkages reveal that Information and Analysis positively influences Strategic Planning, Human Resource Development and Management, and Process Management. Information and Analysis also has a direct causal influence on Organizational Performance Results.
4. Human Resource Development and Management, Process Management, and Organizational Performance Results all positively influence customer satisfaction. These results indicate that improving staff interactions with patients, the design and delivery of medical and non-medical processes, and internal performance all lead to improved external performance (customer satisfaction).
5. The results of this study provide the first comprehensive evaluation of the causal influences and performance relationships proposed by the Baldrige Health Care model. The development of a measurement model and empirical validation of Baldrige theory contribute to this field of research.