Read Case Study 21-1: Strategy, Stability, and Strength Bronsons Journey to Excellence on pages 468-471 and answer the following questions.

1. What specific change would you recommend to Bronson to improve their strategic planning process and effort?

2. What specific organizational type do you think Bronson is trying to become? Defender, Analyzer, Reactor, or Prospector?

Case Study 211 Strategy, Stability, and Strength Bronsons Journey to Excellence Excellence has always been a focus of Bronson Methodist Hospital, a not-for-profit tertiary hospital based in Kalamazoo, Michigan. But it was not until 1999 that the organization adopted the Baldrige criteria and put into place a systematic approach to organizational excellence. In the mid-1990s, as Bronson designed and prepared to move into a new, all-private-room facility, Bronsons leadership seized the opportunity to raise the bar on the quality of their internal processes so they could match the quality of the hospitals new state-of-the-art patient-care environment. The building project became a catalyst for moving the organizations culture from good to great. When the Baldrige criteria for health care became available in 1999, Bronson was poised and ready to begin using the modela systems perspective for understanding performance management provided by the Baldrige National Quality Program (www.quality.nist.gov). We were attracted to this model because the Baldrige criteria are not prescriptive; they do not tell an organization what to do. Instead, the criteria challenge an organization to review and understand how it is doing things. This was precisely the formula for self-evaluation that Bronson was looking for to become a great hospital and sustain long-term success. Since implementing the Baldrige criteria, Bronson has achieved strong performance improvement and results in every key area measured, including low Medicare patient mortality, high overall patient, employee and physician satisfaction, and national recognition for workplace excellence. We have seen significant improvement in use of prophylaxis, registered nurse turnover rate, and the integration and use of technology; Bronson also has pioneered efforts to reduce waste and pollution. As a result of these and many other accomplishments, Bronson Methodist Hospital was named one of six recipientsfrom across American industriesof the Malcolm Baldrige National Quality Award in November 2005. A critical component of the organizations success can be attributed to Bronsons Leadership System. In the past, we had been unable to clearly articulate exactly how we led the organization. Working with the Baldrige criteria compelled us to specifically delineate and document how the organization fits together in terms of strategy, performance standards, action, results, and accountability. As a result of this work, we created the Strategic Management Model to provide Bronson with a systematic approach that aligns all of our planning, including strategic, workforce, financial, capital, and information technology. Because strategy is the foundation for success, we have found that the consistent use of this tool has contributed greatly to our organizations evolution. Focus: Bronsons strategy revolves around our Plan for Excellence, which captures the vision, mission, values, and service expectations of all staff and leaders Table 211. It includes our strategies, the three Cs: clinical excellence, customer service excellence, and corporate effectiveness. We use the plan extensively during employee, physician, volunteer, and other stakeholder interactions to effectively communicate the hospitals vision and actively engage them in achieving it. In the early years of using the Baldrige criteria to focus our planning, we realized that the hospitals mission and vision also needed to be refined and focused. Our mission at the time was: We are committed to improving the health of those we serve by providing services that are of value, that are comprehensive, and that are accessible through an integrated network of cooperating providers. As we talked with stakeholders, we realized that this mission seemed too corporate in its language and was difficult to understand. Furthermore, it only vaguely addressed community health and partnerships with other organizations, which was difficult to measure. We decided our mission should be succinct, direct, and measurable and address the needs of anyone seeking our services whether they are members of the community or not. Thus, our mission today is simply: Provide excellent health care services. This mission is easy to communicate, deploy, and measure. In a similar vein, we rewrote our vision, which was: Bronson and its partners will be the system of choice in our region. The old vision focused on being the best in our area. But to truly raise the bar on organizational performance, it was critical that we benchmark ourselves against the best in the nation. As a result, our current vision is: Bronson will be a national leader in health care quality. This vision has driven the organization and helped fuel performance improvement processes. The simplification of the mission and vision now keeps the entire organization focused and moving in a clear direction. Re-evaluation: An important component of our Strategic Management Model is our Strategic Input Document (SID), which informs the planning process. The SID is a formal compilation of our assumptions about the environment and how those assumptions will affect Bronson during the year. We look at developments in the community; changes occurring in competing organizations; governmental issues on the local, state, and national levels; and the needs and wants of our stakeholders. While we always had considered these issues during our annual planning process, we had never formally documented them so that we could refer to them easily, prioritized our challenges, and most importantly, continuously re-evaluated them throughout the year. The SID is a simple yet critical process improvement. It helps us to react quickly to environmental changes yet stay on task with our plan. Accountability: Before we adopted the Baldrige criteria and developed the Strategic Management Model, Bronson did not use scorecards to set targets and track our progress formally. As we implemented the Strategic Management Model, we designed detailed tactics based on metrics to achieve goals aligned with the three Cs. For example, the clinical excellence goal of reducing Medicare mortalitywhich is reported to our board in an overall scorecardcascades down to specific measurable activities on leader- and staff-level scorecards. We think of these detailed tactics as strings that are attached from Bronsons overall goals to every person in the organization. Thus the entire workforce, our employees and physician partners, know exactly how their efforts contribute to the organizations success. Not only do scorecards reinforce the responsibility that staff have in achieving the hospitals overall goals, but alsobecause of the metrics, which include meet, exceed, and far exceed scoring criteriastaff know exactly where they stand at any given time. We monitor the impact of our efforts to improve accountability through our scorecards and employee and physician opinion surveys in which we ask them whether they understand our strategic direction and their role in reaching organizational goals. Heightening the sense of accountability among staff also was made easier when we modified the vision and made a conscious decision to bring Bronsons strategic plan to light at all levels of the organization. Today, even our specific tactics are widely publicized throughout the hospital. Such disclosure has made a huge difference with the leadership team, employees, medical staff, and volunteers, who now feel connected to the vision. Ownership: In the past, Bronsons strategic planning was primarily orchestrated by the vice president of Planning. In an effort to improve our results, we created Strategic Oversight Teams for each of the three Cs led by members of the executive team. The teams establish short- and long-term plans for their C, develop the accompanying scorecards, and monitor results. With this approach to planning, we have better deployed ownership of the plan at the executive level and with leaders and key physicians who now feel as though they own the plan. Integration: When we first began using the Baldrige criteria, we treated it as a separate process and convened a separate committee. This changed when we realized the true value of the Baldrige model is in integrating it into what you do every day to run your organization. Once we did this, we understood how it was going to make us a better business. By aligning the six categories of the Baldrige criteria, we learned the importance of examining the interrelationships among all facets of the organization. For example, through the process, we realized that we were approving capital purchases separately from our strategic planning cycle. Now, our capital and technology planning are wrapped into one process. Bronson holds a day-long retreat focused on reviewing and prioritizing clinical technology as part of developing the next years strategic plan and budget. Prior to using the Baldrige criteria, many of our processes were people dependent. Fortunately, we employed excellent people who did a great job of carrying out the work assigned to them; however, we realized that this was risky in both the short and long terms. If those people left the organization, how would the processes be sustained? Tools like the Plan for Excellence, the SID, the Strategic Oversight Teams, and scorecards are now hardwired into the way we work; they are documented and repeatable. This helps ensure that organizational stability and the high-quality service and excellent outcomes that we have achieved will be sustained in the future, regardless of any personnel changes. Using the Baldrige criteria has dramatically changed how we serve our patients. Community preference for Bronson as the areas best hospital also is at a record high. Independent study data show there is a 32-point gap between Bronson and its closest competitor. This preference has translated into market growth as well: Inpatient volume at Bronson grew 34 percent between 2000 and 2005.

Need question 1 and 2 answered please!