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Aligning, Improving Key Measures Net Texas Healthcare Organization Baldrige Honor

by Janet Jacobsen

Consumers today have many options for how and where to spend their money. Whether they are selecting an auto mechanic, a hair stylist, or a healthcare provider when seeking emergency medical care, consumers can become overwhelmed by the sheer number of companies offering services.

For example, more than 50 urgent care clinics and freestanding emergency rooms (ERs) have opened in the Austin, TX, metro area since 2011. Faced with this evolving and highly competitive market, leaders within Austin-based St. David’s HealthCare knew it was critical for the organization to continually improve.

StDavids Baldrige

From left to right: Dr. Willie E. May, acting director, NIST; Dr. George Benson, chair, Baldrige Foundation; David Huffstutler, president and CEO, St. David’s; David Thomsen, vice president of quality, St. David’s; and Bruce H. Andrews, deputy secretary, U.S. Department of Commerce.

Improving a critical performance metric—goal time for ER patients until seen by a doctor—and slashing it by half, is just one example of how St. David’s changed its work practices and improved key measures to remain competitive in the market. But beyond providing great service to patients and support for employees, St. David’s learned how to leverage the Baldrige framework to drive improvements, which culminated in the system receiving the nation’s top award of its kind: the National Institute of Standards and Technology’s (NIST) Malcolm Baldrige National Quality Award in 2014.

Case Study At a Glance . . .

Aligning, Improving Key Measures Net St. David's HealthCare Baldrige Honor

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-When St. David’s HealthCare first adopted the Baldrige criteria, leaders viewed it as an improvement framework to shape a culture of quality and performance excellence.

-Once immersed in the framework, leaders used it as a tool to help align and improve the work of the organization and key performance measures.

-The organization’s emergency departments served as a prime example of improving key metrics, as wait times were significantly shortened to meet competitive challenges.

-In 2014, St. David’s HealthCare earned the nation’s top honor for performance excellence, the Malcolm Baldrige National Quality Award.

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St. David's Healthcare Case Study

About St. David's HealthcareSt. David's Healthcare Logo

Founded in 1924, St. David’s HealthCare began serving the Austin community as a small, not-for-profit hospital. Becoming a joint venture with Hospital Corporation of America (HCA) in 1996 and then adding nearby Georgetown Hospital in 2006 and Heart Hospital of Austin in 2010, the healthcare system now consists of 8,500 employees, contractors, and volunteers, and includes six hospitals, six ambulatory surgery centers, aligned physician practices, and numerous other outpatient facilities.

Adopting the Baldrige Framework

St. David’s performance excellence journey using the Baldrige framework dates back to 2001, when Jon Foster was hired as CEO. Foster, who remained CEO until 2011, came to St. David’s from an organization that had earned a Baldrige-based state award in Kentucky. Knowing the many benefits of creating a culture that used the Baldrige framework, Foster gathered a few key leaders to encourage them to become involved in the state Baldrige program, the Texas Award for Performance Excellence. Since Foster understood the critical steps and rigor required in implementing the Baldrige criteria, he knew St. David’s had multiple gaps to address if it were to be successful at the state and national level.

“We never really talked about the Baldrige Award or the criteria, but rather about laying the foundation,” said David Thomsen, vice president of quality, “so standardizing and getting in writing our mission and values came first.”

St Davids Operation

Since 2007, St. David’s HealthCare has completed an annual Baldrige-based self-assessment to measure the organization’s processes against the Baldrige criteria. While many organizations across the world complete assessments, only a small number submit a formal application. When available, the organization also used reports from state and national examiners to drive performance improvement initiatives to greater levels.

Because the organization did not initially concentrate on submitting a formal application, but rather on improvement, it took a measured approach to integrating the Baldrige criteria with the work of the organization by focusing on more general topics, such as connecting staff to the organization’s vision and mission. Thomsen said an example of this approach was to include Baldrige criteria questions in the strategic planning process. Some of the questions used in this process included:

  • How does the organization collect and analyze relevant data to support strategic planning?
  • How do strategies and action plans address the organization’s strategic challenges?
  • How does the organization deploy action plans to all stakeholders?
  • How does the organization determine performance projections related to action plans?
  • How does the organization monitor and measure the effectiveness of strategies and action plans?
  • How do strategic objectives achieve appropriate balance among varying and potentially competing priorities?

As staff members became further immersed in the Baldrige framework, St. David’s hired consultants to provide senior leadership training, while webinars were developed for remaining staff to learn about topics related to each of the Baldrige framework categories.

Creating a New Vision

Once senior leadership had become more familiar with the Baldrige concepts, they were encouraged to attend the Quest for Excellence Conference, the national symposium for the Baldrige Award, to learn valuable, first-hand perspectives of the framework and its benefits. During the 2009 conference, leaders from St. David’s met with other senior executives from the manufacturing, healthcare, hospitality, and education industries. This gathering provided an ideal opportunity for Foster and his senior leadership team to talk to other CEOs and leaders, sharing his organization’s history of being a sound, mission-driven organization and learning from others about the value of a vision statement for the organization.

St. David's ER

Upon returning to Austin, Foster gathered his leadership team to study vision statements. In 2010, as a cycle of learning for the historically mission-driven organization, St. David’s CEO Council went through a formal visioning exercise, considering the organization’s future state, input from key internal and external stakeholders, and vision statements from world-class organizations. As a result, a year later St. David’s established its vision “to be the finest care and service organization in the world.”

“The mission can be accomplished by individual people, but the vision is something individuals can’t accomplish by themselves. It has to be a team effort with our six hospitals, surgery centers, and physician practices all working in concert,” Thomsen said. “That’s inspiring because people love being a part of an organization that wants to be best.”

Learning from the Application Process

St. David’s first major recognition for its work in implementing the Baldrige criteria came in 2008 when it received the state’s highest honor, the Texas Award for Performance Excellence. State award examiners noted a high level of collaboration and coordination between the represented facilities. Additional strengths of St. David’s noted by the awarding body were its:

  • Three goals: exceptional care, customer loyalty, and financial strength
  • ICARE values (integrity, compassion, accountability, respect, and excellence)
  • Strong strategic planning process
  • Employee development program, as evidenced by the St. David’s Institute for Learning
  • Commitment to service excellence

A year later, the organization escalated to the national level when it submitted its first Baldrige application in 2009, followed by applications again in 2010 and 2011. Thomsen said the value of submitting an annual application isn’t simply from compiling a 50-page synopsis of the organization, but rather the dialogue that takes place during the assessment process. The conversations include asking questions like, “How do we do that? Do we do that consistently? Is that effective?”

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For More Information 

  • To learn more about St. David’s HealthCare, visit
  • Additional details about the Baldrige Performance Excellence Program are available at
  • For more information about St. David’s performance excellence journey, call 844-863-2652 or send an email to
  • Find a listing of state quality awards based on the Malcolm Baldrige program by visiting the Alliance for Performance Improvement website at
  • To view this and other case studies, visit the ASQ Knowledge Center’s Case Studies landing page at

About the Author 

Janet Jacobsen is a freelance writer specializing in quality and compliance topics. A graduate of Drake University, she resides in Cedar Rapids, IA.

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