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Posted May 21, 2018

Adventist Health Castle’s 15-Year Baldrige Journey

By Kathryn Raethel, FACHE, MHA, MPH, RN, CEO, Adventist Health Castle

When I was offered a position at Adventist Health Castle as their CNO in 2000, I wasn’t sure it was the right move for my family. We were firmly settled in California, and I just couldn’t imagine uprooting them to move to a tiny island in the middle of the Pacific Ocean. As it turns out, the charms of Hawaii are difficult to resist, and as soon as we made a trip to visit the area, I was hooked.

Adventist Health Castle is a 160-bed facility with more than 1,000 employees and 300 physicians, situated just outside of Kailua on the island of O’ahu. It is part of the 20-hospital network of the Adventist Health System, headquartered in Roseville, California.

Adventist Health Castle is a 160-bed facility with more than 1,000 employees and 300 physicians, situated just outside of Kailua on the island of O’ahu. It is part of the 20-hospital network of the Adventist Health System, headquartered in Roseville, California.
Adventist Health Castle is a 160-bed facility with more than 1,000 employees and 300 physicians,
situated just outside of Kailua on the island of O’ahu. It is part of the 20-hospital network of the
Adventist Health System, headquartered in Roseville, California.

When I came to the organization, one of the first people I met was Steven Bovey, the quality supervisor, who had been with Castle since the late ‘80s. My main takeaway from our conversation was that Steven was passionate about making the organization a leader in patient safety and quality, and he strongly believed we should work to earn the Malcolm Baldrige National Quality Award. Prior to our meeting, I’d never even heard of it. But I could tell, based on Steve’s passion, that this was something worth exploring. After learning more about the Baldrige award, I took the idea to our CEO and got the “green light” to start focusing on the quality and performance standards aligned to Baldrige award evaluations.

The Malcolm Baldrige National Quality Award recognizes performance excellence focusing on five key areas:

  • Product and Process Outcomes
  • Customer Outcomes
  • Workforce Outcomes
  • Leadership and Governance Outcomes
  • Financial and Market Outcomes

Adventist Health Castle submitted our first state-level Baldrige application in 2003. We were confident we were doing well as an organization, but when we got the report back, we had achieved the “bronze” level. And that wasn’t good enough for us. We kept working, and in 2007, we submitted to the state again, this time achieving the “silver” level award. By 2014, we had worked our way up to “gold” at the state level. Our progress up to that point made us eager to achieve more.

The following year, we submitted our first national Baldrige application. Again, we felt confident following our site visit from the Baldrige organization, but when we got the report back, there were major areas of concern. In fact, we were the worst performer in our cohort. As an organization, I think it’s fair to say that we were disappointed. We’d worked hard and were proud of our achievements, but we knew we still had a lot of work to do. We took a year off, worked on our areas of opportunity, and by 2017, we were ready to try for the national award again. We submitted and waited impatiently to learn whether our hard work had paid off. Steve made me promise that he would be the first one I called when I learned if we’d won.

Of course, we all wanted to win the award, but at this point it was about more than the distinction among our peers. We learned so much on the journey about ourselves, our patients and what it means to be excellent. The process made us a stronger and more resilient organization. We refined and focused on our core competency of “love matters” (what we call our patient, associate and physician experience efforts) to provide consistently exceptional care, and we engaged our team in everything we were doing.

Castle's core competency, “love matters” (what they call their patient experience efforts), help the organization to provide consistently exceptional care and engage their team.
Castle's core competency, “love matters” (what they call their patient experience efforts),
helps the organization to provide consistently exceptional care and engage their team.

I was traveling on the mainland when the call came in. I was so nervous my hands were shaking. When the voice on the other end of the phone told me that we had won, I broke down in tears. I wanted to call Steve, but I wasn’t together enough yet, so I called my husband, who calmed me down. When I could speak in coherent sentences, I dialed Steve. He is an even-keeled fellow, but when Steve got the news, he cried like a baby. For me, achieving Baldrige-level excellence had been a 15-year journey, but for him, it had been his life’s work.

Highlights from Adventist Health Castle’s Malcolm Baldrige National Quality Award:

  • Top decile performance for the intensive care unit (ICU)
  • Rate of zero for central-line-associated blood stream infections (CLABSI) for four of the last five years
  • Rates below 1 percent for hospital-acquired infections and patient falls
  • Zero catheter-associated urinary tract infections (CAUTI) in inpatient units for three years and five months
  • Improved performance by 12 percent from 2014-2016 in patient safety, evidence-based care and mortality related to clinical care processes
  • Top 3 percent of U.S. healthcare organizations for inpatient care results for Value-Based Purchasing for the past three years
  • Physician engagement results in the top 10 percent in the nation

A few months later, as we prepared to accept the Malcolm Baldrige National Quality Award, I was given the option to bring one other member of my team to the awards ceremony. Most people bring a top-ranking executive or board member, but I knew it had to be Steve. And he was on that stage with me when we were handed the award.

CEO Kathy Raethel and Quality Supervisor Steven Bovey accept the Malcolm Baldrige National Quality Award.
CEO Kathy Raethel and Quality Supervisor Steven Bovey accept the Malcolm Baldrige National Quality Award.

It has been important to bring our people with us on the Baldrige journey. I believe that everyone at Castle feels like they own a piece of this award. The day I got back to the hospital after the ceremony, I met one of our housekeepers in the hallway. “Oh Mrs. President,” she said (she’s the only one that calls me that). “I have chicken skin (Hawaiian for “goosebumps”). We won!”

Kathryn Raethel, FACHE, MHA, MPH, RN, assumed the presidency of Adventist Health Castle (AHCS) on December 5, 2011. Prior to this appointment, Raethel had been vice president for patient care services at AHCS for eleven years. During this time, she provided administrative direction and clinical oversight of patient care at AHCS, and she oversaw numerous departments, including the nursing units, the Emergency Department, Quality Resources, and Risk Management​.

Author

  • Kathryn Raethel

    Kathryn Raethel, FACHE, MHA, MPH, RN, CEO, Adventist Health Castle

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