When trying to understand where we are going with this integrated model, the best place to start is at the end. How do we measure breakthrough performance? The veterinary profession is a conservative bunch at best. When we attempt to "benchmark" excellence, we ask what the average is for the nation, or the state, for our community, or for similar practices. Average is only the best of the worst, or the worst of the best. It is not a meaningful yardstick of excellence.

As a profession, it appears that they have never found a "benchmark" that acts as a yardstick of performance excellence. As a consulting firm, we have always told our consulting partners (clients) to benchmark against themselves, using their own standards of care and the established elements of continuous quality improvement (CQI).The veterinary profession needs a system to measure practice performance(s) against the "best of the best". The Baldrige National Quality Program (BNQP) is now used by human healthcare facilities as the top benchmark, and that is mainly because it is based on measuring the improvements of self-assessment needs.

A useful overview of the BNQP is provided at the web site: www.quality.nist.gov/eBaldrige/Step_One.htm, as well as in their sixty-nine-page publication Healthcare Criteria for Performance Excellence (T1116), published in 2003 by the American Society for Quality (call 1-800-248-1946, or request by e-mail from asq@asq.org).

Baldrige Performance Excellence is defined as an aligned approach to organizational performance management, effective leadership, delivery of increased value to clients (customers), improved organizational effectiveness/capabilities, and methods to measure and monitor results. Baldrige has published core values:

 Visionary leadership.

 Patient-focused excellence.

 Organizational and personal learning.

 Valuing staff and partners.

 Agility.

 Focus on the future.

 Management by fact.

 Managing for innovation.

 Public responsibility and community health.

 Focus on results.

 Creating value.

 Systems perspective.

The Healthcare Criteria for Performance Excellence Framework combines the core values and BNQP concepts into seven criteria:

1.  Leadership.

2.  Strategic planning.

3.  Focus on patients/clients, other customers, and markets.

4.  Measurements, analysis, and knowledge management.

5.  Staff focus.

6.  Process management.

7.  Organizational performance results.

The above seven factors can be illustrated as a flow chart (an integrated model), some with feedback arrows, and others with directional intensity.

Figure 15:

While a diagram is often advisable for seeing the relationships, it cannot be considered "the whole story". The rest of the concept is in the print, so read on, please.

Organizational profile: This sets the context for the way your organization operates. Your environment, key working relationships, and strategic challenges serve as an overreaching guide for your organizational performance management system. Obtain your own copy at the National Institute of Standards and Technology website: www.quality.nist.gov/eBaldrige/Step_One.htm.

Systems operations: The systems operations are composed of the six Baldrige Categories in the center of the above diagram that define your operations and the results you can achieve:

 Leadership (Category 1), Strategic Planning (Category 2), and Focus on Patients/Clients, Other Customers, and Markets (Category 3) represent the leadership triad. These categories are placed together to emphasize the importance of leadership focus on strategy and patients/clients/customers. Practice owners set the organizational direction and seek future opportunities for the practice entity.

 Staff Focus (Category 5), Process Management (Category 6), and Organizational Performance Results (Category 7) represent the results triad. Your organization's staff and its key processes accomplish the work of the practice entity that yields your performance results.

 All actions point towards Organization Performance Results, a composite of health care, patient/client, other customer, financial, and internal operational performance results, including staff and work system results, and social and public responsibility results.

 The horizontal arrow in the center of the framework links the leadership triad to the results triad, a linkage critical to organizational success. Furthermore, the arrow indicates the central relationship between Category 1 (Leadership) and Category 7 (Organization Performance Results)..The two-headed arrow indicates the importance of feedback in an effective performance management system.

System foundation: Measurements, Analysis, and Knowledge Management (Category 4) are critical to the effective management of the practice entity, and to a fact-based system for improving healthcare and operational performance. Measurements, analysis, and knowledge serve as a foundation for the performance management system.

Criteria structure: The seven criteria shown in the above figure are subdivided into items and areas to address.

There are nineteen items, each focusing on a major requirement. Each item has titles and point values:

Areas to address: Items consist of one or more areas to address (Areas). Organizations should address their responses to the specialty requirements of these Areas.