Quality improvement using the Baldrige Criteria for Organizational Performance Excellence.

PURPOSE: The criteria needed to achieve the Malcolm Baldrige National Quality Award (MBNQA) are described. SUMMARY: The MBNQA was created in 1987 to recognize quality and performance and to encourage excellence in American companies. In 2003, Saint Luke's Hospital, the largest hospital in the Saint Luke's Health System, received the MBNQA. In the years since, the hospital has continued to use the Baldrige approach and has pursued the award on the health-system level. The Baldrige Criteria for Organizational Performance Excellence provide a framework that focuses on obtaining the highest levels of organizational excellence. These criteria consist of seven categories-leadership; strategic planning; focus on patients, customers, and markets; measurement, analysis, and knowledge management; work-force focus; process management; and results. At Saint Luke's Hospital, a category leader was designated for each of the seven categories in order to fully apply the criteria to the organization. Pharmacy leaders worked closely with each category leader to ensure that the appropriate format was being followed and to contribute positively to the written application and the site visit conducted by MBNQA examiners. The MBNQA involves its own vernacular and pattern. Effort should be made to fully understand and embrace the path that the organization's leaders have chosen. Departmental activities should be placed in front of an individual's leadership so that he or she can play an active part in demonstrating quality-improvement success stories. CONCLUSION: The criteria for the MBNQA are structured around seven categories that form a framework by which any organization or department can structure its own pursuit of quality and excellence. Pharmacy leaders can play an important role in the successful pursuit of quality within their organization.

Effects of changes in patient cost sharing and drug sample policies on prescription drug costs and utilization in a safety-net-provider setting.

PURPOSE: The impact of cost-containment strategies on prescription drug utilization and costs in an ambulatory care safety-net-provider setting was studied, along with the impact of these strategies on patient out-of-pocket expenditures. METHODS: Aggregate monthly prescription drug cost and utilization data were obtained from a health system's outpatient pharmacy computer system for the targeted clinic. The data represented approximately 42,000 patient visits over 38 months. Univariate and multivariate statistics were used to evaluate the influence of copayment increases and changes in prescription drug sample policies on prescription drug costs, prescription drug utilization, and patient expenditures. RESULTS: Prescription drug copayment increases were associated with significant decreases in prescription drug utilization and costs. An average per visit prescription drug copayment increase of $5 was associated with a significant reduction in prescription drug utilization per visit and a $26.07 reduction in prescription drug expenditures per visit per month. Removal of samples from the clinic did not result in a significant decrease in either prescription drug costs or utilization. The presence of samples, however, was associated with a significant reduction in per visit patient expenditures by an amount similar to the copayment for one brand-name prescription drug per visit. CONCLUSION: An increase in patient copayments was associated with reductions in a clinic's drug expenditures and prescription drug utilization per visit. Removal of prescription drug samples had no effect except increasing patients' out-of-pocket drug costs.