Baldrige Award for Healthcare: An overview of potential improvements

The Baldrige Award is all about "performance excellence". Recently I had a conversation with the head of a medical center, who's hospital had won the Baldrige Award a few years ago. He mentioned that he categorized their program as being a holistic effort, so I asked him what he meant by this. It turns out that he meant there was involvement from a wide spectrum of the hospitals employees. In my world, holistic is defined as including all of the natural evidence-based prevention and treatment modalities that can improve healthcare while reducing cost. After further discussion with this doctor, if became very clear that this was not the holistic approach I hoped it would be. In fact, when I asked how he had managed to win this award with virtually no innovative natural medical strategies he indicated that he had improved all of the hospitals processes. It was then that I thought to myself, "that sounds really ridiculous". In other words, a company can build a terrible car, but win an award for excellence because their processes were great. It reminded me of a quote from Marc Hyman, MD. at a Senate Hearing on healthcare when he said:

"We will not solve the current healthcare crisis
if we just continue to do the wrong things better."

The remainder of this document will lay out just some of the reasons why this quote is so important to the work of the Baldrige Award organization as it considers how to make this award a true measure of performance excellence in the area of healthcare. Please consider the following vitally important factors:

1. Patient input- When a patient enters a hospital there is a detailed information gathering process, but what if much of the most important information was missing? Could that have an impact on the treatment they received?

a. Blood tests- Blood is usually draw, but there are usually many tests that are not included because they are not understood by conventionally trained doctors. Functional medicine doctors understand them and sometimes include them. Examples include:¹

• GlycoMark test- a better test for glucose because it includes the after meal influence of glucose increases caused by eating carbohydrates or sugars.
• Vitamin D3- a better test for the risk of many illnesses because it can explain the risk for the flu, viral infections and even cancer.
• 8-OHgD test- this test helps to determine the accumulated DNA damage in a person's body, which influences liver function, drug interactions and overall treatment response.
• Cortisol test- this test helps to determine the roll that stress maybe having on the patient's condition.
• Magnesium RBC- this test is much better in terms of helping to explain high glucose levels and the presence of many symptoms being experienced by the patient.
• Galectin 3 test- this test helps to identify changes in cellular behavior on the way to illnesses such as heart disease and cancer. Heavy metals are often implicated and doctors can often use better, proven medical interventions to begin to improve the health of these cells.^2,3,4

b. Genetic test- Genetic testing can help to identify SNP's (Single Nucleotide Polymorphisms) that could dramatically influence diagnosis and treatments. In one recent study, it was shown that people with certain SNP's were more likely to get thyroid cancer if they took certain medications. There are hundreds of such factors, which are not considered for the majority to patients being admitted to hospital.⁵

c. Prescription medications- When patients list the prescription medications they take there is no analysis of the negative side effects of these combinations medications. Further, there is no evaluation of the nutritional deficiencies being caused by these medications. There are well documented studies showing these interactions and deficiencies, which are not factored in during this input process. These short comings in this initial stage of information input likely contributes to many of the negative responses to treatment, as well as to the high levels of readmissions that can occur.⁶

d. Artificial intelligence analysis- One of the biggest, and potentially most serious problems with this input process is the lack of any overall comparison to all of the information provided. There is now an AI platform, based on functional medicine, with the ability to analyze all of this input information to produce a more complete and accurate evaluation of each patient's condition, as well as the best course of action for immediate and long-term treatment. Why is this obvious best practice tool not being used by every hospital in the country?⁷

2. Patient treatment- The current healthcare system is broken and unsustainable. It is a system that treats chronic illness symptoms primarily with drugs and surgery. It is the most expensive medical system in the industrialized world and it consistently products the lowest level of services and outcomes. Here are some of the statements about this situation from scientific studies (specific citations available).

a. Over 90 % of chronic illness is preventable, but we only spent 5% of health dollars on prevention.⁸

b. Our diets are killing us and doctors aren't trained to help. Ninety percent of cardiologists in a recent study reported receiving minimal or no instruction on nutrition during medical training.⁹

c. Medical Guesswork was the title of an article in Business Week Magazine in 2006. This was based on a comprehensive analysis to all conventional medicine treatments by Dr. David Eddy who found that there was only good evidence to support 20-25% of what doctors and hospitals were doing.¹⁰

d. Insurers and individuals are spending tens, if not hundreds of billions of dollars on dangerous, invasive, expensive and mostly ineffective surgical procedures.^11,12

e. Even coronary bypass surgery only prolongs life in some 3% of those undergoing it. Modern medicine is effectively putting $100 billion straight down the drain.¹³

f. Only 1% of patients using statin drugs live longer than if they had not used them.¹⁴

g. In pre-diabetic patients Metformin prevented 31% of patients from advancing to full diabetes, while diet and exercise prevented 59% of patients from advancing to full diabetes.¹⁵

h. The Cleveland Clinic reports that hundreds of studies searching for a cure for Alzheimer's failed 99.6% of the time, with virtually no overall impact on treatment. These were all mono-therapy approaches.¹⁶

i. Dr. Dale Bredesen from UCLA used a multi-therapy, functional medicine approach, to achieve a 90% success rate in memory improvement for Alzheimer's patients. The benefits have been sustained and even improved over the three-year period after the study.¹⁷

j. Regarding the use of NHPs (Natural Health Products) to treat gastrointestinal disorders and UTIs, typically outpatient conditions, the studies demonstrated that NHPs did provide cost savings, ranging from 19 to 73%.¹⁸

k. The Davey et al. study showed that Vitamin E supplementation was cost-effective as compared with control by an average of $578 USD in improving outcomes post MI.¹⁹

l. Vitamin E was shown to be more effective in treating fatty liver disease than any available prescription medication.²⁰

m. Fifty percent of patients on dialysis were able to be removed from this treatment after taking 180 mg of Coenzyme Q10 for three months.²¹

n. Lung cancer survival increased by 47% with high doses of vitamin D3.²²

o. Mayo Clinic found that high levels of vitamin D3 increased lymphoma survival rates by 50%.²³

p. The Dana-Farber Institute used high levels of vitamin D3 to increase survival rates of colon cancer by 48%.²⁴

q. The Journal of Clinical Evidence reports that only 11% of typical conventional medical treatments may be categorized as beneficial, by randomized controlled trials.²⁵

r. A large study published in the British medical journal Lancet Oncology found that diet (plant-based) yoga, meditation, and lifestyle changes increased the length of telomeres. Shorter telomere length has been associated with conditions such as hypertension, obesity, diabetes, heart disease and prostate cancer.²⁶

s. High levels of vitamin D3 have been associated with a lower risk of viral infections, including all of the various stains of the flu.²⁷

t. Conclusion: at least 75% of today's global healthcare costs are not being prudently spent.²⁸

This represents a fraction of the evidence-based outcomes available to hospitals and doctors. There are over 40,000 scientific studies imbedded in the previously mentioned AI platform based on functional medicine. This represents a mountain of best practice examples for hospitals that would like to pursue the "performance excellence" available to an optimized Baldrige Award program. If all of these health improvement strategies were effectively deployed the improvement in patient care would be astronomical, as would the cost reductions.

3. Post hospital evaluation- If 90% of all chronic illnesses are preventable, and if 75% of all healthcare costs are not being prudently spent, what are the possible measures of success after a patient experiences a truly excellent hospital visit, followed up by truly excellent doctors care afterwards? Currently excellence is measured by whether someone most come back to the hospital within the next 6-12 months, or if they contracted a sepsis infection or not. That does not sound like the bar is being set very high. How about using the following types of post care measures?

a. Did your doctors offer non-surgical or non-prescriptions medicine options for you to consider?

b. Did you feel that your options were based on good science and good explanations?

c. Did your hospital team provide a complete evaluation of your overall health in order to address any related issues for your optimal recovery?

d. Did your hospital team produce a comprehensive plan for you to follow, including consultation with your team of family and friends.

e. Did your hospital team provide a complete nutritional program based on your health needs as well as your nutritional preferences?

f. Did your hospital team go over the use of all prescription medications, herbal remedies and other nutritional supplements to ensure their appropriate and effective use?

g. Did your hospital team also go over any items related to stress, exercise and detoxification programs if they were included elements in your plan?

h. Did your hospital team review the compliance survey with you in order to be able to accurately track how well you are able to follow the recommendations provided?

i. How would you rate your hospital experience in following categories?

1. Wait time prior to registration.
2. Time necessary to complete the initial input process.
3. Staff support and effectiveness during the input process.
4. Time and convenience in securing a room for your care.
5. Time it took for the first doctor to see you.
6. Overall doctor care during your time in the hospital.
7. How satisfied were you with the treatments you received?
8. Time necessary to process you for release from the hospital.

j. Did the hospital call you within 3 days to ask how you were doing?

k. Did the hospital send the compliance survey after 3 months of your release? This survey would have included benchmarks for improvement. If you were basically in compliance with your plan, did your benchmarks indicate improvement based in your symptoms and other measures?

l. Did the hospital share your information with your family doctor, especially the plan prepared by the hospital for your health improvement? Did the doctor provide follow up testing? If so, did the results indicate improvement? (On a scale of one to ten). This is one of the main measures of performance excellence. If the plan was good, and the compliance was good, then the improvement should have been good. This is how a hospital visit should be measured.²⁹

4. Continuous improvement- It is impossible to measure performance excellence if all aspects of performance are not measured. Quality is about key factors being measured in a timely and accurate manner. For example:

a. The timing of service delivery is crucial. Many timing measures are provided.

b. The quality of service is crucial, even the perception of quality.

c. The effectiveness of the service provided is important, and this should be how the patient feels as well as how the actual test results change, and improve.

d. The outcomes are the most important measure. Did the patient's health improve, and can this improvement be substantiated?

e. Were the processes smooth and coordinated to provide a seamless and efficient delivery of the necessary services?

f. Were best practice health and medical practices used, including all evidence-based modalities?

g. Were costs continuously reduced, based on best practice procedures? Patient cost and time.

h. Was patient feedback utilized to allow hospital teams to use problem solving tools to provide continuous improvement reports to the hospitals leadership? This would be an organizational measure for the hospital.

i. Were these improvement measures and reports included in the performance measurement ratings for employees at all levels in the organization? Performance evaluations of staff at every level should be included in the hospitals accountability system. Every part of the patient's evaluation data should be incorporated in the accountability system. This makes the patients success meaningful and personal for every hospital employee.

j. Do the internal hospital teams have service level agreements in order to be able to measure how well they providing service to each other in a timely and effective manner? A hospital is only as successful as the unified and coordinated evaluations that collectively present a true and accurate picture of the patient experience.

Summary
This is just a snapshot of how every hospital should be conducting their business. In 2014 the Cleveland Clinic decided to move in this direction with the establishment of a functional medicine center. They did this after two years of study comparing their conventional medicine protocols to those followed by functional medicine practitioners. They did this based on 40,000 scientific studies that indicated this was the right thing to do. They brought in Marc Hyman to lead in the creation of this program. It seems very appropriate to use a variation of Marc Hyman's previous statement to the US Senate to explain why the Baldrige Award needs to move in this direction.

"Hospitals will never be able to reach
true performance excellence if they
just continue to go the wrong things better".

Footnotes

1. Early Warning Cancer Tests - Charles Bens, Ph.D., Healthy at Work, Feb. 15, 2020.
2. Michfield, Citrus Pectin Protects Against Vascular Hardening, Better Health Publishing, Nov. 20, 2012, 07:00 ET.
3. De Berg, Steven. "A Lifesaving Nutrient in Citrus Fruit.", Life Extension Magazine, Oct. 2014.
4. Moss, Ralph PhD. "Modified Citrus Pectin Fights Cancer Metastases." Moss Reports, 2 May 2019, www.mossreports.com.
5. Price AL. Spence CCA et al. (2015) Progress and promise in understanding the genetic basis of common diseases. Proc R Sol B 292:1684. And A clinical guide to common drug-nutrient interactions, Fullscript, February 2009.
6. "Preventing Pharmaceutical-Induced Nutritional Deficiencies.", Life Extension Magazine, March 2006.
7. Bens, Charles K. PhD. Is Artificial Intelligence Going to Save Healthcare, Healthy at Work, Newsletter.
8. Bens, Charles K. PhD. "Beginning of the End of the War on Medicine.", Green Med Info, Wednesday 7th, 2016, at 11:15 a.m.
9. Ibid.
10. Carey J., Medical Guesswork, Bus Week, May 2006, May 29:72.
11. An Empirical Study of Chronic Diseases in the United States: A Visual Analysis Approach to Public Health, Raghupathi W, et al. Int J Environ Res Public Health. 2018 Mar;15(3):481.
12. The High Cost of Unnecessary Care, Aaron E. Carroll, M.D. The JAMA Forum, Nov. 16, 2017.
13. Yes, Prevention is Cheaper than Treatment, Dean Ornish, Jan. 6, 2015. New England Journal of Medicine.
14. Study Reveals Statins Not Very Effective or Safe. Joseph Merida, March 18, 2015. Originally in Expert Review of Clinical Pharmacology.
15. Exercise and diet reduce risk of diabetes, US study shows, Fred Charatan BMJ, 2001 August 18; 323(7309):359 (Originally from data at www.hih.gov).
16. Alzheimer's R&D suffers as trial failure rate hits an astounding 99.6%, John Carroll, July 3, 2014, 10:50 a.m. Originally from Cleveland Clinic Report.
17. Reversal of cognitive decline: novel therapeutic program, Dale Bredesen, AGING, September 2014, Vol 6, N9, Published at www.impactaging.com.
18. Cost Effectiveness of Natural Health Products: A Systematic Review of Randomized Clinical Trials. Evidence-Based Complement Alternat Med. 2009, Sep; 6(3):297-304.
19. Ibid.
20. Vitamin E helps diminish a type of fatty liver disease in children. National Institute of Health, April 27, 2011.
21. Singh RB, et al. Randomized, double-blind placebo-controlled trial of coenzyme CoQ10 in patients with end-stage renal failure. J. Nutr Environ Med 2003; 13:13-22.
22. Circulating 25-hydroxyvitamin D levels predict survival in early-stage non-small cell lung cancer patients. Xhou W, et al. J Clin Oncol 2008, Feb 10;25(5):479-85.
23. Mayo Clinic Study Finds Vitamin D Associated with Survival in Lymphoma Patients, Drake M, et al., Mayo Clinic, Feb 19, 2010.
24. Vitamin D: Can It Prevent or Slow Cancer? Ng K. et al., Dana-Farber Cancer Institute, August 29, 2017. Updated June 13, 2019.
25. Available at: http//clinicalevidence.bmj.com/x/set/static/cms/efficacy-categorizations.html. Accessed January 6, 2019.
26. Increased telomerase activity and comprehensive lifestyle changes: A pilot study. Ornish D, et al. The Lancet Oncology, Volume 9, Issue 11, P 1048-1057, November 01, 2008.
27. Vitamin D helps fend off flu, asthma attacks, American Journal of Clinical Nutrition, March 10, 2010.
28. Integrative medicine to tackle the problem of chronic diseases, Roy R. J Ayurveda Inter Med 2010, Jan.-Mar.; 1(1):18-21.
29. Form Follows Function: A Functional Medicine Overview, Hanaway P. Perin J. 2016 Fall; 20(4):16-109.

Additional References

1. The Encyclopedia of Natural Medicine- Michael Murray and Joseph Pizzorno, Atria Books, New York, 1998;2012.
2. What the Drug Companies Won't Tell You and Your Doctor Doesn't Know- Michael Murray, Atria Books, New York, 2009.
3. The Natural Pharmacy- Alan Gaby, Three Rivers Press, New York, 2006.
4. The Health Hoax- Raymond Francis, Health Communication, Inc., Deerfield Beach, Fla., 2014.
5. The Disease Delusion: Conquering the Causes of Chronic illness for a Healthier, Longer and Happier Life- Jeffrey Bland, Harper Wave, New York, 2014.
6. Eat, Drink and Be Healthy- Walter Willett, Simon & Schuster Source, New York, 2001.
7. Dr. Dean Ornish's Program for Reversing Heart Disease: The Only System Scientifically Proven to Reverse Heart Disease Without Drugs or Surgery- Dean Ornish, Ballantine Books, New York, 1990.
8. The End of Alzheimer's: The First Program to Prevent and Reverse Cognitive Decline- Dale Bredesen. Avery, New York, 2017.
9. Biochemical Individuality: The Basis for the Genetotrophic Concept- Roger Williams, Keats Publishing, New Canaan, Connecticut, 1956, 1984, 1998.
10. Roy, R. "Integrative Medicine to Tackle the Problem of Chronic Diseases". J Ayurveda Inter Med. 2010, Jan/Mar; 1 (1):18-21.
11. Goldman E. "Cleveland Clinic Gets Functional". Holistic Primary Care, Saturday, 30 August 2014 21:58.
12. Kennedy DA, Hurt J and Sealy D. "Cost-Effectiveness of Natural Health Products: A systematic Review of Randomized Clinical Trials", Evid Based Complement Alternat Med. 2009 Sep, 6 (3): 2917-304.
13. Broad Lieb EM, Devries S and Willett W. Our Diets Are Killing Us and Doctors Aren't Trained to Help. 10/18/10 07:00 PM.
14. Bens C. "Hospitals Consider Using Integrative Medicine". Healthy at Work. 2018, November.

Baldrige Award for Healthcare