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A Public Health Performance Excellence Improvement Strategy

Diffusion and Adoption of the Baldrige Framework Within Tennessee Department of Health

Roberts, Micky MDiv, MCHES; Reagan, David R. MD, PhD; Behringer, Bruce MPH, DHL

Journal of Public Health Management and Practice: November 28, 2018 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/PHH.0000000000000926
Practice Full Report: PDF Only

In 2011, Tennessee was faced with poor state health rankings with newly elected officials promoting customer-focused government. To refocus, the Tennessee Department of Health chose a multiyear plan to adopt, diffuse, and integrate the Malcolm Baldrige Performance Excellence framework. Senior leaders changed the organizational culture using participatory strategic planning coupled with introduction of performance improvement initially led by departmental staff who volunteered for training by the state Baldrige affiliate. New tools and processes were diffused across the department's central and regional offices and county health departments. Departmental units documented performance improvement through hundreds of internal projects and more than 100 innovation-driven Baldrige achievement awards. Over time, performance improvement approaches were integrated into existing departmental programs and new initiatives, leading to additional successful process changes and population health improvements. The department's approach included multiple steps: adopt Baldrige Performance Excellence as means to promote culture change with a goal of improved organizational and population health performance; use the visual Baldrige framework and its categories to underscore inclusiveness, comprehensiveness, and synergies of desired change; choose, invest in, and implement multiple evidence-based management strategies to support culture change toward improvement; and continuously evaluate outcomes, linked to required reports to suppliers (governor and legislators) and customers (public, patients, and partners). The Baldrige Performance Excellence framework was found to be an effective approach to promote culture change through emphasizing improvement in a public health organization.

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Tennessee Department of Health, Nashville, Tennessee.

Correspondence: Bruce Behringer, MPH, DHL, Tennessee Department of Health, Andrew Johnson Tower, 710 James Robertson Pkwy, Commissioner's Office, Fifth Floor, Nashville TN 37243 (

The authors declare no conflicts of interest.

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