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The Malcolm Baldrige National Quality Award provides a set of criteria for organisational quality assessment and improvement and has been used by thousands of business, healthcare and educational organisations for more than a decade. The criteria can be used as a tool for self-evaluation, and are widely recognised as a robust framework for design and evaluation of healthcare systems. As described by Batalden, Nelson and colleagues, a clinical microsystem can be defined as "the small, functional front-line unit that provides health care." 1, 2 In 2005, the Malcolm Baldrige Award took a specific interest in the clinical microsystem concepts, as they could operationalise the Baldrige criteria and bring them into mainstream efforts to improve the performance of large and small healthcare organisations. Towards this end, a focus on clinical microsystem thinking was included in the case study written for the 2006 annual examiner training. Following examiner training, the case study was made available to the public as a resource that is illustrative of an award application (available online at http://baldrige.nist.gov/Arroyo.htm ).
The purpose of this paper is to explore the insights that can be gained from considering the Malcolm Baldrige criteria for healthcare in the context of high-performing clinical microsystems. Specifically, we discuss whether the microsystem success characteristics, identified in prior research, 1 cover the same range of issues addressed by the Baldrige criteria; examine whether this comparison might better inform our understanding of either framework; and investigate what we might learn about high-performing microsystems by looking at them through "Baldrige lenses". Finally, we discuss the tools that are available for those wishing to engage in self-assessment based on the Baldrige Award criteria and microsystem characteristics. These are summarised and presented as recommendations for organisations ready to accept the challenge of using a system-based approach to improve the quality and safety of care provided to their patient populations.
OVERVIEW OF THE MALCOLM BALDRIGE NATIONAL QUALITY AWARD
The Malcolm Baldrige National Quality Improvement Act, signed into US law in August 1987, led to the creation of the Malcolm Baldrige National Quality Award in 1988. The purpose of this competitive award programme is to improve quality and productivity in the USA by establishing guidelines and criteria that can be used by organisations to evaluate their own...