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Memorial Hermann Sugar Land Hospital: 2016 Malcolm Baldrige National Quality Award Winner

Memorial Hermann Sugar Land Hospital (MHSL) is a 149-bed, not-for-profit hospital located in Fort Bend County, one of the fastest growing and most ethnically diverse counties in the nation, in the greater Houston, Texas area. Founded as a for-profit hospital in 1982, the Fort Bend Hospital, as it was then known, quickly developed a reputation for delivering high-quality care in a family-friendly environment. The Houston-based Memorial Hermann Health System (MHHS) acquired the Fort Bend Hospital in 1999.

After the acquisition, the senior leadership team set its sights on becoming one of the nation's leading community hospitals. Guided by the mantra "Why Not Us," the leaders set out to an organization known for outstanding clinical care, zero harm, and delivering an amazing patient experience. In 2016, the MHSL Hospital won the prestigious Malcolm Baldrige National Healthcare Quality award in recognition of its exemplary level of patient care.

The MHSL Hospital provides inpatient and outpatient services in the specialties of general medical and cardiovascular, surgical, intensive care, orthopedics, sports medicine and rehabilitation, diagnostic, and woman's and children's services. It is 1 of the 14 hospitals in the larger Memorial Hermann Health System. Each of the 14 hospitals in the system operates as a strategically located business unit that provides services tailored to support the needs of its local community.

Unlike other health systems in which individual hospitals might compete with each other by offering the same services, MHHS has developed a highly integrated system to deliver community-based comprehensive care. As patients' needs change, they are referred to the appropriate business unit within the larger health system. Health care services are aligned across the MMHS's strategic business units so that each unit is able to focus, improve, and innovate on a select set of services.

Vision and Values and Operating Framework

MHSL seeks to become the preeminent community hospital in the nation by providing exemplary family-centered care that is highly reliable, safe, and effective. To achieve this vision, the MHHS core values emphasize accountabilitycompassioncollaborationempowermentinnovationresults orientation, and one Memorial Hermann system. The MHHS leaders also created the ADVANCE model as the overarching framework to design, implement, and evaluate programs and services across the system and to guide work on a daily basis.

The ADVANCE model components are the following:

  • A—Align with Physicians
  • D—Delivery Quality Care
  • A—Achieve Operational Targets
  • N—Nurture Growth and Innovation
  • C—Consumer-Centric
  • E—Enhance Population Health

Workforce Development and Engagement

The MHSLH workforce is the foundation for its success: much emphasis is placed on workforce development and engagement at all levels of the health system. In particular, the MHHS uses a workforce lifecycle model to recruit, retain, and develop professional staff and employees. The focus is on finding individuals who share systemwide values to support the family-oriented culture and the goals of safe and high-quality clinical care. The workforce engagement phases include the following:

Phase 1 Discover and Recruit

The model begins with attracting new employees to the Sugar Land Hospital. This phase emphasizes attracting individuals who can contribute to, and enrich, the organizational mission, vision, and culture, and who reflect the ethic and cultural diversity of the community. The ideal employee brings diverse thought and possesses strong technical skills needed to achieve the organization's performance goals. New employees are recruited though a variety of methods including events and job fairs, referrals, direct marketing, out-of-state recruitment, and social media. Executive-level and highly specialized roles are handled by professional recruiting firms. Similarly, physicians are recruited to MHHS hospitals in collaboration with the Memorial Hermann Medical Group, the University of Texas, and the MHSLH executive team including the director of business development.

Phase 2 Welcome and Connect

All potential employees are screened for cultural fit with the MHHS values as well as the skills and competencies required to perform in positions. Once individuals have passed the initial screening phase, they participate in a three-step hiring process that includes an in-depth assessment by trained recruiters to determine alignment with the organization's values. Skills and expertise are further assessed and background checks are completed at this time. In the second step, candidates complete either the Hartman Value Profile, to gauge their capacity to make value judgments about themselves and the world, or the Prophecy Assessment, designed to evaluate nurses' clinical, situational, and behavioral competencies.

The final phase of recruitment includes behavioral interviews conducted by a panel of trained employees who assess the candidate for fit with organizational values and specific roles within departments. Recruitment concludes with additional background checks, physicals, and other mandatory preemployment requirements. New employees attend a systemwide "Culture Day," followed by a multiday new employee orientation and a department-specific orientation that concentrates on helping new employees acclimate to the surroundings, understand expectations, and how to function in departments.

Physician recruitment and retention are handled in a similar manner, beginning with rigorous interviews and credentialing to identify and attract physicians who share the MHHS values and possess clinical and leadership skills to contribute to the goals of patient care quality and safety. Physician onboarding includes welcome sessions with the senior leadership team and a review of hospital policies, procedures, clinical priority areas, and equipment. The concepts of the ADVANCE model and the core organizational competency of patient safety are the focus of the physician orientation programs. New physicians are invited to participate in 30-60-90-day follow-up meetings with managers that provide opportunities to offer support and further clarify clinical and operational goals and expectations.

Phase 3 Enrich and Energize

This phase focuses on enriching and energizing the workforce through performance feedback. The core value of accountability is foundational to the workforce engagement strategy at MHSLH. Leaders energize and motivate the workforce by setting high expectations and performance targets, working collaboratively toward a common purpose, empowering individuals to innovate and try new ideas, providing access to an open and visible leadership team, and conducting formal and informal feedback sessions.

The MHSL organizational culture encourages individuals and teams to exceed performance goals and expectations through distinguished achievement levels. In turn, exemplary performance and achievements are rewarded with financial incentives, performance evaluations, and formal recognition. To support high performance, managers and leaders at all levels provide individuals with ongoing feedback to identify opportunities for improvement. Managers provide feedback in daily interactions to reinforce expectations and to guide individual performance improvement. Individuals who fall below the expected performance levels are required to follow an improvement plan.

Phase 4 Recognize and Refuel

This phase focuses on recognizing and rewarding accomplishments. Recognition programs are used to celebrate individual and collective successes. Peer recognition programs such as Employee Partner of the Year, Physician Partner of the Year, Volunteer Partner of the Year, Employee Appreciation Days, and Doctor's Days are examples of programs that recognize a job well done and further support the MHSLH culture of excellence. High-performing individuals at all levels are eligible for a merit raise that is managed through each department's incentive budget. To reinforce the One Memorial Hermann model, each employee receives quarterly incentives as system-level goals on each of the ADVANCE strategies are met.

Phase 5 Growth

Individual growth and development are an important part of the MHSLH employee engagement model and a key driver of sustainable high performance. Specific workforce development needs are segmented and tailored to take education, job responsibilities, and organizational change needs into account. Examples of workforce growth and development programs and opportunities include tuition reimbursement/loan repayment, flexible scheduling, and opportunities to participate in change and performance improvement efforts as well as governance councils and committees. Flexible scheduling is offered so that individuals are able to balance the responsibilities of their work and family life, which reinforces the MHHS Family Caring for Family culture.

Fort Bend is a rapidly growing metropolitan area that requires an agile approach to workforce management. Change management strategies are used to design and execute job duties so that each employee is supported and empowered to provide the highest levels of service and clinical care. The workforce management approach includes

  • (1)
  • a workforce plan;
  • (2)
  • professional development and educational programs to develop knowledge, skills, and competencies;
  • (3)
  • employee involvement in process improvement and design efforts; and
  • (4)
  • reward and recognition programs.

The overall workforce management plan is managed by the system-level human resource management group. When reductions in workforce are needed within one business unit, the affected individuals are given the opportunity to move to another unit in the system. Cross-training, continuing education, and mentoring programs are also used to ensure that the workforce possesses the knowledge and capabilities that support the organization's performance goals.

Performance Management

The ongoing performance management and feedback model ensures that individuals have a clear understanding of how they contribute to performance goals and the ways in which they can improve their contributions to the patient experience. A formal employee engagement survey and annual review provide data and insights about changes in behaviors required to ensure high performance in the areas of clinical care, patient safety, and exemplary service. Additionally, the annual workforce engagement survey is used to identify the top factors associated with high performance and engagement across different employee groups. In turn, the leadership team uses the data to make corrections and improvements to the overall workforce engagement strategy.

Employees contribute to the performance evaluation process by completing a self-assessment at the end of each year that is used to guide the development of mutually agreed-on personal and team performance goals and objectives during the formal performance review. The effectiveness of the informal and formal feedback methods is assessed against measurable changes in patient care quality and operational efficiency measures.

Each year managers across the MHSLH review the skills and competencies of the employees in their units. The annual review is used to identify individuals who are ready to assume leadership positions or new career opportunities as well as gaps in the current workforce composition necessary to support organizational goals. The data gathered though the annual review inform succession planning, leadership development, and continuing education programs for the coming year.


  1. What are the key factors in Memorial Hermann Sugar Land Hospital's successful approach to motivation?
  2. Do you see weaknesses in the Memorial Hermann Sugar Land Hospital's approach?
  3. Can the Memorial Hermann Sugar Land Hospital's approach be replicated in other health care organizations? What are some important barriers and facilitators to using the Memorial Hermann Sugar Land Hospital's approach?

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