One’s a little bit country, and the other’s a little bit rock and roll. But despite differences in size and geography, the two winners of the most recent Malcolm Baldrige National Quality Award in health care have some things in common.

Eighty-six-bed Hill Country Memorial Hospital, in bucolic Fredericksburg, Texas, uses the Baldrige methodology as an umbrella for integrating a variety of quality improvement techniques and strategies, leaders say. On the other hand, St. David’s HealthCare, based in the nation’s live music capital of Austin and a joint venture among HCA, St. David’s Foundation and Georgetown Health Foundation, relies strictly on the Baldrige approach for its quality improvement efforts.

Eight years after both organizations started their Baldrige process, they were honored late last year with the top federal quality award.

Hill Country’s leaders got interested after hearing Sister Mary Jean Ryan give an enthusiastic talk about the Baldrige improvement process after her organization in 2002 became the first winner in the health care category. Ryan was CEO of the organization, which is now SSM Health.

“I was intrigued by that concept,” says Debbye Dooley, executive director of business intelligence. “We were performing near the national median on quality and other metrics. We knew we wanted to be better. We were looking for a system that would help us to improve our organization as a whole.”

Hill Country adopted the Baldrige criteria for its performance improvement, and applied for the award in 2010 and 2011. After taking a break from applying in 2012, the hospital applied again in 2013 and was given special recognition for “best practices in the leadership criterion,” according to the National Institute for Standards & Technology, the Commerce Department agency that administers the Baldrige process.

Nearby Enchanted Rock has become a symbol of Hill Country’s three core competencies: being a values-driven organization, having a keen ability to execute and exhibiting strong relationship-building, says Jayne Pope, Hill Country CEO. To demonstrate their commitment, hospital staffers climbed the pink granite boulder.

According to NIST, Hill Country Memorial was recognized in part because it ranks in the top 10 percent nationally in satisfaction and engagement for employees and for employed and independent physicians. The hospital also had the best performance in the state for a value-based purchasing program run by the Centers for Medicare & Medicaid Services.

St. David’s, meanwhile, won partly because of its consistent performance across different disease categories. The system’s composite performance on core measures reported by CMS has been in the top 10 percent of health care systems nationally for each disease group since 2009.

“We’ve seen pretty significant improvement in every aspect of our operation, including clinical work, our patient and family experience, as well as our operations and financial performance,” says C. David Huffstutler, president and CEO. “

St. David’s has organized its work around the Baldrige method’s seven categories of improvement. “We feel as though it’s an approach that’s worked for us.” says Huffstutler.