Winning a Malcolm Baldrige National Quality Award — the nation's highest presidential honor for companies that embrace continuous performance improvement — isn't easy. That's why only 15 of the nation's thousands of health care organizations even applied to be considered for the award last year. Two won: 160-bed Baylor Regional Medical at Plano (Texas) and 48-bed Sutter Davis (Calif.) Hospital.

Despite the slim odds, hospitals are showing increased interest in the award criteria because of the ways that it can improve operations, says Bob Fangmeyer, director of the Baldrige Performance Excellence Program. He points out that those who receive site visits from Baldrige examiners improve faster than their peers, and winners of the award are 83 percent more likely to be among the top-performing hospitals in the field.

"You can do a very simple self-assessment to determine where your major gaps are, and what are the things that you don't understand about your organization that you need to understand," Fangmeyer says. "That's simple. Receiving the award is very difficult. There's a lot of value in just beginning to use the criteria as an internal tool that has nothing to do with striving for the award."

In addition to the 2013 health care winners, unveiled by the Commerce Department's National Institute of Standards and Technology in late November, two hospitals received honorable mentions: Duke University Hospital in Durham, N.C., and Hill County Memorial in Fredericksburg, Texas.

At Sutter Davis, key improvements include halving the door-to-doctor time in its emergency department, from 45 minutes in 2008 down to 22 in 2012, well below the California benchmark of 58 minutes. The small hospital is in the top 10 percent in the nation for readmission rates and average lengths of stay for pneumonia, heart failure and acute myocardial infarction.

Sutter Davis CEO Janet Wagner, R.N., says her hospital did not have to add staff or spend extra dollars to pursue the Baldrige aims. Going through the process, she believes, gave her organization more structure, and the wherewithal to pursue further improvement.

"It does take some discipline and focus to stay with the process, but it's definitely a meaningful way to make improvements in your organization," Wagner says. "For us, it was the right thing to do at the right time. It actually has given us more energy to do some of the things that we want to do in the future."

In addition to sterling clinical outcomes, both winners also emphasize employee satisfaction and retention. Baylor Regional Medical at Plano has maintained 90 percent-plus retention of first-year employees the past three years. Its 94 percent overall retention rate — achieved through everything from retention committees to 90-day check-ins with employees and behavioral interviewing techniques — places the hospital in the top 25 in the nation.

Jerri Garison, R.N., president of Baylor Regional, says applying the Baldrige criteria is not easy, but she urges every hospital leader to take a closer look at the process for the results it can produce.

"It is not a quick fix; it's a lifelong journey. Just because we won doesn't mean we're not going to continue doing this," Garison says. "But the investment in the process, what you learn and how you improve your organization are all invaluable."