Kay Downey-Ennis, Quality and Education Officer, Daughters of Charity Services


Across Europe, those who use healthcare services are increasingly dissatisfied with increased waiting times and with the way they are treated. At the same time, funding bodies are calling for efficiencies and reform of the way services are planned and delivered. As a result there have been a number of initiatives in Europe to improve clinical services through standard-setting, evidence-based medicine, audit, and benchmarking. While these initiatives may improve clinical quality, there appear to be few strategies for organisational improvement, apart from total quality management. In response to this need for organisational improvement, the European Foundation for Quality Management (EFQM) was set up.

Business Excellence Model

The Business Excellence Model originated in the US with the Malcolm Baldridge Award for Corporate Excellence. In 1988 companies from across Europe met under the umbrella of the EFQM and endorsed the Business Excellence Model. Many national quality associations have adopted the model. In Ireland, both the Irish Centre for Business Excellence and Excellence Ireland have adopted this model as their core approach to quality management.

European Foundation for Quality Management (EFQM)

The EFQM ensures that the business excellence model reflects the changing and dynamic environment in which all organisations operate. Following a major two-year research and consultation exercise, the updated version of the model was launched in Geneva last year. The aim was to ensure that the EFQM business excellence model migrated with the dynamic environment and continued to reflect up-to-date management thinking. The new model includes a public and voluntary sector version for healthcare and education organisations. The EFQM Healthcare Working Group, on which I represent Ireland, is developing a specific model for healthcare.

The model does not impose a set of prescribed standards, but is more a framework for helping everyone to think about all aspects of their service in order to identify strengths and weaknesses. Success is dependent on coaching and building confidence at senior staff level before rolling it out to the junior staff. The key message is ‘no blame’. Weaknesses are acknowledged and seen as opportunities to make improvements. The model has proven an effective tool in the implementation of the UK government’s controls assurance agenda in the National Health Service. Within European healthcare the model is now well established in Norway, the Netherlands, Sweden and Spain, with a number of organisations implementing the model in the UK. To date two Irish healthcare agencies are in the early phase of implementation.

As already mentioned, the model is a non-prescriptive framework but it is underpinned by nine fundamental concepts:

  • Results orientation
  • Customer focus
  • Leadership
  • Process management
  • People management
  • Continuous learning
  • Innovation
  • Partnerships
  • Public responsibility

The model is based on nine criteria–five look at how things are done (enablers) and four focus on results. The EFQM believes that ‘excellent results with respect to performance, customers, people and society are achieved through leadership driving policy and strategy, people, partnerships and resources and processes’.

As shown in Figure 1 below, the model assigns different weightings to the five enablers and four results:

To successfully implement the model, an organisation needs to follow the RADAR logic:

  • Determine the Results (financial, operational and customer perceptions) it is aiming for as part of its policy and strategy-making process.
  • Plan and develop an integrated set of sound Approaches to deliver the required results both now and in the future.
  • Deploy the approaches in a systematic way to ensure full implementation and that full integration is achieved.
  • Assess and Review the approaches followed based on monitoring and analysis of the results achieved and on ongoing learning activities. Based on this, identify, prioritise, plan and implement improvements where needed.

The undertaking of regular measurement promotes learning and leads to improvement activities. This mirrors Deming’s continuous improvement cycle of ‘plan-do-check-act’.

Organisations need to know how well they are performing and to have effective means of assessing their performance in order to gain their maximum potential. To do this they need measures that are meaningful, interpretable and of demonstrable value. One system which can provide this is the Business Excellence Model.


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