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Baldrige is a system-wide approach for improvement to be used as circumstances dictate. There is a need to understand how hospitals earning Malcolm Baldrige National Quality Awards – Health Care (MBNQA – HC) assure high quality performance. Examine the dynamic capabilities of MBNQA – HC winning hospitals though the theoretical lens of stakeholder theory and dynamic capabilities. Stakeholder theory calls attention to the synergistic potential for value creation across a firm’s stakeholder groups. Dynamic capabilities consist of processes and activities aimed at identifying opportunities (sensing), mobilizing resources (seizing), and making necessary changes for value creation (transforming). Our data are provided by the MBNQA – HC applications of 10 hospitals judged to have earned the awards for the years 2010–2016. As a primary methodology for performing qualitative analysis, thematic analysis of the applications was our analytic method. 66 sensing activities, 29 seizing activities, and 57 transformations were identified. Sensing and seizing spanned stakeholder groups including customers, competitors, community, and industry. Organization cultures promote system–wide engagement by empowered internal stakeholders, leading to superior performance. Relying on a supportive system-wide culture that empowers internal stakeholders, MBNQA – HC winners engage in numerous sensing, seizing, and transforming activities. These ongoing activities are commonalities of top performing hospitals.

Dynamic capabilities and stakeholder theory explanation of superior performance among award-winning hospitals