Reap maximum ROI from benchmarking partners
Look inside, outside of health care for best value
Common sense and courtesy go a long way when it comes to benchmarking. Sift out the nice-to-know pieces, and keep the absolute essentials. The time you spend will net best results if you pinpoint what you need to know and frame your questions around it. Once you've got your act together, do as much as possible by phone and e-mail.
Finding partners inside the industry
The stakeholders in your quality projects probably have their heroes in their respective fields of expertise, so why not give them a chance to contact them peer-to-peer? Rosemary Keeley, Improvement Services director at VHA-Central Atlantic in Charlotte, NC, points out that when the nurses, administrators, or radiologists, for example, call peers they meet at professional meetings or read about in professional journals, the rate of returned calls is 60% to 70%.
Before they call, Keeley helps teams brainstorm scripts of questions 'so if we contact a total of 20 hospitals on a radiology procedure, we can compare the feedback apples to apples,' she points out. For convenience, Keeley helps her teams set up the interview forms with questions and space to write the answers. 'We work within a short time frame of one to two weeks. People make about three calls each so nobody's overburdened,' Keeley explains.
'After the benchmarking calls, the idea level goes skyrocketing during the team interactions,' Keeley notes. Part of the credit belongs to the method she teaches her data gatherers for organizing and presenting findings. Each person distills his or her interview material twice. The first cut extracts key ideas of fairly immediate applicability to the hospital. Then each person makes a great ideas sheet of must-dos and especially artful solutions. The 'creativity is phenomenal' as team members debrief their process improvement groups, Keeley says. (See the diagram of Keeley's benchmarking model, p. 62.)
With current budgetary constraints, site visits are more the exception than the rule, she notes. At VHA, they only happen when benchmark partners are within a day's drive, round trip. When you have such an opportunity, she suggests, prepare your questions, grab one person from your QI project team, and make the drive.
Benchmarking outside of health care
External benchmarking may be your shortest route to recognizing and correcting customer service flaws or waste in your home territory. To find partners, look for industries using functions similar to your own, advises Mike Ricard, senior staff assistant at General Motors North American Operations in Warren, MI. Take billing, for example. 'There are similarities in billing processes in any business, but there are steps we build into it like extra handling procedures that do not further the goal of moving those bills out the door.'
Health care is a service industry, he explains, so when you look for benchmarks, search your own community for businesses you regard as 'world class' service providers and analyze their procedures. If you take a broad view, quality lessons are yours for the taking at grocery stores, auto dealerships, factories, or fast food restaurants.
Benchmarking data are lifeless unless you 'open up their ability to be useful,' says Jeffrey Woods, associate vice president of HCIA, an Englewood, CO-based health care consulting firm. To that end, Woods offers four suggestions for benchmarking clinical and operational processes:
1. Pick patients you can help the most.
Variability in patients' health status statistics are helpful because you can selectively improve care for the more routine, less complex patients. Begin by looking at the extremes of conditions, the most and least sick. Remove the extremes, such as those who died, as well as the outliers who have extreme utilization rates. Then use the middle and less-sick group as the targets of improvement efforts and benchmarking.
2. Walk in the shoes of your target audience so you can frame the data into useful packages.
For instance, for physicians your graphical presentations might include the average age of a patient population plus a separate display of the old-old, those ages 75 and older. Be sure to present comorbidities so your physicians have a context in which to study variations in resource consumption and resulting health outcomes.
When providing benchmarks to your doctors, be sure the figures reflect the ways they actually work. In the case of a physician group which shares the care of a certain patient population, assemble the numbers to reflect the work of the total group rather than only by individual doctors.
3. Use benchmarks to appeal to different target groups.
If the objective is to improve performance vis-a-vis another work team within your institution or system, then benchmark against their outcomes. If your sights are set on besting your competition down the road, benchmark them. If you intend to achieve a clinical ideal for control of surgical wound infection, then benchmark the best practice guidelines.
4. Stress the change you want instead of the measurements you'll use.
'Ask yourself or your team what your desired outcomes are then track the structure or process measures that likely make a difference,' Wood explains. Orient your benchmarking toward something you can really change. What you choose will dictate which benchmarking partner can deliver it for you.'
[For further information on benchmarking, contact Rosemary Keeley, Director, Improvement Services, VHA Central Atlantic. Telephone: (704) 378-2444. E-mail: rkeeley@vha.com. Mike Ricard, Senior Staff Assistant, General Motors North American Operations. Telephone: (810) 986-6738. Jeffrey Woods, HCIA, 6300 S. Syracuse Way, Suite 630, Englewood, CO 80111. Telephone: (303) 714-9674.
For background and other resources, contact: American Productivity and Quality Center (APQC), 123 N. Post Oak Lane, Suite 300, Houston, TX 77024. Telephone: (800) 776-9676 or (713) 681-4020. World Wide Web: http://www.apqc.org.
For a guide to benchmarking, read Benchmarking: The search for industry best practices that lead to superior performance (Robert C. Camp, 1989, APQC Quality Press).]
