Benchmarking in ambulatory surgery

AORN Journal,  Oct, 2002  by Nancy A. Copp

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The health care system in the United States continues to consume more of the gross national product. (1) This poses a problem for health care organizations, which are pressured constantly to decrease spending. In an effort to find the most efficient, high quality, low expenditure processes, health care organizations are borrowing techniques from the business world. One quality improvement technique that has been employed is benchmarking.

Benchmarking originated in nonhealth care industries and has been defined as "the process of regularly comparing oneself to others performing similar activities so as to continuously improve." (2) Benchmarking was recognized and first practiced at the Xerox Corp, Rochester, NY, less than 20 years ago. (3) Since then, the concept has spread rapidly throughout business organizations because "it works." (4) Benchmarking is both general and flexible, so it is adaptable to numerous situations. Xerox defines benchmarking as "finding and implementing the best practice." (5)

Benchmarking requires that existing processes in an organization be analyzed and understood before they are compared with processes outside the organization. (6) According to some authors, when applying the principles of benchmarking to the health care industry, the following elements are key.

* Focus on core products, services, or processes. It is important to focus on processes that will have a large impact on the organization so cost savings from the new process will outweigh costs incurred from creating the benchmark.

* Adopt the attitude of a learner. Learning from others is basic to the benchmarking process. The capacity for learning can accelerate or retard benchmarking effectiveness.

* Adapt best practices to fit an organization. Part of every benchmarking project must be determining how to apply what has been discovered. Using quality improvement teams within the organization offers the potential for breakthrough improvements. It is a way to learn and practice the discipline and achieve uniform results.

* Improve patient care practices. The fundamental purpose for health care benchmarking is improving patient care practices.

* Focus on producing healthier communities. Health care organizations should benchmark the process of delivering care to make people healthier. (7)

These five principles can be combined to create a definition for health care benchmarking as a continual and collaborative discipline, which involves measuring and comparing results of key processes with the best performers and adapting the best practices to achieve breakthrough process improvements in support of healthier communities. (8)

Understanding benchmarking in this way implies that collaboration, not competition, is a more effective way to improve practices and outcomes on behalf of those served. The use of benchmarking in this manner serves the common good of the health care industry and local communities and helps individual health care organizations thrive.

BENCHMARKING IN HEALTH CARE

Benchmarking has been used by organizations to make improvements in many processes, including those concerning worker's compensation, fulltime equivalent costs, acuity staffing ratios, billing, payroll, purchasing and delivery of clinical supplies, average surgery cost, average length of stay, and medical records. Administrative processes generally are less complex and traditionally have been more attractive candidates for benchmarking. (9) Clinical benchmarking projects must be controlled carefully, using matched subjects to achieve credible results.

The effect that benchmarking has had on nursing and the health care industry is similar to those of any quality improvement technique. As new techniques and processes are identified, nursing practice and the health care industry improve.

BENCHMARKING PHASES

The benchmarking process comprises 11 steps that are divided into four phases (Table 1). The steps begin with identifying the area for improvement and end with monitoring whether the desired improvement was achieved.

The first of the four phases is the planning phase. Benchmarking requires an investment of time and resources, so it needs to yield a return. Select a subject to benchmark. To select indicators to measure, determine which are the most important. For example, the choice might include turnover time, physician preference cards, or patient satisfaction surveys. One useful test is to ask whether the data collected can be used to solve a problem or achieve a specific result. If the answer is no, then the data need not be collected.

The second phase is the analysis phase. To actually collect the data, the benchmarking team will need a methodology to fit its particular needs. Much of the necessary data already may be available in a useable format generated from medical records. If so, the quality improvement team may discover differences when comparing data. These differences can project future performance.

The integration phase is the third phase. The team communicates results of the findings to staff members, determines what changes could and should be made, and establishes functional goals.