Comparative data lay foundation for benchmarking
(Editor’s note: This is the first in a three-part series on the Catholic Health Association’s (CHA) performance improvement program, "Living Our Promises, Acting on Faith." This article will deal with the comparative data process, the first step in a 3½ year journey. The second article will describe the organization’s benchmarking study, while the third will address implementation.)
It seemed a fairly straightforward assignment at first: strengthening the identity of Catholic health care. But as the process improvement team at the St. Louis-based CHA soon would find out, "It ended up consuming much more time and energy than we had expected," says the Rev. Michael Place, STD, president and CEO of CHA.
CHA, founded in 1915, represents more than 2,000 Catholic health care sponsors, systems, facilities, and related organizations.
"In February of 1998, the board began a discussion about a new strategic plan," Place recalls. This plan was to include setting as a strategic direction for the CHA to "strengthen our ability to understand, articulate, and act on Catholic identity," as set forth in the organization’s 2000 publication, Year One: Baseline Date and Observations.
"In discussing how we might do that, we observed that Catholic health care had become sophisticated in utilizing benchmarking processes to measure performance in clinical areas and in financial areas, and that those efforts have contributed to a continuous quality improvement environment," Place explains.
"So, we opined, could there not be a way for us to take the learnings from the work in the clinical and operational areas and apply them to our qualitative commitments, which are reflected in one way in the ethical and religious directive that the bishops of the United States have directed as a resource to Catholic health care?" he asks. "In other words, could we not explore using that resource as a baseline to develop a process for benchmarking our qualitative performance?"
Laying the foundation
The initial process was one of having to learn a great deal about benchmarking. "The areas in which we worked had not been primarily identified with clinical or operations, but with the Catholic dimension — that which distinguishes us," Place adds.
Nevertheless, he notes, "We did have the expertise available to us." In terms of primary staff, there were three members of the leadership team, which worked with several different member committees as the process evolved.
The project had three overriding objectives:
- Convert descriptions of Catholic identity into measurable and accountable outcomes.
- Identify successful practices as hallmarks of the health care ministry of the Roman Catholic Church.
- Provide measures for ongoing performance improvement.
Before it could define the measurement system to be used, the task force identified what it called "The Constitutive Elements of Catholic Identity":
- 1. Promote and defend human dignity.
- 2. Attend to the whole person.
- 3. Care for poor and vulnerable people.
- 4. Promote the common good.
- 5. Act on behalf of justice.
- 6. Steward resources.
- 7. Act in communion with the church.
Since the task force decided to concentrate initially on acute-care facilities, the measurement system was based on organizational behaviors and realities within an acute-care facility. The data collection tool ultimately was organized around five current critical issues:
Organizational Culture:
- patients’ perception of respectful treatment;
- employees’ perception of respect among co-workers;
- employees’ satisfaction with involvement in decision making.
Holistic Care:
- certification of pastoral care staff;
- patients’ satisfaction with pastoral care services;
- pastoral care visits in the inpatient setting.
Care for Poor and Vulnerable People:
- unreimbursed charity care as a percentage of operating expenses;
- tax benefit as a percentage of increase in unrestricted net assets;
- fiscal stewardship: earnings as a percentage of total income;
- fiscal stewardship: long-term debt to capitalization;
- socially responsible investing.
Care of the Dying:
- family care conferences for dying patients;
- support services for dying patients;
- effectiveness of pain management;
- patient/family satisfaction with pain management.
Relationship to the Church:
- meetings with diocesan bishop or liaison;
- updating diocesan bishop or liaison on activities and issues;
- employee education on the (ethical and religious) directives;
- physician education on the directives.
For each of the five key issues, the measurement tool included measures of organizational performance as well as corresponding characteristics. For example, one measure for organizational culture was the percent of employees indicating that they experienced mutual respect among co-workers. Among the characteristics included in the tool were: "The facility offers an employee assistance program," and "Criteria for granting physician privileges include respect for employees and caregivers."
The tool was pilot-tested in 32 acute care facilities, and a total of 239 ultimately participated. The data were submitted via CHA’s web site and collected during January and February 2000.
Based on the comparative database of organizational performance, the next phase began with the selection of a performance improvement topic based on input from CHA-member organizations. Despite the fact that more time and effort were involved than had been anticipated, "We ended up feeling it was well worth the time and energy," Place concludes.
Need More Information?For more information, contact:
- Michael Place, STD, President and CEO, The Catholic Health Association of the United States, 4455 Woodson Road, St. Louis, MO 63134-3797. Telephone: (314) 427-2500. Fax: (314) 427-0029. Web site: www.chausa.org.
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