Meaningful data: Ask the right questions at the right times
Do your managers know how to conduct a benchmarking interview?
Be careful what you ask for because you might get it. This adage originally may not have referred to benchmarking, but its wisdom still applies when it comes to identifying best practices among your peers, says Jim Burke, vice president of operations at Lehigh Valley Hospital and Health Network in Allentown, PA.
"First, you must ask questions to find out how your operation works down to the smallest detail, and secondly, you must ask the right questions to be able to compare it with the operation of the top performers," says Burke, who is overseeing a five-year initiative to reduce workforce expense by $12 million. In this effort, which already has eliminated $2.8 million from the 1998 fiscal year’s budget, departmental managers are responsible for critically examining their own operations and using comparative data to improve their unit’s performance by identifying best practices.
The keys, Burke says, are the questions managers ask themselves as well as those they ask their benchmarking peers. Without the answers as a solid foundation, managers may be tempted to blame poor comparisons on the differences between themselves and the benchmarking peer, rather than seek operational tactics that just might work in their own unit.
"It’s easy to ask questions [of your benchmarking peers] to defend your own status quo, but it’s harder to ask questions to determine exactly what improvements they made to achieve their performance," Burke says.
For example, departmental managers inexperienced in benchmarking may concentrate inadvertently on what Burke calls "counting questions."
"They may ask questions that solicit answers that show how the other facility differs from their own," he says. "They’ll say, Oh well, they didn’t count xyz and we do, so we won’t be able to identify best practices.’"
Eleanor Anderson-Miles agrees. "A rigid insistence on comparing apples to apples’ can mask the real opportunity for improvement, says the corporate communications director at MECON, a benchmarking firm in San Ramon, CA. "No two departments are 100% alike. And if you go into the benchmarking contact looking for only the differences, that is what you’ll find."
Start with yourself
But before you can know what to ask others about their operation, you have to rigorously review your own. "The most successful benchmarking processes begin with a significant amount of homework," says Anderson-Miles. She shares with Healthcare Benchmarks several questions managers should ask themselves and their staff:
• What are you doing?
• How are you doing it?
• What is your measure of how well you are doing it?
• Why are you looking for improvement?
To help managers answer those questions at Lehigh Valley, the benchmarking steering team created cost-gap analyses from MECON’s department comparison report, Burke says. The reports examine myriad operational performance and characteristics, such as staff configuration, workload intensity, and labor productivity ratios, that allow for department-to-department comparisons with other facilities in the MECON data base, Anderson-Miles explains.
Then the steering committee helped managers develop a benchmarking action plan that would enable them to formally document peer facility contacts, learn from them, and implement best practices.
Think like a journalist
To learn from your benchmarking partner, Anderson-Miles suggests using the same categories of questions from the departmental probing, plus two more:
• Have you made recent improvements?
• What are you planning to do during the ext year?
But unless you tailor these questions to your specific situation, you won’t be able to see all the pieces of the puzzle, Burke says.
For example, Callie McClatchy, MS, CCC/ SLP, Lehigh’s director of speech language pathology and audiology, says contacting her benchmarking peers was an exercise "in the art of the interview. I quickly learned that because everyone’s facility is different, you must ask very specific questions, not generic ones," she says. (See her list of questions, p. 171.)
McClatchy also faxed the detailed list of questions to her benchmarking contacts ahead of time, along with a formal request for a telephone interview. "I highly recommend this because it gives them time to gather information and collect their thoughts. Otherwise, you may catch them off guard and not get the answers you really need."
McClatchy’s goal was to find out what best performers were doing to maximize the time therapists actually spent in therapy. After eight to 10 interviews, she was able to identify two best practices that ultimately improved her department’s operational efficiency.
First, she saved on the speech pathologists’ labor by turning one pathology position into two speech assistants. "They can perform routine tasks while the complex cases go to the pathologists," she explains.
Second, she cross-trained both groups of pathologists and assistants to reduce downtime spent traveling between the system’s two facilities and build flexibility that buffered the department’s scheduling against the fluctuation of volume in acute care.
"Before, when a pediatric procedure was ordered at one facility, the pathologist who was trained in that procedure had to drive the four miles to get there," she says. "Now they all can cover any site." Four miles is not a great distance, she says, "but little things add up."
The devil is in the details
In the engineering department, managers also were benchmarking. "They were discussing the energy costs per square foot when the subject of reducing steam pressure came up," Burke says.
A subsequent reduction by slowly cutting back from 100 to 85 pounds per square inch of steam has saved about $300,000 and has not resulted in any negative consequences such as steam traps malfunctioning or steam condensing on sterile packs, says Doug Helfrich, senior management engineer.
"We had always used 100 pounds per square inch but had never asked if this was the right number," Burke adds.
Helfrich, who is on the benchmarking steering committee, stresses that such directed and focused questions help managers identify performance gaps. In the second year of the initiative, he plans to put more emphasis on the benchmarking interview by offering peer coaching "from those managers who had great success. These internal consultants’ will be trained so they can provide one-on-one training with the manager to develop questions that are more directed," he says.
"What you ultimately get is so dependent on how you ask the questions."
[Editor’s note: For more information, contact: Jim Burke, Lehigh Valley Hospital, P.O. Box 689, Allentown, PA 18105-1556. Telephone: (610) 402-0627.]
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