Be careful when judging performance on tight data
Take a broader view using cost, speed and quality
Is your unit performing as well as the best hospital in your market? Are you using your nurses efficiently?
The answers aren’t likely to emerge from any one source in your hospital’s database. More likely, you’ll have to look at a broader picture of performance to make any valid assessments of your achievements, advises consultant Sharon A. Lau, a principal with the Los Angeles office of Medical Management Planning, a benchmarking research firm based in Bainbridge Island, WA.
Administrators often mistakenly base their accomplishments on a narrow set of parameters. Basing performance on cost alone, for example, actually tells you very little about your unit’s performance, Lau observes. "Your unit may be a truly low-cost provider, but it could be setting records on poor patient outcomes or clinical inefficiency," she adds.
Benchmarking yields clues about others
More importantly, these falsely interpreted measures can lead to distortions in weighing a hospital’s future strategic planning. "If you’re really doing that great, stop and look at all your parameters. You may get a sharply different view," Lau advises.
Optimally, performance should be gauged on a combination of three variables:
• Cost, which is determined by how many nurse hours worked or expenses incurred per patient day.
• Speed, as in the time elapsed when a nurse orders a prescribed medication and when it’s delivered.
• Quality, including patient outcomes and satisfaction measures.
And, don’t be afraid to compare yourself to your competitors on these performance factors, especially the best ones nationally or locally, she says. In fact, it’s advisable to emulate the best performing facilities. "It isn’t illegal to steal ideas that work. It actually raises the bar for everyone else," Lau adds.
Benchmarking, if used correctly, has become a valuable tool for comparison. For example, a recent quarterly report on nurse productivity among neonatal ICUs conducted by Medical Management Planning shows that among children’s hospitals nationwide, the median number of hours that nurses worked per patient day stood at 14.51.
The total number of patient days reported by the median hospital stood at 490. (See graph, left.) The worst performing hospital among the 15 surveyed reported 27.6 hours over 90 patient days. The best-performing facility posted 9.51 hours and a total of 1,411 days. If you shoot for the median level on nurse hours you wouldn’t be wrong, consultant Lau says.
While the information is revealing by itself, unfortunately, it presents only a partial picture of overall performance, Lau says. "The data tell you a lot about cost, but nothing about the positive effect of nurses on their patients or their outcomes."
Hospitals that want to participate in a performance benchmarking survey can contact Lau at Medical Management Planning, 2049 Balmer Drive, Los Angeles, CA 90039. Telephone: (323) 644-0056. E-mail: [email protected].
[Editor’s note: In the April issue, Critical Care Management will devote a more expanded report to benchmarking for managers.]
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