Benchmarking can boost efficiency, improve outcomes for your ICU
Compare yourself to someone who is doing something better than you are’
The clinical data stored in your department’s information system are priceless. The numbers paint a picture of your ICU’s performance that no amount of guesswork or speculation can replace. Best of all, the data can be used to set benchmarks in key performance areas such as cost per discharge or patient satisfaction that can help boost efficiency and achieve better clinical outcomes, according to proponents of hospital benchmarking.
The challenge, however, lies in getting other hospitals to share their numbers with you for comparison. Another potential problem involves determining which set of data is suitable for comparison and which numbers are not. Will you be comparing apples with oranges?
Consultant Sharon A. Lau says clinicians shouldn’t be too concerned about these differences.
"In fact, you want to compare yourself to someone who is different and doing something better than you are. You can learn from them," says Lau, a principal with the Los Angeles office of Medical Management Planning, a benchmarking research firm in Bainbridge Island, WA.
A number of resources now exist to help clinicians make intelligent calculations about their performance. The growing interest in health care benchmarking in recent years has led to a wealth of data. Government agencies, medical societies, accounting firms, and many trade organizations have begun to collect data for comparison. The Internet can also help you find many sources as well.
However, you may have to perform a wide-scale search because much of the information pertinent to critical care or other hospital specialties is fragmented or presented in aggregate statistics. Many agencies and benchmarking information sources don’t keep large amounts of critical care-only performance data.
"The field is still largely in its infancy stages. There are data out there, and the availability is improving," says Mary E. Kingston, RN, MN, director of The Best Practice Network, a benchmarking resource formed by a partnership of 30 health care organizations. The American Association of Critical Care Nurses in Aliso Viejo, CA, and the Society of Critical Care Medicine in Anaheim, CA, are members.
But retrieving the data, even selectively and after some searching, can yield enough information for a reasonable benchmarking study of your ICU. And you can use as much of it as you like in an "adopt or adapt" fashion that allows you to use a broad set of indicators or use the information piecemeal, says Lau. (See box on benchmarking resources, p. 39.)
In critical care medicine, key indicators in benchmarking are known to most nurse managers. They include measures of nurse hours worked per patient days and time to medication. They also can include cost per admission and discharge, in-hospital infection rates, readmission rates, and adverse drug events.
The goal is to select indicators that will reveal your performance gaps, Kingston says.
The same national interest in pursuing health care benchmarking also has spawned a number of claims about what in fact benchmarking can and should do. Unfortunately, it hasn’t motivated hospitals to view the discipline as mutually beneficial or encouraged them to share their performance information with each other, says Lau.
Hospitals should view the effort as an opportunity that eventually benefits all hospitals, she adds. Benchmarking is a quality tool that can be used to set targets to shoot for, which can guide you to where you want to be, Kingston says. The effort should lead to the development of best practices that ultimately benefit patients.
If you determine what makes the best hospitals work in a given clinical area and borrow from them, your own hospital can benefit from the knowledge transfer.
Much of the process is data-driven, and there has to be a willingness by ICUs to share their data. But hospitals guard much of their information for competitive reasons. A paradox inherent in hospital benchmarking reveals that institutions most likely to share their data amicably are the ones seemingly least threatened by the potential competition posed by the other facility. Yet one of the purposes for benchmarking has been to help hospitals become more competitive with each other.
Children’s hospitals are an exception, according to Lau. The National Association of Children’s Hospitals and Related Institutions (NACHRI) in Alexandria, VA, collects data from about half of its 151 member institutions and shares the information with members.
The group charges members a fee to meet research costs, but the information covers a gamut of useful performance indicators, including average daily census, average worked hours and paid hours per patient day, and several patient-severity indicators such as morbidity and mortality data.
The indicators are presented in a unit-by-unit comparison, and are available in five reports comprising:
1. An executive-level graphical report.
2. A management-level tabular report.
3. A hospitalwide performance overview.
4. A comprehensive report that covers additional indicators such as staff education and unit leadership activities.
5. An overall hospital comparison by specific criteria such as types of patients, level of computerization, trauma center, or nurse labor organizing.
Participants use special software to download the reports. They can obtain the data in a form to compare themselves to a group of hospitals or to only one facility. The identities of the hospitals are not kept secret, says Greg Frongello, NACHRI’s director of applied consulting services, however, member hospitals have to sign a disclosure agreement not to identify the hospitals.
The association also sponsors 10 focus groups in specific areas such as emergency medicine, radiology, and critical care. The groups, consisting of some 400 individuals and 56 member facilities, meet quarterly to cover new issues, set best practice standards, and review benchmarking criteria.
Children’s hospitals are in a position to share their performance data more openly partly because they belong to a tightly knit community of specialty facilities, Frongello says. "Many of the critical care practitioners train with each other. There’s a great sense of camaraderie and mutual interest in children’s medicine," Frongello adds.
Adult hospitals should emulate these values, adds Lau. Yet, once you begin to benchmark remember that it’s an ongoing process without necessarily short-term expectations.
"It’s a kind of quest," remarks Kingston. The discipline is relatively new, and the values deemed the best by some benchmarking standards are changing quite rapidly.
Clinicians need to be discriminating in the way they view even the best benchmarking data. "There’s a lot of benchmarking out there that doesn’t actually reflect the best we can do. A lot of it just isn’t good enough. I wouldn’t be satisfied with it," Kingston concludes.
(Editor’s note: Next month’s issue of Critical Care Management will feature a report on an Institution for Healthcare Improvement survey tracking cost and quality outcomes in critical care.)
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