Benchmarking method relies on data snapshots
Reports cover performance measures
Here’s an operating room (OR) benchmarking method that takes a real-time data "snapshot" of your process and compares it with concurrent data from similar facilities.
The methodology designed by OR Benchmarks of Santa Fe, NM, differs from those based on patient records or other hospital reports. All data used by OR Benchmarks come from the participants who register to benchmark selections from a list of surgical procedures. "Usually they are high-cost procedures and those with high variability," explains Judy Dahle, RN, MS, director of OR Benchmarks.
One participant in the cataract extraction group is McKay-Dee Hospital Center in Ogden, UT. McKay-Dee uses OR Benchmarks to provide hospital staff and physicians a common ground on which to set continuous improvement goals. "Primarily, physicians are scientists. When you give them data to react to, it’s better than when someone says Do this,’" says Suzanne Richins, RN, MBA, FACHE, director of patient care at McKay-Dee.
Reports cover performance measures based on the current analyses as well as comparative data collected by OR Benchmarks since its inception in 1996. For instance, total supply costs for cataract extraction have declined steadily, but they still show significant variation.
In 1999, the median cost was $367. However, the range was $199 to $578, a variation of 76%.
The procedure list for each year’s benchmarking is based on client requests. This year, for example, the 16 items include total hip replacement, carpal tunnel, breast biopsy, and colonoscopy.
To register, clients choose the procedures they wish to benchmark. They receive data collection worksheets and instructions, including a time frame in which to complete their data. OR Benchmarks requires a minimum of five sheets, or five cases involving each procedure. The company’s OR-trained nurses conduct validation reviews, calling the participants to resolve omissions or apparent inaccuracies. "If a certain piece of equipment is used, for example, we want to know which soft goods [i.e., towels or pads] went with it," says Dahle. OR Benchmarks analyzes the data with specially designed software.
A nagging concern about performance reports is the grouping of sources to adjust for facility size and other variables. OR Benchmarks addresses it in these ways:
• Peer groupings. Participants are categorized by type — ambulatory and inpatient, teaching and nonteaching, not-for-profit and for-profit, five OR rooms and 10 OR rooms, and so forth.
• Real-time data collection. While it sounds cumbersome to record supplies, turnaround time, or staffing ratios during surgical procedures, Richins describes it as relatively painless. McKay-Dee, like many facilities, has computer software to routinely collect such data for each patient.
In this respect, however, McKay-Dee might differ from other hospitals — the clerical assistant for the surgical suite manages the data collection. "Clinicians could make errors clerically, and they would resist doing data collection, anyway," states Richins. "Our clerical assistant is knowledgeable and very accurate. She consults the nurses on clinical points." As a result, the department turns out exceptionally accurate information for surgical billing as well as benchmarking. And staff say they like that method because it uses their time and skills to best advantage.
• Multiple-use reports. Once a year, OR Benchmarks compiles an operational benchmarking report on salary ranges of management and nonmanagement staff as well as 18 data segments representing the operation of an entire surgical service. The reports are displayed in comparison charts for individual peer groups.
• Recognition of excellence. The designations "best performer" and "better performer" go to participants showing the strongest results on each criteria in their peer comparisons. As a best performer in cataract extraction, McKay-Dee Hospital has used the OR Benchmarks method since the company opened for business.
McKay-Dee Hospital is a 350-bed nonteaching, not-for-profit inpatient/outpatient facility with 10 ORs. Its managed care penetration is 23%. It is one of 23 hospitals that comprise the Intermountain Healthcare System based in Salt Lake City. "We’ve been doing QI forever," says Richins. "We always thought we did well, but when OR Benchmarks came along, we saw the opportunity to substantiate our improvements and to learn more."
The benchmarking experience helped to strengthen collaboration with the community-based physicians who practice at the hospital, she says. "It’s easier to change behavior with data than by other means. We have always believed in partnerships instead of adversarial relationships with our physicians. When you get a few of your physicians excited about making changes, then you can count on them to put peer pressure on the rest."
The OR Benchmarks reports also stimulate the push for additional improvement. For example, the orthopedic surgeons tend to use a lot of drapes for infection control, Richins says. "But when we showed them data from other hospitals with lower rates of drape use, our surgeons said, All right, show us information about their infection rates for the same procedures.’" She cites exposure to other health care organizations as an important benefit from benchmarking. "As health care providers, we have to network to improve our service."
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