Compare and Contrast

Ask any business executive and they’ll tell you that one thing they want information on (next to their bottom lines) is how their company stacks up against the competition. Benchmarking is a means to achieve this; a measuring stick that businesses, including outpatient surgery centers, can use to determine where they stand.

So we asked Jennifer Green, RHIT, CMSC, vice president of network development at Surgical Outcomes Information Exchange, based in Richmond, Va., to discuss with us some of the ins and outs of benchmarking.

How does a facility conduct a benchmarking study?

Benchmarking can be done through a variety of means. Using a performance measurement system and by doing literature searches for the aspect of care they want to benchmark; by participating in studies offered by professional organizations or by canvassing colleagues in the field or other facilities in your area or corporate complex.

How can a facility benefit from going to a commercial benchmarking company, instead of using already published resources?

A commercial company has a reputation to uphold; after all, this is their business. If they don’t do a good job, they won’t be in business very long. A commercial company may be able to do most, if not all, of the data analysis, saving the facility precious time that they need to take care of their patients. A commercial company should provide uniform definitions and be able to assure “apples-to-apples” comparisons. With published resources, you may not know how they arrived at their “benchmark” or you may not be able to perform your study in exactly the same way. Remember, a benchmark is a standard by which you are going to compare your own measurement. It’s like using different rulers to measure the same thing – if you make your measurement in centimeters and I make mine in inches, we’re not comparing ‘apples-to-apples.’ You can’t always be sure of this when you have not actually “participated” in the establishment of the benchmark.

Finally, a commercial company should be able to offer benchmarks that are based on ‘national’ data. When you compare yourself to national data, you can find out how things are being done in other parts of the country. Is there a better way that has not been introduced to your area?

Typically what is the timeline for the study?

There is no exact timeline and it will depend on how large your database needs to be for what you’re studying. In other words, you’ll need enough cases to reflect meaningful statistics. A study can last indefinitely, or only a few days depending on what you’re studying.

For something like an infection rate, you could evaluate the rate each month, but you’d also want to keep a running total in order to know your overall average over the course of this year so that you can tell if the rate spikes during certain months. This kind of measurement is usually ongoing and never stops.

The bottom line is, you need to plan your study before jumping in. Know what you’re trying to measure – what do you want to learn from the measurement; what is the goal of the study? Then determine what volume you need and how long it will take you to reach that goal.  For a very large facility, a sample of 10 percent of their cases for one month might be sufficient, while for a very small facility, they may need to look at 100 percent of their cases for three years before they have enough data to make a definitive conclusion about the results.

What are the indicators used?

Again, it depends on what you’re measuring. The indicator should clearly state what you hope to learn. For example, if you’re looking at infection rates, do you want to separate ‘deep’ infections from superficial wound infections?  If you do a lot of procedures involving implants, your indicator might be the rate of deep wound infections reported within six months of the procedure. In a nutshell, the indicator can be just about anything, from ‘the percent of red cars that pass through xyz intersection every hour’ to ‘the percent of patients who complain of post-op pain following GI endoscopy.’

What is the action plan you recommend after acquiring an external benchmarking study?

That would be entirely dependent upon how your study results compared to the benchmarking study results. Your study might end up showing a result that is better than the benchmark, in which case, no action would be needed. On the other hand, if you know that you’re comparing likes to likes and your results are worse than the benchmark, then you would probably want to take action to improve your results. For example, if your recovery time in knee arthroscopy was 120 minutes, but the benchmark was 60 minutes, then you’d probably want to find out why your recovery time is twice as long as the benchmark and take necessary action to reduce and improve your recovery time. This is why it’s so important to be sure you’re comparing likes to likes. You’ve got to make sure you can hold yourself up to a given benchmark before you can determine whether or not you need to make a change.

How long does it take to show ROI after contracting a benchmarking study? In a tight economy, what is the strongest argument to move forward on one?

When you benchmark and compare yourself to certain standards or goals, you gain information that you didn’t have yesterday. The information may reassure you that you are as good as you thought you were, or it may point out that you’re as good as you thought. The point is, you know something today that you didn’t know yesterday, and it’s hard to put a dollar figure on knowledge. The cost factor in all of this is sometimes hard to measure, but everyone agrees that improvements in performance almost always equate to increased revenue, OR increased savings. Either way, conscientious benchmarking efforts always pay off and those who think otherwise are probably going about it the wrong way.

As far as ROI, it can be immediate, or it can be slow in coming, depending on the study itself. And, it depends a great deal on how you benchmark – if you are not comparing apples-to-apples, your return is going to be very small, if any. But if you know you’re measuring the same thing everyone else is measuring, and you’re measuring it in the same way, then the ROI can be quite significant, whether you find out you are better than you expected, or need to make some improvements.

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