Integrate benchmarking with your PI efforts for long-term success
Integrate benchmarking with your PI efforts for long-term success
Seamlessness keeps initiatives alive and vibrant, aiding compliance
Like many performance improvement activities, benchmarking has its own nomenclature, its own tools — and, in a way, even its own culture. But focusing on those differences, rather than on making benchmarking an integral part of your ongoing performance improvement program, can doom your efforts to early failure.
"Management is always looking for the next silver bullet or panacea, never realizing there are none," says Robert G. Gift, president of Systems Management Associates Inc. in Omaha, NE.
"What I mean is, you should pick a set of tools that is appropriate for what you are trying to address and keep at it. This requires diligence, and that’s in short supply because everyone wants a quick fix," he adds.
"It’s like anything else; if benchmarking is not an integral part of the performance improvement plan in your hospital, there are only so many flavors of the month’ you can handle at one time, so many plates you can have in the air," explains Sharon Lau, a consultant with Los Angeles-based Medical Management Planning (MMP).
"There’s only so much one manager can do. If it’s like living and breathing — I do PI regularly, and benchmarking is just one tool — it’s easier," she says.
"I think the problem for many people is if they treat the benchmarking effort as one of those books that come in periodically, they lose interest," notes Kevin Hammeran, CAO, James Whitcombe Riley Children’s Hospital for Children, in Indianapolis. "They just look at it when it arrives, but they never really make full use of the data."
The knowledge triangle
Lau refers to a structure called the knowledge triangle to outline the keys to successful integration and ongoing success for benchmarking. The three points of the triangle are tools, structure, and accountability. (See illustration below.)
Speaking of the tools, Lau explains, "The organization has to have an established way to use data, to summarize and interpret data; and everyone in the hospital needs to know how to use the charts of performance improvement.
"They need to be trained so that they will have familiarity with those tools — this is what I look for in a Pareto chart; this is what a bar chart looks like, and so on," she adds.
When it comes to structure, it’s important to have an organizational culture that promotes change and facilitates decision making, Lau notes.
"If you have this benchmarking data you see every month and you’re excited about it, but your organization is not letting you do anything about it, that’s a killer," she says. "The organization has to support you acting upon it."
Being well-trained is not enough, according to Lau; you also must be held accountable. "The squeaky wheel gets the oil, so if no one holds me accountable, I might do other things.
"Have regular meetings of the performance improvement council where managers come and present their data, tell how they’re using them, and how they’ve improved performance; that’s going to keep your benchmark efforts going," she suggests.
Gift agrees. "I really encourage organizations to put some kind of management accountability on whatever they are trying to achieve," he says. "It’s really a matter of putting it in the performance evaluation; if you find a way to link it to people so it becomes important to them, they’ll do it."
Following the knowledge triangle, Lau asserts, should form the basis of your efforts to either keep your benchmarking program vital, or to go back and revitalize a dormant program.
Maintaining momentum
Building upon similar principals, Hammeran says that one of the keys to maintaining your program’s momentum is to make it real.
"Figure out how to take the information contained in your reports and operationalize it — build it into the basic system you use for building and maintaining organizational performance," he advises.
For example, he suggests, don’t look at your data in a vacuum, but relate them to overall performance. "Your ED may have the best results in terms of worked hours per visit — say, the fewest hours per visit in the nation. [That may seem positive, but] if you tie that to your own patient satisfaction score, there should be an inverse correlation, or at least a point where satisfaction rates reach their peak," he observes.
"So, if you have the most efficient hospital, you probably also have the highest number of walkaways and the lowest satisfaction rates."
The goal, in this case, is to identify the point to which those hours might be raised and patients are satisfied, before satisfaction rises again as patients notice that "there are a lot of people sitting around doing nothing. The trick is to find that point where everything is maximized," says Hammeran.
"This is also how you make data come alive in conversations with doctors; it gives you a vehicle for discussion you might not have otherwise," he points out. Your data also should create opportunities to interact with your peers at other institutions, he says.
"Some years ago we looked at our data and our cost per adjusted patient day was pretty high, which did not make sense," he recalls. "I picked up the phone and called some of our peers who seemed to be doing better."
Revitalize benchmarking efforts
In some cases, the difference turned out to be a function of how the data were reported, but some other facilities were simply doing a better job. "One facility was handling registration at the bedside; I had never thought about putting a laptop on the cart," Hammeran notes.
When this type of interaction is translated to the departmental level, he adds, "The value is they will have contact with their peers."
"If people are looking to revitalize their efforts at benchmarking and are truly committed, what I try to encourage them to think about or do is to look for a different set of data or a different topic," adds Gift.
"For example, if the organization is always benchmarking their cost position and using the same data, what I encourage them to do is maybe look at the criteria from the top 100 hospitals or some other criteria. After beating on costs for a given period of time, it gets pretty old and people get bored with it," he says.
That doesn’t mean you forget about costs, however. "It’s the same as offense and defense in football," Gift explains. "Offense is more glitzy, but if you look at the history of the Super Bowl, nine out of 10 times, the top defensive team wins. So if you’re going to sustain performance, you need to look at costs."
When it comes to maintaining your momentum, never forget the all-important role of leadership. "Having a champion is critical — first and foremost — and it has to be executive leadership," notes Tammy Gray, CPHQ, bench coordinator for Children’s Memorial Hospital in Chicago.
"Our program lost its luster; the original champion of the project was our CEO, who then retired. Somehow, the whole thing lost its way," she says.
Gift says when projects lose their momentum, "Part of it has to do with leadership’s inability to sustain any kind of initiative."
Creativity a plus
Creative initiatives also can help your program retain its vibrancy, Lau says. "Everything needs to be revived and revised every once in awhile," she asserts.
Lau recalls two particularly creative programs she instituted when she was a manager at a hospital. "I supervised material management, so I had supply and laundry [nonclinical] people on the staff," she says.
"Every Wednesday we would have Matman’ [material management] education, where someone from another department, like nursing or the pharmacy, would talk about what they do. So later on, when a nurse said she needed something stat, the staff knew why," Lau adds.
Once a year, during Matman Week, Lau would organize a Matman Olympics. "I’d come running down the hall holding a flashlight aloft to open the ceremonies," she says.
Some of the events included "mail sort and toss" and "sterile wrap and pack," in which the hospital had VPs compete. "Again, this created structure of learning about the value of data — we benchmarked against how we did the year before," she says. "Everyone participated, and we publicized the results, but we also gave people a lot of tools."
Another way tools and results were shared, she says, was the annual benchmarking fair, where different departments set up booths and told fellow staff members what they were doing in terms of benchmarking.
Gray basically was handed a clean slate when she took over the program at Children’s Memorial in 1997.
"At that time, essentially no one was handing in any data," she recalls. Her hospital had been given an ultimatum by the other members of the BENCHmarking Effort for Networking Children’s Hospitals (BENCH), a project of MMP, that if it did not submit any data, it could not get any data from the other members of the group.
Data collection
"We had to structure ways in which the stakeholders were reminded [to submit data] and provide tools to collect the data in a timely manner," says Gray.
"E-mail was a good vehicle, but we also sent them hard-copy reminders with very colorful cover sheets that had the stakeholder’s name and what they were responsible for, as well as due dates," she adds.
Two other events proved to be turning points. A new chief nurse executive came on board three years ago from one of the other member hospitals of the MMP benchmarking group — one with a record of very good compliance. "We didn’t really have a senior leader embracing the project at that time, and we formed a really good bond," Gray says.
Then, about one year ago, a steering committee was formed, representing all the stakeholder leaders — emergency department, infection control, all critical care areas — finance, and the pharmacy. "We knew we had to do some inter-rater reliability activities to make sure we were collecting data in the way they were intended to be collected," says Gray.
"Together we assessed our data sources and talked about how we were using the data," she continues. "That’s the other key piece; if you collect data, but you don’t talk about how you’re going to use them, then it’s pointless."
Gray must be doing something right. "My first year here we were about 66% compliant [with BENCH’s requirements]; now, we’re in the 90s," she reports.
Finally, Gift says, it’s essential that you have a good idea of what you’re going to do with your data before you begin benchmarking.
"I always get concerned when someone calls me and says, We want to do benchmarking.’ What I want to know is, what are they trying to accomplish?" he asks.
Need More Information?
- Kevin Hammeran, CAO, James Whitcombe Riley Children’s Hospital, Indianapolis. Telephone: (317) 274-4093. E-mail: [email protected].
- Sharon Lau, Consultant, Medical Management Planning. 2049 Balmer Drive, Los Angeles, CA. Telephone: (323) 644-0056. E-mail: [email protected].
- Tammy Gray, CPHQ, Children’s Memorial Hospital, 2300 Children’s Plaza, #95, Chicago, IL 60614. Telephone: (773) 880-3081.
- Robert G. Gift, President, Systems Management Associates, Inc., 4410 S. 176th St., Omaha, NE 68135-3603. Telephone: (402) 894-1927. Fax: (402) 894-1962. E-mail: [email protected]. Web: www.systemsmgt.com.
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