Benchmarking data may underestimate ED staffing needs, study reveals

Hospital administrators at academic medical centers are increasingly relying on benchmarking data from outside organizations such as Mecon, part of the University Health System Consortium, to determine staffing needs in the ED, but some administrators are concluding that such comparative data can be misleading.

"We use the Mecon benchmarking data fairly extensively at our hospital to look at staffing productivity," says Peter Kendall, senior assistant hospital director at Medical College of Georgia in Augusta. "As we submit data to that company on an annual basis, we then can compare our performance with other hospitals in the system."

However, continues Kendall, the data must be interpreted carefully to avoid false conclusions. "We have to determine whether we’re comparing apples to apples. Where we’re not, we take note of what the differences are and factor that in," acknowledges Kendall.

Administrators frequently use the data to make decisions about cutting staff. "We look at that information very closely every year when it comes out and use it to set targets for staffing and productivity in all departments," Kendall explains. "We’re trying to get to the 25th percentile, both as the hospital and as individual departments. In the ED, if we look at data that says that percentile is using 2.1 hours per patient visit, we see what we can do to achieve that."

When members of the Benchmarking Alliance Group, a collaboration of Midwest ED leaders, became concerned that many hospital administrators were cutting staff to the point that ED personnel were unable to care for patients, they embarked on a study of the benchmarking data from Mecon, International Healthcare Consulting Group, and the Center for Healthcare Industry Performance Studies—the sites that administrators got the data they frequently used to justify such decisions. (To learn more about the Benchmarking Alliance Group, see the July 1996 issue of ED Management.)

"We were being told by the administrators how we should be staffing the department, and we weren’t sure where their data was coming from. When we went to look at the companies providing that data, we had some serious questions about the methodologies used," says John McClay, MS, MD, director of medical informatics at Emergency Physicians Medical Group in Ann Arbor, Michigan.

Using comparative benchmarks to set staffing goals has become standard practice for administrators, says McClay. "Ceilings for FTEs or cutting staff by 10% in a given year come from the hospital administration without a close look at how it fits their own situation, and that’s a concern," he says.

The benchmarking data appears to offer administrators a way to cut costs while maintaining quality—an offer that’s often too attractive to pass up, says Bruce Janiak, MD, FACEP, medical director of the ED at Toledo Hospital. "They’re looking for ways to cut the fat, so when they see an ad in the paper that says call me, I’m XYZ benchmarking company and we’ll show you how you can trim 25% of your staff so you can meet the financial benchmark, they hire the consultants," he explains.