Small facility explores benchmarking options
Small facility explores benchmarking options
If this 24-bed hospital can do it, why can’t you?
Northfield (MN) Hospital is a 24-bed facility 25 miles and a world away from the nearest metropolitan area. But despite the size and location of her institution, Ann Reuters, quality coordinator, still manages to put her facility through its benchmarking paces.
Reuters says she measures high-volume DRGs as well as high-risk procedures and processes. "We want to know if we are providing care according to the current standard," she says. "Also, what in our organization generates occurrence reports? Are there trends in our risk management database that suggest a need to look for ways to improve a process so that we get better outcomes?"
As part of a health system, Northfield Hospital has some ready-made data-sharing partners, but she says that such cooperative ventures can be hampered by inconsistent definitions of measures. "There are efforts to organize and coordinate this at the corporate level, but consensus is hard to achieve, and the process has been slow."
Unlike many who find the various regulatory requirements of the Joint Commission on Accred-itation of Healthcare Organizations onerous, Reuters says the ORYX initiative gives her access to useful comparative data. "Although this process is also somewhat slow, I have hopes that as the system becomes more refined, the data will become more useful and real time,’" she says. "We currently contract with vendors to measure patient satisfaction, adverse outcomes, and LOS [length of stay] for CHF, mortality and LOS for pneumonia, and primary C-section rates."
Reuters also uses the state peer review organization for comparative data. There are statewide projects on disease management that she says are pertinent to Northfield’s patient population. "They coordinate projects by defining the measures, and analyzing and reporting the data. Reports typically include data comparisons with other facilities and with the statewide standard."
Small doesn’t mean incapable
Other sources of information come from medical literature and also from computer listservs that allow Reuters to connect with her peers in quality management. "They generate conversations, questions, and answers that give a good idea of how others are defining and measuring processes of care."
Although Northfield is a small, rural facility, Reuters doesn’t see that as an impediment to benchmarking. "It is difficult to find the resources, but I don’t believe our size has much to do with it. I believe, as health care budgets get tighter, even large facilities experience difficulty in finding resources for performance improvement. If you plan for performance improvement at the strategic level, resources are easier to come by."
That means wrapping quality and performance improvement into your overall strategic business plan, and keeping the board of directors updated on what is happening with resource utilization and your internal environment, as well as with the clinical aspects and the patient experience of care, Reuters adds. "Then as data show the need for improvement, those areas also make it to the table for consideration as possible strategic or organizational goals."
There are still obstacles that Reuters and her staff have to overcome. She says when projects are mandated by government or regulatory agencies, it’s harder to get acceptance from medical and administrative staff. "Although, if we are aware of new laws and standards, we try to plan for them at the strategic level, which usually creates some buy-in upfront."
Reuters has these tips for limiting objections to performance improvement projects:
1. Avoid projects that aren’t of interest to staff. "Give them the data around important and risky processes, help them analyze them, and let them decide which [projects] are a priority to work on," she says.
2. Use a rapid-cycle, problem-solving method, says Reuters. "Keep the goal small and focused and, as success is realized, leave it up to the team as to whether to quit there or keep building on it. This avoids life sentences to teams."
3. Avoid creating large teams. Reuters uses three to five people — as long as team members understand that it’s up to them to represent the whole organization. "To do this, they need to communicate frequently with their peers, bringing back fresh ideas and concerns to the team."
4. Use a facilitator to help establish measurable goals and keep focused on them, advises Reuter.
How well Reuters has been able to galvanize the whole organization is demonstrated by a recent project in the Northfield Hospital operating rooms. "We had some concerns about our turnover processes in the operating rooms," she says. "After hearing concerns about this from surgeons, we searched the literature to find out how to measure this process."
For three weeks, the team collected data and displayed it compared to what was in the literature. "Although our times were very comparable, it showed that the longest time frames were not during the cleanup and setup — nursing time — as many had thought, but rather after the patient entered the room until the incision was made — interdisciplinary time. This information created some ownership by all disciplines at the outset. Now, as we embark on our cycles of improvement, we will be led by a surgeon and will work as an interdisciplinary team."
Reuters has a mantra about benchmarking that keeps her focused. "If you don’t know where you’re going, if you haven’t set a goal, how are you going to get there?"
[For more information, contact:
• Ann Reuters, Quality Coordinator, Northfield Hospital, Northfield, MN. Telephone: (507) 645-6661.]
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