Children's hospitals benchmark through restricted Internet site
Children’s hospitals benchmark through restricted Internet site
Easy, quick access eliminates paper chase, distribution woes
If information is power, then 24 children’s hospitals are about to reap even more benchmarking benefits as a new Internet initiative makes data sharing easier and quicker among those who need it most.
The five-year-old program, called Benchmarking Effort for Network-ing Children’s Hospitals (BENCH), not only identifies which facilities score the highest on a particular indicator but also pinpoints and shares best practices by reporting how the hospitals achieved that level of performance, says Sharon Lau, consultant for Medical Management Planning (MMP), the project’s facilitator and consulting vendor, based in Bainbridge Island, WA.
This year, the group decided to put the benchmarking information on line for easier and quicker access. By transferring the data to a password-secured site, MMP hopes to ease distribution and improve access to more than 150 indicators for cost, quality, outcomes, and speed of service. (See indicators, pp. 156-157.)
For members with a modem, an Internet provider, and a browser that supports JavaScript, distributing that information is now much easier. Previously, each facility’s benchmark coordinator received a quarterly comprehensive report replete with graphs, surveys, charts, and analyses. Then he or she had to review the material in the notebook which can be up to three inches thick and copy and route the information to appropriate individuals throughout the hospital. The process was time-consuming, Lau admits. "It’s not just hospitals that need the information, but specific managers within the hospital and a paper system doesn’t always allow timely access," she explains.
Because front-line managers rarely received copies of the entire quarterly report, they didn’t have the informational tools contained in the big picture to help them make quality improvement decisions. "Getting the report about only one indicator may not necessarily help you improve performance because you only have one piece of the puzzle," Lau says.
For example, a department that had a high productivity indicator for worked hours per procedure may not reflect the true situation. "One piece of productivity data by itself doesn’t mean much. You’d also need to look at a process indicator such as physician satisfaction, or maybe another productivity indicator such as numbers of mislabeled lab tests," she explains. "Otherwise, you could run the risk of being so efficient at the wrong thing!"
Site expedites discovery
Having all the pertinent benchmarking data at one’s fingertips leads to the second part of the improvement effort: identifying best practices. (See story on best practices for asthma, p. 159.)
"We not only focus on which facility scores the highest on a particular indicator, but we also report on how that hospital achieved the performance," Lau says.
All information supplied to the benchmarking database is identified by site or facility. "Years ago, when I was a materials manager at a children’s hospitals, we only had blinded and averaged benchmarking data to work with," Lau remembers. "For example, I knew the figure for soiled linen per patient was 15.1 pounds, but I had no idea where that number came from or what it meant, much less how to identify the most important thing to do to improve our practice."
Because the source of the data is clear, coordinators can network more easily with their peers and clarify questions regarding sources of data, collection techniques, and comparability. Questions about special circumstances, anomalies, and variances directed to the coordinator who supplied the data always produce more usable feedback, Lau says.
Mary Anne Morris, RN, assistant vice president for patient services and benchmarking coordinator at Cincinnati Children’s Hospital, says she especially appreciates the section of the Web site called Operational and Clinic Characteristics. Here, managers can find out which facilities are most comparable to their own in relation to the particular function being measured. "In addition to the normal benchmarking demographics, the site contains many other useful variables to give users a true picture of the facility identified as having the best practice," Lau explains.
Information about environmental services, for example, would let a user determine if the best-practice facility was responsible for cleaning operating rooms, parking lots, the kitchen, and other areas. "By breaking down these characteristics, the site allows members to hone in where their differences are. It’s important information when the question is, Why does it take us longer?’" she says.
A manager’s directory also provides a veritable who’s who in children’s benchmarking by listing names, phone and fax numbers, and e-mail addresses.
"We can tell if the other facility is like us before we even call to find out how they implemented the best practices," Morris says. "Half the battle in benchmarking is knowing who to call, and this puts the information right at your fingertips."
And the survey says . . .
Morris, who served last year as a survey coordinator, also finds the survey portion of the Web site valuable. "MMP conducts surveys for those indicators that we don’t need to measure on a continuing basis," she says. Some of the questions included in the 90-plus surveys are:
• How many beds are in your sleep lab?
• What types of lactation services are provided in your hospital?
• Who does asthma education in your hospital?
• What is your sibling visitor policy?
Any member hospital can initiate a survey to query its peers on the specifics of a program or practice, Lau says. "After the manager writes his or her question and faxes or e-mails it to use, we draft the survey and send it out for review to four members who are experts in that topic area," she explains. "This step is to make sure the questions are clear and also to allow any additional questions to be tacked on to prevent the survey from begetting a survey."
After review, MMP distributes the surveys to member hospitals. "Participation is high because we all realize we will need to initiate a survey in the future," Morris says.
MMP consolidates survey results into a spreadsheet, which is distributed to those who have responded. Although the process currently takes about four to five weeks, Lau expects the Web site’s forum section will expedite it because the paper trail will be eliminated.
Best practices at your fingertips
Another important asset of the Web site is that managers can now view and print the parts of "white papers" containing best practices as identified by member hospitals during focus group meetings. In the past, members traveled three or four times a year to attend these best practice forums, but Lau expects discussions on the Web site’s forum will help reduce the number of face-to-face focus groups. "In these days of limited travel budgets, we needed to find a way members could still get together and discuss improvements," she points out.
Although MMP consultants write the white papers, the information is based on that generated from the focus groups. In the past, members met and used laptop computers connected to a server to facilitate brainstorming. "It allowed everyone in the room to see another’s ideas instantaneously on the screen," Lau says. "Because all input is captured on a file, participants don’t have to go home with disparate notes that may or may not reflect exactly what was said." In the future, all notes can be captured in the forum discussion groups that take place on the Web.
No matter the technology, the process for determining best practices is essentially the same. Take the issue of extensive wait time in the emergency department (ED), for example. A focus group of nurses, physicians, registrars, and admitting staff first breaks the process of being seen in the ED into smaller processes such as registration and triage, Lau explains. "Then focus group members go back and measure those parameters in their own facilities," she says.
In addition to those data, members also created a profile of their operation, including the location of the radiology suite and the number of rooms, nurses per patient, physicians, and students. After MMP analyzed the data, the group returned to map out the findings and examine who had the lowest wait times in each part of the total wait.
"Members then discussed what their facilities were doing to accomplish short wait times, while others talked about what obstacles they faced," Lau says. "By the end of the day, we had a list of what does and doesn’t work."
Then participants took the list to their facilities and asked all stakeholders involved in ED wait times to grade those practices according to impact on cost, quality, and speed as well as the overall impact. (See grading system chart, p. 160.)
"For many members, this was the first time they had sat down to list all specific improvement opportunities and then rank them," she says.
MMP took the top scorers and compiled about a dozen white papers for the site’s "Top 10 Best Practice" section, featuring processes such as admitting and ED wait times.
"The evidence in the white papers goes a long way in convincing staff that their process can indeed be improved upon," Lau explains. "For example, the most common excuse for long waits in the emergency department is We don’t have enough treatment rooms.’ But when staff can see that the best performers have fewer rooms, they realize it’s their process, not the facility that’s the real problem."
[Editor’s note: For more information, contact Sharon Lau, Medical Management Planning, 2049 Balmer Drive, Los Angeles, CA 90039. Telephone: (213) 644-0056. E-mail: [email protected]. Web site for BENCH: http://www.mmpcorp.com. Mary Anne Morris, RN, Cincinnati Children’s Hospital, 3333 Burnet Ave., Cincinnati, OH 45229. Telephone: (513) 636-4780.]
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