Hit the benchmark bull's-eye to develop stronger patient education programs

Comparison of data helps identify which areas to improve

More and more patient education managers are jumping on the benchmarking bandwagon, but is it a good idea? Cezanne Garcia, MPH, CHES, manager of patient and family education services at the University of Washington Medical Center in Seattle, gives benchmarking a thumbs-up. It provides qualitative and quantitative data to allow you to compare and contrast your patient education system with others, she says.

"I come to it from the perspective of what can I learn from the data we have collected and continue to make this system or process better. I also come to it hoping that at some point, we can make a contribution to literature or the research body to help all of us working in the patient education field do better and be better," says Garcia.

To improve patient education at the University of Washington Medical Center, Garcia benchmarks patient education efforts against data from other university medical centers. This is possible because her facility pays a fee to be part of the Boston-based Picker Institute Patient Satisfaction Data program.

The institute sends surveys to patients at subscribing health care facilities and compiles the data the facilities send back. An institution can compare its overall program to others, as well as comparing each category of data.

For example, patients are asked if the nurses give them information in a way they can understand. A hospital with an average score in this area can call hospitals with a high score and ask them what they do differently that contributed to that high score.

Using the data, it’s also possible to benchmark within your own facility, says Garcia. Her facility receives nine breakouts for the outpatient clinics providing information on which clinics are strong in an area of patient education and which clinics do poorly. "What’s beneficial here is that we can assume the clinics are operating under the same set of resources, such as staffing and general overhead, as well as in a very similar health care environment internally and externally," says Garcia.

While the Picker Institute provides quantitative data, Garcia also is involved in a qualitative benchmarking project. The University of Washington Medical Center is partnering with two other local health care facilities to provide the community with comprehensive oncology services. To set up the best program, staff are contacting facilities that have strong cancer patient education services across the nation to interview program directors in order to determine best practices.

They also are using the Bethesda, MD-based National Cancer Institute’s (NCI) Guidelines for Establishing Comprehensive Cancer Patient Education Services. (For information on discovering best practices, see article on p. 99. For information on the NCI guidelines, see article on p. 101.)

A time for benchmarking

Benchmarking is of value when you are putting together a new program or patient education delivery system because it not only helps you see what is being done, but also what the best way of doing it is, says Sandra Cornett, RN, PhD, program manager for consumer health education at The Ohio State University Medical Center in Columbus. When Ohio State was setting up an in-house Intranet system, Cornett benchmarked with the Rochester, MN-based Mayo Clinic after learning that Mayo was more advanced than most facilities at delivering patient education materials via the Intranet. Cornett learned about Mayo’s status in this area by networking with colleagues.

When the patient education committee at St. Joseph’s Hospital in Marshfield, WI, began to explore ways to improve the delivery of patient education, they assembled a survey and sent it to 12 institutions of similar size that were accredited by the Oakbrook Terrace, IL-based Joint Com mis sion on Accreditation of Healthcare Organizations. Currently, they are waiting for all the surveys to be returned. "Before we put a proposal together to give to our administration, we want to find some best practices," says Sue Church, RN, CDE, program manager of the diabetes center of Marshfield at St. Joseph’s.

Once all the surveys have been returned, Church plans to look for similarities. For example, if 90% of the hospitals surveyed have one full-time employee in charge of coordinating and distributing patient education materials, the committee will suggest that their institution’s program create a similar position. "Through our research, what we are able to see are the commonalties between institutions, the strong areas, and almost piece-meal together the ideal patient education center learning from the lessons of other institutions," says Church. (See a copy of the survey, inserted in this issue.)

Church provided a telephone and fax number, in addition to a stamped envelope, for survey responders.

To find health care facilities similar in size to St. Joseph’s, the committee used a directory from the Chicago-based American Hospital Association. They then called the patient education department at each facility to identify the person in charge and ask him or her to fill out the survey.

Benchmarking is not only valuable for determining best practices for new projects, but for overhauling existing ones as well. When you discover a gap or deficiency in your patient education, benchmarking can help you determine how to solve the problems, explains Cornett.

Other institutions provide comparative data

For example, your nurses may not be documenting patient education. In benchmarking, you would look to other institutions or literature to determine what is currently being done in this area. You would use this information as comparative data. That legwork should be done during the assessment phase because the data would provide information on changes that could be made to correct the deficiency, says Cornett. "Benchmarking is getting information from other sources so you have some comparative data," she explains.

However, what works at another institution won’t necessarily work at yours, she warns. Budget restraints, policies and procedures, or differences in the patient population could prohibit implementation of such practices.

Data comparison is an important element of benchmarking, but patient education managers should not stop there, advises Charles M. Kilo, MD, director of Idealized Design at the Institute for Healthcare Improvement in Boston. "A more robust meaning of benchmarking is not only understanding the data of whatever best is found, but actually understanding the processes," says Kilo. "What are the specific process differences between organization X and your organization?"

The truth is, best practices are most likely to be found in bits and pieces, and no single program can claim the title, says Kilo. Therefore, it is a good idea to take those bits and pieces — and the specific processes that lead to a great performance — and string them together to create a new system.

That is why interviewing is an important step in the benchmarking procedure, adds Garcia. However, the patient education manager should first identify the objective of the project and define what he or she is trying to measure.

Once the objective is on paper, the next step should be searching the World Wide Web, the literature, or other resources for details on best practices and writing health care systems for descriptive information. "Use the person’s time during the interview for more analytical or reflective information," says Garcia. Find out what kind of outcome data they have to document or substantiate that they are on the right track, she explains.

For best results during the telephone interview, develop a defined set of questions. Meet with the interdisciplinary group working on the project, and develop a wish list of everything you would like to ask. Then break that down to four to eight open-ended questions, advises Garcia.

After the benchmarking data have been gathered, a final step is to summarize the information. Rather than write a narrative report, use a table format, says Garcia. Look at the qualities and characteristics discussed in the various interviews and build a grid, she suggests.

However, keep in mind during the research process that "best practices" might not exist, says Kilo. "One can argue that the whole health care system needs to be redesigned, and no level of performance we are currently achieving is where it should be. Therefore, benchmarking keeps you bound to our current framework of how we ought to be practicing medicine. What we really need to do is change that framework altogether," he explains.