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PubMed2003

Benchmarking for best practice environmental management.

Benchmarking of environmental performance to demonstrate the achievement of best practice environmental management is a component of a new form of licensing of industrial discharges in Western Australia. The paper describes the approaches to benchmarking for the critical environmental issues for an alumina refinery and wastewater treatment plant. It also describes the lessons learnt from the benchmarking process on appropriate methods, the benefits and difficulties in the benchmarking process, and changes that would assist benchmarking for best practice environmental management.

Aluminum Oxide↗

PubMed2000

Sharing the evidence: clinical practice benchmarking to improve continuously the quality of care.

It is unacceptable for health care professionals to acquiesce quietly to inconsistencies in the quality of health care received by patients. In the United Kingdom, the introduction of clinical governance has formalized the expectation that professionals' practice will meet recognized standards of care consistently. It is being stated that all available evidence is being used to identify national standards of excellence. This will inform professionals not only of expected outcomes but of also the structures and processes that need to be in place to support the attainment of such outcomes. Clinical practice benchmarking is one continuous quality improvement approach, which is being used by paediatric units in 27 National Health Service Trusts in the north-west of England to promote the utilization of available evidence in to practice. The evidence base for benchmarks of best practice is considered continuously using a hierarchy of evidence. This clarifies the different evidence available, upon which benchmarks or standards of excellence can be based, but reinforces the kudos awarded quantitative research evidence within health care. Once benchmarks have been agreed, benchmarking activity supports practitioners in a continuous cycle of comparison and sharing that is aimed at ensuring that children and their families receive evidence-based care, wherever they are admitted in the north-west of England.

Benchmarking↗

PubMed2002

Benchmarking ambulance call-to-needle times for thrombolysis after acute myocardial infarction in Australia: a pilot study.

BACKGROUND: Thrombolysis for patients with acute myocardial infarction (AMI) is of greatest benefit when treatment is commenced as soon as possible after symptom onset. The British Heart Foundation (BHF) recently set a benchmark recommending that eligible patients with AMI receive thrombolytic therapy less than 90 min after calling for medical assistance. AIMS: The purpose of this study was to compare the performance of an urban emergency service to this benchmark. A secondary objective was to determine whether patients treated outside this time were at a greater risk of mortality. METHODS: This study consisted of an explicit retrospective analysis of medical records for all patients who presented by ambulance to the Emergency Department (ED) of Western Hospital and received thrombolysis for AMI within 12 h of symptom onset. The study was conducted for the 18-month period between 1 January 1999 and 30 June 2000. Information collected included times of: (i) symptom onset, (ii) call for ambulance, (iii) ambulance response, (iv) transport to hospital and (v) thrombolysis, as well as final diagnosis and in-hospital mortality. For the purposes of this study, call-to-needle time (CTN) was defined as the time between calling the ambulance and commencement of thrombolytic therapy. RESULTS: One hundred and twenty-seven patients met the inclusion criteria. Median CTN was 81 min (range 42-279 min). Sixty-four per cent of patients were treated within the 90-min benchmark. The relative risk of mortality for patients treated outside the 90-min benchmark was 2.6 (95% CI 0.98-6.72). CONCLUSION: This study showed that the BHF benchmark for CTN was not being met for over one-third of patients in the study region, with potential impact on mortality after AMI. Further research is needed to establish: (i) whether there is relationship between longer transportation times and mortality, (ii) whether the findings of this study may be applied to other regions and (iii) what strategies might be employed to reduce CTN.

Ambulances↗

PubMed2006

Benchmarking national surveillance systems: a new tool for the comparison of communicable disease surveillance and control in Europe.

BACKGROUND: Communicable diseases do not respect national boundaries and are important challenges to health internationally. Considerable variation exists in the structure and performance of surveillance systems for communicable disease prevention and control. European Union (EU) countries should share ideas to improve the quality of surveillance systems. The study aims to support the improvement and integration of surveillance systems of communicable diseases in Europe while using benchmarking for the comparison of national surveillance systems. METHODS: Surveillance systems from England and Wales, Finland, France, Germany, Hungary, and The Netherlands were described and analysed. After comprehensive data collection and validation by several European public health (PH) experts, a descriptive data analysis was carried out. Benchmarking processes were performed with selected criteria (e.g. case definitions, early warning applications, and outbreak investigations). After the description of benchmarks, best practices were identified and described. RESULTS: Benchmarking of national surveillance systems is applicable as a new tool for the comparison of communicable disease control in Europe. The countries included in the study have in general well-functioning communicable disease control and prevention systems. Nevertheless, there are different strengths and weaknesses in various countries. Practical examples from the various surveillance systems were demonstrated and recommendations were given to policy makers. CONCLUSION: A gold standard of surveillance systems in various European countries is very difficult to achieve because of heterogeneity (e.g. in disease burden, personal, and financial resources). However, to improve the quality of surveillance systems across Europe, it will be useful to benchmark the surveillance systems of all EU member states.

Benchmarking↗

PubMed2006

Evaluating treatment effectiveness: benchmarks for rehabilitation after partial meniscectomy knee arthroscopy.

OBJECTIVE: The purpose of this study was to give a detailed description of recovery benchmarks that occur in patients whose therapy after partial meniscectomy knee arthroscopy consists of a home program of exercise. These benchmarks can be used as a basis for clinicians to compare improvements to individual patients who receive supervised care. DESIGN: Thirty-nine patients (five females, mean age = 41) who underwent an uncomplicated arthroscopic partial meniscectomy were included. Test sessions occurred at 5 and 50 days after surgery. Outcome measures included: 1) Hughston Clinic knee self-assessment questionnaire; 2) EQ-5D Tariff for assessment of quality of life; 3) number of days taken to return to work after surgery; 4) knee passive range of motion; and 5) knee swelling assessed by evaluation of knee circumference. Stepwise regression analysis was used to evaluate factors that might have influenced the amount of pre- to posttest change in the outcome measures (the benchmarks) during the first 7 wks after surgery. The factors used in this analysis were: 1) age, 2) body mass index, 3) period from injury to surgery, and 4) the baseline value of the variable to be examined (except for return to work, where we used a score estimating the challenge to the knee offered by work). RESULTS: None of the factors considered (age, body mass index, period from injury to surgery, stressfulness of the work on the knee) affected the number of days taken to return to work. Baseline scores affected change in all the other outcomes, and knee girth change was also affected by body mass index. Regression equations are presented where suitable for the benchmarks presented. CONCLUSIONS: Quick recovery occurs in these patients when only a home exercise program is given. This paper highlights the utility of using historical control group data instead of test-retest analysis of measurement error in evaluating patients whose recovery with a home exercise program is rapid. Of the variables analyzed in this study, quality of life and knee self-assessment changes offer the most useful benchmarks for evaluating treatment effectiveness.

Adult↗

PubMed2005

Does physician benchmarking improve performance of laparoscopically assisted vaginal hysterectomy?

BACKGROUND: Benchmarking techniques were implemented to optimize operating time and charges associated with laparoscopically assisted vaginal hysterectomy (LAVH). MATERIALS AND METHODS: The baseline LAVH profile over a period of 4 years (167 cases) was compared with 1-year data (47 cases) after a benchmarking educational program (disseminating data ranking performance by each surgeon plus suggestions for improvement). Preintervention and postintervention profiles were compared by means of Student t test and wilcoxon rank sum analysis. Hierarchical multiple regression was used to identify additional sources of variation for operative charges and time. RESULTS: Mean operating times after implementing benchmarking were lower, averaging 182 versus 197 minutes in the control subjects (P = 0.05). We found no significant difference in total or operative charges. After adjusting for potential confounders, benchmarking remained associated with decreased operating time in the multivariate model (P = 0.01). CONCLUSIONS: LAVH operating times decreased after a surgical benchmarking and education intervention, but operating charges did not.

Benchmarking↗

PubMed1998

Defining the boundaries of physiological understanding: the benchmarks curriculum model.

We set out to develop an anatomy and physiology (A&P) curriculum with a content that was relevant and well rationalized. To do this, we developed a benchmarks curriculum process that helps us to determine what our students need to learn in A&P and then to make sure there is alignment between those learning objectives and what we teach and how we assess our students. Using the benchmarks process, we first set the broad skill and content goals of the course. We then prioritize the topic areas to be covered, allocating the course time accordingly, and declare the learning objectives for each topic. To clarify each learning objective, a set of benchmark statements are written that specify in operational terms what is required to demonstrate mastery. After the benchmarks are written, we assemble the learning activities that help students achieve them and write assessment items to evaluate achievement. We have implemented the curriculum in a relational database that allows us to specify the numerous links that exist between its different elements. In the future, the benchmarks model will be used for ongoing A&P curriculum development with geographically distributed contributors accessing it via the World Wide Web. This mechanism will allow for the continuing evolution of the A&P curriculum.

Anatomy↗

PubMed2001

Towards benchmarking in British acute hospitals.

The 1997 White Paper--The New NHS--on the future of the National Health Service accorded a high profile to the use of benchmarking as a means of improving efficiency over the following decade. Here, I examine the prospects for the successful adoption of benchmarking in the acute-hospital sector. A benchmarking model is superimposed upon a model of receptive contexts for change, and the components are used to explore the background to the development of benchmarking and likely attitudes towards its implementation. Where appropriate, empirical evidence is introduced to shed light on the ideas explored. I conclude that the wider political agenda accompanying benchmarking has potentially far-reaching implications for the re-distribution of resources on regional, or even national, bases. However, the steady drip-drip on stone is necessary to achieve results at local operational levels. Only by harnessing the strengths of extant cultures will efforts to identify and adopt the most efficient/effective medical practices succeed and potentially conflicting social tensions be resolved.

Benchmarking↗

PubMed2005

A methodology for deriving tissue residue benchmarks for aquatic biota: a case study for fish exposed to 2,3,7,8-tetrachlorodibenzo-p-dioxin and equivalents.

Tissue residue-based toxicity benchmarks (TRBs) have typically been developed using the results of individual studies selected from the literature. In the past, TRBs have been developed using a point estimate (e.g., LC50 value) reported in a study on a single species deemed to be most closely related to the receptor of interest. Despite attempts to maximize the protectiveness and relevance of TRBs, their relationship to specific receptors remains uncertain, and their general applicability for use in broader ecological risk assessment contexts is limited. This article proposes a novel framework that establishes benchmarks as distributions rather than single-point estimates. Benchmark distributions allow the user to select a tissue concentration that is associated with the protection of a specific percentage of organisms, rather than linked to a specific receptor. A methodology is proposed for searching, reviewing, and analyzing linked, tissue residue effect data to derive benchmark distributions. The approach is demonstrated for contaminants having a dioxin-like mechanism of toxic action and is based on residue effects data for 2,3,7,8-tetrachlorodibenzo-p-dioxin (2,3,7,8-TCDD) and equivalents in early life stage fish. The calculated tissue residue benchmarks for 2,3,7,8-TCDD toxic equivalency (TEQ) derived from the resulting distribution could range from 0.057- to 0.699-ng TCDD/g lipid depending on the level of protection needed; the lower estimate is protective of 99% of fish species whereas the higher end is protective of 90% of fish species.

Animals↗

PubMed2006

Towards a benchmark simulation model for plant-wide control strategy performance evaluation of WWTPs.

The COST/IWA benchmark simulation model has been available for seven years. Its primary purpose has been to create a platform for control strategy benchmarking of activated sludge processes. The fact that the benchmark has resulted in more than 100 publications, not only in Europe but also worldwide, demonstrates the interest in such a tool within the research community In this paper, an extension of the benchmark simulation model no 1 (BSM1) is proposed. This extension aims at facilitating control strategy development and performance evaluation at a plant-wide level and, consequently, includes both pre-treatment of wastewater as well as the processes describing sludge treatment. The motivation for the extension is the increasing interest and need to operate and control wastewater treatment systems not only at an individual process level but also on a plant-wide basis. To facilitate the changes, the evaluation period has been extended to one year. A prolonged evaluation period allows for long-term control strategies to be assessed and enables the use of control handles that cannot be evaluated in a realistic fashion in the one-week BSM1 evaluation period. In the paper, the extended plant layout is proposed and the new suggested process models are described briefly. Models for influent file design, the benchmarking procedure and the evaluation criteria are also discussed. And finally, some important remaining topics, for which consensus is required, are identified.

Benchmarking↗

PubMed2004

Student experiences in web-based nursing courses: benchmarking best practices.

The purpose of this study, part of a larger benchmarking study, is to seek to confirm benchmarks for best practices for teaching and learning in web-based courses. Six hundred thirty-one responses to two open-ended questions from a survey of nursing students in undergraduate and graduate nursing programs at five participating schools were analyzed to understand the student experience and confirm the predetermined benchmarks. Using qualitative description, responses were analyzed using content analysis procedures. Students provided rich descriptions of the study benchmarks such as use of technology, active learning, feedback, respect for diversity, interaction with faculty and peers, convenience, access, professionalism, preference for face-to-face interaction, connectedness, and orientation to technology use. The students also identified additional student support variables such as the need for information about the course, orientation to using technology, and the importance of learning resources that should be considered as additional benchmarks for best practices in web-based courses.

Adult↗

PubMed2003

Accepting critically ill transfer patients: adverse effect on a referral center's outcome and benchmark measures.

BACKGROUND: Common methods of benchmarking clinical performance rarely, if ever, account for admission source and, in particular, the effect of a patient being transferred from one medical center to another. Small biases in comparisons of observed versus expected deaths can substantially affect how high-quality institutions compare with peer hospitals. With the most sophisticated and validated set of case-mix measures available for patients, the intensive care unit is an ideal setting in which to study the effect of a patient's being transferred from another hospital. OBJECTIVE: To determine the extent of bias in benchmarking outcomes when performance measures do not account for transfer patients' greater severity of illness. DESIGN: Prospectively developed cohort study. SETTING: Medical intensive care unit (MICU) at a tertiary care university hospital. PATIENTS: 4579 consecutive admissions for 4208 patients from 1 January 1994 to 1 April 1998. MEASUREMENTS: MICU and hospital lengths of stay, MICU readmission, and hospital mortality rates. RESULTS: Compared with directly admitted patients, MICU patients transferred from another hospital had significantly higher Acute Physiology Scores at the time of admission and discharge (P = 0.001). Even after full adjustment for case mix and severity of illness, transfer patients had a 38% longer MICU stay (95% CI, 32% to 45%), a 41% longer hospital stay (CI, 34% to 50%), and a 2.2 times greater odds of hospital mortality (CI, 1.7 to 2.8) than directly admitted patients. With identical efficiency and quality, a referral hospital with a 25% MICU transfer rate compared with another with a 0% transfer rate would be penalized by 14 excess deaths per 1000 admissions when a benchmarking program adjusts only for case mix and severity of illness and not for the source of admission. CONCLUSIONS: In a setting with the most thorough diagnostic-based, case-mix adjustment and the most physiologically precise severity-of-illness information, accepting transfer patients can adversely affect efficiency and quality benchmarks. Benchmarking and profiling efforts beyond intensive care units must also recognize and account for this phenomenon; otherwise, referral centers may have an incentive to refuse care for patients who could benefit from being transferred to their facility.

APACHE↗

PubMed1998

Perfusion services national process improvement benchmarking.

The Joint Commission on Accreditation of Health Care Organizations recommends national and regional benchmarking in the quality improvement process. Benchmarking is comparing your organization's patient care process outcomes to the best. This communication describes a national benchmarking process for peer comparison of indicators in perfusion patient services process improvement. A databasing communication aplet was designed to facilitate national benchmarking as part of a larger perfusion service management software application. When patient information is entered in the patient database post precedure, patient-specific numeric data and 'yes'/'no' queries are entered at the clinical site. At any time, the local perfusionist system manager may transmit their own data and receive national database group results by modem and a 1-800 phone number. Local indicator outcomes are compared to national results. Strategies are employed to assure that institution and patient name remain anonymous and institution specific data are stored at the clinical site. Participating institutions employ an e-mail aplet to discuss and decide which indicators to employ as a group. Nine institutions have contributed outcome data for more than 6,425 cardiopulmonary bypass (CPB) procedures to a national database for ten months. National and institutional means for six discrete CPB outcome parameters are compared. The percent 'yes' responses to four procedure-related questions are compared. Joint Commission recommended benchmarking is accomplished while patient care is improved by comparing outcomes.

Benchmarking↗

PubMed2001

Improving group practice performance with benchmarking.

Group practices can use benchmarking to improve physician productivity to best-practice levels. The benchmarking process can be broken down into two phases. In the first phase, the problem is identified. This phase involves identifying critical drivers, choosing an external benchmark, gathering internal data, identifying variances, and establishing targets. In the second phase, action is taken. This phase involves identifying actions to take, defining responsibilities, implementing the changes, and monitoring performance. Group practices that use benchmarking need to understand the tool's limitations. Benchmarks serve as roadmaps, but any action plan should be tailored to the practice and take a variety of factors into consideration.

Benchmarking↗

PubMed2003

Measuring client satisfaction with public education II: comparing schools with state benchmarks.

Because the results of the client satisfaction evaluation trials conducted in the state's public schools revealed that levels of client satisfaction differed in significant and meaningful ways between parents and students as well as between types of schools, this research consultancy provided school versus benchmark comparison reports based on groups of generally comparable school types. The state benchmark for each set of comparable schools estimated how easy it was, on average, for the members of the benchmark group (parents or students) to endorse each of the 20 School Opinion Survey Likert-scale items (King and Bond, 2003). The school satisfaction level for each item was calculated by a similar process to estimate how easy it was, on average, for the members of the school sample (parents or students) to endorse that item. Reports to individual schools used easy to interpret Parent/Student Satisfaction Graphs which plotted the Rasch-modeled differences between the state benchmark level and the school level for each item. In very small schools where the small amount of data did not allow for item-by-item graphs to be constructed, overall satisfaction graphs provided one global comparison with the appropriate benchmark to be reported.

Adolescent↗

PubMed2006

Procedure to normalize data for benchmarking.

INTRODUCTION: The hospital billing system is usually the source for reporting activity counts used in benchmarking efforts. Because billing is associated with a specific procedure, benchmarking data are often reported as procedure-days, procedure-shifts, or procedure-hours. Normalizing (usually to procedure-days) is required when comparing data for benchmarking purposes. For an institution that uses hourly billing, simply dividing procedure-hours by 24 (or procedure-shifts by 2 or 3) will underestimate the procedure-days reported by a daily billing system, because daily billing systems use the convention that any fractional day of service is rounded up to the next higher day. The purposes of this study were: (1) to simulate sets of data and determine the expected error with conversion by simple division, (2) to derive a more accurate procedure for normalizing benchmarking data, and (3) to compare the new normalization procedure to simple division, using simulated and actual data. METHODS: A reference population of simulated patient data was created using a spreadsheet to generate random start times paired with actual procedure durations (eg, hours of mechanical ventilation) for 5,000 patients. The spreadsheet calculated "true" billable procedure-days and procedure-shifts from the simulated procedure-hours. Next, a resampling procedure was used to simulate the effect of submitting benchmarking data based on various numbers of patients. The resulting sets of data were used to examine the association between sample size and conversion error when converting from procedure-hours to procedure-days and to generate an alternative conversion procedure that uses linear regression to estimate procedure-days from procedure-hours. An additional regression equation was generated from actual patient data, using simultaneously recorded procedure-hours and procedure-days. The set of mean conversion errors for the 2 regression equations was compared using the Mann-Whitney rank sum test. RESULTS: In general, conversion errors (both systematic and random errors) were smaller with larger sample sizes and with longer service periods, approaching an asymptote at a sample size greater than about 20. Using division, the conversion errors for a sample size of 100 were +/-16% for hourly reporting, +/-11% for 8-hour shifts, and +/-8% for 12-hour shifts. The regression equations for conversion derived from simulated data were as follows. For hourly billing, procedure-days = +/-0.237 + (0.049) (procedure-hours). For 8-hour shifts, procedure-days = +/-0.205 + (0.372) (procedure-shifts). For 12-hour shifts, procedure-days = +/-0.114 + (0.541) (procedure-shifts). Using those regression equations, the conversion errors for a sample size of 100 were +/-1% for hourly reporting, +/-0.2% for 8-hour shifts, and +/-0.2% for 12-hour shifts. The regression equation (for hourly billing) derived from simulated data gave better results than did the equation derived from actual data (median error 0.39 vs +/-2.92, p = 0.013).

Benchmarking↗

PubMed2006

The Medical Library Association Benchmarking Network: development and implementation.

OBJECTIVE: This article explores the development and implementation of the Medical Library Association (MLA) Benchmarking Network from the initial idea and test survey, to the implementation of a national survey in 2002, to the establishment of a continuing program in 2004. Started as a program for hospital libraries, it has expanded to include other nonacademic health sciences libraries. METHODS: The activities and timelines of MLA's Benchmarking Network task forces and editorial board from 1998 to 2004 are described. RESULTS: The Benchmarking Network task forces successfully developed an extensive questionnaire with parameters of size and measures of library activity and published a report of the data collected by September 2002. The data were available to all MLA members in the form of aggregate tables. Utilization of Web-based technologies proved feasible for data intake and interactive display. A companion article analyzes and presents some of the data. MLA has continued to develop the Benchmarking Network with the completion of a second survey in 2004. CONCLUSIONS: The Benchmarking Network has provided many small libraries with comparative data to present to their administrators. It is a challenge for the future to convince all MLA members to participate in this valuable program.

Advisory Committees↗

PubMed2006

How to utilize benchmarking in the clinical laboratory.

Benchmarking of clinical laboratory activities has become a tool used increasingly to enable administrators and managers to obtain an independent evaluation of the performance of the laboratory and identify opportunities for improvement. Benchmarking is particularly important because of the diversity and complexity of the various sections of the laboratory. The critical component of laboratory benchmarking is peer comparison, as solutions to shortcomings or problems can be titrated and planned through this process. The reliability of benchmarking must be supplemented and modified by the input of the manager's detailed understanding of local circumstances. At this critical moment, the changes in peer review strategies instituted by JCAHO, CAP, CLIA, and individual states create an urgent opportunity to assist medical directors and laboratory managers in maintaining an overview of the performance and quality of laboratory operations. Unannounced site visits will require prompt reports and alerts of undesirable changes in performance. The future goals of benchmarking must expand to include surveys of laboratory test utilization and patient outcomes as ultimate measures of test utility in the clinical process and important assessments of the quality of patient care.

Benchmarking↗