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PubMed1994

Benchmarking: finding ways to improve.

BACKGROUND: This article provides health care organizations with a benchmarking methodology to use in comparing practices and processes to identify and actualize opportunities for improvement. The 15-step model can be used to guide internal and external benchmarking activities in a variety of health care settings. EXAMPLES: Two internal benchmarking case studies are illustrated: (1) one hospital used the Baxter model to evaluate its laparoscopic cholecystectomy services, and (2) another prepared for expansion of cardiac catheterization services. CONCLUSIONS: Two key factors of a successful benchmarking initiative are highlighted: management commitment and involvement, and the need to understand internal practices and processes before benchmarking.

Cholecystectomy, Laparoscopic↗

PubMed1996

Feasibility of national benchmarking of patient satisfaction with Australian hospitals.

PURPOSE: This paper discusses the feasibility of developing national benchmark questions on patient satisfaction with hospital care in Australian hospitals. The research was undertaken for the Australian government under the National Health Outcomes Programme. DATA SOURCES AND SELECTION: The paper draws on a review of research with consumers to identify issues of importance to them about hospital care. The Australian sources were reports by consumer and community organizations, research reports by hospitals, governments and academics, and data from complaints authorities. The emphasis was on consumers' own views. The main debates on patient satisfaction methodology were reviewed. Published material from the USA and Britain highlighting organizational policy issues was reviewed, as well as literature on benchmarking. Material was obtained through journal searches and identification of organizations which undertake consumer-oriented or service development research. CONCLUSIONS: The paper argues that national benchmarking of patient satisfaction is not reliable because patient satisfaction is a poorly understood concept and not a unitary concept. Also, the paper argues that benchmarking is about processes, and that the link between survey results and hospital processes is not well researched or understood. While patient satisfaction surveys appear to promote consumer perspectives, they remain caught within a passive approach to consumer participation in shaping service development and improving the quality of hospital care. The task of government is to mandate consumer feedback, resource the development of expertise and technologies, trial and evaluate approaches to obtaining feedback, disseminate research and effective models, and resource consumer organizations to be participants at all stages. This is described as providing the resources for benchmarking at local levels.

Australia↗

PubMed1996

Benchmarking in the UK National Health Service.

Traces the development of benchmarking in a number of UK National Health Service trusts, highlighting practical processes and the benefits of benchmarking but also identifying common pitfalls and ways of handling them when they arise or, better still, anticipating them. Several examples of successful benchmarking initiatives are given, emphasizing the advantages of using a systematic benchmarking approach, using benchmarking clubs and the need to develop ad hoc performance measures. Concludes by emphasizing the need for a new commitment to continuous improvement by senior managers to avoid the failures of previous drives for improvement.

Efficiency, Organizational↗

PubMed2002

Benchmark dose calculations for methylmercury-associated delays on evoked potential latencies in two cohorts of children.

Delays in evoked potential latencies were observed at increased exposures to methylmercury from seafood in two cohorts of children. Because this outcome parameter appeared to be virtually independent of confounders, including cultural differences, a joint analysis of benchmark doses was carried out. Comparable cohort members included 382 Faroese and 113 Madeiran children without middle ear infection or neurological disease at age seven years. Maternal hair-mercury concentrations at parturition in the Faroese cohort ranged from 0.6 to 39.1 microg/g (geometric average, 4.49 microg/g). In Madeira, mothers who had not changed their diet since pregnancy had current hair-mercury concentrations ranging from 1.1 to 54.4 microg/g (geometric average 10.14 microg/g). The mercury-associated delay in peak III latencies at two frequencies (20 and 40 Hz) showed similar regression equations in the two groups of children, and benchmark dose calculations were therefore carried out for the two groups separately and jointly. For a doubling of a 5% prevalence of abnormal results of the peak III latencies at 40 Hz in a linear dose-response model, the benchmark dose for the maternal hair-mercury concentration was 8.79 microg/g for the Faroese children; 8.04 microg/g for the Madeiran children; and 9.46 microg/g for both groups. Results were similar for the 20 Hz condition. Benchmark dose results were substantially lower using a logarithmic or square root curve function, although the difference in fit between the curves was far from statistically significant. The benchmark results using evoked potential latencies are in close agreement with results based on neuropsychological test performance.

Adult↗

PubMed2001

Benchmark dose calculation from epidemiological data.

A threshold for dose-dependent toxicity is crucial for standards setting but may not be possible to specify from empirical studies. Crump (1984) instead proposed calculating the lower statistical confidence bound of the benchmark dose, which he defined as the dose that causes a small excess risk. This concept has several advantages and has been adopted by regulatory agencies for establishing safe exposure limits for toxic substances such as mercury. We have examined the validity of this method as applied to an epidemiological study of continuous response data associated with mercury exposure. For models that are linear in the parameters, we derived an approximative expression for the lower confidence bound of the benchmark dose. We find that the benchmark calculations are highly dependent on the choice of the dose-effect function and the definition of the benchmark dose. We therefore recommend that several sets of biologically relevant default settings be used to illustrate the effect on the benchmark results and to stimulate research that will guide an a priori choice of proper default settings.

Animals↗

PubMed2005

Benchmark calculations for perchlorate from three human cohorts.

The presence of low concentrations of perchlorate in some drinking water sources has led to concern regarding potential effects on the thyroid. In a recently published report, the National Academy of Sciences indicated that the perchlorate dose required to cause hypothyroidism in adults would probably be > 0.40 mg/kg-day for months or longer. In this study, we calculated benchmark doses for perchlorate from thyroid-stimulating hormone (TSH) and free thyroxine (T4) serum indicators from two occupational cohorts with long-term exposure to perchlorate, and from a clinical study of volunteers exposed to perchlorate for 2 weeks. The benchmark dose for a particular serum indicator was defined as the dose predicted to cause an additional 5 or 10% of persons to have a serum measurement outside of the normal range. Using the data from the clinical study, we estimated the half-life of perchlorate in serum at 7.5 hr and the volume of distribution at 0.34 L/kg. Using these estimates and measurements of perchlorate in serum or urine, doses in the occupational cohorts were estimated and used in benchmark calculations. Because none of the three studies found a significant effect of perchlorate on TSH or free T4, all of the benchmark dose estimates were indistinguishable from infinity. The lower 95% statistical confidence limits on benchmark doses estimated from a combined analysis of the two occupational studies ranged from 0.21 to 0.56 mg/kg-day for free T4 index and from 0.36 to 0.92 mg/kg-day for TSH. Corresponding estimates from the short-term clinical study were within these ranges.

Air Pollutants, Occupational↗

PubMedDate not supplied

The use of quality benchmarking in assessing web resources for the dermatology virtual branch library of the National electronic Library for Health (NeLH).

BACKGROUND: In 1998, the U.K. National Health Service Information for Health Strategy proposed the implementation of a National electronic Library for Health to provide clinicians, healthcare managers and planners, patients and the public with easy, round the clock access to high quality, up-to-date electronic information on health and healthcare. The Virtual Branch Libraries are among the most important components of the National electronic Library for Health. They aim at creating online knowledge based communities, each concerned with some specific clinical and other health-related topics. OBJECTIVES: This study is about the envisaged Dermatology Virtual Branch Libraries of the National electronic Library for Health. It aims at selecting suitable dermatology Web resources for inclusion in the forthcoming Virtual Branch Libraries after establishing preliminary quality benchmarking rules for this task. Psoriasis, being a common dermatological condition, has been chosen as a starting point. METHODS: Because quality is a principal concern of the National electronic Library for Health, the study includes a review of the major quality benchmarking systems available today for assessing health-related Web sites. The methodology of developing a quality benchmarking system has been also reviewed. Aided by metasearch Web tools, candidate resources were hand-selected in light of the reviewed benchmarking systems and specific criteria set by the authors. RESULTS: Over 90 professional and patient-oriented Web resources on psoriasis and dermatology in general are suggested for inclusion in the forthcoming Dermatology Virtual Branch Libraries. The idea of an all-in knowledge-hallmarking instrument for the National electronic Library for Health is also proposed based on the reviewed quality benchmarking systems. CONCLUSIONS: Skilled, methodical, organized human reviewing, selection and filtering based on well-defined quality appraisal criteria seems likely to be the key ingredient in the envisaged National electronic Library for Health service. Furthermore, by promoting the application of agreed quality guidelines and codes of ethics by all health information providers and not just within the National electronic Library for Health, the overall quality of the Web will improve with time and the Web will ultimately become a reliable and integral part of the care space.

Dermatology↗

PubMed1994

Experts discuss how benchmarking improves the healthcare industry. Roundtable discussion.

Healthcare Financial Management engaged four benchmarking experts in a discussion about benchmarking and its role in the healthcare industry. The experts agree that benchmarking by itself does not create change unless it is part of a larger continuous quality improvement program; that benchmarking works best when senior management supports it enthusiastically and when the "appropriate" people are involved; and that benchmarking, when implemented correctly, is one of the best tools available to help healthcare organizations improve their internal processes.

Efficiency, Organizational↗

PubMed1996

Benchmarks and performance indicators: two tools for evaluating organizational results and continuous quality improvement efforts.

Benchmarks are tools that can be compared across companies and industries to measure process output. The key to benchmarking is understanding the composition of the benchmark and whether the benchmarks consist of homogeneous groupings. Performance measures expand the concept of benchmarking and cross organizational boundaries to include factors that are strategically important to organizational success. Incorporating performance measures into a balanced score card will provide a comprehensive tool to evaluate organizational results.

Consumer Behavior↗

PubMedDate not supplied

Flow chart to benchmark.

BACKGROUND: Benchmarking is the process used to search for best-in-class, compare results, discover the enablers of superior process performance, and take action to achieve quantum process improvement. It sounds simple, but all too often benchmarking efforts fail. The first obstacle often is failing to understand how work is currently being performed. METHODS: Through linear flow charts, connection charts, and cross-functional flow charts, teams identify each step in a process, see how the people in the process interact, follow the work flow, and label the type of a step. When this is accompanied by supporting documentation, this method provides teams a way to visually see the work flow and know where there are glitches and where things are going well. RESULTS: Through flow charting, benchmarking teams can understand what they are doing so they know what to look for in a benchmarking partner and how to identify the enablers of a superior performance. CONCLUSIONS: Without flow charting, teams will not get the maximum benefit from benchmarking.

Appointments and Schedules↗

PubMed1999

The philosophy of benchmark testing a standards-based picture archiving and communications system.

The Department of Defense issued its requirements for a Digital Imaging Network-Picture Archiving and Communications System (DIN-PACS) in a Request for Proposals (RFP) to industry in January 1997, with subsequent contracts being awarded in November 1997 to the Agfa Division of Bayer and IBM Global Government Industry. The Government's technical evaluation process consisted of evaluating a written technical proposal as well as conducting a benchmark test of each proposed system at the vendor's test facility. The purpose of benchmark testing was to evaluate the performance of the fully integrated system in a simulated operational environment. The benchmark test procedures and test equipment were developed through a joint effort between the Government, academic institutions, and private consultants. Herein the authors discuss the resources required and the methods used to benchmark test a standards-based PACS.

Benchmarking↗

PubMed2003

Benchmark criteria: a tool for selecting appropriate models in the field of water management.

A milestone in the field of European water protection policy is the European Union's Water Framework Directive (WFD), which came into force in December 2000 and which integrates the management of European waters in many ways. In this study, we start by focusing on management issues connected to the implementation of the WFD and pose a question: "what type of models would be the most suitable for use in the context of the WFD?" With this question in mind, we aim to establish a set of operational and functional selection criteria for (computer) models whose application is intended to support decision-making related to a particular water management issue. These so-called "benchmark criteria" should help water managers and other model users in choosing appropriate models, e.g., for the WFD implementation purposes. We first describe models and their use in general and then propose an approach for setting the benchmark criteria for models, basing it on the concept of uncertainty management, while keeping firmly in mind the important role of citizens and citizen organizations in water management. The suggested benchmark criteria are in the form of 14 questions through which each model can be evaluated. Finally, the process for testing and refining the benchmark criteria is highlighted.

Benchmarking↗

PubMed2004

Impact of the choice of benchmark on the conclusions of hospital report cards.

BACKGROUND: Hospital report cards for outcomes following acute myocardial infarction (AMI) are being produced with increasing frequency. Implicit in the statistical methods used is the fact that hospitals are being compared with an average hospital. Prior research has demonstrated that institutional characteristics such as a high annual volume of AMI patients and academic status are associated with improved outcomes. This raises the important issue of what is an appropriate benchmark against which hospitals should be compared. The objective of the current study was to determine whether the number of hospitals identified as mortality outliers depended upon the benchmark against which hospitals are compared. METHODS: We examined all patients discharged with a diagnosis of AMI from 163 Ontario hospitals between April 1, 2000, and March 30, 2001. Logistic regression models that incorporated random provider effects were used to identify hospitals with a mortality rate significantly higher than average. The initial model included only patient characteristics, whereas additional models incorporated both patient and hospital characteristics. RESULTS: After adjusting for patient characteristics only, 3 hospitals had significantly higher mortality compared to an average-mortality hospital, while 4 hospitals had significantly lower mortality than an average-mortality hospital. However, after further adjusting for peer group, only 1 hospital was identified as having significantly lower mortality than an average-mortality institution in its peer group. CONCLUSIONS: The use of peer-group-defined rather than overall benchmarks has a substantial impact on the identification of mortality outliers. The choice of the appropriate benchmark is related to the underlying purpose of the comparison.

Benchmarking↗

PubMedDate not supplied

Improving midwifery practice: the American College of Nurse-Midwives' benchmarking project.

Quality management in clinical practice involves the use of numerous techniques that monitor the quality of care clinicians provide. Quality improvement is an approach to quality management that emphasizes system and processes, rather than a focus on individual performance. Quality improvement examines objective data to improve these processes, even when high standards of performance appear to have been met. Benchmarking measures one's processes and outcomes against "best in class" and is a part of a quality improvement program. By using benchmarking to provide goals for realistic process improvement and identification of the most efficient and effective methods of meeting all of their customer's needs, health care providers can document their effectiveness in terms of cost, quality, and satisfaction. This article details the American College of Nurse-Midwives' benchmarking project and presents benchmarks for obstetric practice from the year 2004.

Benchmarking↗

PubMed2004

Development of an occupational exposure limit for n-propylbromide using benchmark dose methods.

This paper presents the development of an occupational exposure level (OEL) for n-propylbromide (nPB) using benchmark dose methods. nPB is a non-ozone depleting solvent, proposed under the Significant New Alternatives Policy (SNAP) for use as a precision vapor degreaser. OELs have generally been developed on the basis of a NOAEL or LOAEL and application of uncertainty factors; this paper represents a departure from historic methods. Six recently completed toxicological studies were critically reviewed to identify (1) toxicologically significant endpoints, (2) dose-response information on these endpoints, and (3) uncertainties and limitations associated with the studies. Dose-response data were compiled and entered into the USEPA's benchmark dose software for calculation of a benchmark dose (BMD) and a benchmark dose low (BMDL). Once values were estimated for all relevant studies, they were then incorporated into a weight-of-evidence approach to develop a single BMD and BMDL representative of nPB. This approach is similar to that recently taken by USEPA to develop their own recommended OEL for nPB. USEPA's approach is compared and contrasted with ours, particularly in relation to the application of uncertainty factors (UFs) to generate a final OEL. There are no published criteria for application of UFs in developing an OEL. Although USEPA recommends utilizing a UF of 9, based on intraspecies variability and pharmacokinetic differences between rats and humans, to meet the goal of protecting healthy adult in a workplace setting, no uncertainty factor was deemed necessary for nPB in this paper. Therefore, the BMDL was recommended as the OEL.

Animals↗

PubMed2006

Benchmarking of performance of Mexican states with effective coverage.

Benchmarking of the performance of states, provinces, or districts in a decentralised health system is important for fostering of accountability, monitoring of progress, identification of determinants of success and failure, and creation of a culture of evidence. The Mexican Ministry of Health has, since 2001, used a benchmarking approach based on the WHO concept of effective coverage of an intervention, which is defined as the proportion of potential health gain that could be delivered by the health system to that which is actually delivered. Using data collection systems, including state representative examination surveys, vital registration, and hospital discharge registries, we have monitored the delivery of 14 interventions for 2005-06. Overall effective coverage ranges from 54.0% in Chiapas, a poor state, to 65.1% in the Federal District. Effective coverage for maternal and child health interventions is substantially higher than that for interventions that target other health problems. Effective coverage for the lowest wealth quintile is 52% compared with 61% for the highest quintile. Effective coverage is closely related to public-health spending per head across states; this relation is stronger for interventions that are not related to maternal and child health than those for maternal and child health. Considerable variation also exists in effective coverage at similar amounts of spending. We discuss the implications of these issues for the further development of the Mexican health-information system. Benchmarking of performance by measuring effective coverage encourages decision-makers to focus on quality service provision, not only service availability. The effective coverage calculation is an important device for health-system stewardship. In adopting this approach, other countries should select interventions to be measured on the basis of the criteria of affordability, effect on population health, effect on health inequalities, and capacity to measure the effects of the intervention. The national institutions undertaking this benchmarking must have the mandate, skills, resources, and independence to succeed.

Adult↗

PubMed2002

A combination of an extrapolation method and a benchmark method to develop quantitative health targets for Japan.

The aim of the present study was to propose a methodology to formulate quantitative health targets which combined an extrapolation method and a benchmark method, and to estimate the targets for mortality rates (Mb) for selected causes of death by the year 2010 in Japan. Using the extrapolation method, based on the nationwide Mt from 1988 to 1997, the Mt in 2010 was predicted using a regression model. Using the benchmark method, the paired-mean of the age-adjusted mortality rates (Mts) of the top five prefectures among 47 prefectures was calculated as the benchmark. Combining the predicted mortality and the benchmark mortality, year 2010 targets were determined. As a results year 2010 targets as percentages compared with Mt in 1997 for cancer at all sites, stomach cancer, lung cancer, colo-rectal cancer, liver cancer and stroke were estimated to be 93, 52, 94, 102, 53 and 52% for males, and 84, 43, 86, 82, 60, and 45%, for females, respectively. The methodology presented in this article could be used as a standard procedure to formulate realistic quantified health targets, which can be adopted to develop health policies in nations, regions and communities.

Benchmarking↗

PubMed2003

Comparison of available benchmark dose softwares and models using trichloroethylene as a model substance.

By using trichloroethylene as a model substance the U.S. EPA benchmark dose software was compared to the software by Crump and the software by Kalliomaa. Dose-response and dose-effect data on the liver, kidneys, central nervous system (CNS), and tumours were selected for the evaluation. Based on the present study the U.S. EPA software is preferable to the other softwares for dichotomous data. A wider range in benchmark doses was often observed for dichotomous data when the numbers of dose levels were limited. The log-logistic model in most cases gave the best fit when ranking the dichotomous models. In addition, the log-logistic model often implied a more conservative benchmark dose. For continuous data it was more difficult to find a model describing the data. The softwares by Kalliomaa and by the U.S. EPA offered the best opportunities for benchmark dose modelling of continuous data. Flexible models, like the Hill- and the Mult model, are needed for S-shaped continuous data but these models demand more dose levels in order to describe the data. Since the number of dose levels are important for model selection study design is important and should be further evaluated.

Benchmarking↗