Benchmarking moves upstream


Benchmarking moves upstream

While most healthcare organizations have used benchmarking as a way of assessing its processes and outcomes for many years, its use is now expanding in the sector. Emily Rhinehart of Lexington Insurance assesses the implications.

Like most industries, healthcare has long made good use of benchmarking for operations, clinical processes and outcomes. Organizations routinely measure things such as losses, claim costs, and insurance costs, and compare data over time and against their peers.

Now, potential patients can also use benchmarking tools to assess healthcare providers. With just a few keystrokes, government-sponsored websites show healthcare consumers exactly how one facility measures up to another in quality of patient care and patient outcomes. Everything from how the nurses and doctors communicate with patients, to the number of deaths following broken hips and hospital-acquired infections, is benchmarked for the world to see.

An institution that trails its peers may experience not only more incidents or adverse events (and claims), it may seriously damage its reputation and revenue streams. Potential patients may choose to go elsewhere.
Consequently, healthcare institutions are under tremendous pressure to get to the root cause of losses and prevent adverse incidents from occurring in the first place. Tallying claim costs per bed versus other institutions is important. It is also useful for an institution to know if its costs are higher because of an above-average incidence of falls.

But along with looking at adverse outcomes and complications, organizations should be sure they have the right processes and structures in place to protect both their patients and their business. That means moving further upstream and—in keeping with the previous example—understanding how, and where, current practices for preventing falls are failing. At Lexington, we have developed best practices and benchmarking tools for our healthcare clients to allow them to assess where they stand versus published standards in specific high-risk areas such as obstetrics. 


These benchmarking tools, known as Best Practice Assessments or BPAs, present dozens of detailed questions and guidance that hospitals and long-term care facilities use to evaluate their existing practices against industry-standard, published best practices, such as those from the Centers for Disease Control and Prevention for mitigating hospital-acquired infections, or the American College of Obstetricians and

Gynecologists for preventing birth injuries.

They cast a wide net, delving into the wide-ranging issues that impact on patient safety, risk management and professional liability—from clinical practices to structural issues. BPAs are designed to focus on the most sensitive and claim-ridden areas of healthcare, including obstetrics, emergency services, perioperative services, credentialing and privileging, healthcare-associated infections, behavioral healthcare and long-term care.

As best practices are assessed, areas for improvement are pinpointed and tangible recommendations are put forth to improve practices and resultant outcomes. For instance, the American College of Obstetricians and Gynecologists sets a 30-minute standard for performing an emergency caesarean section.

A hospital using this measure to benchmark its own performance as part of a BPA recorded its timeframes and flagged incidents that exceeded this standard for further assessment. By digging deeper and tracking the start time or delay for each emergency C-section, the assessment ultimately revealed that the lag consistently occurred when the anesthesiologist who lived further away from the facility was on call. It sometimes took her 40 minutes to arrive at the hospital. Procedures were revamped so that this doctor would stay at the hospital when on call. Continued monitoring demonstrated that emergency C-sections were consistently initiated in 30 minutes or less, and an area of vulnerability was eliminated. 

BPAs can also be used to examine training and protocols. For example, a hospital used a BPA to evaluate its training program for nurses to assure their competence in electronic fetal monitoring (EFM). The BPA illuminated how the institution’s training measured up to recommendations of the Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN) Joint Position statement, both in terms of the percentage of nursing staff trained in EFM and the frequency of training. Where practices fell short, protocols were adjusted to align with the industry-standard best practices.


BPA results have other practical implications for risk managers. In a time of limited budgets, analysis of the overall BPA results can help management steer resources where they are most needed to elevate clinical and loss prevention strategies. BPA results can be used to benchmark externally against industry peers, or benchmark internally to periodically check the effectiveness of efforts to improve practices. A multi-facility organization might compare BPA scores at its various locations and use the findings to instil consistent prevention efforts and practices across the organization.

Moreover, just as BPA results can be used with management to demonstrate a tangible improvement in compliance with industry-leading practices, they can also be a valuable tool in defending professional liability claims. A BPA can arm a hospital with hard data to support its adherence to accepted standards of practice and its diligence in improving practices.

Every healthcare organization wants the best outcomes for its patients and its business. The best outcomes depend on having the best practices, processes and structures in place—the practices that will lead to the best outcomes. So it makes sense that benchmarking has evolved to focus not only on what is ailing a particular healthcare organization, but on the best possible cure. 


Upstream, healthcare, benchmarking, insurance, Patient, Best Practice Assessments, Care