Benchmarking in health care: a review of the literature

Benchmarking facilities providing care: An international overview of initiatives

We performed a literature review of existing benchmarking projects of health facilities to explore (1) the rationales for those projects, (2) the motivation for health facilities to participate, (3) the indicators used and (4) the success and threat factors linked to those projects. We studied both peer-reviewed and grey literature. We examined 23 benchmarking projects of different medical specialities. The majority of projects used a mix of structure, process and outcome indicators. For some projects, participants had a direct or indirect financial incentive to participate (such as reimbursement by Medicaid/Medicare or litigation costs related to quality of care). A positive impact was reported for most projects, mainly in terms of improvement of practice and adoption of guidelines and, to a lesser extent, improvement in communication. Only 1 project reported positive impact in terms of clinical outcomes. Success factors and threats are linked to both the benchmarking process (such as organisation of meetings, link with existing projects) and indicators used (such as adjustment for diagnostic-related groups). The results of this review will help coordinators of a benchmarking project to set it up successfully.

Use of the extended therapy outcome measure for children with dysarthria

Increasing demand on healthcare resources has led to a greater emphasis on the examination of the impact of service delivery on outcomes. Clinical assessments frequently do not cover all aspects of change associated with interventions for those with complex conditions. This paper reviews the need for more comprehensive outcome measurement suitable for clinical practice and benchmarking. It describes an extension of the Therapy Outcome Measure for specific use in reflecting the impact of the broad range of interventions commonly required when managing children with dysarthria. Three case histories are used to illustrate the approach, and data from four speech-language pathology services are used to illustrate the value of benchmarking.

Introducing the therapy outcome measure for AAC services in the context of a review of other measures

PURPOSE

This article discusses the importance of outcome measures in improving Augmentative and Alternative Communication (AAC) services, reviews existing methods and introduces a new approach.

METHOD

Three methods were used in this study. 1. A literature review identifying outcome measures used in AAC research. 2. A questionnaire to AAC services in the UK which aimed to identify the objectives of their services and the outcome measures commonly used. 3. A working group of AAC experts provided additional information and interpretation. Central properties and conceptual framework were considered.

RESULTS

The literature review and questionnaire identified 23 outcome measures none of which cover the conceptual frameworks associated with all of the overall objectives of AAC provision. The review has informed the further development of a particular outcome measure the AAC Therapy Outcome Measure (AAC TOM) ensuring that basic principles of the International Classification of Functioning (ICF-WHO) are retained and the measure can be used in benchmarking.

CONCLUSION

An outcome measure needs to reflect change associated with service delivery. AAC services endeavour to impact on all of the domains of the ICF. A new measure is required in order to reflect the nature of these services. This article introduces an outcome measure which is in the process of being trialled by some services in the UK.

What makes a hospital manager competent at the middle and senior levels?

Objective. The purpose of this paper is to confirm the core competencies required for middle to senior level managers in Victorian public hospitals in both metropolitan and regional/rural areas. Methods. This exploratory mixed-methods study used a three-step approach which included position description content analysis, focus group discussions and online competency verification and identification survey. Results. The study validated a number of key tasks required for senior and middle level hospital managers (levels II, III and IV) and identified and confirmed the essential competencies for completing these key tasks effectively. As a result, six core competencies have been confirmed as common to the II, III and IV management levels in both the Melbourne metropolitan and regional/rural areas. Conclusions. Six core competencies are required for middle to senior level managers in public hospitals which provide guidance to the further development of the competency-based educational approach for training the current management workforce and preparing future health service managers. With the detailed descriptions of the six core competencies, healthcare organisations and training institutions will be able to assess the competency gaps and managerial training needs of current health service managers and develop training programs accordingly. What is known about the topic? A competent health service management workforce is critical to the effective functioning of the healthcare system. Consequently, a competency-based educational approach has been proposed to prepare current and future health professionals including health service managers. Although the literature has suggested that core competencies exist for different management levels in different healthcare settings, there has been no study which has provided valuable data to indicate what the core competencies are for hospitals managers in Australian public hospitals. What does this paper add? This paper identified and confirmed that six core competencies are common to middle to senior level managers (levels II-IV) in Victorian public hospitals in both Melbourne metropolitan and regional/rural areas. What are the implications for practitioners? The findings of the study is the first step towards supporting the competency-based educational approach for training and preparing current and future health service managers for their roles. The six identified core competencies provide a very useful guide to the identification of competency gaps and managerial training needs, and the further development of the health service management training curriculum.

North-American Lidcombe Program file audit: replication and meta-analysis

Thousands of North American clinicians have trained for the Lidcombe Program of Early Stuttering Intervention, yet there are no benchmark data for that continent. This retrospective file audit includes logistical regression of variables from files of 134 children younger than 6 years who completed Stage 1 of the Lidcombe Program. Benchmarking data for clinic visits to Stage 2 is available for these files. Meta-analysis supplements worldwide Lidcombe Program benchmark data. The median number of clinic visits to Stage 2 was 11. High pre-treatment stuttering severity predicted more clinic visits than low severity. A trend toward statistical significance was found for the frequency of clinic visits. Frequent attendance of mean less than 11 days was associated with longer treatment times than infrequent attendance of mean 11 days or more. Results for North America were consistent with benchmark data from the UK and Australia. The mean attendance trend is clinically important and requires further investigation because of its potential clinical significance.

Competencies required by senior health executives in New South Wales, 1990 - 1999

It is accepted that health care reforms and restructuring lead to the change of the tasks and competencies required by senior health care managers. This paper examined the major tasks that senior health executives performed and the most essential competencies required in the NSW public health sector in the 1990s following the introduction of major structural reforms. Diverse changes, restructuring and reforms introduced and implemented in different health care sectors led to changes in the tasks performed by health care managers, and consequently changes in the competencies required. What is known about the topic?The literature confirms that health reform affects senior health care managers’ acquisition and demonstration of new skills and knowledge to meet new job demands. What does this paper add?This paper provides a detailed description of the competencies required for senior health care managers in New South Wales in the 1990s after the introduction of the area health management model, the senior executive service and performance agreements. It confirms that restructuring and reform in the health care sector will lead to changes of the tasks performed by health care managers and, consequently, changes in the competencies required. What are the implications for practitioners?The competencies required by health care managers are affected by distinct management levels, diverse health care sectors and different contexts in which health care systems operate. The competencies identified for senior health executives in this study could guide educational programs for senior health managers in the future.

Comparing Outcomes of Voice Therapy: A Benchmarking Study Using the Therapy Outcome Measure

The quality cycle requires clinicians to assess the outcomes of interventions. Benchmarking is an approach that has been advocated to compare current performance across different services to identify commonalities and significant differences. This article gives the results of a study of outcomes in speech and language therapy (SLT) using the therapy outcome measure (TOM) for patients with voice disorder (dysphonia) comparing outcomes of seven separate speech and language therapy services. The study aimed to identify the similarities and differences in outcomes of care provided by different services. Two hundred and forty patients with dysphonia (age range 3-87.5 years, average 51.9 years) were treated. The results indicated that although there was no significant difference in the profile of the severity of symptomology of patients referred to speech and language therapy in different geographical areas, there was a significant difference in the treatment outcomes across the services and in the stated reason for discharge from treatment. Nevertheless, most patients with dysphonia had a good outcome and this was associated with completion of the course of treatment. There were significant differences in the number of treatment contacts provided by the different services and in the duration (between admission and discharge) of treatment across the services. Benchmarking can provide useful information through use of routinely collected clinical data.

Benchmarking best practices in Web-based nursing courses

This article describes the framework and process to determine best practices in online learning communities for Web-based nursing courses. The benchmarks for best practices were determined based on evidence-based research in higher education. These quality indicators were then used to develop and pilot test a benchmarking survey across three state schools of nursing. The results of the pilot test, as well as the applications and implications for benchmarking best practices, are discussed.