Benchmarking resource allocation and performance metrics

Benchmarking Human Resources: Monitoring the Effectiveness of a "Tell it to the Director" Initiative on Patient Satisfaction at a Department of Veterans Affairs Medical Center

As the nation's largest healthcare provider, the Department of Veterans Affairs (VA) has the responsibility to use taxpayer resources to their maximum advantage in accomplishing its longstanding mandate to "care for him who shall have borne the battle, his widow and orphan" (Doebbeling et al., 2002). To help it accomplish this important mission, the VA has long used benchmarking to identify opportunities for improving the provision of healthcare services in its medical centers, outpatient clinics and Vet Centers across the country. As a result of these initiatives, the staff at some VA medical centers used other benchmarking techniques to identify further opportunities to improve patient care and satisfaction, with one such example being a "Tell It to the Director" program at the VA Medical Center in Oklahoma City. This paper provides a review of the relevant literature to assess the results of this program over time, followed by a summary of the research in the conclusion.

Review and Analysis

Beginning with the Quality Improvement Checklist (QUIC) initiative in 1991, the VA began its benchmarking efforts in earnest as the VA sought to respond to veteran, congressional and public criticisms concerning the quality of care that was being provided to the nation's veterans. According to the Quality Improvement Checklist's lead developer, Dr. Galen Barbour, "In 1991, the Department of Veterans Affairs developed an instrument to monitor various aspects of quality in Veterans Affairs hospitals. The instrument, the Quality Improvement Checklist, is composed of a series of clinical indicators or questions about administrative or clinical processes, structures, or outcomes" (p. 127). The benchmarking data that were needed for the majority of the questions on the QUIC were gathered efficiently through the use of automated searches of electronic patient data-bases that were maintained in each VA medical center. The respective data for each medical center were then aggregated and compared in tabular and graphic formats to identify trends and provide comparisons of VA medical centers' performance across a broad range of indicators, including a dimension for patient satisfaction (Barbour, 1991).

One of the task force members who participated in the development of the QUIC instrument returned to his position as a quality assurance program specialist at the VA Medical Center in Oklahoma City where he applied the methods he learned from Dr. Barbour in developing additional benchmarking applications for local applications. One of these initiatives was the "Tell It to the Director" program that provided veteran patients with a confidential and accessible method of communicating directly with the medical center's director, Steven Gentling (West, 1992). This rationale in support of this initiative was that to the extent that veteran patients had easy access to an effective alternative problem-resolution avenue would be the extent to which patients who encountered problems at the medical center requesting assistance from their congressional representatives would decrease.

Because the office of quality assurance (OOQA) had already benchmarked patient satisfaction levels based on various measures such as congressional inquiries, patient incident reports and other sources, the effect of the Tell It to the Director initiative could be assessed, at least in a general fashion, from its inception onward using this historic benchmark data using a goal of reducing the overall number of congressional inquiries by at least 10% in the first year of the program's operation. An analysis of the program's effectiveness using the benchmark average from the past 5 years which was 227 inquiries (167 from U.S. representatives and 60 from U.S. senators) based on the number of congressional inquiries received following the program's launch in January 1992 is set forth in Table 1 and depicted graphically in Figure 1 below.

Table 1

Number of Congressional Inquiries Received Related to Patient Satisfaction: January 1992-December 1992

Source

Jan

Feb

Mar

Apr

May

Jun

Jul

Aug

Sep

Oct

Nov

Dec

Total

U.S. Reps

7

11

8

9

6

3

5

2

1

4

3

2

61

U.S. Senate

10

12

7

5

7

4

2

5

2

3

2

2

61

Total

17

23

15

14

13

7

7

4

3

7

5

4

Figure 1. Number of Congressional Inquiries Received by OOQA: January 1992-December 1992

Given that it is axiomatic that in order to improve anything, it must first be measured, this benchmarking process is relevant to any organization's strategic planning. Although the results of the Tell It to the Director program appear to have positively affected the number of congressional inquiries received during 1992, a number of other initiatives sponsored by the OQQA also took place during this year that may have contributed to this overall reduction. For example, OOQA sponsored several workshops, seminars and a "House of Healthcare Horrors" on Halloween that served to raise awareness among the medical center's healthcare providers concerning the primary reasons that were being cited by veterans in their congressional inquiries in ways that would contribute to overall patient satisfaction.