Benchmarking for Healthcare Quality Improvement Initiatives

Introduction to Benchmarking in Healthcare

The subject of healthcare quality has been gaining increasing prominence within an operational climate where research and healthcare financing are more competitive and less secure. One potential means of aiding healthcare organizations in improving and maintaining superior-quality care is service benchmarking. Benchmarking within the context of healthcare has been described as the procedure of identifying and comparatively assessing the reasons underlying superior performance levels. A key aspect of this concept is that it is not meant to be a mere generic measurement of one healthcare institution against another; rather, it also encompasses studying and transferring exemplary practice. Stanford describes benchmarking as the process by which field leaders are identified so that others in the field may understand and follow their practice. Benchmarks are points of comparison. A second key element of benchmarking is understanding the processes whereby organizational performance may be improved, instead of blindly mimicking another process, since what works for one healthcare facility might prove highly detrimental for another (Thonon, Watson & Saghatchian, 2015).

The benchmarking concept was introduced during the 1930s within the industrial sector. Within the field of healthcare, comparing outcome indicators across organizations — typically hospital mortality rates — is a practice traceable as far back as the seventeenth century. However, it was only employed as a structured technique during the mid-1990s, in Britain and America, owing to the need to compare healthcare organizations' outcomes in order to account for their funding (Thonon et al., 2015).

Among the main advantages of the benchmarking technique is its ability to help overcome opposition to organizational change by highlighting alternative solutions to problems. Knowledge-sharing and learning from other entities about which practices and procedures have proved successful in the past can work wonders when it comes to increasing task manageability. To simplify the process, a large number of healthcare organizations publish their own benchmarking guidelines. NHS Wales (2018), for instance, puts forward the following guidelines for facilitating identification of practice scope in a regular clinical benchmarking endeavor:

Research Methodology

This research will be conducted using nurses from two private healthcare facilities: the first having 22 nursing personnel and 112 beds, and the second having 19 nursing practitioners and 103 beds. Study subjects would be expected to employ the latest evidence-based best practices and expertise relevant to patient care in order to address identified deficits — that is, quality improvement — rather than attempting to formulate novel interventions or generate new knowledge through research. The critical patient care manager must identify a problem in the quality improvement system that requires rectifying. In other instances, multiple departmental problems might need to be examined, or the manager might be approached by a graduate or undergraduate nursing student seeking recommendations for a capstone project. Determining which venture to address requires evaluating whether sufficient resources — including time, expertise, and organizational support — are available to manage the project's complexity and ensure it can be performed effectively (Stausmire & Ulrich, 2015).

The two private hospitals were chosen for this study because they are academic institutions affiliated with a regional federal university. Furthermore, they have initiated action to improve patient safety and care quality and to manage risks, which indicates a sincere commitment backed by substantiated outcomes. Both hospitals have been pursuing accreditation and have relied on quality indicators since becoming part of Pro-Hosp in 2011. Lastly, they employ several quality indicators gathered by nurses, which are subsequently studied and assessed by technical managers as well as nurses. The study population will include all nursing workers in both organizations who are directly involved in patient care and who participate in at least one of the following steps: acquisition, study, and/or appraisal of indicators. The exclusion criterion will be nursing personnel who were absent from work for any reason.

A semi-structured interviewing technique will be used for data collection. Interviews with nurses will be fully recorded and then transcribed. The following questions will guide the interview process:

Furthermore, respondents will complete an American Association of Critical-Care Nurses-developed questionnaire (2015), which evaluates the following elements of healthcare system quality improvement:

Depending on the nature of the practice problem, the study may incorporate tangible elements such as staffing levels, number of in-patients that can be accommodated, staff mix, advanced practice nurse (APN) availability as mentors, population served, mean acuity scores, mean patient age, intensivist or hospitalist use, collaboration with resident doctors, most commonly occurring diagnoses, quality improvement programs, technology associated with available supplies and equipment, technology for documenting medical records, evidence-based practice (EBP) tools such as bundles and checklists, and general patient safety issues. Intangible factors, which are harder to measure, can include personnel professionalism expectations, communication methods with colleagues, patients, and their families; interface with other care systems; learning opportunities for personnel and patients; and the staff mix relative to experience and knowledge — ranging from novice to expert (Stausmire & Ulrich, 2015).

Role of Nursing Staff

Nursing practitioners will contribute significantly to the provision of authentic information. Higher authority figures — comprising supervisors, managers, and physicians — will offer additional support and guidance pertaining to quality improvement indicators. Outcomes will be examined using content analysis, a method that involves a sequence of three chronological phases: pre-analysis, examination of material and outcome processing, and deduction and interpretation. Interviews with nurses will be carefully scrutinized to ensure full comprehension of the text and an accurate understanding of what each subject intended to communicate. The subsequent phase will involve thematic selection for identifying core meanings or semantically similar aspects. The final step will involve categorization grounded in the existing literature (Silveria et al., 2015). Questionnaire responses will be assessed according to the scoring instructions provided by the authors.

References

Bourne, L. (2015). Targeted communication: The key to effective stakeholder engagement. Procedia — Social and Behavioural Sciences, 226, 431–438.

NHS Wales. (2018). Benchmarking. Retrieved from

Nursing Times. (2015). Nursing research: Ethics, consent and good practice. Nursing Practice, 110(1).

Silveria, T., Junior, P., Siman, A., & Amaro, M. (2015). The importance of using quality indicators in nursing care. Rev. Gaucha Enferm, 36(2).

Stausmire, J., & Ulrich, C. (2015). Making it meaningful: Finding quality improvement projects worthy of your time, effort, and expertise. Critical Care Nurse, 35(6).

Stetler, C., Ritchie, J. A., Rycroft-Malone, J., & Charns, M. (2014). Leadership for evidence-based practice: Strategic and functional behaviors for institutionalizing EBP. Worldviews on Evidence-Based Nursing, 11(4), 219–226. doi: 10.1111/wvn.12044

Thonon, F., Watson, J., & Saghatchian, M. (2015). Benchmarking facilities providing care: An international overview of initiatives. SAGE Open Medicine, 3. doi: 10.1177/2050312115601692