The question that derails benchmarking
By Shelley Burns
What kills a hospital benchmarking process faster than anything else? It’s what happens when the administration asks department heads to do something with the benchmark results.
HMC produces a series of benchmarks for our hospital clients on functional cost, clinical cost and utilization, quality, and patient satisfaction. Hospital managers participate in developing the benchmarks by validating the data and our procedures handling it. The benchmark results are presented, and an administrator tells the department heads: “Find out what the lower cost/higher quality hospitals are doing differently than you!”
What do the hospital managers do? They compile long lists of differences, usually focused around their albatrosses, to rationalize the cost difference between themselves and the lower cost/higher quality hospitals. They present this list of differences to administrators as explanation for the cost/quality variances, whether or not said “difference” has a measurable and commensurate impact on cost or quality.
A few examples:
• A hospital with over a million dollars in excess labor costs in environmental services maintains that its high costs are necessary for a clean hospital. Staff cleans all restrooms every two hours. Other hospitals have “lower standards” because they clean restrooms based on need – frequently-used restrooms are cleaned more often; least-used restrooms might only need cleaning once per day.
• A sterile processing manager justifies a cost/ surgical case that is three times higher than all hospitals in their group because they have over 100 physician-preference cards, the Cadillac of sterile processing systems, and a full-time RN trainer to teach techs how to use it.
• A cath lab manager rationalizes her higher costs by noting that other cath labs have shorter operating hours than her 10 hours per day. She averages less than two cath lab procedures per day, but the cath labs, prep, and recovery are staffed three to four hours per day longer than her peers.
How can you break out of this cycle? Don’t ask your department heads what OTHERS do differently, or ask them to compile lists of differences. Instead, ask your department heads what THEY can do differently to improve their costs and quality. Task them with developing strategies and implementing solutions to cost and quality problems. Put the onus on your managers to take action and make change, not lists and excuses.
A subtle mind shift to be sure, but a critical one.
Shelley Burns is head of knowledge management at HMC.
