Benchmarking: It's All About Performance

Benchmarking in healthcare offers a practical way of measuring and comparing services.

It can help improve performance, set standards of excellence and identify gaps in learning.

So, how is it done?

What is Benchmarking?

Benchmarking is a powerful management tool that was originally developed to maintain high standards in industry.

Although a relatively new initiative for many healthcare organisations, benchmarks are now rapidly gaining recognition as a useful tool to help ‘shine a light’ on critical areas of nursing (Hospice UK 2017).

It’s the process of establishing a high standard of excellence by regularly comparing healthcare services with best practices from other institutions.

One of the great advantages of benchmarking is its adaptability to certain nursing specialties. From acute to long-term care, health promotion and self-care, through to pain management and pressure ulcers, benchmarking can be successfully applied to almost any clinical speciality.

Whilst it’s important to differentiate between 'best practices benchmarking' and 'peer benchmarking', Ettorchi-Tardy (2012) notes that a key characteristic of all benchmarking is that it’s part of a comprehensive and participative policy of continuous quality improvement.

According to the Royal College of Nursing (2017), benchmarking theory is built primarily on performance comparison and gap identification. Or, to put it another way, it’s a form of quality assurance using active collaboration between organisations to create a spirit of competition and apply best practices.

Using benchmarks gives nursing teams a relatively easy way to identify practices where performance could be improved or where new initiatives could be introduced to help raise standards of care.

Key to this is a willingness to share information and compare outcomes with other peer organisations.

Advantages of Benchmarking

• Providing a systematic approach to the assessment of practice
• Promoting reflective practice
• Providing an avenue for change in clinical practice
• Ensuring pockets of innovative practice are not wasted
• Reducing repetition of effort and resources
• Reducing fragmentation and geographical variations in care
• Providing evidence for additional resources.

(RCN 2017)

Defining the Scope of Practice

One of the key benefits of benchmarking is that it can help overcome resistance to change by highlighting alternative ways of solving problems.

Learning from others and sharing knowledge of what has worked well during benchmarking can go a long way in making the task more manageable. To make the process easier, many hospitals publish their own benchmarking guidelines.

For example, NHS Wales (2018) offers the following guidelines to help identify the scope of practice for a typical clinical benchmarking project:

1. Regularly compare functions or processes with best practice
2. Identify where performance could be improved
3. Seek fresh views and ideas to bring about improvements in performance
4. Follow up by implementing improvements
5. Monitor progress and review the benefits.

Teamwork is Essential

To work well, benchmarking needs to be a team process.

As part of the purpose of benchmarking is to raise standards, it’s likely that the outcomes may involve changes to current practices. This means that the effects of change could be felt throughout the entire clinical team and possibly extend throughout the department.

So, for benchmarking to be successful, it needs to be a team process with understanding and support for any potential changes that may lie ahead.

The willingness to share good practice is also essential. Without it, benchmarking cannot even begin.

This is why benchmarking isn’t just an activity for managers. Nurses and midwives at every level of seniority play a vital role in ensuring that their healthcare facility is a leader in meeting national benchmark standards.

Continuous Quality Improvement

In recent years, benchmarks have also developed into a valuable quality assurance tool that can easily be adapted for use in a wide variety of healthcare environments.

Many different benchmarking models exist. For example, Ettorchi-Tardy (2012) recommends a 9-step model, whilst the Royal College of Nursing (2017) expands this to a 12-step model.

Both share key similarities with other organisations and include the following steps:

1. Selecting the service or activity to be improved
2. Gathering expert input and identifying benchmarking partners
3. Identifying measurement factors
4. Identifying the competitive gap by comparing against benchmarks of best practice
5. Designing a scoring method and scoring current practice
6. Setting future performance targets
7. Communicating the benchmarking results
8. Developing action plans and implementing changes
9. Monitoring progress, updating and re-scoring.

All of these steps are built around the four core principles of benchmarking that are relevant to nursing (York 2015):

1. Maintaining quality
2. Improving customer satisfaction
3. Improving patient safety
4. Continuous improvement.

Sower (2007) goes further by suggesting that benchmarking should not just involve comparing your hospital with national averages - it should also involve looking at best-in-class hospitals and finding out what they do, or even looking beyond the healthcare industry to learn from other service industries too.

Improving the quality and effectiveness of care is a key aim for all practitioners, regardless of clinical speciality or size of the department, and sharing good practice is one of the best ways to achieve this.

Benefits of Shared Benchmarking Across Institutions and Across Countries

• Allows for a sharing of knowledge and experience
• Promotes contacts and networks
• Identifies gaps between current practice and ‘good practice’
• Brings an external focus to an internal review
• Improves decision-making through referencing comparative data
• Helps to demystify and encourage change
• Can lead to the identification of new ideas and innovative approaches.

(University of Tasmania 2018)

Whilst most benchmarking projects involve comparisons with other local or national institutions, some practitioners go further by seeking international comparisons.

Although this can significantly add to the workload, it may also broaden learning and lead to a greater sharing of good practice and further quality improvements.

The benefits of international comparisons are also strongly endorsed by Agarwal et al. (2016), who used benchmarking to explore the quality of management practices of public hospitals in the Australian healthcare system alongside seven other countries, including the UK.

Eiff (2015) also endorses the benefits of international comparisons, stating that hospitals worldwide are facing the same opportunities and threats.

The demographics of an ageing population, steady increases in chronic disease and severe illness, and a steadily increasing demand for medical services all pose universal healthcare challenges. Yet, Eiff also urges caution, suggesting that making comparisons without 'looking behind the figures' can limit the quality and reliability of findings.

Reputations Count

Bevan (2018) takes this inherent desire to share good practice a step further, suggesting that part of the motivation for benchmarking is the need to maintain a good reputation.

Drawing on research conducted in Italy and the UK, it has been shown that benchmarking can improve poor performance through naming and shaming, and enhance good performance through competitive benchmarking and peer learning.

Conclusion

Benchmarking can be a valuable technique for quickly lifting the performance of an organisation.

It’s not only about auditing practice to ensure high clinical standards - it’s also a way of supporting open comparison and sharing information to allow continuous improvement and development (Kay 2007).

Without a doubt, nurses in all specialties are being challenged to adapt to the changing demands of healthcare.

With this comes the need to provide cost-effective, highly efficient, quality patient care, and benchmarking is one of the tools that can be used to achieve this.