When Goodyear embarks on a benchmarking project, it also spends up to three months planning and preparing for the task. There are meetings, analysis, strategy sessions and developing materials to help streamline the process. There are lively discussions about what the company hopes to get out of it and what it hopes to achieve in the long run. Those who participate in the process receive training on how to use their analytical skills to benchmark successfully.
Of course, learning about the inner workings of other companies is a key element to effective benchmarking. Olberding of the Society for Quality and Participation suggests targeting previous award winners that no longer are so highly sought after, but have the materials and public relations infrastructure in place to deal with requests. Effective benchmarking requires more than knowledge of how to network, however. Asking the right questions is vital.
The fact is, they have 20 questions all over the place. They ask how you structure your funding for training or how you evaluate things in general. The questions must be tightly focused.
The questions they ask can be quite different. At Xerox, benchmarking teams often bounce ideas back and forth. And by the time Xerox is ready to use the telephone or a meeting to conduct a benchmarking interview with another organization, the focus is perfectly clear.
As expected, this no-nonsense approach spills over into the meeting itself. Adapt to your own culture. Which of these ideas fit into my environment? As Kodak re-engineered operations—including HR—it has increasingly turned to benchmarking to supply answers. Using detailed questionnaires, surveys, E-mail, videoconferencing and other methods to communicate with other firms, it constantly surveys the landscape for new ideas and ways to tweak existing practices.
Once armed with the information, Kodak incorporates ideas and outstanding practices into its own corporate fabric—while striving to retain its own identity. At the time, other firms were beginning to move away from single replacement products and toward one large insurer. So the company embarked on a thorough benchmarking project—combined with surveys, interviews and focus groups—only to discover its demographics and culture were better suited to the existing system, with some changes and improvements.
It was the easiest and least risky solution. View benchmarking as an evolution. Because maintaining perspective can be so difficult, many companies now opt to use outside consultants to help them steer through the choppy waters of benchmarking.
They know the critical-success factors, they know who the leaders are within the industry and they know how to obtain the necessary information and use it. An added benefit—a consultant also can design a benchmarking survey to protect the confidentiality of sensitive material. Murray believes one of the keys to benchmarking success is to adopt a philosophy of involvement and participation from the start.
That might translate into opening up a planning meeting, using team-based interviews, passing around tape transcripts after an interview and establishing debriefing sessions that allow questions and an honest critique to flourish. These two qualities can lead to far more spectacular gains. Besides, benchmarking can create its share of problems. And not all management teams are willing to fund or support benchmarking to the degree needed. However, when benchmarking works, the results are often impressive.
Benchmarking within HR can help identify ways to structure a medical plan more effectively or determine whether turnover exceeds the industry norm and what the ramifications might be. And not just in obvious ways.
Thus began the development of indicator-based comparative evaluation of hospital performance. The aims of the PATH Performance Assessment Tool for Quality Improvement in Hospitals project designed by WHO were to evaluate and compare hospitals' performance at the international level using an innovative multidimensional approach, to promote voluntary inter-organization benchmarking projects and to encourage hospitals' sustained commitment to quality improvement processes Groene et al.
Its long-term objective was to create a set of indicators that could be used to identify new avenues of research on healthcare quality in OECD countries. These indicators would essentially serve as the starting point for understanding why there were differences and what means could be used to reduce them and improve healthcare in all the countries Arah et al.
There were also other international projects based on comparison of performance indicators. One of these, for example, was a project in the Nordic countries on healthcare quality indicators. The aim of this project of the Nordic Council of Ministers was to describe and analyze the quality of services for major illnesses in the Nordic countries Denmark, Finland, Greenland, Iceland, Norway and Sweden Mainz et al.
In the United States, since the s, the AHRQ Agency for Healthcare Research and Quality has been developing and expanding a series of indicators, or QIs quality indicators , using a conceptual model with four dimensions to measure the quality, safety, effectiveness and efficiency of services provided both within and outside hospitals. These indicators are produced using only hospitals' clinical and administrative data AHRQ , Several other studies have targeted the comparison of healthcare indicators in a given area.
For example, Earle and colleagues compared the intensity of end-of-life care for patients with cancer by using Medicare administrative data. Two other studies, one American and the other Australian, looked at comparative analyses of mental health indicators among several healthcare organizations Hermann et al.
Other local and regional comparative indicator-based initiatives were developed in France:. These projects made it possible to develop indicators and to begin doing comparisons in the healthcare sector. In Denmark, the national indicator development project was created in Between and , several professional clinicians appointed by scientific societies developed evidence-based quality indicators for the management of illnesses.
The objective of this project was to document and develop quality of care for the benefit of the patient. Another aim of this project was to conduct benchmarking processes through regular dialogue between the agency collecting the indicators and the representatives of a region's institutions about the results of the indicators, as well as structured dialogues with institutions whose results were atypical.
This approach fits within a framework that is midway between internal improvement and external monitoring, in the sense that the agency would conduct a visit if this dialogue did not produce satisfactory explanations Mainz et al. It is based on indicators indicators in 26 healthcare domains in Hospitals receive their own results as well as those of the other hospitals.
Hospitals whose results are in the reference panel carry out, as part of the structured dialogue, an analysis of atypical results outliers , as in Denmark, but in addition, there are discussions between professionals in the different healthcare institutions to identify the reasons for the performance disparities.
The results for several specialties and the reasons for the differential evolutions between the regions are followed from year to year; finally, the indicators are analyzed and discussed from the methodological standpoint. In the United Kingdom, Essence of Care is an approach to healthcare services, launched in , that aims to improve the quality of the fundamental components of nursing care. It uses clinical best practice evidence to structure a patient-centred approach to care and to inform clinical governance, a generic term designating the managerial policy of making care teams directly responsible for improving clinical performance.
Benchmarking, as described in Essence of Care, helps practitioners adopt a structured approach to sharing and comparing practices so that they can identify best practices and develop action plans NHS , , ; Nursing Times Several publications dealt with this strategy and its application in various sectors of care. Butler's article analyzed the political, professional, social and economic factors that contributed to the development of this approach, focusing particularly on benchmarks related to treating bedsores.
It will be interesting to follow the European Union's EU initiative, which used a structured, seven-step benchmarking process as a new tool to evaluate national communicable disease surveillance systems in six member states in order to identify their strengths and weaknesses.
The objective was to make recommendations to decision-makers for improving the quality of these systems Reintjes et al. The aim of this project is to identify ways to promote strong linkages between quality measurement and a hospital's internal management.
Coached by a team of advisers, hospitals learn how to analyze current emergency-room treatment processes and identify measures for improvement, as well as how to interpret outcomes by comparing them OFAS ; Schwappach et al. The literature review highlighted how benchmarking approaches have evolved in the healthcare sector. This evolution produced numerous definitions, whose common theme is continuous measurement of one's own performance and comparison with best-performers to learn about the latest work methods and practices in other organizations.
We recommend adopting Ellis's definition, which clearly reflects the benchmarking process and offers the advantage of focusing particularly on the use of indicators and on the functions of learning and of sharing methods.
Likewise, Pitarelli and Monnier put forward the key elements of a benchmarking process, i. Their model clearly shows that comparing indicators is only one step in the benchmarking process — a fundamental step, certainly, yet not enough in itself to be considered benchmarking. Benchmarking in healthcare is not, to our knowledge, a subject that has ever been studied in a systematic and standardized way.
This is why our review is based on multiple sources that often mix facts and opinions; we were unable to present the readings on the various experiences in as structured a grid as would be found in a classical review of articles based on similar methods. Another limitation of our review is that we did not do an exhaustive literature search, focusing rather on identifying articles that best illustrated our point of view, with the reading done by a single author.
Finally, we looked at the socio-economic context that encouraged the use of benchmarking in the healthcare sector, but not the motives underlying the use and funding of the benchmarking projects undertaken in the experiences we selected for this article.
At the international level, while most projects for developing and disseminating performance indicators exhibit benchmarking-type objectives, these projects remain restricted to indicator comparisons. The original intent of developing action plans for improvement and of reducing disparities often comes up against the difficulty of reaching consensus on the validity of data used for interorganizational comparisons. The choice and validity of indicators used for internal and external comparisons between healthcare services and systems remains a matter of debate Mainz et al.
At the national and international levels, there is a need to invest in quality measurement systems and in better international collaboration Mainz et al. Comparing data within or between healthcare systems also raises the question of how such comparisons affect performance improvement and how they are to be incorporated into existing policies. Benchmarking is put forward as a solution to strengthen the use of indicators.
This is undoubtedly one of the reasons that the benchmarking approach in healthcare is always based on indicators, which is not systematically the case in industry, where qualitative approaches are also applied.
The literature review showed that benchmarking as practised in industry is rarely implemented. Other terms have been used to designate approaches that are conceptually similar to benchmarking, such as the Breakthrough Series and Quality Improvement Collaboratives. These are all cases of collective methods of improvement.
While these processes are purported to be different from one another, in fact, the actual scope of any such differences is questionable. Rather, are they simply taking advantage of current trends or communication methods to use supposedly new terms to re-ignite interest in what are actually old approaches? This approach is based on the notion of significant advances and breakthroughs.
The Breakthrough Series can be expressed as series of rapid advances in quality that are based on innovation, the search for the latest available scientific research, accelerated testing of changes and a sharing of experiences among many organizations.
Even though this method cannot be developed without monitoring outcomes, the notion of indicators does not figure predominantly in the Breakthrough Series method, and inter-site visits are not systematic. Quality Improvement Collaboratives are carried out by multidisciplinary teams from different healthcare services and organizations who decide to work together using a structured method for a limited time a few months to improve their practices Schouten et al.
This approach has been increasingly used in the United States, Canada, Australia and several European countries. In the United Kingdom and in the Netherlands, the public authorities support the development of such programs. All these approaches are based on the same elements: multidisciplinary and multi-site characteristics, the implementation of improvement initiatives, and measurement.
It is difficult to consider them completely equivalent, because each one focuses on one or another element, which necessarily influences its implementation strategy. In particular, the Breakthrough Series focuses on the rapidity of interventions, and the Collaboratives on the time-limited nature of the exercise. Benchmarking focuses on gathering indicators for long-term monitoring, making this method truly a CQI approach. Research streams on benchmarking are numerous and quite varied, because they have not been very much developed before now.
At the strategic level, it is important to ensure that healthcare benchmarking achieves its objective, which is to better delineate those areas where policy efforts should be concentrated to improve healthcare system performance Wait and Nolte Technically, the success factors for benchmarking, which in general are closely related to those required by the main improvement approaches involvement of management, planning and project management, use of tools to support working in groups, suitable training policy , very likely include specific elements such as a culture that is receptive to transparent exchanges.
At the sociological level, a better understanding is needed of how indicators can be more widely adopted in healthcare organizations through the use of benchmarking processes and greater involvement of front-line professionals. Of course, benchmarking is primarily a management tool; nevertheless, it requires care team involvement, at least in the analysis of practices and in comparisons with other care teams. The upcoming implementation of a structured benchmarking process in more than 30 healthcare organizations in Aquitaine will make it possible to study the factors that best support the adoption of this type of process.
Benchmarking often refers to the comparison of indicators in a time-limited approach. It is not yet often perceived as a tool for continuous improvement and support to change. Benchmarking's key characteristic is that it is part of a comprehensive and participative policy of continuous quality improvement. Indeed, benchmarking is based on voluntary and active collaboration among several organizations to create a spirit of competition and to apply best practices.
Thus, this approach will need to be assessed for feasibility and acceptability. National Center for Biotechnology Information , U. Journal List Healthc Policy v.
Healthc Policy. Author information Copyright and License information Disclaimer. This article has been cited by other articles in PMC. Abstract Benchmarking, a management approach for implementing best practices at best cost, is a recent concept in the healthcare system.
Methods Documentary search To better understand how the concept has evolved and how it is currently defined, we decided to extend the boundaries of the literature review to encompass all sectors.
TABLE 1. Search strategy — Open in a separate window. Selection criteria for articles A first selection was done by reading the titles and abstracts of articles. Selection criteria for other documents The exploratory search provided articles, reports or personal pages published on the Internet. Results Articles and documents selected The various search strategies in the three databases identified 2, articles; of these, titles and abstracts were read.
Selection of articles for the literature review — Are we getting better over time? What are the barriers to improvement? What key metrics do we want to benchmark?
Start Small With those questions answered, Sinha said, some basics of your benchmarking plan will begin to fall into place. Eventually, as you continue to identify key business drivers, be sure you single out those that are integral to your business strategy. When companies are just beginning to benchmark, they should zero in on one or two critical processes over which they have some control and by which they can boost their bottom line, Zimmerman and Sinha said.
Manufacturers might find it instinctive to focus on primary manufacturing processes, but everyday business processes such as accounting or delivery logistics also may be ripe for benchmarking. Comparing Apples to Apples Once you have a plan in place, the real work begins. The hardest part of benchmarking is tracking down the information you wish to measure and compare. Data-gathering might seem daunting, but you should find many options for collecting the information you need.
Become active in the various trade associations for your industry.
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