Benchmarking projects: How do you measure up?
Benchmarking projects: How do you measure up?
While outcomes measurement and benchmarking projects take time and money, they are critical parts of any same-day surgery’s internal quality improvement program.
They also provide important information needed in managed care contract negotiations and accreditation surveys, say experts interviewed by Same-Day Surgery.
The Accreditation Association for Ambulatory Health Care in Skokie, IL, requires facilities to have a process to gather information on quality indicators and compare themselves to other facilities, says Kathy Bryant, executive director of the Federated Ambulatory Surgery Association (FASA) in Alexandria, VA. (For more information, see Same-Day Surgery, July 1999, p. 83.) While the Joint Commission on the Accreditation of Healthcare Organizations in Oakbrook Terrace, IL, doesn’t require outcomes measurement as part of accreditation as an ambulatory surgery center, it is an issue that will be addressed in the near future, says a Joint Commission spokesperson.
The current and future accreditation requirements are one reason FASA initiated an outcomes monitoring project in 1997. (See organizations with outcomes monitoring projects, p. 131.) The project is open to FASA members only and measures patient satisfaction, operational indicators, and outcomes, says Bryant. "We send a survey to all members each quarter with 25 questions addressing the three areas we measure. Members complete the questionnaire and return it to FASA. Reports that detail an individual facility’s results as well as national results are generated," explains Bryant.
Approximately 15% of the FASA members participate, but Bryant says the goal is higher participation. "We want our members to be able to see how they compare to similar facilities, but it will take higher levels of participation to enable us to subdivide the data," she explains.
In addition to using her outcomes data for accreditation, Annie Meeks, BSN, administrator of Mountain View Surgery Center in Loveland, CO, uses the results of her measurement program to market her surgery center to managed care programs.
Although Meeks does not currently participate in a national benchmark study, she compares her measurements to standards published by national professional organizations that address issues such as infection control. "I can show that not only do we have low infection rates, but we also have high patient satisfaction scores," she explains.
National data provide benchmarks
Comparing your same-day surgery program to similar programs is helpful, but being able to compare yourself to national benchmarks is very important, says Ann Geier, RN, MS, CNOR, chief operating officer of Medicus Surgery Center in Anderson, SC. Geier’s facility participates in Surgical Outcomes Information Exchange (SOIX), a not-for-profit organization based in Richmond, VA, that provides benchmarking services for ambulatory care centers.
"SOIX gives us the chance to compare procedure-specific data such as length of surgery, discharge times, and postoperative complications," says Geier. Staff record the data needed for the survey on the patient’s chart, then Loretta Warder, RN, the surgery center’s CQI coordinator, enters the data into the computer and uploads the information to SOIX.
At this time, SOIX cannot provide comparisons to similar programs because they, like FASA, are building a large enough client base to allow a statistically correct subdivision of data, says Jennifer Green, ART, vice president of network development for SOIX. "We are collecting data related to numbers of procedures performed each year as well as type of procedures so we can offer these comparisons when we have enough clients," she adds.
Costs can be minimal
Smaller same-day surgery programs benefit the most from association outcomes monitoring projects because they may not be able to afford fees charged by commercial outcomes measurement companies, says Bryant.
Green agrees with Bryant that same-day surgery programs don’t have huge amounts of money to invest in outcomes studies and says that SOIX is priced to accommodate all sizes of surgery centers.
"Our prices range from $870 per year for programs performing fewer than 1,000 procedures per year to over $3,000 per year for day-surgery programs with three or more sites," she says.
If you are considering participation in an outcomes monitoring project, don’t forget to include staff costs involved in collecting and inputting the data, Geier advises. Even the simplest program requires staff involvement, she says.
Choose an outcomes program carefully
If you want to participate in an outcomes measurement program that you hope to use as a benchmarking tool, be sure to look for the following:
• Comparison of apples to apples.
One problem with many outcomes projects is poorly defined criteria, says Meeks. Be sure that you are measuring your performance against programs that define turnover time, for example, in the same way you do, she says.
• Timely, useful reports.
Geier points out the need for reports to be developed in a time frame that enables you to identify and address potential problems. Quarterly reports are useful. It’s also important that the reports be in a format that can be easily read, she adds.
"After receiving our first SOIX report, we asked the company to redesign our report so we could see our data and the national data on the same page," she says. The company quickly complied, and Geier now has a report that is easy to read and translate to staff and physicians.
Another key to a successful outcomes measurement program is the buy-in of staff and physicians, says Meeks. Mountain View instituted a physician survey that records complications reported after the day-surgery staff’s involvement with the patient ends. (See story on medical outcomes, above). The physicians not only approved the survey, but they made completion of the monthly form a condition of reappointment to staff, adds Meeks.
"Be realistic about your expectations for an outcomes measurement program," says Bryant. Also, make sure you are collecting clinical or operational information that physicians and staff members want. "Ask questions of the medical and nursing staff to find out what they want to know," she says.
Begin by measuring basic indicators for which the data can be easily collected, such as delays in starting surgery, turnover time, or patient satisfaction, Bryant suggests.
"It is better to do a good job of collecting and reporting a smaller amount of pertinent data rather than do a haphazard job of collecting a large amount of data that may not mean anything," she says.
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