Benchmarking In Health (part Ii)
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The papers in this special issue cover a range of topics and issues on benchmarking in
health. The papers cover a wide range of perspectives, from practitioners and
academics, covering theoretical and practical aspects of benchmarking. Benchmarking
has become an increasingly widespread practice in managing health care provision.
The label of benchmarking covers a diverse range of practices. The diversity of
practices is explored in this special issue. The papers in this special issue emphasise
the growing application and significance of benchmarking and examine the possibility
of its use to better understand and improve health service performance.
Internationally, many schemes have been devised to assist health care practitioners
and managers to improve services and cost efficiency. Governments have introduced
new cost and information systems and managerial practices, including benchmarking,
in seeking to control the fiscal burden of health care provision. Benchmarking has been
employed in various guises from external cost comparisons through to improvement of
health care procedures. This special issue draws together evidence of various attempts
to better understand best practice(s).
Benchmarking is not a passive process and is likely to alter behaviour in areas
being benchmarked. This is a powerful tool if correctly targeted at appropriate
“benchmarks”, but can equally be dysfunctional where ill-conceived benchmarking
practices are adopted. Benchmarking initiatives can be controversial and may be seen
by some in health care as another way of merely justifying cost-cutting behaviour, and
there may be examples where this is the case. However, there is scope for
benchmarking clinical as well as financial metrics/outcomes.
The following summary of each of the papers provides an overview of the range of
Several papers deal with the introduction of benchmarking practices to the New
Zealand health sector. Papers from New Zealand resulted from an invitation by the
editors whilst presenting a plenary on benchmarking at the First New Zealand “Health
Sector Finance Conference: From Financial Foundations to Management Decisions”,
19-20 May, 2003. We invited submissions from those involved in benchmarking policy,
design and implementation, and this resulted in interesting examples of benchmarking
practices being submitted.
The health service in New Zealand operates through 21 District Health Boards
(DHBs). The New Zealand Ministry of Health has developed diagnosis-related group
(DRG) based costing and benchmarking approaches. Two papers explain aspects of
this approach and the possibilities of using the data in benchmarking activities.
Stevanovic, V., Feek, C. and Kay, R., “Using routine data for benchmarking and
performance measurement of public hospitals in New Zealand”
Stevanovic, Feek and Kay describe the development work on benchmarking and
performance measures at a diagnosis-related group level being undertaken by the New
Zealand Health Information Service. New Zealand District Health Boards and hospitals are encouraged to monitor how widely their values are dispersed from the benchmarks
determined for the same groupings and to identify potential gains. This approach
provides an indication of which DRGs and outcome variables may be worth looking at
in more detail.
Welsh, B. and Kakaua, J., “New Zealand District Health Board Mental Health Service
The paper by Welsh and Kokaua illustrates how the Ministry of Health developed a
DHB mental health service profile (Profile) that for the first time compares performance
on a number of quality indicators for the populations of the 21 DHBs. The Profile is
based on a national data collection system of client use of community and inpatient
services, and records nine quality indicators for seven broadly defined client groups.
Each DHB has a record of its own performance and the opportunity to compare this
with similar information for all the other DHBs. The aim is to encourage the use of
objective information to assess performance and guide decisions to improve, and the
initiative has been well received by DHBs.
Booth, M., James, P. and Stevanovic, V., “Benchmarking of hospital activity data:
an international comparison”
The international use of benchmarking is covered in a paper by Booth, James and
Stevanovic. Their paper describes a comparative benchmarking exercise of
anonymised patient level data from hospitals in the UK and New Zealand. The aim
of the study was to examine the feasibility of comparing hospitals internationally and
to highlight some of the barriers. Problems encountered included the different clinical
coding systems that were in use, which necessitated the mapping of all records to a
single consistent database, and the different methods of counting inpatient activity
that is used in the two countries. Despite these problems some comparative analysis
was possible and differences were found, particularly in lengths of stay between the
two countries. It is hoped that further investigations will build upon this analysis to
improve its robustness.
France, N.C. and Francis G.A.J., “Cross-laboratory benchmarking in pathology: scientific
Management or the art of compromise?”
The paper by France and Francis evaluates the potential of performance
benchmarking as an expenditure-control tool for a national pathology service
comprising both public and private service providers. Primary data were provided by
direct consultation with a wide range of stakeholders. The paper concludes that
appropriate performance benchmarking may have the potential to be applied as a
useful service rationalisation and realistic price-signalling tool.
We hope you enjoy this collection of papers. We make no pretence that this special
issue is definitive and strongly encourage further research and cooperation in this area.
Finally we would like to thank Professor Angappa “Guna” Gunasekaran for his
support and encouragement with this special issue, and all those who gave their time to
act as anonymous referees.
Graham Francis and Stewart Lawrence
Previously published in: Benchmarking: An International Journal, Volume 12, Number 6, 2005
Emerald Group Publishing Limited
; November 2005
49 pages; ISBN 9781845448462Read online
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Title: Benchmarking In Health (part Ii)
Author: Graham Francis; Stewart Lawrence
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