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Benchmarking In Health (part I)

Benchmarking In Health (part I) by Graham Francis; Stewart Lawrence
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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 healthcare 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 issues covered. Northcott, D. and Llewellyn, S., “Benchmarking in UK health: a gap between policy and practice?” In their paper Northcott and Llewellyn note that benchmarking is one of the private sector-grown managerialist tools whose application and significance is rapidly increasing in the UK public sector. Despite its prevalence, the nature (competitive or comparative), the process (based on indicators or ideas) and the outcomes (standards or best practice) of benchmarking in public services remain unclear. Their paper aims to inform the debate on the merits (or demerits) of relative performance evaluation through an examination of current UK National Health Service (NHS) benchmarking policy and practice. Specifically, recent literature and government pronouncements are drawn on to explore whether benchmarking is being used dynamically, to disseminate best practice in healthcare, or whether it is primarily a government tool to enforce static competitive performance standards. The findings reveal that benchmarking requirements, imposed by government policy, are articulated in terms of comparative ideas-benchmarking with the stated objective of sharing best practice, but are operationalised and disseminated in the form of indicator league tables with standardised benchmarks for performance. Hence, there is an apparent “articulated policy – implemented practice gap”. This paper concludes that, while benchmarking may be an effective political instrument, its potential for supporting health care improvement remains largely unrealised. Wait, S. and Nolte, E., “Benchmarking in health systems: trends, conceptual issues and future perspectives” The Wait and Nolte paper presents an overview of current international and national benchmarking initiatives in health. They discuss the challenges posed by existing benchmarking indicators and conclude with a discussion of how health policy research and practice are evolving to meet these challenges and how further research and applications are needed to ensure that benchmarking in health helps better our understanding of where to focus policy efforts in order to improve the performance of health care systems. Price, C., “Benchmarking in laboratory medicine: are we measuring the right outcomes?” The paper by Price reviews the application of the principles of benchmarking to the field of laboratory medicine. It identifies the main performance indicators employed in the benchmarking programmes that have been developed and the impact that these studies have had on laboratory performance. The review highlights the consequences of the fact that benchmarking in laboratory medicine is undertaken in isolation from the clinical setting in which it is applied. Some examples of outcomes studies are discussed which demonstrate the value of the laboratory medicine service and which highlight the complexity of developing a more outcomes approach to benchmarking of laboratory medicine services. Matykiewicz, L. and Ashton, D., “Essence of Care benchmarking: putting it into practice” Matykiewicz and Ashton’s paper introduces “Essence of Care” a benchmarking tool for health care practitioners and an integral part of the NHS Clinical Governance agenda. It provides a case study of how one NHS Community Health Trust has attempted to introduce benchmarking. The findings from the evaluation highlight that whilst raising awareness is relatively straightforward, putting “Essence of Care” into practice is more difficult to achieve, especially when happening at a time of significant organisational change. The authors consider the need for a receptive context for change and whether “Essence of Care” can be used as a framework for developing an improvement culture. Wynn-Williams, K., “Performance assessment and benchmarking in the public sector: an example from New Zeland” Several papers deal with the introduction of benchmarking practices to the New Zealand health sector. A paper by Kate Wynn-Williams examines the practices of Pharmac, a governmental body whose obligation is to control the cost of pharmaceuticals. Using one of New Zealand’s largest public health organisations as an example, the author argues that increasing accountability and meaningful reporting can be promoted through a combination of internal benchmarking, process benchmarking and increased public documentation. 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
Guest Editor

Previously published in: Benchmarking: An International Journal, Volume 12, Number 5, 2005

Emerald Publishing Limited; Read online
Title: Benchmarking In Health (part I)
Author: Graham Francis; Stewart Lawrence

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