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Benchmarking In Health (part Ii)

Benchmarking In Health (part Ii) by Graham Francis
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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 issues covered. 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 Profile” 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
Guest Editors

Previously published in: Benchmarking: An International Journal, Volume 12, Number 6, 2005

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

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