Performance Management Through Benchmarking Simulation - Literature review Example

Performance Management Through Benchmarking Simulation Introduction: Before starting the SIM exercise, understanding of ‘benchmarking’ was confirmed; the definition given by Camp and Tweet (1994) was found to be clear and simple: “Benchmarking is a structured framework for pursuing worthwhile goals in an organized way.” I set myself the goal of using the SIM experience as a test of my existing knowledge and understanding, and worked through the processes first time around without accessing much of the help and advice available. This was a ‘different’ approach for me, given my military background and commitment to teamwork. At the outset, it was interesting to note the quotations and images of Florence Nightingale and Avedis Donabedian. These prompted further research into the connections between them and their contributions to quality healthcare outcomes, the learning from which will be mentioned in the conclusion. This paper will report my results, working through the headings and questions provided, and will conclude with a summary of learning and its potential application. Root Cause: The background information explained that LHAC’s rise in nosocomial infections, reaching 4.8% as against a desired lower figure of 3%, was a critical issue. The cost of such infections in the U.S.A. was $4.5 billion, and deaths of 80,000 patients. It could therefore be inferred that the hospital stood to lose credibility, reputation, patient uptake, and revenues if the situation persisted. Because medical equipment is widely used throughout a facility like LHAC, I identified the root cause of the problem as ‘Inefficient Equipment Management.’ Ian Watts, Chief Operating Officer, accepted this as the correct decision; that created confidence in my personal judgment and encouraged me to continue with the challenge. Because of this, I did not seek advice or assistance, and though the outcome was correct, I believe that conferring with senior colleagues would be a better option in the future. Establish Airway: The two Process Improvement Options I recommended as most likely to provide a ‘best mix’ were that ‘Equipment to be Terminally Cleaned’ and ‘Nursing Manager to Check for Unattended Equipment’. The cleaning decision was based on the links made between root cause and nosocomial infections, and the evidence-based assumption that better managed hygiene practices would have the biggest positive impact, with measurable reductions. A handout on preparation for JCAHO inspection, provided by Murray-Calloway County hospital, cited that “All equipment must be disinfected by the department/Environmental Services prior to being serviced…” (2004-2005). Guidelines previously examined, regarding best practice in reducing hospital-acquired infections, also cited the need for regular cleaning of all equipment: “There must be effective systems in place for decontamination of equipment.” (Coia, Duckworth, Edwards, Farrington, Fry, Humphreys, Mallaghan and Tucker, 2006). The Nursing Manager checks choice was based on the belief that the hands-on approach and authority within that role would ensure that the correct messages were filtered through to staff. The hypothesis here was that a more rigorous and vigilant adherence to hygiene practices, championed by the Nursing Manager, would result in good outcomes. I perceived the role and responsibility of that person as an adjacent process, already in place, and that by incorporating checks within it, would be cost effective and assist in improving staff action and accountability. The outcome of this part of the SIM demonstrated this was not the case, as Optimal Processes, as in ‘Appoint Inventory Clerks’ was the better option. Given that the budget was $300,000, my decisions were eating into this at the rate of $263,900. Reflecting on my decision, after looking at the correct process, allowed me to recognize that the salary and remit of a Nursing Manager far outweighed those of Inventory Clerks, and that staff dedicated to this specific role would cost less and be the better option. Again, I believe that a more detailed examination of background information and conferring with senior managers would have been more beneficial, and this was an important learning point. Of the Metrics chosen, ‘Total Cost of Managing Equipment’ was not as good a measure as ‘Idle Time’, though the choices of ‘Carrying Cost of Unutilized Equipment’ and ‘Utilization versus Cleaning Log Ratio’ were good, despite the fact that the former could incur high costs. Benchmarking Partner: Ruth and Rose General Hospital (RRGH) was chosen, because when comparing all the potential partners, the similarities in healthcare between LHAC and this facility were apparent. A 40% similarity of processes and the length of time RRGH had employed these (30%) made them the best choice. Their carrying cost of equipment was much less than LHAC, as was the cost of repair and maintenance. There was a 10% difference in equipment utilization; RRGH with 85%, as opposed to LHAC’s 75%. By adopting and emulating the partner’s processes, LHAC could achieve improved performance. Ian Watts confirmed this decision as correct. I would not be likely to change my decision, as I could see it as totally rational and relevant to keep RRGH as a benchmarking partner. Process Improvement Strategies: RRGH’s benchmarking data should have directed my decision, but from some activist, personal challenge motivation, I picked ‘Automate Equipment Management’. This choice was based on the idea that if equipment data were automated and so accessible to all, the management process would be easier. However, in making this decision, no account was taken of the cost of setting this up, and more importantly, not enough attention was paid to the JCAHO Elements of Performance. As Subhan (2007) stated: “The EP requires a written plan that describes the processes…one of the key documents reviewed by the JCAHO surveyors.” On reflection, I recognized that putting everything onto an automated database would not measure improved performance; the information might be more readily available, but its utilization and cost effectiveness could not be accepted as a wholly measurable improvement. It would not necessarily comply with JCAHO standards and was a cosmetic rather than realistic strategy. The outcome on the SIM showed this to be the case, and the decision was not based on all relevant factors. Ian Watts identified the best strategy as ‘Reduce Equipment Inventory’, which would result in a closer match to those used at RRGH, the partner LHAC sought to emulate. Had this strategy been selected, leased, unused equipment could be returned, saving costs, and surplus equipment sold or rented to other facilities, generating revenue. A future approach for me would be to examine each Process Improvement Strategy offered in more detail before making my decision. Summary and Conclusions: By treating the SIM as a personal test, it demonstrated for me that although the majority of my decisions were correct, leading to some improvement potential, they were not all the right choices. It showed me that working through the challenge without seeking assistance or examining the finer details was a mistaken approach. Given my military training and loyalty to other team members, this was a very different way of working for me. The major learning points I identified were the need to invest time in absorbing all information and to consult with more experienced colleagues. Had I done so, I believe I would have been better informed and equipped to understand the implications involved in each decision and so made better choices. I would have looked then at the bigger picture and seen the impact on adjacent processes and cost, as well as reducing infection with the best strategic choices. Having recognized what I needed to do in future, I researched Florence Nightingale’s involvement in gathering essential data to make improvements in healthcare. In an article in Evidence-Based Nursing Notebook by Lynn McDonald (2001), project director of The Collected Works of Florence Nightingale, a particular quote struck me as the essence of the vital importance that data should be collected and used by those in charge to make improvements. “We do not want a great arithmetical law; we want to know what we are doing in things which must be tested by results.” (Nightingale, 1891, letter to Benjamin Jowett). Avedis Donabedian, at the beginning and end of the SIM, demanded further examination. In an article on how to assess the quality of care, he expressed in great depth, and also in simplified terms, the rational of gathering: “The information from which inferences can be drawn about the quality of care can be classified under three categories: “structure”, “process” and “outcome”. (Donabedian, 1997) His statement, “good structure increases the likelihood of good process, and good process increases the likelihood of good outcome.” (1997) put the whole object of the SIM exercise into perspective and makes it an easy concept to grasp and retain. After looking closely at his processes, I went through the exercise again, this time accessing background information, senior colleagues’ views, and definitions of each component. With hindsight and the help of the research conducted, I was able to make the correct decisions. In summing up the learning, I would say that I enjoyed the challenge of testing myself, using my own knowledge and skills. From the outcomes, I learned that seeking the knowledge and advice of others, combined with a methodical gathering of relevant data was more likely to result in better decision-making. The SIM also provided a good starting point for further research, so adding to knowledge that can be carried forward. This learning will stay with me and be applied, as the concepts of why I need to gather data and how I need to use them for a purpose are firmly in place. Structure, process and outcomes, thanks to the SIM and the learning it prompted, have become concrete rather than abstract ideas and I can relate these to application in a healthcare facility and hopefully, make a contribution to measurable positive improvements. Reference List Camp, R. C. and Tweet, A. G. 1994. Benchmarking applied to health care. Abstract. Joint Committee Journal of Quality Improvement. May 20(5):220-38. Retrieved September 7 2007 from: http://www.ncbi.nlm.nih.gov/sites/entrez?Db=PubMed&Cmd=ShowDetailView&TermToSe… Coia, J.E., Duckworth, G.J., Edwards, D.I., Farrington, M., Fry, C., Humphreys, H., Mallaghan, D.R., and Tucker, D. R. 2006. Guidelines for the control and prevention of meticillin- Resistant Staphylococcus aureus (MRSA) in healthcare facilities. Journal of Hospital Infection (2006) 635, S1-S44. Fig. 1 S15. Retrieved September 7 2007 from www.elsevierhealth.com/journals/jhin Donabedian, Avedis. 1997. The Quality of Care: How can it be Assessed? In Archives of Pathology and Laboratory Medicine. Special Article. Nov. 1997 Retrieved September 8 2007 from: http://findarticles.com/p/articles/mi_qa3725 Health Care Quality Management and Outcome Analysis. Performance Management Through Benchmarking. Simulation Exercise McDonald, L. Ph.D. 2001. Florence Nightingale and the early origins of evidence-based Nursing. Evidence Based Nursing 2001 4:68-69. The BMJ Interview. EBN Notebook Retrieved September 8 2007 from: http://ebn.bmjjournals.com/content/full/4/3/68 Murray-Calloway County Hospital 2004-2005. JCAHO Reference Guide Element 6. p.24. Retrieved September 6 2007 from: http://www.hospitalsoup.com/public/hout-JCAHO- Eductool.2.pdf. Subhan, A. 2005. JCAHO Journal of Clinical Engineering 30 (4) p. 187-190. 24x7 website Retrieved September 7 2007 from: http://www.24x7mag.com/issues/articles/2007-01_05.asp. Read More