Benchmarking Hospital Services - Theory and Practice From an Austrian Model Project

Benchmarking Hospital Services - Theory and Practice From an Austrian Model Project Jürgen M. Pelikan, Peter Nowak, Ursula Trummer 9th conference of ESHMS; 28-31 August 2002; University Medical Centre Groningen, The Netherlands WHO - Collaboration Centre for Hospitals and Health Promotion Ludwig Boltzmann-Institute for the Sociology of Health and Medicine 1

Overview Why benchmarking hospital services in a quality improvement project? Methodology of benchmarking Design of the project Selected results from patient surveys Contribution of / to Sociology of Health & Medicine 2

Why benchmarking hospital services in a quality improvement project? Hospitals have to adapt to a rapidly changing environment: demographic changes (elder population) epidemiological changes (more chronic diseases) economic changes (limited budgets) technical changes (more possibilities for diagnosis, therapy,..) Patients demands on quality of life, active involvement.. Quality (Management) became the main response to this on an organisational level Benchmarking is a systematic method to improve the quality of services in an inter-organisational co-operation 3

Benchmarking = a method of organisational learning / of a learning organisation to improve the quality of results, processes and structures by systematic comparison and exchange of experience between partners, which have to fulfil comparable tasks / solve comparable problems. 4

Benchmarking a complex integration of change management and action research Project-management Organisational Development obliging structuring of change processes content time social structure resources Quality management Q o = f (Q s, Q p ) quality cycle measuring evaluating comparing learning by errors / deficits Benchmarking open development process characteristic stakeholder approach Interorganisational Learning exchange over system borders learning from successes of others adoption of successful solutions 5 LBISHM 2001

Benchmarking in the quality cycle Realised Best Performance as scale for the assessment of outcomes 1 Definition of targets and criterions of quality 6 Evaluation of measures 2 Identification of strengths & weaknesses 5 Implementation of measures 3 Diagnosis of relevant causes 4 Planing of improvement measures Realised Best Practice as role model for change 6 LBISHM 2001

7 steps in a benchmarking project 1) Defining areas and aims for quality improvement 2) Selecting partners and constituting a common project 3) Deciding measuring methods and measuring the qualityof outcomes 4) Identifying Best Performance in outcomes by comparison 5) Analysing processes and structures behind this Best Performance 6) Analysing ones own processes and structures and comparing with Best Practice 7) Adopting successful / Developing improved processes and structures 7

Design of the Austrian model project 3 year action plan 1998-2000 Initiated by the federal ministry of health as a benchmarking project with 11 hospitals in close co-operation with scientists and process facilitators: assess quality in a benchmarking process (baseline) implement interventions in reaction to results evaluate interventions in second benchmarking Four general aims of increase of patient- and staff orientation, health gain, cost effectiveness 8

4 subprojects to improve quality at central interfaces extramural care hospital SP3: organisation of the Operation Room SP2: internal services (x-ray/lab) extramural care SP1: admission PATIENTS SP4: patient oriented organisation of hospital ward SP1: discharge 9 LBISHM 2001

Selected results: Designing benchmarks for patient orientation increase of patient-orientation as general aim was i.a. defined as empowering patients i.a. by improved information (health literacy) viewing patients as a co-producer of healing processes and their health following the differentiation of the patients role in health care in respect to joint decision making active participation in health care delivery joint responsibility 10

Coresponsibility Differentiation within the patient role Co-producer in treatment/ care and recupeation Producer of own health Client/ consumer of treatment and care Co-decision making Compliant Servant in treatment and care Workpiece of treatment / care Co-work 11 LBISHM 2001

Selected results: Specification of benchmarks for improved information for surgery patients Quality of pre-surgical information talk Adequate content (as identified in patient surveys) reason for surgery advantages of surgery procedures Adequate time at least one day before surgery (legal regulation in A) Adequate social setting surgeon and anaesthesiologist as communication partner (legal regulation in A) 12

Selected results: Quality of pre-surgical information talk - content 100% Hospital 1 Hospital 2 Hospital 3 Hospital 4 Hospital 5 Hospital 6 80% 60% 40% 20% 0% t1 1 t2 2 t1 3 t2 4 t1 5 t2 6 t1 7 t2 8 t1 9 10 t2 11 t1 12 t2 sufficiant Reihe3 2 % 2% 12 % 8% 19 % 8% 4 % 2% 4 % 5% 19 % 6% partly sufficiant Reihe2 23 % 26% 35 % 24% 34 % 50% 29 % 24% 41 % 17% 39 % 46% insufficiant Reihe1 75 % 72% 52 % 68% 47 % 42% 67 % 74% 55 % 78% 42 % 49% n= 44 47 113 101 166 52 75 83 49 41 52 66 t1 = 1st survey t2 = 2nd survey 13 LBISHM 2001

Selected results: Quality of pre-surgical information talk - date of performance before surgery 100% Hospital 1 Hospital 2 Hospital 3 Hospital 4 Hospital 5 Hospital 6 80% 60% 40% 20% 0%... before surgery t1 1 t2 2 t1 3 t2 4 t1 5 t2 6 t1 7 t2 8 t1 9 t2 10 11 t1 12 t2 the day / shortly Reihe3... 9 % 3% 15 % 8% 12 % 32% 11 % 9% 7 % 6% 34 % 31% one day Reihe2... 31 % 21% 30 % 24% 41 % 33% 18 % 46% 11 % 4% 26 % 19% (up to) two days Reihe1... 60 % 76% 55 % 68% 47 % 36% 71 % 46% 82 % 90% 40 % 51% n= 69 70 156 120 214 71 101 98 54 46 85 99 t1 = 1st survey t2 = 2nd survey 14 LBISHM 2001

Selected results: Quality of pre-surgical information talk - communication partner 100% Hospital 1 Hospital 2 Hospital 3 Hospital 4 Hospital 5 Hospital 6 80% 60% 40% 20% 0% any other cases surgeon and anaesthesiologist t1 1 t2 2 t1 3 t2 4 t1 5 t2 6 t1 7 t2 8 t1 9 t2 10 11 t1 12 t2 Reihe2 67 % 66% 60 % 43% 69 % 61% 54 % 54% 57 % 59% 82 % 53% Reihe1 33 % 34% 40 % 58% 31 % 39% 47 % 46% 43 % 41% 18 % 48% n= 65 70 152 101 204 73 100 99 54 48 77 101 t1 = 1st survey t2 = 2nd survey 15 LBISHM 2001

Contribution of Sociology of health & medicine to this project Knowledge input, e.g. on: Benchmarking as an inter-organisational learning process Relevance of interfaces for quality in health care Patient as stakeholder Communication as key process Co-production Development and realisation of evaluation designs indicators instruments analysis 16

Contacts http://www.univie.ac.at/qik juergen.pelikan@univie.ac.at peter.nowak@univie.ac.at uschi.trummer@univie.ac.at 17

Further project reading BAUMER, E.-M.; BISCHOF, B.; FINDL, I.; POLANETZKY, G.; PREISSL, C.; SCHMIED, H.; (REDAKTION) (2001): PatientInnenorientierte Stationsorganisation. Wien: BMSG. BERGER, A.; DUNKL, A.; FRIEDL, B.; FRIEDLER, E.; KAPLANS, H.; KLEIN, G.; KRAINER, F.; MÜLLER, G.; SCHRAML, R.; NOWAK, P. (2001): Aufnahme- und Entlassungsmanagement. Wien: BMSG. BERGER, M.; EBERL, P.; FERSTL, H.; JESCHOFNIK, R.; KOGLMANN, J.; KRICZER, C.; NEUMARK, J.; PRAMMER, K.; QUINTUS, B.; REINER, E.; TRUMMER, U.; WEITMAYR, E.; WINKLER, H.; WONDRATSCH, W. (2001): OP-Organisation. Wien: BMSG. EBNER, H.; LAMPERT, S.; NOVAK-ZEZULA, S.; PEER-KÜHBERGER, R.; SEEDOCH, R.; STIDL, T.; HASENÖHRL, N.; (REDAKTION) (2001): Schnittstellenmanagement - medizinische Dienstleistungen. Wien: BMSG. NOVAK-ZEZULA, S.; NOWAK, P.; PEINHAUPT, C.; PELIKAN, J.M. (2001): Qualitätsverbesserung durch Benchmarking zwischen Krankenhäusern. Ein Beispiel für interorganisational unterstützte Organisationsentwicklung. In: Organisationsentwicklung. 20, 3, (S.26-41) NOWAK, P.; PELIKAN, J.M. (2002, in press): Benchmarking eine Strategie der Qualitätsentwicklung. In: Lobnig, H.; Schwendenwein, J.; Zvacek, L. (Hg.): Veränderung der Beratung. Beratung der Veränderung. Gabler Verlag, 18