Increasing Nursing Productivity through Benchmarking Data – A Review

 

Dr. V. Indra

Academic Head, SON, Texila American University, Coimbatore, India

 

ABSTRACT:

Collaboration is a substantive idea repeatedly discussed in health care circles. The benefits are well validated. Yet collaboration is seldom practiced. The lack of a shared definition is one barrier. Additionally, the complexity of collaboration and the skills required to facilitate the process are formidable. Much of the literature on collaboration describes what it should look like as an outcome, but little is written describing how to approach the developmental process of collaboration. In an attempt to remedy the all too familiar riddle of matching ends with means, this article offers key lessons to bridge the discourse on collaboration with the practice of collaboration. These lessons can benefit clinical nurse managers and all nurses who operate in an organizational setting that requires complex problem solving.

 

 

INTRODUCTION:

Healthcare is a growing sector in India with CAGR of 15%. Medical tourism & clinical research are also emerging as the major sources of revenue and technology development in the country. Even with these positives the business faces a lot of challenges that include [1]:

·       Increasing population resulting in hospitals being overburdened.

·       Concerns regarding ethics, medical negligence, commercialization of medicine, and incompetence acting as threat.

·       Low margins & high operational costs results in budgetary constraints for manpower

·       Lack of established benchmarks on productivity, norms on Staffing to Capacity ratio.

 

The modern and the present lifestyle has thrown various health related challenges for people across the globe and the citizens, the Government agencies and the healthcare organisations are very much concerned about the healthcare related issues and the proactive measures to be taken to improve the healthcare scenario. The health related problems differ dramatically from developed countries to the developing countries and similarly from urban centres to the underdeveloped rural areas [1].

 

The health problems suffered by people living in urban centres are more in the nature of high blood pressure, diabetes, heart attack etc. which are largely caused due to the increased stress level and hypertension, whereas, people in the underdeveloped rural areas have more of physical health related problems like skin disease, pneumonia, typhoid, etc. largely due to unhygienic living conditions and lack of healthcare facility [1].

 

Given this scenario, the healthcare sector has gained prominence around the world and most of the countries have started focussing on establishing healthcare infrastructure by taking various measures such as developing healthcare policies and programs, creating and allocating healthcare budgets and funds, establishing public healthcare facilities and healthcare organisations, encouraging private participation in developing healthcare facilities, incentivising and supporting innovations in various aspects related to healthcare, increasing the use of IT and telecommunication technology in effectively managing and providing high end healthcare facilities [2].

 

Due to the challenges, healthcare providers face persistent issue of losing key employees to its competition and new players while also struggling to hire required talent. Companies are also not clear about the right compensation for a specific role and end up either paying higher or lower salary [2].

 

Considering this, in 2014 SDF initiated a HR Healthcare Council and compensation benchmarking was taken up as a project to ensure healthcare providers have a common ground for comparison. 5 of the leading healthcare providers participated in the study [2].

 

How benchmarking is done:

1. Hospital Classification:

The first job was classifying units under each service provider on basis of operational beds to ensure proper matching of roles. Basis the data, hospitals were classified into the following classes:

·       Small – Less than 100 beds

·       Medium 1 – 101-250 beds

·       Medium 2 – 251-500 beds

·       Large – 500 beds and above

 

2. Job Matching:

Then we began delving deep into the organization’s overall structure to understand key roles and departments to be included as part of the study. This involved looking at the following job complexity factors as shown in Figure 1 [3]:

 

What are required inputs for the job to be executed		What does the job entail		How does the job impact organization objectives?
Knowledge, skills and experience		Span of control responsibility and complexity		Impact on organization

 

Figure 1. Job Matching Process

 

3. Collection of Salary Data:

Once the mapping was completed, next step was to collect data. This involved creating a standard template which was shared with all the participants. Data was collected from all the participants in the defined template. Three rounds of validation were done on the data to ensure all the common guaranteed cash items were considered. Any assumptions that were created with respect to the compensation were shared with the participants.

4. Data Analysis and Report:

Post all the validations, data analysis commenced which involved calculating the 10th, 25th, 50th, 66th, 75th and 90th percentile on the salary data. Individual participants salaries were also compared with the industry standards for that position to indicate if they were leading, lagging or were at the market compensation.

 

Benchmarking in critical care processes:

Benchmarking is the process of identifying the highest standards of excellence for products, services, or processes, and then making the improvements necessary to reach those standards, commonly referred to as “best practices”. Thus, the concept of benchmarking which is basically modeled on the business industry helps an organization to identify the gap between where it actually is, and where it would like to be. This has proven to increase productivity, enhance learning, potentiate growth, and facilitate continuous improvement of standards. The Xerox Company introduced this revolutionary concept in the late 1980s when its market share in copiers reduced sharply from 86% to only 17% [4].

 

The company was the first to “benchmark” by first assessing its own internal processes and following it up by studying its competitors, eventually resulting in a dramatic turnaround of its profits. In the areas of health care too, attempts have been made to benchmark both the processes of health care delivery and patient outcomes, especially in areas such as cardiovascular medicine, transfusion programs, adolescent health, pain management, etc. These processes have been applied to the intensive care unit (ICU) as well. Gershengorn and colleagues argue that among the key lessons ICU physicians can learn from the business world; benchmarking is a vital component as comparison with peer units or institutions is essential to identifying areas of strength and weakness [5].

 

In this issue of the Indian Journal of Critical Care Medicine, Dr Kapadia and co-workers have sought to benchmark the rates of tracheal tube displacements within their unit at <1% per patient and at <0.5% per tracheal tube day, and to sustain these targets, over a 10-year period. After measuring their own performance over the preceding 7-year period, the above targets were set and specific programs and actions were implemented to maintain the benchmarked target. For the successful benchmarking of any process, it is essential to identify the critical success factors, i.e., those factors on which the success of the benchmarked target will depend on [5].

 

Kapadia and colleagues have ensured the use of standard procedures for securing endotracheal tubes; encouraged active communication between all health care workers, as well as between patients and their health care providers; developed guidelines to manage pain, anxiety, and delirium; promoted the use of sedation according to target sedation scores; standardized the use of physical restraints, including the preferential use of mittens in agitated patients; and used appropriate humidification techniques, besides ensuring the availability of adequate nursing personnel to take care of intubated patients in the unit [6].

 

Tying down patients, as rightly pointed out by the authors, is not only inhumane and unjustified most of the time, but can even lead to increased delirium and posttraumatic stress disorder in patients. In fact, some studies have reported that forcefully restraining patients actually increases the risk of unplanned extubations. By applying concise definitions, clear stratification of airway incidents and reliable surveillance techniques, Kapadia and colleagues ensure accurate reporting and collection of data. Reporting of all incidents, however insignificant they may be thought to be, and a culture of non-retribution and openness is essential to the success of such programs [6].

 

Changes occur when the process has started and needs the constant support of individuals committed to the process and continuously striving to make it better. It is also laudable to note that every incident reported was recorded immediately by a designated person and discussed with the consultant in charge within the following 12-24 hours to ascertain the cause and classify the incident appropriately. Using these principles, the benchmarked rates were sustained over a 10-year period, a remarkable feat in any ICU [7].

 

While such a process of internal benchmarking helps to determine the internal performance standards of the unit, the identified best internal procedures may also be utilized and adopted in other areas of the hospital, thereby benefiting the larger organization. Later, these targets may be even used as a baseline for external benchmarking, something that the authors should perhaps consider as the next step in this continuing process of growth and improvement [7].

 

This study should provide an impetus for clinicians to develop their own continuous quality improvement programs. Often forays into domains of quality control may be perceived as a lot of “hard work”. There may also be fears of increased vulnerability to the misuse of data by the media, health insurance companies, and even boards of control, especially when the benchmarked targets are not met. Moreover, unjustified condemnation, when this happens, can lead to staff demotivation and thus backfire in respect to the goal of quality improvement. Staff motivation and a culture of openness and encouragement can offset most of these unfounded fears and the payoffs have been more than substantial for those willing to take up the challenge. Beyond the direct effects of benchmarking, the improved process and climate that results from the whole process improves the whole organization [7].

 

“If you want to maintain the status quo, then don't benchmark. If you want to remain where you are, secure in the knowledge that you are doing the best that you can, don't benchmark. If reality checks are not your cup of tea, don't benchmark. Benchmarking will open an organization to change, and to humility. Benchmarking provides the stones for building a path toward competitive excellence and long run success” [8].

 

CONCLUSION:

This section concludes the article on a review of Increasing Nursing Productivity through Benchmarking Data.     

 

REFERENCES:

1.      Elmuti, D, Kathawala, Y. (1997). An overview of benchmarking process: A tool for continuous improvement and competitive advantage. Benchmarking Qual Manag Technol. 4:229–43.

2.      Camp R. C. (1999). Learning from the best leads to superior performance. J Bus Strategy. 13:3–6.

3.      Uckay, I, Ahmed, Q. A., Sax, H, Pittet, D. (2008). Ventilator-associated pneumonia as a quality indicator for patient safety? Clin Infect Dis. 46:557–63.

4.      Gershengorn H. B., Kocher R, Factor P. (2014). Management strategies to effect change in intensive care units: Lessons from the world of business. Part I. Targeting quality improvement initiatives. Ann Am Thorac Soc. 11:264–9.

5.      Kapadia, F. N., Tekawade, P.C., Nath, S.S., Pachpute, S.S., Saverkar, S.S., Bhise, R.A. (2014). Prolonged observational study of tracheal tube displacement in intensive care unit: Benchmarking an incidence <0.5-1% in a general medical-surgical adult intensive care unit. Ind J of Crit Care Med. 18:273–277.

6.      Da Silva, P. S., Fonseca, M. C., (2012). Unplanned endotracheal extubations in the intensive care unit: Systematic review, critical appraisal, and evidence-based recommendations. Anesth Analg. 114:1003–14.

7.      Omachonu, V.K., Ross, J.E. (2004). Principles of total quality. 3rd ed. Boca Raton: CRC Press. 512.

8.      McNair, C.J., Leibfried, K.H. (1992).  Benchmarking: A tool for continuous improvement.  Omneo/Ozliver Wight Publications.

 

 

 

 

 

Received on 11.04.2019          Modified on 10.05.2019

Accepted on 01.06.2019        © A&V Publications all right reserved