Professional Documents
Culture Documents
Key Words
Healthcare, Benchmarking, Operation Theatre, Process, Quality Improvement,
Performance Measurement, and Supply Chain
Key Messages
• Cost of surgery varies from discipline to discipline with Oncosurgery being most
expensive
• Medical equipments contribute to significant capital costs in OT
Abstract
INTRODUCTION
Benchmarking firms must assess the strengths and weaknesses of their current work
processes, analyze critical cost components, consider customer complaints, spot areas for
improvement and cycle time reduction and find ways to reduce errors and defects or to
increase asset turns. Benchmarking firms must find out who is the best of the best. To
identify the best of the best, benchmarking firms must learn from leaders, uncover where
they are going, learn from the leader's superior practices and why they work, and emulate
the best practices. It is the process of measuring against best practice, similar products &
processing industry leaders and world class buisness.(3)
BENCHMARKING IN HEALTHCARE
In India, Hospitals gained the status of corporate sector in the year 1984. This has led to a
spurt, which is evident by the growing number of hospitals in the country. The opening
up of the General Insurance to Private companies has come up as a turning point and an
effort to make healthcare accessible to even a common man.
Benchmarking is one of the tools of Total Quality Management. The concept of seeking
best practices and implementing those practices within individual organizations can be
applied to any type of organization, including health care. The move towards
Benchmarking in health care is a relatively new concept.(1)
1. Managerial areas: Pricing, Utilization, Patient and payer mix, Productivity and
efficiency, Revenue, expenses, and profitability.
2. Clinical areas: Ambulatory care services, Anesthesia services, home care
services, Medical services, Obstetrical and newborn services, Pediatric services,
Post-anesthesia recovery services, Psychiatric services, Rehabilitation services,
Respiratory care services, Special care unit services, Surgical services,
Housekeeping services, Infection control program, and Laundry and linen
services.
3. Process areas in an operation theatre. The Process facilities are compared and
benchmarked with other participants in the peer group. Peer groups are
determined based on facility size, outpatient, inpatient, or combined services; and
teaching or non-teaching facilities available.
4. Some of the process areas where benchmarking can be undertaken are: Patient
Scheduling, Preoperative Screening, Day of Surgery, Management Information
Systems, Procedure Supply Preparation, Intra operative processes, Between Case
Processes, Materials Management, Review of Purchasing and Supply Chain
Performance and Measurement, Equipment Management, Facility Utilization,
Labor Utilization, Physical Facilities, Performance Improvement Monitoring,
Instrument Reprocessing, and Day of Surgery Flow Control.
Healthcare has significantly changed in the last few decades. With rapid strides in the
field of medical science and technology, Hospitals are competing neck- to- neck to attract
patients not only from the local areas but also from the Afro-Asian countries. Increasing
costs and shrinking resources have created an increased focus on patient outcomes.
Executives engage in a constant and valiant struggle to master the fine art of juggling. In
health care, concurrent goals of high patient satisfaction must be balanced against
organizational efficiency and fiscal solvency. It's a fine line pushing hard to reduce costs.
The value of health care to the customer is the ratio of quality to cost. To increase the
value of health care, quality must increase more than cost or remain stable while cost
decreases. Quality is difficult to define. Currently, there are numerous performance
measurement systems that use different definitions for the same quality measure. This has
led to inconsistent measure sets across organizations that do not allow for comparison of
performance. Benchmarking ushers in a new direction to the way activities are performed
in Hospitals, as there is no other tool by which performance is measured in a reliable and
comparable level.
BENCHMARKING PROCESS
BENEFITS OF BENCHMARKING
The present study provides an insight of Internal Benchmarking being put to a start in the
Hospital. A minimum of twenty cases of a procedure performed during the period of
study is considered. The Operation Theatre of a Corporate Hospital was selected as the
Study Area. The Operation Theatre has the Operation Rooms - OT1 , OT2, OT3, OT4,
OT5, OT6, OT7 , OT8 , OT9 , OT10.
METHODOLOGY
The data for the study was collected from the log data at the scheduling station of a
corporate hospital for a period of four consecutive months in the year i.e., from October
2004 to January 2005. The data consists of the Procedures performed in the Operation
Rooms by the Surgeons and the time taken for each procedure on a daily basis. There are
7 major and 3 minor Operation Rooms and for the sake of confidentiality they have been
named as Operation Rooms OT1 to OT10. Like wise the Surgeon's names are also
masked. The Surgeons who have performed less than 8 cases all through the period of the
study are not taken into consideration.
The following table gives the timings (in minutes) of procedures performed by various
specilists and Mean, Standard Deviation (SD) of the respective procedure.
The basis for benchmarking of procedure timings is the control charts for studying the
variation. The reasons for the cause of variation can be attributed as two factors: 1)
Controllable - skill of the staff, equipment and material availability, medical attention,
coordination and communication, 2) Uncontrollable - sudden failure of equipment,
condition and severity of the patient, Age of the patient, technology, scarcity of material.
Benchmarking helps in reducing erratic variation in procedure timings and enable
internal consistency, which is crucial for organization for improving process
performance. Critical success factors can be identified for continuous improvement in
process. They include: i) Patient's physical (including complications) and psychological
condition, ii) Skill of the Surgeon based on the Qualification, Experience and Exposure,
iii) Type of anesthesia used, iv) Availability of state-of-the-art Equipment, v) A proper
and good maintenance schedule, vi) Coordinated effort of anesthetist, nursing staff and
supportive staff.
CONCLUSION
The intensive competition encountered in most markets has led to a new emphasis on
measuring performance not just in absolute terms, but also rather in terms relative to the
competition, and beyond that to 'best-practices'. The results of the benchmarking study
can be used to overcome and eliminate complacency within the organization. Hospitals
set up by the Government and the Corporate Hospitals constitute a large proportion of
healthcare providers in the country. In order to enhance performance, Internal
Benchmarking must be adopted for identifying the performance indicators of individual
hospitals. Some Key Performance Indicators can be: process timings, Length of Stay
(LOS), success rates in surgeries, supply chain process, equipment maintenance, Return
on Investment, Quality of service. In order to progress in the present competitive
environment, healthcare organisations need to adopt benchmarking practices for
continuous improvement in their operations and perform better than competitors for
improving their market share.
REFERENCES