Benchmarking and Safety: Should We Be Concerned?Posted: May 8, 2013
- A standard of excellence, achievement, etc., against which similar things must be measured or judged.
- Any standard or reference by which others can be measured or judged.
When I was young, my friends used to say I was too competitive for my own good–though they described my competitive tendencies with a little more color. They even accused me of “bending the rules” at times just to gain a competitive advantage. Whether it was the testosterone of my teens, or just something inbred in my character, I hated losing. As I grew older and entered healthcare, the competitive fire mellowed and my vocabulary changed to phrases like “win-win” situations, collaboration, shared learning…and benchmarking.
Benchmarking is a very important tool used in most industries including healthcare. I have always been a big believer in benchmarking one’s outcomes against others. From an improvement standpoint, how else can we assess where we stand against a norm, and then use those benchmarks to focus on quality and safety improvements? Made total sense to me. Besides, from a safety and quality standpoint, hospitals are constantly being benchmarked against one another by numerous organizations that publish grades, scorecards, self-developed rankings, and more.
A few things have now made me re-think some of my beliefs related to benchmarking, and the possible unintended consequences that may be occurring in the quality and safety domain. One challenge to my thinking occurred when Paul Levy (Not Running A Hospital) recently spoke to over 100 quality, safety and risk management leaders from across our health system. Paul spoke on transparency, and the ground-breaking work done at BI Deaconess while he was CEO there many years ago. During his talk, he also shared his thoughts on benchmarking and stated:
“There is no virtue in benchmarking to a substandard norm. Eliminate. Don’t benchmark!”
Wow – Don’t Benchmark?? His statement reminded me of a quote I have often heard throughout the years…”In the land of the blind, the one-eyed man is king”.
As I connect with safety colleagues and friends across the country, it seems we have all set the quality and safety benchmarking goal of being in the top 10% of hospitals across the country. Math was never my best subject, but even I can figure out we can’t all possibly be in the top 10%. It also means those that benchmark to the top 10% still have a long way to go to eliminate harm, as Paul points out.
Striving to achieve quality and safety greatness is vital for all us; using outcome measures to track our progress is a necessary component in achieving that highest level of care. However, my growing concern is that benchmarking might be used only to gain the “competitive advantage” for increasingly uncertain healthcare dollars. If this mindset takes hold, then why share safety and quality best practices with others for fear you might lose your ranking to a competitor? I don’t believe safety and quality people think this way…but am concerned many CFO’s have to. Competing on safety is something other high-risk industries, like aviation, have never done. Airlines may compete on things like on-time arrivals, lost baggage, or customer service, but they always share safety learnings and best-practices.
Paul is right. As far as safety goes, if we strive to eliminate (versus benchmark against a substandard norm), we only compete against ourselves. We know what the ultimate measure of success is – zero harm. More thoughts on competitive concern to come…