Now that you are aware of what healthcare benchmarking is and why it is important, in this blog post, we will focus on the key steps to implementing an effective benchmarking project to begin reaping those benefits.

Benchmarking Process and Key Steps

It is not secret that a well thought out process is essential to the success of any major project. Implementing a benchmarking project is no different. Below are the key areas of focus to consider before undertaking any benchmarking initiative. I have derived many of the specifics using a variety of resources, such as Six Sigma, the Juran Model, etc., to provide further context around each step. You might say, I have taken the “best of the best” from each resource…coincidence, I think not.

Plan and Prepare
Identify Opportunities and Prioritize¹ – Top management must decide which processes are critical to the success of the organization and select projects from these. Once a shortlist of processes to be bench-marked is ready, the processes need to be prioritized as per a predetermined set of criteria to fulfill the requirements of all customers (stakeholders), especially the end customer¹.

Deciding the Benchmarking Organization¹ - The next step in the process is to decide the organization whose processes will serve as the benchmark. The benchmark can be a single entity or a collective group of companies, which operate at optimal efficiency². Information on their processes should be gathered from various sources and the most suitable organization selected¹. It is always important to ensure that more detailed information about the selected organization will be accessible and that comparison with the organization’s process will be relevant and useful¹.

Organize a Benchmarking Team – The most successful benchmarking projects involve a team approach³. The organization should leverage existing teams that may be involved in similar topics to those that are being bench-marked, if possible. In the event a new team needs to be created for a benchmarking project, The Joint Commission, suggests that the organization seek the following when building the team³:

• Individuals closest to and most knowledgeable about the process or issues under investigation
• Individuals critical to implementation of any potential changes
• Individuals likely to be directly affected by any changes that result from a project
• A respected and credible leader who has a broad knowledge base
• An individual who has the authority to make decisions
• Individuals with diverse knowledge base and strong analytical skills
• Individuals familiar with benchmarking and how it can be used in performance improvement
• Individuals who are skeptical, resistant or even opposed to certain ideas and who can service as sounding boards or provide alternative viewpoints.

Collect Data
This step is perhaps the most important, most difficult and most time consuming activity in the process¹. It involves creating a plan for collecting data from selected targets, conducting site visits and creating a site visit report⁴. Many times the information on processes and procedures followed at another company are confidential, and it is not always easy to gather authentic information, even after making a planned and approved visit at another organization¹. The preparation for collecting necessary information and documenting this information in a systematic way has to be carefully planned and executed.

Analyze Data
Validation and Normalization⁵ – The key activities here are the validation and normalization of data. Before any meaningful analysis can be performed, it’s essential that all data be validated to establish its accuracy and completeness. Some form of data normalization is usually required for direct comparisons to be made.

Identify Gaps⁵ – To be of value, the analysis must indicate the benchmarker’s strengths and weaknesses, determine (and, where possible, quantify) gaps between the benchmarker’s performance and the leaders’, and provide recommendations for the focus of performance improvement efforts. Based on this thorough analysis, an improved process(s) should be developed. Properly identifying the gaps will result in a clear picture of the organization’s processes in comparison with others within the business or industry.

Communicating Results – Communicating the benchmarking results and their implications to significant audiences in the organization and motivating them to carry out changes is vital⁴. It will result in a complete understanding by the target audiences of the necessity for changes in the processes involved and a desire to carry them out⁴. The communication must be delivered in a very clear, concise, and easily understood format via an appropriate medium⁵.

Implement
Create Goals - The project team’s next step is to set/revise goals for the improvement of the organization’s existing process, close the performance gap(s) identified in step 3 and create realistic and unambiguous new standards for the processes involved^1&4. These goals can, and probably should, be stretch goals that will result in a process even better than the other organization’s best-in-class process¹. Make sure management has approved and that all in the organization/business area understand.

Develop and Execute Action Plan¹ - After the improved process and goals are accepted by all concerned or likely to be affected by it, a formal, detailed action plan is drawn with all key activities taken as inputs as well as the organization’s culture. The detailed action plan should carry the important things like a time line, individuals responsible for carrying out the tasks, any short-fall in the completion of tasks and what stretch targets are taken to compensate the short-falls. Those responsible should be committed enough to ensure that the tasks and assignments are completed on time.

Measure
Monitor Process – As with most projects, in order to reap the maximum benefits of the benchmarking process, a systematic evaluation should be carried out on a regular basis². Senior management must be committed enough to ensure proper coordination of various activities, monitor the progress of implementation of the plan and work as a barrier-remover in the implementation process¹. When the revised process is in place, a complete report has to be prepared, showing the benefits of the revised process compared with the expectations at the time of approval of the proposed revision of the process¹.

Recalibrate as Necessary⁴- The organization needs to ensure it remains on the cutting edge by continuously evaluating the bench-marked practices and re-instituting the benchmarking process when necessary. This will prevent complacency by creating the habit of evaluating procedures to identify opportunities to improve.

Benchmarking is a very powerful performance improvement tool. However, it is vital to understand the basis behind it, follow a proven implementation methodology and gain organization-wide commitment to the cause. Benchmarking is critical for healthcare organizations to achieve and sustain the clinical effectiveness and operational performance they so desperately need.

Does your healthcare organization benchmark? Does the organization have a process that is followed similar to the aforementioned process? Has it proven successful?

Resources for this blog post:

1. http://www.isixsigma.com/methodology/benchmarking/benchmarking-ten-practical-steps-review-points/
2. http://www.tutorialspoint.com/management_concepts/benchmarking_process.htm
3. http://books.google.com/books?id=2mQpVORlulEC&printsec=frontcover#v=onepage&q&f=false
4. http://www.qualitydigest.com/feb/bench.html
5. http://businessfinancemag.com/business-performance-management/7-steps-better-benchmarking-0

One way to drive such a reduction strategy is to enable analysts and providers with business intelligence tools that put various re-admissions metrics at their fingertips.  Additional value is garnered when those metrics can be filtered, sliced, diced and compared against a number of useful dimensional attributes.  Developing and automating such tools helps business users avoid having to write monotonous queries, piece together disparate data from various sources, and manually compile things like month end readmission rates.

In his post, Steven explains the process he followed and the solutions implemented to help the client analyze their re-admissions data.  You can read his full post here.

As an Apple lover for years, I have a myriad of Apps I enlisted to help. Between TargetWEIGHT, MYFitnesspal, MapMyFitness, myWOD, and Nike Fit Band, I have been unsuccessful in maintaining the health and fitness level of my satisfaction.

When I heard about the Apple HealthKit platform and the ability for it to sync with third party application data, the question I posed to myself was, will this help me? I have no chronic illness. I’m not sick. I just want to be healthy. After doing some primitive research, if Apple can pull this off as they say they can, it will revolutionize not just my health technology experience, but the way any doctor in my future will diagnose and treat me.

The Apple HealthKit in addition to the Myhealth App promises to connect Apple Applications & other devices to one another, and to your physician if you choose to. Alleged, my myriad of applications will update one another automatically so I can work (at my nutrition & fitness) smarter and more accurately. Or, if I choose to use the Myhealth, this data will aggregate within the application in a single profile to use and share. Myhealth has 47 different tracking options to help me reach my goals, along with tracking my health milestones and medications/allergies. Furthermore, in case of an emergency, this historical account of my vitals, fitness level, and health milestones such as a chronic illness diagnosis are logged and can be shared with the ER Doctor. This may be critical in saving my life.

I am very conscious however that many folks are extremely uncomfortable with having this type of data in the cloud. I believe this will be a large barrier for Apple along with other 3^rd party development partners to overcome. However the technology to keep this information secure exists, and I believe it can be done right. The challenge for Apple is to relay to the public the capabilities of internet security. Now educating Baby Boomers, Generation X, and Y’ers on Cloud Security and gaining the trust to make this Application helpful to all generations may be a challenge and will come with time.

Luckily, as a thirty-something that needs to keep track of my own family’s health along with my aging parent’s health, having health information at my fingertips may not just be convenient but literally may be a life saver. The Mayo Clinic thinks so, they have partnered with Apple along with Epic to make this endeavor successful. You can read more at:

http://www.imedicalapps.com/2014/06/apple-partnership-epic-game-changer/?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+iMedicalApps+%28iMedicalApps%29

Despite this new focus on consumer engagement, health plan infrastructure and systems are typically inadequate to meet user demands. New levels of integration are required between front-end portals and back-end systems, so health plans’ growing social and collaborative relationships with customers can be maintained. To keep costs low but yield improved customer service and satisfaction, scalable cloud-based applications are becoming increasingly viable solutions.

Having a customer relationship management (CRM) solution at the center of the overall business strategy allows health plans to adapt to new regulatory requirements while meeting the needs of the connected consumer. Tools that enable personalized user experiences in a secure, yet flexible, environment, make connected health a reality.

A comprehensive CRM solution includes marketing, customer acquisition, retention and overall care management. CRM systems help healthcare organizations have a more personalized approach when reaching consumers (they are people, not numbers) and enable patients, providers and health plans to share information easily – creating an integrated experience and improved patient outcomes.

The consumer-centric approach is all about empowering consumers to be more involved in their health journey. In order to connect with consumers, healthcare organizations must engage with them in new ways using a more personalized method. Customer relationship management (CRM) technologies allow healthcare organizations to do just that; they are a natural fit for the healthcare industry that has adopted the “retail” model.

The food, retail and healthcare industries are going to continue to merge as we head toward a more holistic health model, and CRM will be an integral part in the success of this evolution.

Is your organization using a CRM solution? How have you seen CRM solutions evolve in the healthcare industry? Share your thoughts with us on Twitter @Perficient_HC

This would be the 2^nd phase of this year-long project. On deck was the task of improving workflow through the Patient Experience program. The Patient Experience program is an internal program common to any healthcare system that focuses on patient satisfaction and quality. Surveys are a key component of the data gathering processes many healthcare institutions use to manage patient experience.

In his post, Greg explains the solution used to manage their data overload where they were spending countless hours downloading reports, creating spreadsheets and number crunching. You can read his full post here.

IaaS is certainly not a new concept. It has been around for a while. But it does merit a re-visit every now and then, since many healthcare organizations still struggle with integrating multiple systems and data sources.

At the core of IaaS is the concept of developing a common data model (also known as a canonical model) using schematic mapping and master data management. The common data model that is exposed represents multiple autonomous information sources that organizations use in order to transact business on a daily basis.

The essential gain in the IaaS model is that it creates one source of truth for data. Tie this in with a well thought out orchestration layer that is inserted between the common data model and the various applications that need to access the data, and all of the sudden you have a powerful platform that provides a healthcare organization with the ability to quickly develop new applications on multiple platforms including, traditional SOA, cloud or even mobile.

Implemented properly, IaaS can decouple a healthcare organization’s applications from its data stores. The model allows for flexibility, increased reusability, and the ability to move quickly should business or market demands require it. In other words, it allows for an organization to become nimble. And in todays world, healthcare organizations need to be nimble to keep up with the ever changing landscape of new regulations and technologies.

What are your thoughts or experiences surrounding the implementation and maintenance of IaaS in your organization?

For me, the parallel of the two industries really lies in their competitive nature-seeking to be the best. The whole premise of sports is to encourage competition, to be the world’s best player, team, or country. Similarly, the healthcare industry encourages competition by seeking the best physician, practice, health system, equipment, outcomes, cost and efficiencies. However, you cannot be the best unless you know what “best” means. What is the threshold you are comparing yourself to in order to be called the best? What are the weaknesses that are holding you back from being the best?  What is the benchmark for best?

In sports it is a little easier to identify. For example, after six titles, five Most Valuable Player awards and 10 scoring titles, Michael Jordan is considered to be the best player of all time. He is the benchmark of greatness in the sport of basketball-he is what all other players aspire to be and what they evaluate themselves against. Unfortunately, in healthcare it is not as easy, as these types of statistics are not as readily available. However, in recent years, in an effort to help define and understand “best”, more and more healthcare organizations are finding value in benchmarking as a tool to assess their current thresholds and a way to improve their process and overall performance in an attempt to be the best.

In this blog post, you will be provided a general overview of benchmarking. In the next blog post we will take a closer look at the actual process of benchmarking.

What is Benchmarking?
Benchmarking has become a dynamic performance tool in the healthcare industry whose main goal is to improve performance. American Society of Quality (ASQ) defines benchmarking as “a technique in which a company measures its performance against that of best in class companies, determines how those companies achieved their performance levels and uses the information to improve its own performance². By identifying the finest performers in the industry, healthcare organizations can determine the areas in which their own operations may be lacking and help them determine their best practices-techniques that will deliver optimum performance and results³.

Types of Benchmarking – Advantages and Disadvantages
There are generally four different types of benchmarking. Depending on your organization’s goal(s), each will provide a specific output. Below is a table of the different types of benchmarks highlighting their advantages and disadvantages and a healthcare example to help put things in perspective.

Type of Benchmark	Description (4)	Advantages	Disadvantages
Internal	Benchmarking that is performed within an organization by comparing similar business units or business processes. It may be used to identify better practices within the organization. Healthcare Example: Comparing performance of VAP from quarter to quarter or year to year within different areas of the organization (ICU, Surgery, OR, ED, etc.)	Accessing to data and communication is easier because it is internal to the organization Approach is relatively silent, low profile, and low threat Provides a test bed for quicker improvement Supported by top-management and processes and metrics are consistent across the two business units	Lacks external focus and may foster complacency Internal weaknesses can be exposed. For example, lack of leadership Results are generally marginal and improvements are minimal
External/Competitive	Benchmarking that involves the investigation of competitor’s services, processes, practices, styles and products. Healthcare Example: A long-term care organization looking to reduce fall rates may want to benchmark itself against other long-term care organizations to identify ways the facility can reduce falls, determine a target fall rate or illustrate how its fall prevention program is better than its competitors programs (5)	Provides similar structure and constraints in the bench-marked company Accessibility of data is more difficult as compared to internal benchmarking but easier than the best practice benchmarking Relatively low-threat Competitive comparison helps eliminate any chance of complacency within the organization	Difficult to convince the competitors to share data Many constraints, such as legal, ethical and trade secrets prevent the success Restricts the creativity in the improvement process
Functional	Benchmarking that compares a particular business benchmarking function at two or more companies. It may be used to identify better processes elsewhere; but in related industries. Healthcare Example: Benchmarking how the inpatient medication near misses are documented against the local pharmacy	Higher chances of breakthrough, functions are similar and comparison is with best in class Widens the perspective of the organization Similar functions provide opportunity to map the world class	Due to similar functions sometimes data accessibility is minimal Activity becomes high profile due to involvement of best in class Greater ramifications for change Expectations are much greater
Generic/Best Practice	Benchmarking that compares a particular business function or process at two or more companies independent of their industries. It may be used to identify better practices elsewhere, but in unrelated organizations. Healthcare Example: Benchmarking your healthcare organization’s patient registration system and process against that of a hotel that is known for efficient guest check in.	Possibility of breakthrough achievements is tremendous May widen the perspective of the company More useful for stimulating change Easier to exchange information because lack of competition between the two organizations	Greater ramifications for change Compared to internal benchmarking, the access of information is difficult High profile activity due to involvement of world class (best practice) organizations High expectations for change

Benefits of Benchmarking
If properly executed, benchmarking offers healthcare organizations many benefits. The Joint Commission Resources (JCR) highlights some of the potential benefits of benchmarking⁵:

• Improving the quality of patient care
• Yielding greater efficiency
• Encouraging accountability among providers
• Helping obtain a clearer understanding of competitors
• Serving as a source for new ideas
• Enhancing marketing opportunities
• Improving productivity
• Understanding what levels of performance are possible and how much improvement can be achieved
• Meeting accreditation requirements
• Highlighting the strengths of a department or unit to leadership
• Helping to build the business case for more resources
• Justifying the continuation of a service
• Identifying opportunities for improvement
• Verifying that improvement initiatives are working or conversely, need to be modified or abandoned

Healthcare benchmarking can provide tremendous value to an organization. It can identify gaps, improve performance and bring about a positive return overall…if properly executed. We will tackle the importance and necessary steps in implementing an effective benchmarking effort/project in the next post. Stay tuned, the “best” is yet to come.

Do you think benchmarking is a meaningful tool to improve outcomes? Does your organization use benchmarking?

Resources for this blog post:

1. https://dictionary.search.yahoo.com/search;_ylt=A0LEVz9_CLtT4XcAjDpXNyoA;_ylu=X3oDMTB0c3ZndjI3BHNlYwNzYwRjb2xvA2JmMQR2dGlkA1ZJUDQ0Nl8x?p=sport&.sep=
2. http://www.shsu.edu/~mgt_ves/BenchmarkingArticle.pdf
3. http://www.wisegeek.com/what-is-healthcare-benchmarking.htm
4. http://www.transtutors.com/homework-help/industrial-management/benchmarking/types-of-benchmarking.aspx
5. http://books.google.com/books?id=2mQpVORlulEC&printsec=frontcover&source=gbs_ge_summary_r&cad=0#v=onepage&q&f=false

How many stars will you have?

Although there are still details to be worked out by CMS, the required measures for the 2015 beta test are in place. All issuers that wish to continue providing QHPs on the Marketplace will need to provide the required measures. There are two different sets of measures included in the beta specifications.

The first is a set of clinical quality measurements that are mostly taken from the current NCQA HEDIS accreditation process. Many issuers already collect the data for these measures; especially, if they are meeting the requirement to be accredited for the Marketplace today and are using NCQA for that process.

The second is set of measures derived from an enrollee satisfaction survey (ESS) that needs to be performed by an accredited third party survey vendor. Most of the questions in the ESS are drawn from CAHPS. The survey processes requires that a sample of data is drawn, audited by a third party and provided to the survey vendor. The vendor then performs the survey and reports the results to CMS. Questions focus on rating an enrollee’s satisfaction with a plan over a six month period.

While the QRS initiative driven by the ACA attempts to provide transparency, it also creates a competitive market that will force issuers to look at ways to increase the quality of care and enrollee satisfaction to deliver better scores. The prize? For consumers, better products. For issuers, a larger share of the market.

Want to participate and win? Then you need a solution that not only provides the required measures, but also provides insight and the ability to drive quality improvements. This can be accomplished with a well thought out solution architecture that provides processes for delivering the measures and the means for analyzing data to drive improvements.

Micro Mobile: The biggest net delta to be seen in the world of Connected Health between now and 2025 will be in the form of mobile technology.  Mobile capabilities will continue to be provided in smaller form providing the Healthcare industry with opportunities to, for example, use contact lenses that can take pictures of the retina to identify early symptoms of diabetic retinopathy. Sensing capabilities from fiberoptics are currently being used within telehealth in the form of smart carpets that relay signals from footstep patterns.  These capabilities are forecasted to innovate into a form that could signal the possible onset of diseases such as skin cancer when applied to human skin.  Mobile capabilities imbedded in shoes, socks, and baby diapers will impact our ability to monitor weight, fitness goals, hydration, temperature, sleeping patterns, and other symptoms of illness.  Nano tattoos are already used to measure blood glucose levels.  These tattoos, that are half the width of a human hair, are expected to be able to detect precise temperature changes to indicate cardiovascular activity in the future.

Personalized Prevention: Now lets take microscopic mobile and pair it with the more prevalent DNA mapping that will occur in 2025.  Babies born in that year will be tested at the DNA level with full genomic mapping.  We are not talking once or twice.  We are talking continuously tested using nano-probes inserted in the body to identify potential onset of disease.  When it comes to the most costly chronic conditions (both in terms of dollars and hardship), a simple and inexpensive genomics test can be used to help a patient, and their team of clinicians, understand the risk of certain disease states. These individuals can then be given the right treatments and education from the start and throughout life.  Imagine the impact of this level of personalized prevention can have not only for the individual involved but for population health in terms of obesity, diabetes, cancer, and the like.

The Internet of Everywhere: The “internet of things” is defined as an environment where everyday physical objects are connected to the internet and are able to identify themselves to other devices.  We do that at some level today.  By 2025, the internet of things will be everywhere, and everything will be connected.  A report from Thomson Reuters IP & Science states “Thanks to the prevalence of improved semiconductors, graphene-carbon nanotube capacitators, cell-free networks of service antenna, and 5G technology, wireless communications will dominate everything, everywhere.”  What does that mean for Connected Health?  That means your nutrition can talk to you medication because your fridge can talk to your prescription bottles.  Really.

Continuous Data Collection & Instant Reporting: These Connected Health innovations not only provide the ability for healthcare organizations to continually monitor health conditions but also with the ability to collect and report on this data.  This can drive positive behavior change through incentivizing verifiable behaviors.  At the organizational level, this can be used to augment current loyalty programs that rely upon CRM data.  Just imagine the power this also provides to public health research programs worldwide.

Creepy or cool?  What do you think about what is to come in the world of Connected Health?

We show, via a massive (N = 689,003) experiment on Facebook, that emotional states can be transferred to others via emotional contagion, leading people to experience the same emotions without their awareness. We provide experimental evidence that emotional contagion occurs without direct interaction between people (exposure to a friend expressing an emotion is sufficient), and in the complete absence of nonverbal cues.

There has been quite a media frenzy around the study.  Most of it has been negative.  The most compelling of those arguments is around “informed consent”.  The belief there is that even if we can agree that the results are of scientific importance (some don’t) and the methodology of the study is concrete (some don’t), it still violated the rights of research subjects.  After the ethical calamities that are the Tuskegee Syphilis Experiment and Project Chatter, informed consent essentially means that a research subject in a study needs to have basic information about the study, understand the nature of the experiment along with its risks and benefits, and have the ability to withhold consent without fear of harm or retribution.

However, there are also supporters of the study.   Ethicist and lawyer Michelle N. Meyer states that as a private company Facebook is not subject to an academic institutional review board.  She goes further to say that had it been, then this study would have likely passed muster. Supporters further state that, with social media being a relatively new phenomena, Facebook has a moral obligation to inform its users of the social or psychological impact of their website.  It’s likely that studies like this will continue.  With the media firestorm that erupted it is likely, though, that they will not be published.  That comes with its own set of problems.

My concerns move into the realm of public health.  As I mentioned in a 2011 post called “New Tools for Managing a Public Health Crisis“, data is the most important component in managing public health.  With a successful suicide committed in this world every 30 seconds, mental health is a major public health concern.  It takes precious time and resources to manage the health of a planet inhabited by 7 billion people.  This is an interconnected planet, and a public health crisis knows no barriers and time does matter.  One of the breakthrough lessons I received in my life was from Dr. Greg Smith, my graduate data mining professor at Xavier University.  He explained that “like things tend to cluster”.  This makes social media a great way to find the useful data needed to uncover a public health crisis. Social media technology enables two-way communication.  As such, experts are turning to social media outlets like Facebook and Twitter to not only communicate with the public about disease outbreaks and health issues but to also gather necessary data to discover outbreaks at their source.  Social media can also be used to recruit medical volunteers to a location and align response efforts once on the ground.  However, to make this all work, public health officials need to be given access to social media data, and this is often an issue.

So, ultimately, my feelings on the study are quite mixed.  I am a staunch supporter of ethics.  However, I am of the belief that this study passed the ethical bar.  Even more, I have strong feelings on the topic of mental health.  I do believe that social media, with all of its countless benefits, has a new and not yet verified impact on mental health.   I believe that it is data that will help us understand ourselves in ways that we did not before, and that data can save lives.