Best Practices: One View of the Long Term Impact

The need to improve quality, satisfaction and overall performance in health services delivery has never been more pressing. The future only holds more of the same as expectations of quality in health services continue to increase. One of the tools increasingly becoming part of an organization's response to this challenge is that of benchmarking for Best Practices.

Most organizations and their staff are familiar with some form of performance measurement and, in some circumstances, they have even compared themselves to their peers using these performance indicators. In many situations these comparisons are done at a very superficial level.

All too often there are more questions than answers as a result of these comparisons, or the differences in performance between ourselves and others are dismissed based on the fact that "we are different". The full potential of comparative assessments is best achieved by not only knowing that there are differences in performance, but also in understanding how those differences in performance are being achieved. Without this understanding changes can be easily implemented that make no difference to performance, consume valuable (and limited) resources and staff energy, and in some circumstances can actually worsen performance.

A better approach to performance assessment is benchmarking for Best Practices. As this article will convey, Best Practices can be viewed as both a process or action and an outcome or result. It will be demonstrated that benchmarking for Best Practices involves a number of key steps to ensure that any comparisons are as relevant and useful as possible. The desired outcome of this significant effort is to establish a new way of doing something – a Best Practice – relating to some key clinical, administrative or governance process.

So, what is involved in establishing a Best Practice? As with any significant initiative that requires a major commitment of time, energy and resources from an organization, the first and foremost requirement is agreement on what processes should undergo in-depth assessment and comparison. No organization has the resources to assess more than a handful of processes at any one time.

Therefore, the ones chosen must have the potential for the greatest impact on improving organizational performance. Just as important, given the significant and sustained commitment that is required to achieve the full potential of a Best Practices exercise, understanding of and commitment to the process on the part of senior leadership is a prerequisite for success. It is only once these two requirements have been fulfilled that the organization should proceed to the next steps in a Best Practices process.

With senior management on side, and agreement on processes to assess and improve, the next step is to seek out benchmarking partners with whom to compare or benchmark processes and results against. This can happen in a number of different ways, including a preestablished forum (e.g., Best Practices Network), through some national/federal or provincial/state association, private sector measurement programs, industry standards, or through the organization's own efforts to identify appropriate and similarly inclined benchmarking partners. In identifying such partners, do not discount going to outside businesses (i.e., other than long-term care) or outside of your industry (i.e., health services) for potential benchmarking partners - it can be surprising what can be learned and adapted from other settings. It is important to recognize that finding a benchmarking partner that is identical in terms of size, structure, or challenges faced is highly unlikely. The key here is being open-minded and flexible as it relates to learning from the experience of others and in adapting that experience to the organization's special circumstances.

The work at this stage is only beginning. As with any partnership, the full benefits of a Best Practices process will require coming to agreement on key measures of performance upon which to focus comparisons. Among the initial challenges in this work will be ensuring consistency in defining and collecting these measures. As a note of caution, in many circumstances, and despite best efforts, this is likely to be a step that one returns to time and again to gain more experience and knowledge with benchmarking. Most importantly, it takes time to truly understand how the organization's processes and the processes of others lead to the results being observed. This is where patience and sustained effort will be most required on the part of staff and where the benefits of the process will best be obtained.

Once this intensive process of assessment has been "completed", it is important to ensure actions are taken to modify the clinical, administrative or governance process under study to achieve the desired results. This too is where the aspect of adaptation will come into play.

It is at this point that complete understanding of the organization's process and that of the benchmarking partner will prove most valuable. There may be any number of reasons that aspects of a process established by a peer may not make sense for the organization. For example, there may be differences in building layout that allow efficiencies to be gained but simply can't be managed within the current capital plans. The key here is to recognize differences in performance that may persist and to understand the valid reasons for these differences. There is simply no point in demanding improvements in performance that are beyond the control of anyone to effect in the short-term.

Naturally, these process improvements must be sustained once they've been achieved. This is where ongoing monitoring and comparisons are necessary. In addition, depending on the complexity of the process being assessed, one may wish to monitor a number of subprocesses. This allows the capability to more appropriately take action when results for the overall process stray from the targets set. So rather than begin an intensive investigation of the entire process, a particular part that requires corrective action may be more easily singled out. This saves time, money and other resources.

There are numerous initiatives being undertaken to develop "networks" by which formalized benchmarking of Best Practices can be achieved. Already noted is the work of the Best Practices Network that boasts a number of resources, including a project guide, which can help in furthering understanding and application of Best Practices.

In Western Canada two efforts are under way that should be followed with interest. Since 1997, the Saskatchewan Association of Health Organizations (SAHO) has sponsored the Green Ribbon Awards to recognize excellence and foster cooperation among provincial service providers. Awards are available in seven categories and are judged against pre-set criteria by a panel of experts. These awards are supplemented by an annual forum for peer presentations in areas identified by participants as being of particular excellence in their operations. The Province of Alberta has taken another approach, having conducted a review of regional health authorities (RHA) Best Practices in June 1997. Beginning in 1997/98, the provincial Department of Health and Wellness incorporated a search for Best Practices into its multi-year business planning process and further established this strategy as a core requirement of RHA Business Plans.

So what does this mean to an individual senior manager or staff member? It certainly can be expected that the push for comparisons with other providers on key performance measures will only intensify over the next several years. This will either take place in some "regulated" form (e.g., as part of business plan requirements) or through increasing requests to participate as benchmarking partners. Regardless of approach, both senior managers and frontline staff will increasingly be expected to develop the attitude and skills required to assess practices and make changes to achieve better results. In a positive sense, a Best Practice approach offers the ability to improve knowledge and achieve results that would not otherwise be possible through relying solely on internal resources. Assuming that all health care professionals are motivated by a challenge and a desire to continuously improve, a Best Practices effort offers the opportunity to expand the network of knowledge and resources beyond traditional sources.

In many circumstances, Best Practices will accelerate the pace of change in how organizations manage their human resources. Those organizations best able to enlist all of their personnel in the search for best practices, and in their subsequent adaptation to local conditions, will be those that maintain or establish leadership positions in the industry.

Best Practices calls for committed leadership at all levels of an organization. It takes courage to move along this path, particularly since the greatest benefits come from an honest and candid sharing of individual performance results with others - people must be prepared to hang their laundry out to dry. The benefits to the organizations, staff and clients will be worth the effort.