All those involved with managing ambulatory surgery centers know the importance of benchmarking. And they are aware of the value of making changes based on the hard numbers produced by benchmarking reports. That, however, doesn't make the implementation of those changes any easier.
At Frontier Healthcare, we believe benchmarking should be performed on a monthly basis on a variety of metrics that fall into three general categories: operational, financial and clinical. Information technology systems should be in place that allow for figures to be tallied in the week or two following the close of the month. We typically recommend that metrics/reports be run one week after the close of the month.
Based on our experience, we can offer ASCs seven tips for making sure they get the most out of their benchmarking efforts.
Tip 1: Compare apples to apples. Benchmarking a New York City ASC with 20 gastroenterologists against a North Platte, Neb., ASC with five orthopedists doesn't make much sense. Staff may come up with any reason why numbers don't compare favorably, beginning with "that ASC is nothing like ours!" In any benchmark scenario, ASCs should be compared to other ASCs in similar geographies, be of similar size and be of the same specialization.
Tip 2: Buy-in and implementation begins and ends with the on-site manager. The on-site ASC manager is in the center every day and is best positioned to ensure that changes in process and procedure and policy are carried out. Without the manager's buy-in, there is no way change will stick.
Tip 3: Remember that change doesn't happen overnight. Mature centers, especially those that are set in their ways, may have a more difficult time embracing change. The good news is that as mature centers, they shouldn't have to improve too many areas at once. Newer centers, on the other hand, tend to have more operational kinks to work out. Properly motivating supporting staff to make changes for the ASC's ultimate benefit is the key. And even when change is implemented quickly with full cooperation, don't expect numbers to catapult. Real change takes time. The key is to see the proverbial needle moving in the right direction.
Tips 4: Share benchmarking data as widely as possible. Transparency is the key here. It allows ASC management an opportunity to "catch someone doing something right" when a facility ranks highly against comparable centers. It also allows staff to see the results of the changes, i.e., that their numbers are getting better. It also acts as a motivating force to see that other ASCs are performing better; or that other areas within your ASC are performing better. No one wants to be the albatross holding back a center's overall success.
Tip 5: Gain agreement on key metrics to be benchmarked and establish priorities for addressing areas where improvements are needed. There are many metrics that are benchmarked, some more important and central to success than others. Not all can be analyzed, reviewed and fixed each month. Prioritize where time and effort should be spent. Based on our experience, key metrics include cost and cost/case, revenue by payer, overhead expenses, cancellations, patient throughput, incident reports, wait time, patient satisfaction, and other financial benchmarks such as anesthesia and staff wages, administrative, technology and materials costs. Without priorities and training, ASCs can drown in a sea of data.
Tip 6: Benchmarking is not an end. It's the means to an end. The aggregation of the benchmarking figures is the beginning of the process. The benchmarking report is the preface to change. Or to a pat on the back. The numbers don't tell you how to improve operations, but should highlight where improvements can be made and should spark productive and constructive conversations.
Tip 7: Don't complain about the accuracy of the data – Improve the process. Human nature says that we abhor bad news. And we tend to think we're doing a better job than we actually are. So when benchmarking figures come in worse than expected, the tendency is to discredit the numbers. Remember that benchmarking isn't going away, and that it's not a static process. It changes based on the business. So be part of the solution; improve the way figures are collected; and even suggest that different figures need to be collected and analyzed.
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About the Author: Anna Gengel, vice president of operations at Frontier Healthcare, oversees the daily operations of each of Frontier's ASC centers and those in development, focusing on facility management, quality of care, patient flow, staffing, marketing, EMR engagement and preparation for NYSDOH and CMS site surveys. Gengel can be reached at agengel@frontierhh.com, or at 212-874-0107.