Benchmarking Hospital Performance in Health

Sanigest Internacional White Paper
Benchmarking Hospital
Performance in Health
Benchmarking Hospital Performance in Health
Page |2
Objective
Objective: Efforts to assess and rank hospital
performance should rely on a composite
indicator that ranks hospital performance
relative to other hospitals and provide insights
into hospital performance across key areas.
The review of hospital performance indicators
in this paper will provide policymakers,
hospital managers and clinicians with a range
of options for the selection of key performance
indicators for hospital benchmarking.
Authors: James Cercone and Lisa OBrien

Sanigest Internacional 2010
This document is a formal publication by Sanigest
International and all rights are reserved by the
firm.
The views expressed in documents carrying the
name of the author/s are the sole responsibility of
the author/s and do not represent the views of
Sanigest International.
Copyright Sanigest Internacional

Costa Rica Tel: (506) 2291-1200 | United States Tel: +1 (305) 600-4416
info@sanigest.com | www.sanigest.com | Skype: sanigest
Page |3
Table of Contents
INTRODUCTION................................................................
................................................................................................
............................................................. 4
MEASUREMENT OF HOSPITAL
TAL PERFORMANCE IN TTHE UNITED STATES, EUROPE
ROPE AND LATIN AMERICA
AMERI ........................ 5
REVIEW OF HOSPITAL BENCHMARKING
ENCHMARKING TOOLS ................................................................................................
............................................. 7
HOSPITAL COMPARE ................................................................
................................................................................................
............................................................... 7
Scoring System ................................
................................................................................................................................
.............................................................. 7
HEALTHINSIGHT NATIONAL RANKINGS FOR HOSPITALS ................................................................................................
.................................................. 8
Scoring system ................................
................................................................................................................................
.............................................................. 8
LEAPFROG GROUP................................................................
................................................................................................
.................................................................. 8
Scoring System ................................
................................................................................................................................
.............................................................. 9
MICHIGAN MANUFACTURING TECHNOLOGY CENTER (MMTC) ................................................................................................
...................................... 9
Scoring System ................................
................................................................................................................................
.............................................................. 9
US NEWS & WORLD REPORT................................
................................................................................................................................
................................................... 9
Scoring System ................................
................................................................................................................................
............................................................ 10
THOMSON & REUTERS TOP 100 HOSPITALS PROGRAM ................................................................................................
.............................................. 10
Scoring System ................................
................................................................................................................................
............................................................ 11
HEALTH CONSUMER POWERHOUSE ................................
................................................................................................................................
......................................... 11
Scoring System ................................
................................................................................................................................
............................................................ 11
NATIONAL HEALTH SERVICES CHOICES HOSPITAL SCORE CARD ................................................................................................
..................................... 12
Scoring System ................................
................................................................................................................................
............................................................ 12
CHKS TOP HOSPITALS PROGRAM ................................
................................................................................................................................
........................................... 13
Scoring System ................................
................................................................................................................................
............................................................ 13
IASIST TOP 20 HOSPITALS ................................
................................................................................................................................
.................................................... 13
Scoring System ................................
................................................................................................................................
............................................................ 13
WORLD HEALTH ORGANIZATION - PERFORMANCE ASSESSMENT TOOL FOR QUALITY IMPROVEMENT IN HOSPITALS (PATH ) .................... 14
Scoring System ................................
................................................................................................................................
............................................................ 14
INTERNATIONAL QUALITY INDICATOR PROGRAM (IQIP) ................................................................................................
.............................................. 14
Scoring System ................................
................................................................................................................................
............................................................ 15
LESSONS LEARNED ................................
................................................................................................................................
...................................................... 16
DATA ANALYSIS AND COMPOSITE
MPOSITE INDEX ................................................................................................
.................................................... 19
QUALITY ASSURANCE ................................
................................................................................................................................
............................................................ 21
Background ................................................................
................................................................................................
................................................................. 21
Proposed Methodology for Quality Assurance ................................................................................................
........................................... 22
ADDITIONAL CONSIDERATIONS ................................
................................................................................................................................
.................................. 24
IMPLEMENTATION STRATEGY................................
................................................................................................................................
.................................................. 24
SANIGEST INTERNATIONAL ................................
................................................................................................................................
..................................................... 25
ANNEX 1: INDICATORS USED BY VARIOUS HOSP
HOSPITAL BENCHMARKING SYSTEMS .......................................................
................................
26
Tables
TABLE 1: LIST OF HOSPITAL BENCHMARKING INITIATIVES REVIEWED ................................................................
.................................................. 5
TABLE 2: PROPOSED INDICATORS FOR PILOT PROJECT BY CATEGORY ................................................................
................................................. 18
Figure
FIGURE 1: STRUCTURE OF THE LATIN AMERICAN HOSPITAL BENCHMARKING TOOL ..........................................................
................................
20
Page |4
Introduction
Hospitals are a vital part of any health care system and account for a large proportion of a governments
health care budget. Increased competition between providers, the demand for value from payers, patient
safety concerns, and mounting evidence of variation in medical practice has placed the assessment of
hospital performance high on the agenda of policy makers, payers, patients and regulators around the
world. In low and middle-income
income countries, such as those found in many emerging markets, hospitals
continue to be the main providers of health care. The ability to measure and compare hospital
performance within this
his context is an important step in beginning to address some of the health care
disparities that exist in this region.
There are four principal methods of measuring hospital performance: regulatory inspection, public
satisfaction surveys, third-party
party as
assessment
sessment and comparison of statistical indicators. The majority of
these methods however, have not been tested rigorously.1
The use of statistical indicators and third
third-party
party assessments (i.e. accreditation) are becoming popular in
health care institutions throughout the world. Statistical indicators have been used to develop various
hospital benchmarking tools, particularly in the Untied States. Raw or aggregated data from
predetermined areas of interest are voluntarily reported and then combined to produce an overall rating;
no such systematic tool exists or is routinely used for hospitals in the Latin American context.
Furthermore,
rmore, many hospitals in the North America and Europe have undergone accreditation processes
with national and/or international regulatory bodies and this trend is continuing in regions such as Latin
America.
Benchmarking performance of any kind has been shown to be a powerful tool and impetus to for
change. For example, in the United States, hospital comparison tools and benchmarking initiatives such
as Hospital Compare (Centers for Medicare and Medicaid Services) have helped to establish and
disseminate best practices for treating conditions such as acute myocardial infarction, congestive heart
failure and pneumonia. Furthermore, they have provided an avenue for the patient to become more of
an active participant and decision maker in their own healthcar
healthcare.
The present paper reviews the top initiatives in the development and comparison of key performance
indicators to measure hospital performance. The information provided is intended as a menu of
options for policymakers, hospital managers and clinic
clinicians
ians to choose the most appropriate indicators for
their healthcare system or hospital.
How can hospital performance be measured and monitored? WHO Regional Office for Europes Health
Evidence Network. August 2003.
Page |5
Measurement of Hospital Performance in the United States, Europe and Latin

America
Many governments, non-governmental
governmental institutions
and members of the private sector have initiated or
engaged in projects, some in partnership with each
other, to assess hospital performance. The areas in
which hospital performance can be assessed and
the rationale
tionale for doing so are varied, as such a
diverse range of instruments have emerged with
varying indicator sets. Benchmarking tools that
have emerged in the United States and Europe
have primarily focused on outcome and process of
care measures; a measuree of patient
experience/satisfaction is also commonly included
in many of these instruments.
In creating our proposed indicator set for hospital
ranking and benchmarking, we examined
benchmarking systems from around the world that
used statistical indicators
tors to measure hospital
performance (Table 2); a brief overview of 12 of
these benchmarking tools are outlined below and a
full list of indicators by project can be found in
Annex I.
Table 1:: List of Hospital Benchmarking Initia
Initiatives Reviewed
PROJECT TITLE
COUNTRY/REGION
YEAR INITIATED
CHKS Top Hospitals Program
United Kingdom
2001
Health Consumer Powerhouse
European Union
2005
HealthInsight National Rankings for

Hospitals
United States
2004
Hospital Compare
United States
2003
IASIST Top 20 Hospitals
Spain
2000
International Quality Indicator Program
International
1997
Leapfrog Group
United States
2001

Page |6
PROJECT TITLE
COUNTRY/REGION
YEAR INITIATED
Michigan Manufacturing Technology

Center (MMTC)
United States
2005
National Health Services (NHS) Choices

Hospital Scorecard
United Kingdom
2008
Thomson & Reuters Top 100 Hospitals
United States
1994
US News & World Report

World Health Organization
Performance Assessment Tool for
Quality Improvement in Hospitals
(PATH)
United States
1990
International
2004

Page |7
Review of Hospital Benchmarking Tools

Various methodologies have been employed to rank and
benchmark hospital performance. A literature review was
undertaken to learn from the diverse experiences of
hospitals and organizations that have already undertaken
ranking and benchmarking processes. An internet search
was performed using search terms including hospital
performance; benchmarking tools; hospital comparison;
and ranking hospitals. Publically available data from
benchmarking and healthcare organizations were reviewed
including but not limited
ed to WHO reports on measuring
hospital performance, discussion papers regarding the
creation of the WHO Performance Assessment Tool for
Quality Improvement in Hospitals and sample
benchmarking reports from the Michigan Manufacturing
Technology Center. The results of the literature review are
presented below.
Hospital Compare
Hospital Compare is a large public database that uses nationally standardized performance measures to
compare over 4000 US hospitals that submitted data relating to the quality of care provided in their
institutions and allowed it to be made public. The fo
four
ur areas in which hospital performance is measured
and reported are:
Process of care
Outcome of care
Patients hospital experience
Medicare payment and volume
This database is the result of collaboration between both public and private stakeholders.
Scoring System
Hospital Compare doesnt rank hospitals, rather it reports the percentage of patients for which a given
indicator was performed/completed (i.e. 98% of the time patient received prophylactic antibiotics prior
to surgery). Comparative graphss are also available in which the nationwide and state averages for all
hospitals reporting that indicator are displayed alongside the score for the specific hospital(s) chosen.
Website: www.hospitalcompare.hhs.gov
.hhs.gov

Page |8
HealthInsight National Rankings for Hospitals

HealthInsight is a private not-for-profit
profit organization that conducts various health performance rakings
including national rankings for hospitals, home health agencies and nursing homes in an effort to
improve healthcare systems in Nevada and Utah.
It uses publicly reported data from the Centers for Medicare & Medicaid
Services (CMS) Hospital Compare website to conduct the hospital
rankings. Healthinsight
measures hospital performance by examining the process of care
measures for acute myocardial infarction, heart failure, pneumonia and
surgical infection prevention as set out by CMS.
Scoring system
Hospitals are ranked based on their overall success rate for performing the process of care measures for
the above mentioned conditions; rankings are converted and reported as percentiles.
Website: www.healthinsight.org
Leapfrog Group
This initiative is comprised of private and public purchasers of health care that seek to leverage their
purchasing power to improve the quality of services provided by health care institutions.
Unlike Hospital Compare, here hospital performance is measured by using structural indicators instead
of clinical ones to produce a composite index of hospital performance. The Leapfrog Group uses the
following structural indicators to measure hospital per
performance:
Computerized physician order entry (CPOE) system

ICU staffing
High risk treatments (evidence based hospital referral)
Leapfrog safe practice scores (27 procedures in place to reduce preventable medical mistakes)
Leapfrog invites hospitals from

om 39 regions of the US to participate in their survey (although any hospital
is welcome to participate); they target hospitals predominantly in areas where their members have a large
presence. Hospitals voluntarily submit data if they agree to participate in the program. Leapfrog has a
comprehensive incentive and rewards program to encourage and reward hospitals for participating in
their program and implementing their quality/safety standards.

Page |9
Scoring System
Leapfrog uses a scoring algorithm to come up with their ratings which fall into five categories. The
rating system is based on how far the health care institution has come with regards to meeting the
criteria/standards set out by Leapfrog. The five categories are:
Declined to respond
Willing to report
Some Progress
Substantial Progress
Fully Meets Standards
Website: www.leapfroggroup.org
Michigan Manufacturing Technology Center (MMTC)
This benchmarking system uses 23 metrics to measure a hospitals performance. These metrics fall into
the following five categories:
Business (3)
Productivity (5)
Asset utilization (5)
Throughput (6)
Clinical outcomes (4)
Data on hospital practices are also collected in the areas of clinical practices, cost profile and patient
safety policies.
Scoring System
MMTC reports a hospitals relative performance on each measure within a comparison group of similar
hospitals; hospital percentile rankings range from 0 (worst in the group) to 100 (best in the group).
Website: http://www.performancebenchmarking.org/hospital.aspx
Every year the US News & World Report releases a list of the best hospitals in the United States. It ranks hospitals
based on 16 specialty areas (e.g., oncology, cardiology), 12 of which are based on hard data while the remaining four
are based on nominations by specialists that were surveyed.
P a g e | 10
To be considered for one of the 12 data

data-driven
driven specialties hospitals had to meet one of the following
criteria:
Be a member of the Council of Teaching Hospitals and Health Systems

Be affiliated with a medical school
Have at least a certain number of key technologies (e.g., image
image-guided
guided radiation therapy, full-field
full
digital mammography)
In addition to the above mentioned criteria, hospitals also had to perform a minimum number of
specified procedures (specialty dependent) on Medicare patient
patientss to qualify for ranking.
Hospitals that meet all these criteria were then ranked.
Scoring System
A score from 0 100 is assigned based on three factors that are given equal weight:
1. Reputation (random sample of 200 physicians from ABMS database)
2. Death rate (mortality index)
3. Care-related
related factors (nursing staff, technology, volume, patient services)
Hospitals with the 50 highest scores are subsequently ranked.
Website: http://health.usnews.com/sections/health/best
http://health.usnews.com/sections/health/best-hospitals
Thomson & Reuters Top 100 Hospitals Program
The primary goal of this program is to objectively identify US hospitals that have the best organizationorganization
wide performance and make this data publically ava
available.
ilable. The performance of all members of the
hospital is measured including that of the Board, executives and health care professionals. The
organization-wide
wide performance is then compared against national benchmarks.
Hospitals are classified into 5 comparison peer groups based on bed size and teaching status:
Major teaching hospitals

Teaching hospitals
Large community hospitals
Medium community hospitals
Small community hospitals

P a g e | 11
Scoring System
Statistical analyses of publically available data ssources
ources is carried out to rank hospitals. Hospitals are
scored based on a set of weighted performance measures spanning the following 4 areas:
Clinical excellence
Operating efficiency
Financial health
Responsiveness to the community
Hospitals are subsequently

ently ranked relative to their comparison group; median and quartile values are
reported.
Website: http://www.100tophospitals.com
Health Consumer Powerhouse
Health Consumer Powerhouse produces an annual index comparing performance of health care systems
of the European Union in various areas in an attempt to strengthen the position of the healthcare
consumer. It examines indicators in the following 5 sub
sub-disciplines:
Patients rights and information (9)

Waiting times (5)
Outcomes (5)
Generosity of public healthcare systems (4)
Pharmaceuticals (4)
Scoring System
Each sub-discipline
discipline is weighted as follows:
Sub discipline
Patient rights and information
Waiting time for treatment
Outcomes
Generosity
Pharmaceuticals
Relative weight
1.5
2.0
2.0
1.0
1.0
P a g e | 12
Furthermore, each indicator has a maximum possible score of 3; scores are color coded as follows:
green = 3 pts
amber = 2 pts
red/not available = 1 pt
Scores for each sub-discipline
discipline are calculated as a percentage of the maximum possible score and
subsequently multiplied by the weight coefficients and added up to make the final country score. These
percentages are then multiplied by 133, and rounded to a three digit integer; the maximum total score is
1000 indicating the perfect healthcare system.
National Health Services Choices Hospital Score Card
The NHS has developed a scorecard in which hospitals are assessed and compared in a variety of areas
depending
pending on the treatment/condition a patient is interested in.
The following are the areas in which hospitals are assessed.
Wait time from referral to treatment

Length of stay in hospital
Risk of readmission (rated lower than expected, expected, higher
er than expected)
Experience of surgical department with specific procedure
Patient rating of care received
Patient experience during treatment (respect, dignity, feeling involved )
Survival rate for elective procedure (rated better than, worse than or as expected)
Survival rate for emergency procedure
MRSA control for elective patients
Cleanliness of hospital
Scoring System
The overall quality of service for the trust that runs the hospital is colour coded and given a rating of
excellent (green), good (blue), fair (yellow) or weak (red). Hospitals are not ranked against each other,
information is only compared.
Website: https://www.nhs.uk/ServiceDirectories/Pages/ServiceSearch.aspx

P a g e | 13
CHKS Top Hospitals Program

CHKS is a healthcare benchmarking company that annually prepares a benchmarking report
repo on UK
hospitals using data from the National Health Care service. Performance is based on 20 indicators in the
following five areas:
Clinical effectiveness
Health outcomes
Efficiency
Patient experience
Quality of care
Scoring System
Each indicator has an actual value (reported by hospital) and expected value (derived using overall
performance level of the hospitals peers); from these two values an index is derived and hospitals are
subsequently ranked.
Website: http://tophospitals.chks.co.uk/
Top 20 Hospitals is a hospital assessment program that benchmarks public and private hospitals in
Spain. Top 20 hospitals use six indicators in the following three areas tto
o carry out its benchmarking:
Quality
Functioning
Clinical practice
Scoring System
It is not clear how the scoring and ranking system for IASIST works, however, all indicators are equally
weighted and summed once normalized.
Website: http://www.iasist.com/en/top
http://www.iasist.com/en/top--20

P a g e | 14
World Health Organization - Performance Assessment Tool for Quality Improvement in

Hospitals (PATH )
In 2003, the World Health Organization (WHO) Regional Office for Europe initiated a project to
develop a tool to measure hospital performance. This tool was named Performance Assessment Tool for
quality improvement in Hospitals (PATH). It defines five key areas for assessment:
Clinical effectiveness and safety (7)

Patient centeredness (1)
Production efficiency (2)
Staff orientation (5)
Responsive governance (2)
Within these five dimensions are 17 core quality indicators for PATH; additional tailored indicators
exists that can also be used. This tool allows for the collection and analysis of data on a set of indicators
for comprehensive performance assessment in hhospitals
ospitals in regions and countries with different cultures
and resource availability. Hospitals in Europe, Canada and Africa have participated in a pilot project
using this assessment tool.
Scoring System
The PATH tool does not rank hospitals, rather iitt reports the following comparative data:
The number of hospitals reporting the particular/specific indicator

Number of cases
Minimum/maximum values
Mean (standard deviation)
Value for that hospital on that particular indicator
International Quality Indicator

dicator Program (IQIP)
The International Quality Indicator Program is a branch of the Quality Indicator Program (QIP) that
was first developed in the US over 20 years ago. The QIP collects data on quality of patient care and
seeks to identify opportunitiess for improvement. It has a variety of performance metrics depending on
the type of health care institution as does the IQIP. IQIP is the only other international hospital
assessment program aside from the WHOs PATH program.
For acute care institutions,, the IQIP examines acute care process and outcome measures in the
following areas:

P a g e | 15
Acute Myocardial Infarction

Cardiac Surgery
Colorectal Surgery
Appendectomy
Hysterectomies
Maternity and Childbirth
birth
Patient Safety
Infection Control
Ambulatory Care
Heart Failure
Pneumonia
Vascular Surgery
Liver, Biliary Tract, Pancreatic, or Gallbladder Surgery
Hernia Surgery
Orthopedic Surgery
Emergency Care
Intensive Care Units
Internal Medicine
Methyllin Resistant Staphylococcus Aureuss (MRSA)
Over 180 health care organizations in 12 countries use IQIP and its indicators to collect, analyze and
compare their data. Several countries in Latin America are participating in IQIP (# of institutions):
Mexico (7)
Brazil (8)
Argentina (5)
Chile (5)
Colombia (7)
Uruguay (2)
Scoring System
IQIP does not rank institutions, rather it produces an institution
institution-specific
specific report for participants every
quarter, providing both historical and comparative data for each measure that data was submitted for;
more narrowly user-defined
defined peer group reports can also be obtained.
Depending on the nature of the data, outcomes reported include numerators, denominators, minimum
and maximum rates, median, means (weighted and unweighted), standard deviation and quartiles.
q
Website: http://www.internationalqip.com

P a g e | 16
Lessons Learned
In developing the proposed ranking and benchmarking tool we reviewed and summarized 12
benchmarking systems, focusing particularly on indicators that may be relevant in the Latin American
context, challenges to implementation of such a tool and any other rrelevant
elevant lessons that surfaced . The
key lessons that emerged from the review of the various hospital benchmarking systems and that were
taken into consideration when developing the proposed tool are as follows:
The burden of data collection appears to be one of the greatest impediments to the
implementation of a successful performance assessment program. It is important to choose
indicators that are relevant but do not require extensive data collection or greatly increased
resources to collect them. The P
PATH
ATH project found that the burden of data collection was too
high for four of their indicators in particular antibiotic use, surgical theatre use, expenditure
and absenteeism. The PATH project also stated that a lack of personnel, resources, expertise and
an
2
time for participating hospitals to collect data was an issue.
It is essential that clear and very specific definitions of what the indicators mean are established
to ensure that all participants collect the same data and are able to interpret it and ultimately
make the data comparable.
The ease and cost of collecting data from structural indicators is considerably better than with
process and outcomes of care data; however, the relevance of data is greater with process and
outcome of care measures iin
n regards to quality and performance measurement.
The institutional embedding of the performance measurement project at the regional/national

level, consideration of various stakeholder interests and technical support during data collection
have all been sited as essential parts of a successful quality indicator program. 3
Patient
atient experience appears to be a good indicator to include as it is measurable, it can be
improved and collection of this type of data is inexpensive and most hospitals already gather
gat
this
4
type of information.
It is important to ensure that the selected indicators reflect measurement areas that are relevant
to a broad range of institutions.
Different stages of development and organizational structures in institutions, resource availability

and cultural differences between regions and countries may be hurdles that have to be overcome
when implementing a benchmarking tool.
The World Health Organization Performance Assessment Tool for Quality Improvement in Hospitals
(PATH): An analysis of the pilot implementation in 37 hospitals. Groene O, et al. Intl J. Quality Health
Care. 20(3). 2008.
3 An international review of projects on hospital performance assessment. Groene O, Skau JK, Frolich A.
Intl J. Quality Health Care. 20(3). 2008.
4 Hospital performance evaluation: What data do we want, how do we get it, and how should we use it?
Mehrotra A, Lee S, RA Dudley. Institute for Health Policy Studies University of California, San
Francisco
2

P a g e | 17
On the basis of the above review and subsequent lessons learned, it was decided that indicators for the
proposed
osed ranking and benchmarking tool would be selected based on the following criteria:
Measurability of indicator
Availability of data
Relevance to Latin American health care setting
Consistency across other hospital benchmarking tools (see Annex IV for matrix)
Four thematic indicator areas emerged that fit these criteria and which we considered essential for
assessing hospital performance in Latin America: hospital infrastructure and resources; hospital volumes
and wait times; hospital clinical effect
effectiveness
iveness and efficiency; hospital policies and patient experience. A
description of the reasoning behind each choice follows:
The Hospital Infrastructure and Resources component was selected to capture information outlining
both the technical and human res

resources
ources available to hospitals. Hospitals cannot function without
adequate and appropriate staffing and therefore it is important to take these into account when assessing
hospital performance thus hospital staffing and training is the first sub
sub-component
component of
o this category.
Furthermore, it is essential to ascertain the technological resources available to staff to carry out their
duties, facilities and technologies available are therefore the second and last sub-dimension
sub
of this
category. Overall this component
ent consists of the two sub
sub-components
components that attempt to gauge the
readiness and ability of a hospital to serve its community.
The Hospital Volumes and Wait Times component seeks to gather information regarding the
volume of patients attended to as well as the volume of selected procedures performed in the hospital.
These two sub-components
components will allow for the calculation of staff: patient ratios and provide a sense of
whether hospitals are operating under optimal staffing conditions. Finally, wait times in areas
a
such as
surgery, diagnostics and the emergency department are considered to determine if services are being
received in a timely manner.
The Hospital Clinical Effectiveness and Best Practices component seeks to capture and quantify
the quality of hospital services provided as clinical care is the defining hallmark of a hospital. Not only
are outcomes such as mortality, infection and readmission assessed, process of care measures are also
included
ded to determine if hospitals are employing current best practices in their clinical service provision;
thus outcomes of care and process of care are the two sub
sub-components
components of this category.
The Hospital Policies and Patient Experience component attemptss to evaluate two important but
often neglected areas of health care provision: systematic policies reflecting the value a hospital places on
patient and staff safety and patient experience and satisfaction with care received. These two areas thus
form the sub-components
components of this category.

P a g e | 18
Table 2:: Proposed Indicators for Pilot Project by Category
INDICATOR CATEGORY
PROPOSED INDICATORS
Hospital Infrastructure and Resources

Hospital Volumes and Wait Times
Hospital Clinical Effectiveness and Best Practices
Hospital Policies and Patient Experience
1. Staff (volumes)
2. Staff (training)
3. Medical Equipment (availability)
4. Medical Facilities (availability)
1. Patient (volumes)
2. Selected Procedures (volumes)
3. Surgery (wait times)
4. Emergency Department (wait times to see
physician)
5. Diagnostic Tests (i.e. CT scan, MRI) (wait
times from time requested to performance of
test)
6. Cancer Treatment Wait Times (wait time
from time requested
equested to time of treatment)
1. Outcome of care measures
- hospital wide survival/mortality rates
- infection rates
- length of stay (risk-adjusted
adjusted all
discharges)
- readmission rates ( i.e. AMI, CHF, elective
and emergency surgery)
2. Process of care measures
- Acute myocardial infarction (AMI)
- Congestive heart failure (CHF)
- Pneumonia
1. Hospital Patients rights law (present or
absent)
2. Patient access to own medical records
3. Hospital Latex-free
free policy (present or absent)
4. Hospital No-lift
lift policy (present or absent)
5. Hospital Needleless policy (whenever
possible) (present or absent)
6. Patient satisfaction survey (overall satisfaction
rating)

P a g e | 19
Data Analysis and Composite Index

Once data collection is complete and verified, data will be normalized to ensure comparability using the
following procedure: individual hospital scores for a particular indicator will be divided by the average
indicator score from all hospitals and sub
subsequently
sequently multiplied by five. This will create results that are
normalized to fall within a range of zero to ten and have a mean of five, thus allowing for easier
interpretation and comparison of results. For example a hospital that receives a score of 7.5 will be 2.5
points or 50% above the index average whereas a hospital that receives a score of 4 will be 1 point or
20% below the average of the index.
The normalization process is represented by Equation (1) where NVi,j represents the normalized score of
indicator i for hospital j, OVi,j the observed value for indicator i for hospital j and AVGi the average
score for the indicator across hospitals:
Equation (1):
NVi,j = OVi,j * 5
AVGi
For the sub-components

components of the index, simple averages will be calculated for all indicators; for example
the average for all Volume related indicators in the Hospital Volumes and Wait Times component
componen will
be calculated and then weighted according to the corresponding weight of each sub-component.
sub
Consequently, this will create a sub
sub-index
index for each of the four components as outlined below that will
then make up the overall benchmarking index (Figure 22).

P a g e | 20
Figure 1:: Structure of the Latin American Hospital Benchmarking Tool
Hospital Infrastructure
& Resources
Component
A. Hospital
Staffing &
Training
B. Facilities &
Technology
Available
Hospital Volumes
& Wait Times
Component
C. Volumes
D. Wait Times
Hospital Clinical
Effectiveness & Best
Practices Component
E. Outcome
of Care
Measures
F. Process
of Care
Measures
Hospital Policies &

Patient Experience
Component
G. Hospital
Policies
H. Patient
Experience
Indicators
Indicators
Indicators
Indicators
Indicators
Indicators
Indicators
Indicators
A1- A5
B1- B8
C1- C4
D1- D5
E1- E10
F1- F10
G1- G5
H1
Hospital Infrastructure
& Resources
Index
Hospital Volumes
& Wait Times
Index
Hospital Clinical
Effectiveness & Best
Practices Index
Hospital Policies &

Patient Experience
Index
Latin American Hospital Performance Composite Index

The scale for each indicator will range from zero, indicating no data or no action to 10, indicating
optimal performance in regards to achieving the highest standard for that indicator. Reporting no data
for an indicator will result in a score of zero to eencourage
ncourage hospitals to systematically collect and report
the missing information; penalizing hospitals for not reporting data will also ensure fairness in the final
standings. The majority of the selected indicators represent continuous data (83%) such that their values
will either be percentages or absolute values, while a small percentage of the indicators produce binary
data (17%). Binary data will be rescaled to continuous variables using a scale from 0 10.
The four main components that comprise the composite index will be weighted equally (one-quarter
(one
each) to reflect the importance, value and interdependence of all components in contributing to hospital
performance; the eight sub-components
components however, will not necessarily be of equal weight. The overall
over
composite index is therefore represented by the following equation:

P a g e | 21
Equation (2):
Composite Index = 1 * HIRI + 1 * HVWI + 1 * HCEBPI + 1 * HPPEI
4
Hospitals will be separated into peer groups to make for fair comparisons. For example hospitals may be
divided into categories of public or private institutions and then further sub
sub-divided
divided by number of beds
or teaching status.
Once the ranking is carried
rried out, data will be transformed into a visual representation, for easy
interpretation of the overall performance index. Indicator specific comparisons and data on the number
of hospitals that participated and the number of cases involved will also be m
made
ade available.
Various methodologies were consulted in developing this composite index including the OECD
Handbook for Constructing Composite Indexes5and the World Bank Composite HIV/AIDS Response
Index.6
Quality Assurance
Background
Assuring the quality
lity of the data submitted by hospitals is very important as the integrity of the results
and the conclusions that can be drawn from them are based on this. It is therefore important to ensure
that when the data is being collected, processed and warehouse
warehoused
d the following five errors are guarded
against;
Design or conformation errors (i.e. incompatible units)

Collection errors ( i.e. incorrectly recorded values, untimely data collection practices)
Staging errors (i.e. improper translation processes)
Data integration (i.e. improper data alignment)
Query errors (i.e. improper query formation)
A quality assurance strategy for healthcare data must assess, monitor, and ultimately prevent these five
types of data errors. It has also been shown that the inclus
inclusion
ion of fact, aggregate and dimensions filters
can improve the quality of data collected to perform ranking and benchmarking.7
Organisation for Economic Co-operation
operation and Development. Handbook on Constructing Composite
Indicators: Methodology and User Guide. 2008.
6 World Bank. Composite HIV/AIDS Response Index: Benchmarking Eastern Europe and Central Asia
Country Performance in Response to HIV/AIDS
7 Berndt DJ, Fisher JW, Hevner AR and Studnicki J. Healthcar
Healthcaree data warehousing and quality assurance.
5

P a g e | 22
There are several examples of quality assurance measures that are employed by other hospital
benchmarking systems that attempt to address some of these problem areas. The WHOs PATH
program has a two step system in which hospitals submit their data online where it then goes through a
preliminary validation after which the data is reported back to each hospital for verification. Only once
these processes are complete are data included into the PATH database for further analysis. The Centers
for Medicare and Medicaid abstraction and reporting tool (CART) is used as a part of a quality assurance
program for The Centers for Medicare and M
Medicaid,
edicaid, as it is a comprehensive tool that enables them to
collect data, conduct retrospective analyses and do real time reporting. The application is available at no
charge to hospitals or other organizations that seek to improve the quality of care in the
t following
clinical areas:
Acute Myocardial Infarction (AMI)

Heart Failure (HF)
Pneumonia (PN)
Surgical Care Improvement Project (SCIP)
The US Department of Health and Human Services has a Data Integrity Verification Strategy that may
prove useful. The health care institution reporting the data is responsible for the quality of the data being
submitted, while the US Department of Health an
and
d Human Services tests data at the following levels to
ensuring data integrity:
Source to Target Counts (10% of data)

Source to Target Data Verification
Column to Column Verification (for columns undergoing transformations)
Transformation Verification
Exception Processing
Summary and Detailed Results Reporting of Integrity Data
Proposed Methodology for Quality Assurance

To ensure the accuracy and quality of the data received, measures need to be embedded throughout
various steps of the benchmarkin
benchmarkingg process. First, it is important that the standard measures and
definitions that will be provided are understood by the participating institutions; as such training will be
provided in regards to the indicator set and the standardized data collection procedures
pro
that will be
employed.
Once data has been received from institutions and before it is processed, a random sampling of records
(1 - 5 %) will be verified with original sources for all participating hospitals. An accuracy score will be
assigned to each institution based on the following equation:
Computer. December 2001. 34(12); 56-65.

65.
P a g e | 23
Equation (3):
Accuracy Score = Total # of variables verified - Number of inaccurate variables * 100

Total # of variables verified
The minimally acceptable accuracy score is 80%; values below this cutoff will not be included in the
database for processing. Upon passing the data quality assessment, data will be processed into the central
database. Automated data edits will be built int
into
o the processing system such that missing or out of range
data will be identified. Furthermore, post
post-processing
processing measures such as source to target counts, source to
target verification and transformation verification will be employed. The feasibility of conducting
con
independent audits of the participating institutions will be considered for future versions of the
benchmarking tool.

P a g e | 24
Additional Considerations
Implementation Strategy
The implementation of the Latin American hospital ranking and benchmarking tool is a dynamic and
multi-phase
phase process that will invariably undergo modifications as the project unfolds. The following
strategy seeks to establish a preliminary framework in whi
which
ch the ranking and benchmarking project will
be carried out.
Seek out funders for initial ranking project, potentially health insurers or drug companies, until
the project becomes self-sustaining
sustaining
Assign project manager to be the contact person for ho

hospitals
spitals that show interest and want
further information or want to become involved. This person will also serve as the liaison
between funders and other stakeholders and provide support for implementation of
performance measurement within hospitals
Obtain technical advisor to design data collection templates and test benchmarking tool with
simulated data. Web demonstrations and sample reports will be created to show potential
participants
Identify interested hospitals to participate in a pilot test to determine feasibility of collecting

proposed indicators
Review indicator set with pilot hospitals to ensure that they are able to collect/already collect
data; adjustments to indicator set w
will
ill be made based on feedback from hospitals
Identify steps required to develop required information infrastructure, identify technology and
cost implications involved in data collection
Develop rules and standards for data collection and aggregation
Establish protocol for data collection (how and by whom), define documentation procedure
Establish time frame for data collection

P a g e | 25
Sanigest International
Sanigest International is a healthcare consulting and management firm based out of San Jose, Costa Rica
with additional offices in the United States and Europe. For over a decade, Sanigest has worked
extensively in the hospital sector providing high quality service and innovative solutions to its clients in
the public and private sector as evidenc
evidenced
ed by its ISO 9001:2008 certification. Some of Sanigests most
recent success stories include successfully defining a National Health Insurance basic package of
services, a health purchasing plan and implementing a management information system in Belize. In
Slovakia, Sanigest created a hospital restructuring plan and defined provider payment mechanisms and a
health insurance regulatory frame work. Sanigests experience spans the globe with extensive experience
in the developing nations of Latin America suc
such
h as Costa Rica, Belize, Colombia, Ecuador, El Salvador
and Nicaragua. Sanigest is optimally suited and equipped to design, implement and deliver a high impact
hospital ranking and benchmarking tool for Latin America.

P a g e | 26
ANNEX 1: Indicators Used by Various Hospital Benchmarking Systems

BENCHMARKING
INDICATORS INCLUDED
SYSTEM
Aspirin at arrival
Aspirin at discharge
ACE Inhibitor or Angiotensin Receptor Blocker for Left Ventricular Systolic Dysfunction
Beta Blocker at discharge
Fibrinolytic Medication within 30 min of arrival
Percutaneous Coronary Intervention (PCI) received within 90 mins of hospital arrival
Smoking cessation advice/counseling
Heart Failure
Hospital Compare
Evaluation of left ventricular systolic (LVS) function

Discharge instructions
Pneumonia
Oxygenation assessment
Initial antibiotic timing (within 4hrs)
Pneumococcal vaccination
Influenza vaccination
Blood culture performed in Emergency Dept prior to initial antibiotic received in hospital
Appropriate initial antibiotic selection
Surgical Care Improvement Project
Prophylactic antibiotic received within 1 hr prior to surgical incision

Prophylactic antibiotic discontinued within 24 hrs after surgery end time
Prophylactic antibiotic selection
Surgery patients
ients with recommended venous thromboembolism prophylaxis ordered
Surgery patients who received appropriate venous thromboembolism prophylaxis within 24 hrs prior to surgery to 24 hrs after
surgery
Cardiac surgery patients with controlled 6 AM postoperativ
postoperative blood glucose
Surgery patients with appropriate hair removal
Children's Asthma Care
Use of reliever medication for inpatient asthma

Use of systemic corticosteroid medication for inpatient asthma
30 day risk-adjusted
adjusted mortality rate

Heart Failure
Pneumonia
Patient Satisfaction
Patient survey of Hospital Experience
HealthInsight
Aspirin at arrival
P a g e | 27
BENCHMARKING
INDICATORS INCLUDED
SYSTEM
Beta Blocker at arrival
Heart Failure

Pneumonia
Appropriate initial antib
antibiotic selection

Surgery patients with recommended venous thromboembolism prophylaxis ordered
surgery
Cardiac surgery
ery patients with controlled 6 AM postoperative blood glucose
Surgery patients with appropriate hair removal
Structural indicators
Leapfrog Group
Computerized physician order entry

(CPOE) system
ICU staffing
High risk treatments (evidence based
hospital referral)
Safe practice scores
Hospital Policies
Michigan
Manufacturing
Technology Centre
(MMTC)
No lift policy (use lifts to raise patients to avoid staff and patient injury)
Latex-free
free policy
Needleless policy (administer medications without needles whenever possible)
Aspirin at arrival
Heart Failure

P a g e | 28
BENCHMARKING
INDICATORS INCLUDED
SYSTEM
Pneumonia
Clinical outcomes
Hospital-wide
wide Mortality Index
% of cardiac patients with acute readmission within 31 days
% of patients with unscheduled Inpatient returns to OR within same stay
% of Inpatient admissions following unscheduled returns to Emergency Dept within 72 hrs
Business, Productivity, Asset Utilization and Throughput

Operating (profit) margin
Dollars of Expenses per Case Mix
Mix-Adjusted Equivalent Discharge (and wage-adjusted)
adjusted)
Bad Debt Expenses as a % of net Patient Service Revenue
Value added per FTE Employee/Contractor
Value added per Case Mix
Mix-Adjusted Equivalent Discharge (CMAED)
FTE Employees/Contractors per CMAED
Net Patient Service Revenue per FTE Employee/Contractor
Operating Room 'Cut & Sew' Time as % of booked time
Cost per unit of production (adjusted)
Avg length of stay (days), Case
Case-Mix adjusted
% of discharges made before noon
Mean outpatient door
door-to-door time (min)
Mean Emergency Dept Door
Door-to-Physician time (min)
Mean Troponin Lab test turnaround time (min)
Mean radiology order
order-to transcription time (hrs)
Clinical Outcomes and Services
Risk adjusted mortality

Reputation
Number of discharges
Nurse staffing
Nurse Magnet hospital
Advanced technologies
Patient services
Thomson & Reuters Top

100 Hospitals Program
Aspirin at arrival
Heart Failure

P a g e | 29
BENCHMARKING
INDICATORS INCLUDED
SYSTEM
Pneumonia
Appropriate initial antibiotic selection
Prophylactic antibiotic received within 1 hr prior to surg

surgical incision
Clinical Outcomes

Risk adjusted complications index
Risk adjusted patient safety index
Severity adjusted length of stay
Operating(profit margin
Expenses per Adjusted Discharge (case
(case-mix and wage-adjusted)
Cash to total debt ratio
Business
Patients rights & Information
Health
Powerhouse
Consumer
Patients rights law

Patient organizations involved in decision making
No fault malpractice insurance
Right to second opinion
Access to own medical record
Readily accessible register of legit doctors
Electronic patient record (EPR) penetration in primary care
Provider catalogue with quality ranking
Web or 24/7 telephone healthcare info
Waiting Times
Family doctor same day service

Direct access to specialist care
Major non--acute operations
Cancer, radiation/chemotherapy
MRI scan examination
Clinical Outcomes
Heart infarct mortality < 28 days after getting to hospital

Infant deaths/ 1000 live births
Cancer 5-yr
yr survival rates
P a g e | 30
BENCHMARKING
INDICATORS INCLUDED
SYSTEM
Avoidable deaths potential years of life lost (PYLL)/ 100,000

MRSA
Generosity of Public Healthcare Systems
Cataract operation rates per 100,000 citizens (age adjusted)

Infant 4-disease
disease vaccination
Kidney transplants per million population
Is dental care a part of the offering from public healthcare system
Pharmaceuticals
Prescription
escription subsidy %
Layman-adapted
adapted pharmacopoeia
Speed of deployment of novel cancer drugs
Access to new drugs
Clinical Effectiveness and Safety
National Health Services

Choices Hospital Scorecard
Readmission
Length of Stay
Survival rate (elective and emergency surgeries)
Rate of MRSA
Time from referral to treatment
# times surgical department performs operation/yr
Standardized admission ratio (SAR)
Patient rating of overall care
Clinical effectiveness and safety
CHKS Top
Program
Hospitals
Risk adjusted mortality (or mortality index)

Rate of emergency readmission to hospital - 28 days
Rate of emergency readmission to hospital following treatment for
fractured hip
Rate of emergency readmission to hospital following AMI (within 28
dys)
Rate of emergency readmissions to hospital within 14 days for COPD
Rate of MRSA
Rate of C. difficile for patients 65 yrs
Throughput
Risk adjusted length of stay

Day Case rate for target procedures (case mix adjusted)
Day Case conversion rate (case mix adjusted)
% of elective inpatients admitted on day of surgery
Pre-op
op length of stay for fractured neck of femur
Pre-op
op length of stay for elective surgery
% elective in
in-patient admission with no procedure
Missed out
out-patient appointments (1st attendance)
Overall data quality
Procedures not carried oout (hospital decision)
Waiting times for common diagnostic procedures

P a g e | 31
BENCHMARKING
INDICATORS INCLUDED
SYSTEM

Risk adjusted complications index
Risk adjusted length of stay
Readmissions index (risk
(risk-adjusted)
Surgery index (without adjust
adjusted incomes)
Cost per unit of production
World Health Organization

- Performance Assessment
Tool
for
Quality
Improvement in Hospitals
(PATH )
Caesarean Section
Prophylactic Antibiotic Use (surgery)
Mortality (Acute myocardial infarction, stroke, community acquired pneumonia, hip fracture,
coronary artery bbypass
ypass graft)
Readmission
Day surgery for 8 tracers
Admission after day surgery (same 8 tracers)
Return to ICU
Efficiency
Length of stay
Surgical theatre use
Staff Orientation & Safety
Training expenditure
Absenteeism
Working excessive hours
Needle injuries
Staff smoking prevalence
Responsive Governance
Breastfeeding at discharge
Health care transitions
Patient Centeredness
Patient expectations
International
Quality
Indicator Program (IQIP)

surgery

P a g e | 32
BENCHMARKING
INDICATORS INCLUDED
SYSTEM
Use of Devices in ICU
Central line use

Ventilator use
Indwelling urinary catheter use
Management of Labour
Primary C--sections
Repeat C-sections
sections
Total C-sections
sections
Vaginal births after C
C-sections
Process of Care Measures
Active surveillance cultures for MRSA
Device-associated
associated infections in ICU
Device-associated
associated infections in ICU due to MRSA
Surgical site infections
Inpatient mortality
Neonatal mortality
Perioperative mortality
Total unscheduled readmissions within 15 and 31 days
Unscheduled admissions following ambulatory procedures
Unscheduled returns to ICU
Unscheduled returns to OR
Unscheduled returns to ER
Physical restraint events
Documented falls
Documented falls in ambulatory care
Complications following sedation and analgesia in ICU
Complications following sedation and analgesia in Emergency Dept
Complications following sedation and analgesia in Cardiac Catherization lab
Complications following sedation and analgesia in Radiology Suites
Pressure ulcers in acute inpatient care
Deep vein thrombosis and pulmonary throm
thromboembolism following surgery
Multi-drug
drug resistant organisms

P a g e | 33
HOSPITAL
PERFORMANCE
DIMENSION
APPENDIX IV: MATRIX OF INDICATORS FROM REVIEWD HOSPITAL BENHCMAKRING SYSTEMS

BENCHMARKING SYSTEMS
Health
Consumer
Powerhouse
MMTC
Community
Hospital
Benchmarking
Survey
International
Quality
Indicator
Project
National
Health
Service
ScoreCard
(UK)
CHKS 40
Top
Hospitals
(UK)
US
News
&
World
Report
Thomson
& Reuters
Top 100
IASIST
Top
20
Hospitals
(Spain)
Total
Counts
for
Indicator
%
of
systems
with
indicator
Clinical Effectiveness
& Safety
WHO
PATH
Caesarean Section
Prophylactic Antibiotic
Use (surgery)
Mortality
(Acute
myocardial
infarction,
stroke,
community
acquired
pneumonia,
hip
fracture, coronary artery
bypass graft)
Readmission
Day surgery for 8
tracers
Admission after day
surgery (same 8 tracers)
8.3
8.3
8.3
16.7
8.3
8.3
Return to ICU
8.3
Leapfrog
Group
Hospital
Compare
HealthInsight
!
!
Efficiency
Length of stay
16.7
Surgical theatre use
8.3
Training expenditure
8.3
Absenteeism
Working
excessive
hours
8.3
8.3
Staff Orientation &

Safety

P a g e | 34
HOSPITAL
PERFORMANCE
DIMENSION
WHO
PATH
Health
Consumer
Powerhouse
Leapfrog
Group
Hospital
Compare
MMTC
Community
Hospital
Benchmarking
Survey
International
Quality
Indicator
Project
HealthInsight
National
Health
Service
ScoreCard
(UK)
CHKS 40
Top
Hospitals
(UK)
US
News
&
World
Report
Thomson
& Reuters
Top 100
IASIST
Top
20
Hospitals
(Spain)
Total
Counts
for
Indicator
%
of
systems
with
indicator
Needle injuries
8.3
Staff smoking prevalence

No lift policy (use lifts to
raise patients to avoid staff
and patient injury)
8.3
8.3
8.3
8.3
Latex-free policy
Needleless policy (administer
medications without needles
whenever possible)
Responsive Governance
Breastfeeding at discharge
8.3
Health care transitions
8.3
8.3
Patient Centeredness
Patient expectations
Patient
rights
information
&

P a g e | 35
HOSPITAL
PERFORMANCE
DIMENSION
WHO
PATH
Direct
access
to
specialist care
Major
non-acute
operations
Cancer,
radiation/chemotherapy
Health
Consumer
Powerhous
e
National
Health
Service
ScoreCard
(UK)
8.3
8.3
8.3
8.3
8.3
8.3
8.3
8.3
8.3
8.3
HealthInsigh
t
Thomson
&
Reuters
Top 100
IASIST
Top
20
Hospitals
(Spain)
%
of
systems
with
indicator
Hospital
Compare
CHKS 40
Top
Hospitals
(UK)
US
News
&
World
Report
Total
Counts
for
Indicator
Leapfrog
Group
Internationa
l
Quality
Indicator
Project
MRI scan examination

Outcomes
Heart infarct mortality
< 28 days after getting
to hospital
Infant deaths/ 1000 live
births
Cancer 5-yr survival
rates
Avoidable deaths potential years of life
lost (PYLL)/ 100,000
MMTC
Community
Hospital
Benchmarkin
g Survey
!
!
!
!
!
MRSA
Generosity of public
healthcare systems
Cataract operation rates
per 100,000 citizens (age
adjusted)
!

P a g e | 36
HOSPITAL
PERFORMANCE
DIMENSION
WHO
PATH
Cataract operation rates

per 100,000 citizens (age
adjusted)
Infant
4-disease
vaccination
Kidney transplants per

million population
Is dental care a part of the
offering
from
public
healthcare system
MMTC
Community
Hospital
Benchmarking
Survey
National
Health
Service
ScoreCard
(UK)
8.3
8.3
8.3
8.3
8.3
8.3
16.7
8.3
!
!
1
1
8.3
8.3
8.3
Hospital
Compare
HealthInsight
Thomson
&
Reuters
Top 100
IASIST
Top 20
Hospitals
(Spain)
%
of
systems
with
indicator
Leapfrog
Group
CHKS 40
Top
Hospitals
(UK)
US
News
&
World
Report
Total
Counts
for
Indicator
Health
Consumer
Powerhouse
International
Quality
Indicator
Project
Pharmaceuticals
Prescription subsidy %
Layman-adapted
pharmacopoeia
Speed of deployment of
novel cancer drugs
Access to new drugs

Structural Indicators
Computerized physician
order
entry
(CPOE)
system
ICU staffing
High risk treatments
(evidence based hospital
referral)

P a g e | 37
HOSPITAL
PERFORMANCE
DIMENSION
WHO
PATH
Safe practice scores

Process
of
Care
Measures
Acute
Myocardial
Infarction
Health
Consumer
Powerhouse
Leapfrog
Group
Hospital
Compare
MMTC
Community
Hospital
Benchmarking
Survey
International
Quality
Indicator
Project
HealthInsight
National
Health
Service
ScoreCard
(UK)
CHKS 40
Top
Hospitals
(UK)
US
News
&
World
Report
Thomson
&
Reuters
Top 100
IASIST
Top 20
Hospitals
(Spain)
Total
Counts
for
Indicator
%
of
systems
with
indicator
8.3
Aspirin at arrival
33.3
ACE
Inhibitor
or
Angiotensin
Receptor
Blocker
for
Left
Ventricular
Systolic
Dysfunction
Beta
Blocker
at
discharge
Fibrinolytic Medication
within 30 min of arrival
Percutaneous Coronary
Intervention
(PCI)
received within 90 mins
of hospital arrival
Smoking
cessation
advice/counseling
33.3
33.3
33.3
25.0
25.0
25.0
25.0

P a g e | 38
HOSPITAL
PERFORMANCE
DIMENSION
WHO
PATH
Heart Failure
Evaluation
of
left
ventricular
systolic
(LVS) function
ACE
Inhibitor
or
Angiotensin Receptor
Blocker
for
Left
Ventricular
Systolic
Dysfunction
Health
Consumer
Powerhouse
Leapfrog
Group
Hospital
Compare
MMTC
Community
Hospital
Benchmarking
Survey
33.3
33.3
International
Quality
Indicator
Project
HealthInsight
National
Health
Service
ScoreCard
(UK)
CHKS 40
Top
Hospitals
(UK)
US
News
&
World
Report
Thomson
& Reuters
Top 100
IASIST
Top
20
Hospitals
(Spain)
Total
Counts
for
Indicator
%
of
systems
with
indicator
25.0
Smoking
cessation
advice/counseling
25.0
Pneumonia
Oxygenation
assessment
33.3
Initial antibiotic timing

(within 4hrs)
33.3
Pneumococcal
vaccination
33.3
25.0
25.0
Blood culture performed
in Emergency Dept
prior to initial antibiotic
received in hospital

P a g e | 39
HOSPITAL
PERFORMANCE
DIMENSION
WHO
PATH
Health
Consumer
Powerhouse
Leapfrog
Group
Hospital
Compare
MMTC
Community
Hospital
Benchmarking
Survey
International
Quality
Indicator
Project
HealthInsight
National
Health
Service
ScoreCard
(UK)
CHKS 40
Top
Hospitals
(UK)
US
News
&
World
Report
Thomson
& Reuters
Top 100
IASIST
Top
20
Hospitals
(Spain)
Total
Counts
for
Indicator
%
of
systems
with
indicator
Appropriate
initial
antibiotic selection
25.0
Smoking
cessation
advice/counseling
25.0
Surgical
Care
Improvement Project
Prophylactic
antibiotic
received within 1 hr prior
to surgical incision
Prophylactic
antibiotic
discontinued within 24
hrs after surgery end time
33.3
33.3
25.0
16.7
25.0
16.7
16.7
Prophylactic
antibiotic
selection
Surgery patients with
recommended
venous
thromboembolism
prophylaxis ordered
Surgery patients who
received
appropriate
venous thromboembolism
prophylaxis within 24 hrs
prior to surgery to 24 hrs
after surgery
Cardiac surgery patients
with controlled 6 AM
postoperative
blood
glucose
Surgery patients with
appropriate hair removal

P a g e | 40
HOSPITAL
PERFORMANCE
DIMENSION
MMTC
Community
Hospital
Benchmarking
Survey
National
Health
Service
ScoreCard
(UK)
IASIST
Top
20
Hospitals
(Spain)
%
of
systems
with
indicator
8.3
8.3
8.3
8.3
8.3
Primary C-sections
8.3
Repeat C-sections
8.3
Total C-sections
8.3
Vaginal births after Csections
8.3
WHO
PATH
Children's Asthma Care

Use
of
reliever
medication for inpatient
asthma
Use
of
systemic
corticosteroid
medication for inpatient
asthma
Leapfrog
Group
Hospital
Compare
HealthInsight
CHKS 40
Top
Hospitals
(UK)
US
News
&
World
Report
Total
Counts
for
Indicator
Health
Consumer
Powerhouse
International
Quality
Indicator
Project
Thomson
& Reuters
Top 100
Use of Devices in ICU

Central line use
Ventilator use
Indwelling
catheter use
urinary
Management of Labour

P a g e | 41
HOSPITAL
PERFORMANCE
DIMENSION
MMTC
Community
Hospital
Benchmarking
Survey
National
Health
Service
ScoreCard
(UK)
IASIST
Top
20
Hospitals
(Spain)
%
of
systems
with
indicator
8.3
8.3
Heart Failure
8.3
Pneumonia
8.3
Patient
survey
of
hospital experience (i.e.
Consumer Assessment
of Healthcare Providers
& Systems (CHAPS))
8.3
8.3
8.3
WHO
PATH
Leapfrog
Group
Hospital
Compare
HealthInsight
CHKS 40
Top
Hospitals
(UK)
US
News
&
World
Report
Total
Counts
for
Indicator
Health
Consumer
Powerhouse
International
Quality
Indicator
Project
Thomson
& Reuters
Top 100
Other Process of Care

Measures
Active
surveillance
cultures for MRSA
Outcome
Measures
of
Care
30 day risk-adjusted
mortality rate
Acute
Infarction
Myocardial
Other clinical outcomes

Hospital-wide Mortality
Index
% of cardiac patients
with acute readmission
within 31 days

P a g e | 42
HOSPITAL
PERFORMANCE
DIMENSION
MMTC
Community
Hospital
Benchmarking
Survey
National
Health
Service
ScoreCard
(UK)
IASIST
Top
20
Hospitals
(Spain)
%
of
systems
with
indicator
8.3
8.3
8.3
8.3
8.3
Inpatient mortality
8.3
Neonatal mortality
8.3
8.3
8.3
8.3
8.3
WHO
PATH
% of patients with
unscheduled
Inpatient returns to
OR within same stay
%
of
Inpatient
admissions following
unscheduled returns
to Emergency Dept
within 72 hrs
Device-associated
infections in ICU
Device-associated
infections in ICU due
to MRSA
Surgical
infections
site
Perioperative
mortality
Total
unscheduled
readmissions within
15 and 31 days
Unscheduled
admissions following
ambulatory
procedures
Unscheduled returns
to ICU
Leapfrog
Group
Hospital
Compare
HealthInsight

CHKS 40
Top
Hospitals
(UK)
US
News
&
World
Report
Total
Counts
for
Indicator
Health
Consumer
Powerhouse
International
Quality
Indicator
Project
Thomson
& Reuters
Top 100
P a g e | 43
HOSPITAL
PERFORMANCE
DIMENSION
MMTC
Community
Hospital
Benchmarking
Survey
National
Health
Service
ScoreCard
(UK)
8.3
Unscheduled returns to ER
8.3
Physical restraint events
8.3
Documented falls
8.3
8.3
8.3
8.3
8.3
8.3
8.3
8.3
8.3
Unscheduled
OR
returns
to
Documented
falls
in
ambulatory care
Complications following
sedation and analgesia in
ICU
Emergency Dept
Cardiac Catherization lab
Radiology Suites
Pressure ulcers in acute
inpatient care
Deep vein thrombosis and
pulmonary
thromboembolism
following surgery
Multi-drug
resistant
organisms
Leapfrog
Group
Hospital
Compare
HealthInsight

Thomson
&
Reuters
Top 100
IASIST
Top
20
Hospitals
(Spain)
%
of
systems
with
indicator
WHO
PATH
CHKS 40
Top
Hospitals
(UK)
US
News
&
World
Report
Total
Counts
for
Indicator
Health
Consumer
Powerhouse
International
Quality
Indicator
Project
P a g e | 44
HOSPITAL
PERFORMANCE
DIMENSION
WHO
PATH
Health
Consumer
Powerhouse
Leapfrog
Group
Hospital
Compare
MMTC
Community
Hospital
Benchmarking
Survey
International
Quality
Indicator
Project
HealthInsight
National
Health
Service
ScoreCard
(UK)
CHKS 40
Top
Hospitals
(UK)
US
News
&
World
Report
Thomson
&
Reuters
Top 100
IASIST
Top
20
Hospitals
(Spain)
Total
Counts
for
Indicator
%
of
systems
with
indicator
33.3
8.3
8.3
8.3
8.3
8.3
8.3
16.7
8.3
16.7
8.3
8.3
Risk adjusted mortality (or

mortality index)
Rate
of
emergency
readmission to hospital - 28
days
Rate
of
emergency
readmission to hospital
following treatment for
fractured hip
Rate
of
emergency
readmission to hospital
following AMI (within 28
dys)
Rate
of
emergency
readmissions to hospital
within 14 days for COPD
Survival rate (elective
surgery)
Survival rate (emergency
surgery)
Rate of MRSA
Reported rate of C-difficile
for patients 65 yrs
Risk
adjusted
complications index
Risk
adjusted patient
safety index
Readmissions index (risk
adjusted)
!
P a g e | 45
HOSPITAL
PERFORMANCE
DIMENSION
WHO
PATH
Health
Consumer
Powerhouse
Leapfrog
Group
Hospital
Compare
MMTC
Community
Hospital
Benchmarking
Survey
International
Quality
Indicator
Project
HealthInsight
National
Health
Service
ScoreCard
(UK)
CHKS 40
Top
Hospitals
(UK)
US
News
&
World
Report
Thomson
&
Reuters
Top 100
Surgery index (without

adjusted incomes)
IASIST
Top
20
Hospitals
(Spain)
Total
Counts
for
Indicator
%
of
systems
with
indicator
8.3
Business
Operating (profit) margin
Dollars of Expenses per
Case
Mix-Adjusted
Equivalent Discharge (and
wage-adjusted)
Bad Debt Expenses as a %
of net Patient Service
Revenue
16.7
16.7
8.3
8.3
8.3
8.3
8.3
8.3
8.3
!
!
Cash to total debt ratio

Productivity
Value added per FTE
Employee/Contractor
Value added per Case MixAdjusted
Equivalent
Discharge (CMAED)
FTE
Employees/Contractors
per CMAED
Net
Patient
Service
Revenue
per
FTE
Employee/Contractor
Operating Room 'Cut &
Sew' Time as % of booked
time

P a g e | 46
HOSPITAL
PERFORMANCE
DIMENSION
MMTC
Community
Hospital
Benchmarking
Survey
National
Health
Service
ScoreCard
(UK)
8.3
Avg days of receivables
8.3
Avg days
inventory
8.3
Avg length of stay (days),

Case-Mix adjusted
8.3
% of discharges made
before noon
8.3
8.3
8.3
8.3
8.3
8.3
8.3
8.3
Occupancy
beds
rate,
of
staffed
on-hand
Leapfrog
Group
Hospital
Compare
HealthInsight
Thomson
&
Reuters
Top 100
IASIST
Top
20
Hospitals
(Spain)
%
of
systems
with
indicator
WHO
PATH
CHKS 40
Top
Hospitals
(UK)
US
News
&
World
Report
Total
Counts
for
Indicator
Health
Consumer
Powerhouse
International
Quality
Indicator
Project
Throughput
Mean outpatient door-todoor time (min)

Mean Emergency Dept
Door-to-Physician
time
(min)
Mean Troponin Lab test
turnaround time (min)
Mean radiology order-to
transcription time (hrs)
Length
of
Emergency
(hrs)
stay
in
department
Cancellation of scheduled
ambulatory procedures
Patients
leaving
Emergency room prior to
completion of treatment

P a g e | 47
HOSPITAL
PERFORMANCE
DIMENSION
WHO
PATH
Patients
leaving
Emergency room prior to
completion of treatment
Time from
treatment
referral
Health
Consumer
Powerhouse
Leapfrog
Group
Hospital
Compare
MMTC
Community
Hospital
Benchmarking
Survey
International
Quality
Indicator
Project
HealthInsight
National
Health
Service
ScoreCard
(UK)
CHKS 40
Top
Hospitals
(UK)
US
News
&
World
Report
Thomson
&
Reuters
Top 100
IASIST
Top
20
Hospitals
(Spain)
to
Risk adjusted length of

stay
Day Case rate for target
procedures (case mix
adjusted)
Total
Counts
for
Indicator
%
of
systems
with
indicator
8.3
8.3
16.7
8.3
Day Case conversion rate

(case mix adjusted)
8.3
% of elective inpatients
admitted on day of surgery
8.3
Pre-op length of stay for

fractured neck of femur
8.3
8.3
8.3
8.3
8.3
8.3
Pre-op length of stay for

elective surgery
%
elective
in-patient
admission
with
no
procedure
Missed
out-patient
appointments
(1st
attendance)
Severity adjusted average
length of stay
#
times
surgical
department
performs
operation/yr
!
!

P a g e | 48
HOSPITAL
PERFORMANCE
DIMENSION
WHO
PATH
Health
Consumer
Powerhouse
Leapfrog
Group
Hospital
Compare
MMTC
Community
Hospital
Benchmarking
Survey
International
Quality
Indicator
Project
HealthInsight
National
Health
Service
ScoreCard
(UK)
CHKS 40
Top
Hospitals
(UK)
US
News
&
World
Report
Thomson
& Reuters
Top 100
IASIST
Top
20
Hospitals
(Spain)
Total
Counts
for
Indicator
%
of
systems
with
indicator
Standardized
admission ratio (SAR)
8.3
Patient rating of overall

care
8.3
8.3
8.3
8.3
8.3
Overall data quality

Procedures not carried
out - hospital decision
Waiting times for
common
diagnostic
procedures
Reputation
8.3
Number of discharges
8.3
Nurse staffing
8.3
Nurse Magnet hospital
8.3
Advanced technologies
8.3
Patient services
8.3


Benchmarking Hospital Performance in Health

Uploaded by

Document Information

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Benchmarking Hospital Performance in Health

Uploaded by

Copyright:

Available Formats

Sanigest Internacional White Paper