Emergency department benchmarking
In 2009, emergency department benchmarking was launched in six Finnish healthcare districts, and was subsequently expanded to the majority of the districts. NHG has also conducted similar comparisons in Swedish university hospitals.
Emergency care must be seen as part of the overall treatment chain. Throughput times and productivity, for example, can only be assessed against factors such as regional utilisation, emergency visits in relation to the population, other service providers, and admission to follow-up treatment. Through comparison data, different factors affecting the overall system can be identified, and the results used in, for example, triage operations, resourcing and emergency unit profiling.
The comparison uses regularly-collected data describing the patients, visit times and resources, as well as information on diagnoses, treatments and procedures. The results, such as throughput times, loads and patient flows are examined and discussed in meetings, where the practices and development measures used in the different districts are also reviewed.
Surgical benchmarking has been conducted as a continuous service since 2008, involving the vast majority of Finland’s central hospitals.
In surgical benchmarking, the overall productivity is approached through specialities and units: which factors have the greatest effect on productive as a whole? What is the impact of the different approaches employed in outpatient departments, surgical units or wards? Are the areas of specialisation equally resourced, or should the development measures be targeted at specific specialities and concepts? Instead of cuts across the board, it is possible to identify the key development areas and opt for more of a ‘surgeon’s knife’ precision approach.
The comparison database consists of hundreds of thousands of procedures and treatment periods over several years. The material is regularly updated and indicators developed to respond to topical questions. In addition, approaches of the different units are frequently described to define industry’s best practices. Comparison tools are constantly developed in cooperation with our clients.
Internal medicine benchmarking
Internal medicine benchmarking among the Finnish central hospitals began in 2009. Here, data analyses and discussions between the clients are used to identify good practices allowing for higher productivity. Internal medicine benchmarking examines productivity in wards, outpatient clinics and invasive cardiology units. Inpatient capacity and its explanatory factors, outpatient clinic productivity, nurse-doctor ratio, and the underlying concepts are among the particular points of interest.
In internal medicine, the division of work with health centre inpatient wards poses special challenges. Patients in both internal medicine and health centre inpatient wards are often old with multiple diagnosis, resulting is somewhat unclear division of labour. In addition, many patients are in need for follow-up treatment, which often causes delays in the treatment chain. Here, the efficient use of emergency departments in determining diagnoses and treatment plans for the elderly internal medicine patients, may prove beneficial. Impact of the emergency units is a recent addition to the scope of the benchmarking analyses.
When examining the episodes of internal medicine, one needs to bear in mind that the diseases are often chronic in nature, and produce different key metrics than the procedure-oriented surgery. Episodes provide interesting information on the number of clinic visits, whether the patient is received by a doctor or a nurse, and on the number of years the patient receives treatment and monitoring in special healthcare.
Metrics and analyses are developed each year in accordance with the clients’ wishes. As the time series increases, it is possible to develop new and more reliable indicators for the episode studies. The results are discussed twice a year, and the observed good practices addressed in more detail.