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Developing clinical benchmarks to assess progress in wound-care management.

How can health practitioners recognise whether the care they are providing to patients is really making a difference? This article suggests that one way to do this is to devise a set of measures to evaluate outcomes. Taking the example of wound-care nursing, it proposes that such tools should take into account not only the practitioners' perceptions of a patient's progress, but also the views of the patient and those of health service managers.

Benchmarking↗

Priorities and benchmarks for new faculty in physical therapist education programs: perceptions of program directors.

The purpose of this study was to establish development priorities, ideal workload and performance levels, and preferred faculty development activities for new faculty in professional-level physical therapist education programs. A preliminary questionnaire was sent to 183 directors of these programs to identify new faculty and their program directors. Eighty-five new faculty and 79 of their program directors were identified and sent comparable surveys with questions that pertained to the current and ideal teaching, scholarship, and service activities of the new faculty. Results indicated that both new faculty and program directors agreed on ideal workload levels and that workloads for new faculty should shift from teaching to scholarship. New faculty set performance levels that are significantly higher than those identified by their program directors. Development priorities for the new faculty varied from knowledge and skills in instruction as expressed by program directors to scholarship as expressed by new faculty. Individual consultations were the highest preferred faculty development activity reported by both groups. These findings provide direction for the content and delivery method for faculty development activities for new faculty in these and similar education programs.

Attitude↗

Using Essence of Care benchmarking to develop clinical practice.

An ultrasound scan of the bladder using a portable bladder scanner is a reliable, non-invasive way of estimating the volume of residual urine that remains in the bladder after voiding (the post-void residual) (Addison, 2000a). Nurses now use bladder ultrasound scanners in a variety of clinical settings (Lewis, 1995). It has been argued that ultrasound should be a standard investigation for the assessment of patients with bladder problems (Addison, 2000a), in particular when emptying their bladder. Older people, particularly men and those with a neurological disorder, including stroke, are most at risk of having a problem emptying their bladder effectively (Addison, 2000b; Brittain et al, 1998).

Benchmarking↗

Selection bias and the perils of benchmarking.

To find the secrets of business success, what could be more natural than studying successful businesses? In fact, nothing could be more dangerous, warns this Stanford professor. Generalizing from the examples of successful companies is like generalizing about New England weather from data taken only in the summer. That's essentially what businesspeople do when they learn from good examples and what consultants, authors, and researchers do when they study only existing companies or--worse yet--only high-performing companies. They reach conclusions from unrepresentative data samples, falling into the classic statistical trap of selection bias. Drawing on a wealth of case studies, for instance, one researcher concluded that great leaders share two key traits: They persist, often despite initial failures, and they are able to persuade others to join them. But those traits are also the hallmarks of spectacularly unsuccessful entrepreneurs, who must persist in the face of failure to incur large losses and must be able to persuade others to pour their money down the drain. To discover what makes a business successful, then, managers should look at both successes and failures. Otherwise, they will overvalue risky business practices, seeing only those companies that won big and not the ones that lost dismally. They will not be able to tell if their current good fortune stems from smart business practices or if they are actually coasting on past accomplishments or good luck. Fortunately, economists have developed relatively simple tools that can correct for selection bias even when data about failed companies are hard to come by. Success may be inspirational, but managers are more likely to find the secrets of high performance if they give the stories of their competitors'failures as full a hearing as they do the stories of dazzling successes.

Administrative Personnel↗

Successful surgical benchmarking program moves to private sector.

In the late 1980s, Congress passed a law requiring all Veterans' Administration hospitals to report surgical outcomes annually on a risk-adjusted basis and compare them to national averages in the private sector. However, those national averages did not exist. Fifteen years later, efforts to remedy that oversight have led to the creation of the National Surgical Quality Improvement Program and dramatic successes in both patient care and cost management.

Academic Medical Centers↗

Benchmarking outcome in ICU.

There are as yet few well developed systems for comparing the quality of care in Irish hospitals with other hospitals either nationally or internationally. The best known are the perinatal mortality rates of the Dublin maternity hospitals. Other examples include mortality rates after cardiac surgery and survival rates after cancer surgery. We describe a comparison of outcomes in an Irish ICU with internationally validated mortality rates for a given severity of illness. The method of stratifying for severity of illness is by use of the APACHE II scoring system. In 2003 the standardised mortality ratio for Beaumont Hospital ICU was 0.87 with a mean APACHE II admission score of 17.5 which compares favourably with similar data produced from UK units.

APACHE↗