Clinical Benchmarking in a Community Hospital: An Application of Continuous Quality Improvement

INTRODUCTION Continuous Quality Improvement (CQI) and Total Quality Management (TQM) are gaining acceptance in many of today’s health care delivery systems. Hospitals have incorporated this philosophy both as a means of enhancing quality of patient care through continuous improvement and to improve efficiency and effectiveness of management, but also to satisfy the Joint Commission on Accreditation of Health Care Organizations’ (JCAHO) requirements for reaccreditation. Uncertainty in the current health care delivery system and consumer pressure due to rising costs have also prompted the development of cooperative partnerships between employers and health care providers in the quest for quality. Schools and colleges of pharmacy need to incorporate the principles of CQI and TQM into their curricula to prepare students for the reality of pharmacy practice in an era of health care reform that is driven by outcome measures. TQM tools such as benchmarking transcend practice settings. The importance of the pharmacist as a vital member of a cross functional health care team should be emphasized to students. The management literature can be consulted for a comprehensive overview of TQM(1). Benchmarking is the practice of regularly comparing oneself to others performing similar activities so as to continuously improve(2). It is a quality tool that relies on the appropriate use of objective data and allowing that data to become the basis for process improvement. Benchmarking was first practiced by the Xerox corporation in the late 1970’s. When applied to the health care industry, clinical benchmarking strives to improve processes in the delivery of a health care service to achieve the best patient outcomes. Benchmarking is utilized for process redesign whereas traditional TQM tools are employed for incremental process improvement (3). Therefore, clinical benchmarking requires a significant time and resource commitment. Consistent with TQM philosophy, a “Plan-Do-Study-Act” (PDSA) approach is required for benchmarking to be successful. Until very recently, benchmarking has scarcely been used in the clinical setting primarily because of a limited knowledge of TQM methods and lack of support for such initiatives(3). Revised JCAHO requirements, consumer pressures, and inevitable reform of health care have spurred recent interest to adapt benchmarking to clinical practice. Improvements in health care delivery influenced by objec-