Paper presented at the Islamic Hospital Management Workshop
held in conjunction with the 3rd Federation of Islamic Medical Associations (FIMA) Scientific Convention held in
JogjakartaIndonesia on 21st July 2006 by Dr Omar Hasan Kasule MB ChB (MUK), MPH (Harvard), DrPH (Harvard) Professor of Epidemiology and Islamic Medicine,
Institute of Medicine Universiti
Benchmarking for Islamic hospitals employs generally accepted benchmarking criteria such as financial indicators,
overall productivity, quality of care, and management. It must in addition have additional criteria that reflect its added-value
to healthcare in the form of a holistic approach that takes care of the patient’s spiritual, physical, and fiqhi
needs. Success will be achieved in delivering the added-value at a cost comparable to or below that of top performers in the
industry. The cost savings cannot be achieved by compromising quality but can be achieved by a motivated health care team
that is more productive per hour than comparable hospitals and that has a sense of personal responsibility and accountability
not to waste time and material resources. This sense of concern can enable Islamic hospitals deliver cost-efficient holistic
care and at the same time have some resources available to fulfill its duties of mutual social support, takaful, in helping those who cannot afford standard fees. The paper discusses practical benchmarking guidelines
in view of the concepts and assertions above.
1.1 Benchmarking in industry
Benchmarking is new to the hospital industry. It however has been standard practice in other industries. The process
of benchmarking starts with identification of a process to be benchmarked. This is followed by identification of a company
that is considered a leader in the given industry. Sources used in the identification may be business magazines or other published
information about companies. There can be no unanimity of opinion on what constitutes an industry leader since different people
employ different criteria. Management practices, processes, and products are the compared with the chosen industry leader.
The leader may provide details of their operations or they may obtained from industry publications. The purpose of benchmarking
is not to copy the industry leader but rather to evaluate practices in view of what the leader does. This process can generate
new insights about the company and its management. As a management tool it helps companies improve their performance using
a successful leader as a point of reference. Benchmarking also helps a company measure its performance against potential competitors
with the industry leader as a common point of reference.
1.2 Hospital benchmarking
Benchmarks have been used for a very wide range of hospital processes. Reproduced below is a laundry list from recent
literature: percentage of cases referred to a higher center[i], diagnostic criteria for specific conditions[ii], mortality[iii], readmission rate[iv], hospital stay[v], patient privacy[vi], nursing[vii][viii], radiology[ix], disease prevention[x], surgical wounds[xi], mental health[xii], ambulance call-to-needle time in myocardial infarction[xiii], outcomes for acute myocardial infarction[xiv], telephone consultations[xv], emergency care[xvi], drug information center operations[xvii], quality of care after myocardial infarction[xviii], psychiatric rehabilitation[xix], central line infection[xx], pharmacy drug expenditure[xxi][xxii], hospital costs[xxiii], diabetic complications[xxiv], reduction of costs of appendicitis treatment[xxv], digital imaging[xxvi], pathology services[xxvii], day only or ambulatory surgical procedures[xxviii], utilization of the operating theater[xxix], costs of cholesystectomy[xxx], mortality and morbidity outcome for surgical procedures[xxxi], planning, purchasing, and scheduling[xxxii], percapita regional physician workforce[xxxiii], patient satisfaction[xxxiv], cost of antimicrobials[xxxv], and outcomes of tertiary care centers[xxxvi].
Because of interdependence, some benchmarks reflect a combination of items for example hospital stay and utilization
can be combined into one benchmark[xxxvii]. What we learn from this extensive listing is that virtually any process in the hospital
can be benchmarked.
Sources of benchmarking data:
Data for bench-marking is obtained from benchmark data-bases, benchmark registries, or online benchmark tools[xxxviii]. Benchmark data bases are widely used for benchmarking purposes some are national while
others are local or regional. There is however a dearth of such databanks in the hospital industry[xxxix]. These data bases are specific for procedures and processes such as intensive care[xl]. For some procedures special benchmark registries are set up by collaborating institutes
and are used for bench-marking procedures such as intra-aortic balloon counterpulsion[xli]. Special guides on benchmarking may also be consulted[xlii]. Special programs and software has been developed to assist in benchmarking[xliii]. Some institutions that have a high volume of a certain procedure may network to share
data that is used for benchmarking[xliv].
Choice of the benchmark data base or the benchmark to use has an effect on the conclusions reached[xlv] therefore choices must be made carefully. The best performing centers that can be used
as industry leaders for purposes of benchmarking. There are ranking agencies that rank hospitals using a wide range of criteria[xlvi]. Hospitals that are ranked high may be used as a benchmark. Assessment tools are available
for identifying specific institutions as centers of excellence in specific procedures[xlvii]. An institution cannot be an industry leader overall; it can be a leader in a specific
area such as hospital stay[xlviii]. An industry leader or a benchmark is not permanent. It can change for the better or
for the worse therefore benchmarks need constant revision. Industry leaders who are the best performers have a culture of
constant improvement with consequent rise of the benchmark levels[xlix].
Methodology of benchmarking
Data for benchmarking must be checked for completeness and consistency. Then the following basic descriptive statistics
are computed for continuous variables (mean, median, standard deviation) or discrete variables (proportion, rate). These computed
parameters are then compared to the benchmark parameters. Gap analysis is used to study the differences between the internal
and the benchmark parameters. Odds ratios are an additional parameter that can be computed.
Where the hospital concerned has characteristics that differ from the benchmark data base, suitable statistical adjustments
using multivariate techniques can be used for adjustment before reaching conclusions.
After doing the gap analysis to identify differences between the internal and benchmark parameters, action plans are
developed to cover the gap.
Effects of benchmarking
Feedback of benchmarking results has been shown to result in improvement of quality[l], reduction in the cost of labor[li], reduction of the operating budget[lii]
1.3 Islamic basis for benchmarking
If we look at benchmarking as an exercising in comparing ourselves to the leaders in any endeavor, we can identify
a lot of evidence for it in the Qur’an. The Qur’an has described in great detail behavior characteristics of the
righteous, saalihiin, so that we may emulate them. It also has described the transgressors,
dhaalimiin, so that we may avoid behaving like them.
The Qur’an is a book of moral guidance. It therefore gives models and
examples of the righteous, salihiin, to be emulated as well as models of transgressor, dhalimin, to be avoided.
It describes the thoughts, actions, and fate of the two groups in a historical perspective, a contemporary perspective, and
a future perspective. It also provides intellectual arguments as well as makes pleas to humans to emulate the salihiin
and to avoid the dhalimiin. I have made a partial compilation of such verses as an indication of how important this
Surat al Fatihat (S.1): 6-7; Surat al Takwir (S.81): 13-19; Surat al
Mutafifiin (S.83):4-17, 18-26; Surat al Inshiqaaq (S.84): 6-9, 10-15,20-24, 25; Surat al Buruuj (S.85): 4-11, 12-20, 15-17; Surat al A’la (S.87): 11-13, 14-15; Surat
al Ghashiyat (S.88): 1-7, 8-16, 23-26; Surat al Fajr (S.89): 6-14, 21-26, 27-30, 11-19, 20; Surat al Shams (S.91):11-15, 4-7, 8-13, 13-16, 17-21; Surat al Sharh (S.94): 7-8, 6-19; Surat al Qadar (S.97): 1-6, 7-8, 6-7,
8; Surat al ‘Adiyat (S100): 6-8; Surat al Qari’at (S.101): 6-7, 8-11; Surat al Asr (S.103): 2, 3; Surat al Humazzat
(S.104): 1-4; Surat al Fiil (S.105): 1-5; Surat Quraish (S.106): 1-7; Surat al Kafirun (S.109): 1-6; Surat al Masad (S.111):
1-4; Surat al Falaq (S.113): 1-2; Surat al Nas (S.114): 1-4; Surat al Jinn (S.72): 1-7,11-15, 19, 23-24; Surat al Muzammil (S.73): 10-12, 16; Surat al Muddathir (S.74): 11-26; Surat al Qiyamat (S.75): 5-6,
20-21, and 22,31-35; Surat Al Insan (S.76): 4, 5-22, 27-28; Surat al Mursalat
(S.77):15-19, 24, 28-40, 41-44, 45-50; Surat al Naba’ (S.78): 1-5, 21-30,
31-36; Surat al Saff (S.61): 5-6; Surat al Munafiqun (S.63): 1-8; Surat al Taghabun (S.64): 5-8, 16-17; Surat al Talaq (S.65):
8-11; Surat al Tahrim (S.66): 7, 9, 10, 11-12; Surat al Mulk (S.67): 6-11, 12, 28; Surat al Qalam (S.68): 17-33, and 24-41,
51-52; Surat al Haaqat (S.69): 11-12, 19-23, 24-37; Surat al Ma’arij (S.70): 19-21, 22-35, 36-44; Surat al hariyat (S.51):
10-14, 15-19, 24-46, 52-55, 59-60; Surat al Tur (S.52):7-8, 11-16, 17-27, 29-47;
Surat al Najm (S.53): 19-30, 31-32, 33-37; Surat al Qamar (S.54): 4-53, 54-55; Surat al Rahman (S.55): 46-78; Surat al Waqi’at
(S.56): 10-40, 41-57; Surat al Hadid (S.57): 12, 13-15,12-19; Surat al Hashr
(S.59): 1-5, 11-17, 20; Surat ussilat (S.41): 1-8, 13-18, 25-29, 30-36, 40-46; Suurat al Shuura (S.42): 35, 36-43, 44-48;
Surat al Zukhruf (S.43): 5-7, 15-67, 68-73, 74-83; Surat al Dukkhaan (S. 44): 9-29, 34-37, 40-50, 51-56, Surat al Jaathiyat
(S.45): 7-11, 14-15, 21, 23-26, 27-35; Surat al Ahqaaf (S.46): 3-12, 13-19, 20-25, 27-28, 29-32, 34; Surat uhammad (S.47):
1-9, 12-38; Surat Luqman (S.31): 31:1-11,31:20-24; Surat al Sajdat (S.32): 10-30;
Surat al Ahzaab (S.33): 63-73; Surat Saba (S.34):1-9, 20-54; Surat Fatir (S.35):
1-45; Surat Yasiin (S.36): 1-35, 45-83; Surat al Safaat (S.37): 12-74, 149; Surat Saad (S. 38): 1-17, 49-64; Surat al Zumar
(S. 39): 7-75; Surat Ghaafir (S.40): 1-22, 69-85; Surat al Anbiya (S. 21): 1-47; Surat al Hajj (S.22): 1-25, 38-78; Surat
al Muminuun (S.23): 23:51-118; Surat al Nuur (S.24): 24:46-57; Surat al Furqan (S.25): 1-44; Surat al Sha’ara (S.26):
26:92; Surat al Naml (S.27):27:59-93; Surat al Qisas (S.28): 28:51-75; Surat al ‘ankabuut (S. 29): 1-12, 41-69; Surat
al Ruum (S.30): 1-16, 29-60; Surat Hud (S.11): 1-24, 104-123; Surat al Ra’ad (S.13): 19-43; Surat Ibrahim (S.14):18-34,42-52; Surat al Hijr (S.15):1-11; Surat al Nahal (S.16): 19-64, 84-138; Surat al Isra (S.17): 1-22, 40-60, Surat
al Kahf (S.18): 27-59, 18:99-110; Surat Maryam (S.19): 59-98; Surat Taha (S.20): 100-135; Surat al Taubat (S.9): 53-110; Surat
al Taubat (S.9): 111-129; Surat Yunus (S.10): 10:7-70; Surat al A’araf (S.7): 31-53; Surat al an’aam (S.6): 1-73;
Surat al Nisa (S.4): 105-126 ; Surat al Nisa (S.4): 131-152 ; Surat aal ‘Imraan (S.3): 187-200; Surat al Baqarat
(S.2): 2:1-20; and 2:151-162;
So our approach to bench-marking should include looking for both good models and bad models of medical practice.
Another characteristic of Islamic benchmarking is continuous improvement of performance. The prophet taught that he
who has two consecutive days equal in performance is a loser, ‘man istawa yawmaahu
fahuwa maghbuun. It should be a constant effort of Islamic hospitals to improve on a continuous basis.
ON BENCHMARKING FOR ISLAMIC HOSPITALS
2.1 Identifying a hospital that is an industry leader
A central feature of benchmarking is ability to identify an industry leader against whose performance others can
measure. This is a near-impossibility for Islamic hospitals for various reasons. The phenomenon of Islamic hospitals is quite
new and there are few such hospitals and those that exist are small and are struggling to establish themselves. They are experimenting
with various approaches and it will take time before they can develop their standard operating procedures fully. There are
therefore no hospitals that can be clearly identified as leaders in this industry. Even those that may be identified will
be the first to admit that they are still a long way from their own aspirations.
Using non-Islamic for-profit hospitals is also not a viable alternative because of the great differences in approach
to health care. This is because Islamic hospitals aim at holistic care (physical, social, and spiritual modalities) within
a tauhidi paradigm and in conformity with the Law (shari’at). They
therefore have to expend more resources, human and material, in their care than general hospitals. The outcome measures for
Islamic hospitals are also more holistic than general hospitals. Thus a for-profit hospital would not be a suitable benchmark
for an Islamic hospital.
Using religious not-for-profit hospitals as a benchmark is also not a viable alternative. These hospitals may share
compassion and help for the needy with Islamic hospitals. They however have standard operating procedures that are not distinguishable
from standard for-profit hospitals. This is because, unlike Islamic hospitals, they do not have guiding principles akin to
the Law, shari’at, that guide their operations and practices.
2.2 Financial benchmarking
There is a very dangerous tendency among not-for-profit hospitals to think of themselves as charitable institutions
that have to operate far away from the financial concerns found in for-profit institutions. Some managers of not-for-profit
institutions even consider fund-raising to support their operations because they cannot stand on their own. This type of thinking
makes people relax regarding rigorous financial management.
I think that managers of Islamic hospitals must be more concerned about efficient financial performance more than managers
of for-profit hospitals. This is because they expend more resources to provide holistic care but cannot charge very high hospital
fees because their clientele is so far not from the richest strata of society. Secondly being in a precarious financial position
Islamic hospitals have the thread of financial failure hanging over their heads. They cannot afford to fail financially because
whatever else they do well, they will not be around to it if they fail financially. Islamic hospitals like Islamic banks,
Islamic schools, and Islamic Universities are part of a larger ummatic civilizational project whose aim is to rebuild ummatic
institutions destroyed by colonial invasion and occupation. Therefore failure of any hospital contributes to impairment of
a larger ummatic project.
Islamic hospitals must set a basic benchmark to be able to generate revenue to cover their expenses and put aside some
for growth or for the rainy day. This will require more efficient financial management than in the best for-profit hospital.
The Islamic hospital is in other words being called upon to provide maximum services at the least cost. It will have to outperform
the best for-profit institution in the industrially developed countries. Providing more for less will require serious re-engineering
of clinical procedures[liii], and management procedures (especially purchasing and control of waste).
2.3 Outcome benchmarking
Outcome benchmarking is quite easy.
Rates of cure, morbidity, mortality, hospital stay etc are compared directly with those of the benchmark. If there are differences
in the baseline characteristics between the internal and benchmark entities, some form of multivariate analysis is used to
2.4 Productivity benchmarks
Productivity is basically counting procedures done or units of work accomplished and comparing with the benchmark.
Productivity is closely related to revenue. The hospital must make sure that it uses its human and material resources for
2.5 Patient satisfaction
The most important issue for Islamic hospitals
is patient satisfaction but is also the most difficult to measure. Finding a suitable benchmark is also difficult because
Islamic hospitals provide holistic care not found in other institutions.
It seems to me that Islamic hospitals cannot benchmark against an industry
leader because there are few suitable models. What will happen is that several Islamic hospitals shall meet and through discussion
agree on a benchmark for each process. The benchmark should not be static; it can be reviewed regularly to keep up with developments
in the hospital industry or just for the sake of improvement. Thus the role of benchmarking can be assigned to the Islamic
Hospital Consortia. I think that regional consortium benchmarking will be more successful than international benchmarking
because of the great diversity of medical practice at the international level. In terms of priority, Islamic hospitals should
start with financial efficiency and patient satisfaction.
[i] (2- Bossyns P, Abache R, Abdoulaye MS, Miye H, Depoorter AM, Van Lerberghe W. Monitoring the
referral system through benchmarking in rural Niger: an evaluation of the functional relation between health centres and the
district hospital.BMC Health Serv Res. 2006 Apr 12;6:51.
[ii] (3- Miller PR, Johnson JC 3rd, Karchmer T, Hoth JJ, Meredith JW, Chang MC National nosocomial
infection surveillance system: from benchmark to bedside in trauma patients.J Trauma. 2006 Jan;60(1):98-103.)
[iii] (5- Afessa B, KeeganMT, Hubmayr RD,
Naessens JM, Gajic O, Long KH, Peters SG. Evaluating the performance of an institution using an intensive care unit benchmark.Mayo
Clin Proc. 2005 Feb;80(2):174-80. Comment in: Mayo Clin Proc. 2005 Feb;80(2):164-5.)
[iv] (4- Michael Cotten C, Oh W, McDonald S, Carlo W, Fanaroff AA, Duara S, Stoll B, Laptook A, Poole
K, Wright LL, Goldberg RN; NICHD Neonatal Research Network.Prolonged hospital stay for extremely premature infants: risk factors,
center differences, and the impact of mortality on selecting a best-performing center. J Perinatol. 2005 Oct;25(10):650-5.)
[v] (40- Lagoe RJ, Arnold KA, Noetscher CM. Benchmarking hospital lengths of stay using histograms.
Nurs Econ. 1999 Mar-Apr;17(2):75-84, 102)
[vi] (8- Denner L. Benchmarking patient privacy to improve essence of care. Nurs Times. 2004 Jul
[vii] (10- Anonymous. Nursing performance measures to assist hospitals in benchmarking.. Perform Improv
Advis. 2004 May;8(5):51-3, 49.
[viii] 25- Brown DS, Donaldson N, Aydin CE, Carlson N. Hospital nursing benchmarks: the California
Nursing Outcomes Coalition project. J Healthc Qual. 2001 Jul-Aug;23(4):22-7.)
[ix] (11- Jarman L, Coxsey D. Using the benchmarking process to improve care after barium enema.
Prof Nurse. 2004 Apr;19(8):462-5.)
[x] (12- Jarvis WR. Benchmarking for prevention: the Centers for Disease Control and Prevention's
National Nosocomial Infections Surveillance (NNIS) system experience.Infection. 2003 Dec;31 Suppl -8.)
[xi] (14- Birchall L, Taylor S. Surgical wound benchmark tool and best practice guidelines. Br J
Nurs. 2003 Sep 25-Oct 8;12(17):1013-23.)
[xii] (15- Harrison A, Devey H. Benchmarking mental health care in a general
hospital. Nurs Times. 2003 Jun 17-23;99(24):34-6.)
[xiii] (19- Kelly AM, Kerr D, Patrick I, Walker T. Benchmarking ambulance call-to-needle times for
thrombolysis after acute myocardial infarction in Australia:
a pilot study. Intern Med J. 2002 Apr;32(4):138-42.)
[xiv] (53- Rosenstein AH, Swedlow A, Simons T. Benchmarking outcomes for diagnosis and AMI: a multidisciplinary
hospital performance improvement project. Best Pract Benchmarking Healthc. 1997 Mar-Apr;2(2):71-81.)
[xv] (20- Crouch R, Dale J, Crow R. Developing benchmark inventories to assess the content of telephone
consultations in accident and emergency departments: use of the Delphi technique. Int J Nurs Pract.
[xvi] (21- Anonymous. Guidelines set new benchmark for emergency care of children. Clin Resour Manag.
[xvii] (22- Scala D, Bracco A, Cozzolino S, Cristinziano A, De Marino C, Di Martino A, Gonzalez E,
Mancini A, Romagnuolo F, Zeuli L. Italian drug information centres: benchmark report.Pharm World Sci. 2001 Dec;23(6):217-23.)
[xviii] (24- Dorsch MF, Lawrance RA, Sapsford RJ, Oldham J, GreenwoodDC, Jackson BM, Morrell C, Ball SG, Robinson
MB, HallAS. A simple benchmark for evaluating quality
of care of patients following acute myocardial infarction. Heart. 2001 Aug;86(2):150-4.)
[xix] (27- Macias C, Barreira P, Alden M, Boyd J. The ICCD benchmarks for clubhouses: a practical
approach to quality improvement in psychiatric rehabilitation. Psychiatr Serv. 2001 Feb;52(2):207-13.)
[xxi](29- Huntington N. Benchmarking in health-system
pharmacy: experience at Glens FallsHospital.
Am J Health Syst Pharm. 2000 Oct 15;57 Suppl 2:S21-4.,
[xxii] 30- Bhavnani SM. Benchmarking in health-system pharmacy: current research and practical applications.
Am J Health Syst Pharm. 2000 Oct 15;57 Suppl 2:S13-20.)
[xxiii] (31- Magnus SA, Smith DG. Better Medicare Cost Report data are needed to help hospitals benchmark
costs and performance. Health Care Manage Rev. 2000 Fall;25(4):65-76.
[xxiv] (35- Pinzur MS. Benchmark analysis of diabetic patients with neuropathic (Charcot) foot deformity.Foot
Ankle Int. 1999 Sep;20(9):564-7., 55- Pinzur MS, Stuck R, Sage R, Pocius L, Trout B, Wolf B, Vrbos L. Benchmark analysis on
diabetics at high risk for lower extremity amputation. Foot Ankle Int. 1996 Nov;17(11):695-700.)
[xxv] (36- Firilas AM, Higginbotham PH, Johnson DD, Jackson
RJ, Wagner CW, Smith SD. A new economic benchmark for surgical treatment of appendicitis. Am Surg. 1999 Aug;65(8):769-73.)
[xxvi](38- Shelton PD, Lyche DK, Norton GS, Romlein J,
Lawrence DP, Cawthon MA, Thomas JA, Richardson N. Benchmark testing the Digital Imaging Network-Picture Archiving and Communications
System proposal of the Department of Defense. J Digit Imaging. 1999 May;12(2):94-8.)
[xxvii](39- Gordon M, Holmes S, McGrath K, Neil A. Benchmarking
pathology services: implementing a longitudinal study. Pathology. 1999 May;31(2):133-41.)
[xxviii] (41- Cleary M, Lloyd S, Maguire A. A national
day only surgery benchmarking basket. Aust Health Rev. 1999;22(1):122-32., 66- Balicki B, Kelly WP, Miller H. Establishing benchmarks for ambulatory surgery costs. Healthc Financ Manage. 1995 Sep;49(9):40-2,
[xxix] (48- Anonymous. Kaiser shares ambulatory surgery benchmarks. Healthc Benchmarks. 1998 Jan;5(1):5-6.)
[xxx] (42- Anonymous. Use these data to benchmark cholecystectomy costs. Data Strateg Benchmarks.
1999 Jan;3(1):12-4, 1.)
[xxxi] (46- Semmens JB, Lawrence-Brown MM, Norman PE, Codde
JP, Holman CD. The Quality of Surgical Care Project: benchmark standards of open resection for abdominal aortic aneurysm in
Western Australia. Aust N Z J Surg. 1998 Jun;68(6):404-10.)
[xxxii] (51- Poole LW. How to use benchmarking to reduce planning and purchasing
costs. Hosp Mater Manage Q. 1997 Aug;19(1):77-83.)
[xxxiii] (54- Goodman DC, Fisher ES, Bubolz TA, Mohr JE, Poage JF, Wennberg JE. Benchmarking the US
physician workforce. An alternative to needs-based or demand-based planning JAMA. 1996 Dec 11;276(22):1811-7.)
[xxxiv] (57- Draper M, Hill S. Feasibility of national benchmarking of patient satisfaction with Australian
hospitals. Int J Qual Health Care. 1996 Oct;8(5):457-66.)
[xxxv] (59- Rifenburg RP, Paladino JA, Hanson SC, Tuttle
JA, Schentag JJ. Benchmark analysis of strategies hospitals use to control antimicrobial expenditures. Am J Health
Syst Pharm. 1996 Sep 1;53(17):2054-62.)
[xxxvi] (60- Richards MA, Parrott JC. Tertiary cancer services in Britain:
benchmarking study of activity and facilities at 12 specialist centres. BMJ. 1996 Aug 10;313(7053):347-9.),
[xxxvii] (33- Lagoe RJ, Noetscher CM, Murphy ME. Combined benchmarking of hospital outcomes and utilization.
Nurs Econ. 2000 Mar-Apr;18(2):63-70.)
[xxxviii] (32- Anonymous. Benchmark hospital performance against this on-line tool. Data Strateg Benchmarks.
2000 Sep;4(9):133-6, 129.)
[xxxix] (9- Anonymous. Benchmarking and safety: natural fit if you know what to do with data.. Healthcare
Benchmarks Qual Improv. 2004 May;11(5):49-52)
[xl] (5- Afessa B, KeeganMT,
Hubmayr RD, Naessens JM, Gajic O, Long KH, Peters SG. Evaluating the performance
of an institution using an intensive care unit benchmark.Mayo Clin Proc. 2005 Feb;80(2):174-80. Comment in: Mayo Clin Proc. 2005 Feb;80(2):164-5.)
[xli] (13- Cohen M, Urban P, Christenson JT, Joseph DL, Freedman RJ Jr, Miller MF, Ohman EM, Reddy
RC, Stone GW, Ferguson JJ 3rd; Benchmark Registry Collaborators. Intra-aortic balloon counterpulsation in US and non-US centres:
results of the Benchmark Registry.Eur Heart J. 2003 Oct;24(19):1763-70.)
[xlii] (43- Solovy A. Benchmarking guide '99. Hosp Health Netw. 1999 Jan;73(1):49-54, 56, 58 passim.)
[xliii] (47- Anonymous. Despite cost and risk, ORYX PLUS offers benchmarking bonanza. Healthc Benchmarks.
[xliv] (50- Anonymous.Network's cardiology data help
member groups benchmark performance, market services. Data Strateg Benchmarks. 1997 Nov;1(5):72-5.)
[xlv] (6- Austin PC, Alter DA, Anderson GM, Tu JV. Impact
of the choice of benchmark on the conclusions of hospital report cards.Am Heart J. 2004 Dec;148(6):1041-6.)
[xlvi] (44- Anonymous. Study ranks most efficient hospitals by state, targets 1996 Medicare LOS data.
Health Care Cost Reengineering Rep. 1998 Dec;3(12):186-8.)
[xlvii] (56- Ronning PL, Meyer JW. Centers of excellence:
an assessment tool for cardiovascular and orthopedic programs. Hosp Technol Ser. 1996 Oct;15(13):1-29.)
[xlviii] (4- Michael Cotten C, Oh W, McDonald S, Carlo W, Fanaroff AA, Duara S, Stoll B, Laptook A, Poole
K, Wright LL, Goldberg RN; NICHD Neonatal Research Network.Prolonged hospital stay for extremely premature infants: risk factors,
center differences, and the impact of mortality on selecting a best-performing center. J Perinatol. 2005 Oct;25(10):650-5.)
[xlix] (7- Anonymous. Study: top performers also can be top improvers. Healthcare Benchmarks Qual Improv.
2004 Oct;11(10):112-4. Comment in: Healthcare Benchmarks Qual Improv. 2004 Oct;11(10):116-7.)
[l](34- Burstin HR, Conn
A, Setnik G, Rucker DW, Cleary PD, O'Neil AC, Orav EJ, Sox CM, Brennan TA. Benchmarking and quality improvement: the Harvard
Emergency Department Quality Study. Am J Med. 1999 Nov;107(5):437-49.)
[li] (45- Anonymous. Benchmark data, improved productivity help team save $6.9 million in labor costs.
Data Strateg Benchmarks. 1998 Nov;2(11):168-70, 161.)
[lii] (63- Cohen E, Anderson-Miles E. Benchmarking: a management tool for academic medical centers.
Best Pract Benchmarking Healthc. 1996 Mar-Apr;1(2):57-61.),
[liii] Greeson D, Lowenhaupt M. Clinical reengineering. A benchmark strategy. Physician Exec. 1996