Our membership with our benchmarking service is based on surgical volume. For us, it's a little less than $2,000 per year. I have no problem justifying this cost since it gives me access to one-stop shopping for several performance improvement tools and regulatory mandates. Membership also includes consultations with experts who can explain benchmarking, employee satisfaction surveys, cost surveys, infection rate surveys and access to a network of peers. When outcomes aren't as good as you want them to be, you can call other members identified as having "best practices" in a certain area.

Now that benchmarking services have gone online, collecting needed data is easier than ever before. Online benchmarking services let you import data directly to a server, rather than going through a stack of patient charts and filling out forms that need to be mailed. At our facility, it takes 15 to 20 minutes per week to enter the required online data.

Afterward, we receive monthly or quarterly e-mails, notifying us that our reports are ready to be viewed and downloaded from the vendor's secured site. These reports contain quality indicators that tell us how we're doing on such measures as infection rates, procedure times, recovery times, incidence of PACU nausea, urinary retention and post-op pain at home. The data come from the charts and post-op phone interviews of patient groups that we want to study.

Learn things you never knew you never knew
I've found that benchmarking can really pay off by helping you discover issues that you don't even know need improving. For example, 2 years ago we launched a project aimed at improving our patient satisfaction scores following fairly extensive shoulder surgery, a procedure that isn't usually done on an outpatient basis in our community.

Specifically, we wondered how well our patients tolerated post-op pain with just a 24- to 48-hour peripheral nerve block and oral pain medication, as opposed to the IV narcotics they'd receive in the community hospital. What we discovered surprised us.

Using data gathered during our follow-up telephone interviews, we assumed that a lower perceived pain score at home would correlate to a higher perceived overall satisfaction score. After collecting shoulder surgery data for a year, a strange paradox emerged. There was no relation between low pain scores and high patient satisfaction. Many patients who said they experienced a lot of pain were in fact very satisfied with their experience, while other patients who experienced relatively little pain were less satisfied.

Armed with that information and with the help of our benchmarking service, we decided to examine all the variables related to perceived pain scores. We hypothesized that patients' pre-op education regarding regional anesthesia blocks, anticipated post-op pain and use of pain medication would affect how they perceived their post-op experience.

At our facility, patients first meet with an anesthesia provider on the day of surgery. The provider explains the blocks that will be used and what to expect before, during and after surgery. In addition, some surgeons provide patients with information about the surgery during pre-op consults in their offices, but we didn't know exactly what they were telling patients with respect to how much and what kind of pain they would experience after surgery.

Since patients could have been getting mixed signals, we wanted to make sure they received the same information regarding our use of peripheral nerve blocks. We wanted them to know what to expect when they arrived for surgery, to understand expected pain levels after surgery and grasp how they'd feel at home after discharge. We also stressed the importance of taking pain medication before the block wore off.

To make sure every patient received the same information, our department created an educational brochure that orthopedic surgeons give to their patients when scheduling shoulder procedures. We've found that the earlier a patient is educated about what they can expect following surgery, the more likely the information will be retained.

Not long after the surgeons started handing out the brochure, our benchmarking data revealed that perceived satisfaction scores were improving regardless of how much post-op pain patients experienced. We discovered that when patients know what to expect, and feel that what they are experiencing is "normal," they accept post-op pain as part of the process. In turn, they're more likely to be satisfied with their overall surgical experience.

Digging deeper
We're now planning to use benchmarking data to take a deeper look at our shoulder surgery post-op pain and patient satisfaction scores to figure out which of our anesthesia providers are associated with the highest patient satisfaction scores. Then we'll be able to look at what those particular providers are doing well and standardize our practices. Having the benchmarking evidence on file will help when it comes time to provide our best practices data to the anesthesia team. If we weren't using an online benchmarking service, this study would be much more difficult to perform.

Benchmarking is required in many states and by all accreditation agencies. Online services let you easily gather the information you need to meet those requirements. They also let you improve your clinical and business performances, and perhaps help identify and improve areas you didn't know were struggling. In the end, having access to performance data from your facility and from your peers lets you know how you're really doing, not how you think you're doing.