Learning Objectives

Performance Improvement Dashboardsand Benchmarking presented byShelley D. Voelz, RN,BSN, CPHQ, FNAHQDirector Standards Compliance and Patient Safetyfor theIndiana Chapter of International Executive Housekeeping Association April 9, 2010

Learning Objectives • Participants will be able to identify the components of a departmental quality dashboard. • Participants will understand the definition of benchmarking. • Participants will be able to identify organizations that can be utilized for benchmarking performance.

Performance Dashboards Health care executives use performance dashboards to keep tabs on enterprise health based on the concept of an automobile dashboard. Performance dashboards seek to distill reams of performance data into a few key metrics, giving executives user-friendly “snapshots” of a department or organization’s overall performance.

Understanding the Data Delays and difficulties in understanding performance is problematic in that in our current health care environment industry margins have fallen resulting in little room for error, even small divergences from financial projections can plunge you into the red.

Dashboards Speed Up Problem Recognition Creating a dashboard is the first step in ensuring that mounting performance problems are addressed quickly. Dashboards speed up problem recognition but do not force remedial action.

Defining the Service You Provide • In the area of housekeeping management, the counterpart to design specifications is service level. Service level is the combination of tasks and their performance frequencies.

What Level of Service are You to Provide? Many in-house housekeeping operations are mandated by CEOs to provide a dictated service level. The key point is that a housekeeping manager seldom has the authority to significantly change the service level, along with the corresponding budget and resulting benchmarks, without prior approval from somewhere up the chain of command. However, when the service level is adjusted, so is the labor. The higher the service level, the higher the labor used. Labor represents roughly 90 percent of some housekeeping budgets.

Modified Service Levels The goal should be to modify the service level without impacting the hospital's appearance in a noticeable way. In general, the following two rules of thumb can be used to accomplish this: • Adjust the service level in areas out of the public eye; and • Adjust the service level in area types representing the largest percentage of the total square feet.

Patient Satisfaction Creating an exceptional environment of care around your patients will guarantee their safety, comfort, and confidence in their clinical care. Our customer-focused healthcare environmental services start with our employees who deliver consistent levels of performance that yield high patient satisfaction scores. In addition, each manager is trained in our patented hospital housekeeping techniques to improve HCAHPS performance.

Key Elements of an Effective Dashboard 1. Metric Balance: Use financial and operations indicators with leading indicators. 2. Metric Austerity: Performance is distilled to 15 to 30 metrics with little redundancy. 3. Graphic Display: Trends and data interrelations graphed to allow better, more rapid pattern recognition. 4. Action Triggers: Specific targets or threshold, below which immediate action must be taken. These targets are derived from past performance and industry benchmarks.

Creating a Quality Dashboard Four elements of an effective dashboard are: 1. Financial Data 2. Clinical Quality Data 3. Operational Data 4. Satisfaction Data

Metric Balance Financial: This area indicates the organization’s overall profitability, cash flow and ability to meet budget expectations. Operations: Measures for productivity and how well cost containment is working as well as growing the business. Quality: This area illustrates how well the organization is providing its product – patient care which impacts how the organization grows revenue. Measures of clinical quality and service quality should be included. Satisfaction: Measures in this area include patient, physician and employee loyalty and satisfaction.

Financial Measures Variance from Budget Actual FTEs Compared to Budgeted FTEs Productive vs. Non-Productive Hours Supply Costs Hours Worked per Adjusted Discharge

Clinical Quality Measures Nosocomial Infection Rate Findings from Room Inspections

Operational Measures Square Footage Cleaned Discharge Bed Cleaning Lost Work Days due to Injury Environmental Services Labor Expense per 100 adjusted discharges Hours Worked per 1,000 Net Square Feet Cleaned Labor Expense per 1,000 Net Square Feet Cleaned

Examples of Measures Satisfaction: Patient Complaint Rate Employee Absenteeism Staff Turnover Employee Satisfaction Survey Physician Satisfaction Survey

Timeline for Dashboard Construction Month One: 1. Initiate Project 2. Solicit Ideas 3. Gather Data Month Two: 4. Establish Prototype 5. Solicit Feedback 6. Revise Prototype 7. Present to Users Month Three: 8. Implement Dashboard

Added Benefit Attaining consistently high levels of cleanliness, decreasing your HAI rate, and continuously improving quality will naturally result in improved regulatory compliance.

Benchmarking Benchmarking is the practice of being humbleenough to admit that someone else is better atsomething and wise enough to learn how tomatch and even surpass them at it.Carla O’Dell, Continuous Journey, April 1994

Benchmarking Defined A definition that best fits the intent of the long term goals and objectives of a benchmarking effort defines it as “the process of identifying, understanding, and adopting outstanding practices and processes from organizations from anywhere in the world to help your organization improve its performance.”

The Process of Benchmarking Benching is a process of measuring another organization’s product or service according to specified standards in order to compare it with and improve one’s own product or service. Internal benchmarking occurs within the same organization. External benchmarking occurs outside of the organization with another organization that produces the same product or provides the same service. Functional benchmarking refers to benchmarking a similar function or process such as scheduling in another industry.

Types of Benchmarking • There are different kinds of benchmarking depending on the outcome to be achieved. • One source defines three types of benchmarking: internal, competitive and functional. • Internal benchmarking is only compared within a given organization. • Competitive benchmarking compares similar functions performed in different organizations. • Functional benchmarking compares similar functions at different industries.

Use of Benchmarking Techniques More recently, benchmarking techniques have been used in service-oriented companies to the same end. Rightly or wrongly, hospital administrators base many decisions on these data. Thus, knowing how facility housekeeping benchmarks are developed and what can be done to improve them may effect how a facility's environmental services department will be perceived by the hospital's administrator.

Where to Begin? Before a manager attempts to improve his or her benchmark numbers, he or she must first understand how the facility reports its own information, which eventually results in department benchmark numbers. In the case of "cost per square feet," understanding the definition of both "cost" and of "square feet" can help a manager make his or her benchmark numbers look better from the outset.

Know Your Facts and Figures • How does the facility define and report its costs? Given the same square footage, a lower cost will create a better benchmark. Does "cost" mean the total bottom line figure for everything in the housekeeping department or does it mean just labor costs? If the figure includes labor, does that also mean the labor for departmental management and clerical support? Some facilities don't include that in their reporting. Does cost include waste removal tipping fees and other contracted services? Many times, that figure is maintained outside the housekeeping department's budget. If a manager understands exactly what cost means, he or she will be in a better position to face challenges like, "Why are our benchmarks always higher than at 'XYZ Facility?'"

The Benchmarking Process • Plan • Choose the function to benchmark • Depict how you do the function • Choose the benchmarking team • Analyze the industry • Evaluate organizations to benchmark

The Benchmarking Process • Collect Information • Analyze Information • Adapt

Definitions are Important • How does a facility define and report its square footage? Given the same cost figure, a higher square footage number will create a better benchmark. Should a manager report his or her gross square footage or net cleanable square footage? Gross square footage, being a higher number, will create a better benchmark. Does the department clean anything outside the facility like sidewalks or parking decks? If so, it's a safe bet that that square footage is not included in the reporting numbers.

Using Square Footage as a Benchmark • A housekeeping department provides a service (cleaning) to the facility (which is often defined by its square footage). The most basic of all benchmarks for the housekeeping department is "cost per square foot." For example, if a budget is $3 million per year and the department services 1,250,000 square feet of space, the cost for cleaning should be $2.40 per square foot ($3,000,000 divided by 1,250,000). The following are the only two ways to make this benchmark number better: • Decrease the dollars spent cleaning the same square footage; or • Increase the square footage cleaned without increasing the cost.

Benchmarks from the Literature • One sanitary attendant for 10 hospital beds. • One supervisor for 10 sanitary attendants • All 100 bed hospitals must have a housekeeping department headed by a trained qualified executive in housekeeping

Benchmarks from the Literature • 6 Sets of linen per hospital bed • 5.2 Hours worked per adjusted discharge • $62 Labor expense per adjusted discharge • 212.2 Hours worked per 1,000 net square feet cleaned • $2,578 Labor expense per 1,000 net square feet cleaned

Benchmarking Resources • The Benchmarking Exchange • International Benchmarking Clearinghouse • Business Performance Improvement Resources • Malcolm Baldrige National Quality Award • National Executive Housekeepers Association, Inc.

Learning Objectives