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Benchmarking as a Tool for Public Health and Health Promotion

Introduction
A. The Process of Benchmarking
B. Benefits and Challenges of Benchmarking
C. Types of Benchmarking
D. Steps in the Benchmarking Process
E. Benchmarking in the Real World
F. Conclusions

Resources

Introduction
Best practices and performance measurement are common accountability mechanisms in the field of health promotion. Benchmarking is a related concept that is becoming more recognized, particularly in Ontario public health units. At the 8th Annual Ontario Health Promotion Summer School held in June, members of the Ontario Public Health Benchmarking Partnership, Monique Stewart, Program Planning and Evaluation Officer for the City of Ottawa, and Charlene Beynon, Director of Research, Education, Evaluation, and Development at the Middlesex-London Health Unit, shared their experiences and expertise on benchmarking as a tool for health promotion practice.
The author of this article, Sharon Kirkpatrick, graduate student in Community Nutrition at University of Toronto, attended the Health Promotion Summer School on behalf of the OHPE Bulletin. In the next few months - look forward to other feature articles written by Sharon based on workshops and presentation at the summer school.

A. The Process of Benchmarking

Benchmarking refers to an ongoing process which seeks to identify and understand the practices, methods, and processes of others; and to customize such practices to one's own organization and context. The goals of benchmarking include improved performance and more efficient use of resources through the identification and implementation of best practices modified to local circumstances. Thus, benchmarking does not lead to a list of best practices that should be followed by all organizations working in a specific area of health promotion, but instead addresses the fact that what works best in one environment may not necessarily work best in another. Benchmarking is distinct from program evaluation and performance measurement in that it focuses on comparing internal processes and impacts with those of other organizations rather than with predetermined internal standards, indicators or objectives. In this context, program evaluation and performance measurement data actually provide the baseline data for benchmarking, which then identifies how results can be improved.

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B. Benefits and Challenges of Benchmarking

Benchmarking offers several benefits, including the opportunity to build on the work of others, reducing the need and the temptation to reinvent the wheel, and facilitating more efficient use of resources and financial savings. It helps identify not only what needs to be improved, but also how to improve. Benchmarking uses a participatory process that pushes organizations to examine what they are doing and why they are doing it, which often leads to ideas about other possible ways of doing things, even before comparisons are made with other organizations. Further, benchmarking encourages organizations to identify ways to measure their services in terms of inputs and outcomes, promoting a focus on the most important or beneficial aspects of the program. Benchmarking can also benefit organizations by promoting an environment that is conducive to continued improvement and learning, as well as networking with other organizations.

However, the benchmarking process also has challenges. For example, it is a time consuming and labour intensive process that requires considerable skill and knowledge. Further, there are issues around confidentiality and sharing of information, especially when comparing similar organizations against each other. Another limitation to benchmarking is that it is only useful to the extent that the organization is willing to take action and make changes based on the findings of the process. However, in the context of a partnership between committed organizations, these limitations can be overcome so that the numerous benefits of benchmarking can be reaped.

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C. Types of Benchmarking

Standards benchmarking focuses on a standard of performance which an organization is expected to achieve. An example is a courier company that sets a standard to deliver a document within a designated period of time.

Results benchmarking focuses on comparing the performance of several organizations that provide similar services in order to determine the effectiveness with which an organization uses resources and provides services or outcomes compared to other organizations. An example of results benchmarking is the comparison of rates of Caesarian births between hospitals.

Process benchmarking involves a detailed examination of a process that produces a specific output with the goal of determining the reasons for discrepancies in performance between organizations. For example, the Ontario Public Health Benchmarking Partnership has used process benchmarking to identify best practices for specific health units in the areas of heart health coalitions and breastfeeding support.

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D. Steps in the Benchmarking Process

The benchmarking process is not linear, and it is expected that backward movement to earlier steps will occur. However, there is a sequence of steps that facilitates the process:

1. Identify what needs to be benchmarked - usually one or some components of a program rather than an entire program in order to keep the project manageable, and to promote focus on the most important aspects.

2. Determine performance measures and indicators, and collect and analyze internal data: a review of the literature and program logic model may identify indicators, while developed data collection tools and sources of program data may also be useful.

3. Select benchmarking partners: consider organizations that are recognized for their expertise, offer a similar service, serve a similar population, are accessible, and are willing to share information (but don't ask for information that you wouldn't be willing to share).

4. Access data from benchmarking partners: identify differences and performance gaps, and determine whether practices are suitable/adaptable to other settings - consider practices that are successful over time, repeatable, transferable, innovative and which are relevant to local circumstances.

5. Create and implement an action plan to apply identified best practices: translate the findings into a few core principles, and work from principles to strategies to action plans.

6. Monitor results and adjust benchmarks.

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E. Benchmarking in the Real World

The Ontario Public Health Benchmarking Partnership has been active in promoting and supporting benchmarking in Ontario public health units through the completion of several projects.
One such project focused on the practices of Heart Health Coalitions, involving 9 Ontario coalitions, selected on the basis of geographical location, size of the community, size of the coalition, and duration of existence. The benchmarking process was initiated with research on coalitions, the development of a coalition framework, and the identification of process and output indicators in collaboration with the participating coalitions. Subsequently, an interview process was developed, pilot tested and implemented to collect data from coalition stakeholders.
The resulting qualitative data was analyzed and combined with data from coalition documents and research in coalition building to draft summary reports for each coalition. The summaries were used to identify process and output indicators. Process indicators included sense of collaborative partnership, interpersonal relationships, flexibility, communication, planning, and health unit role in the coalition. Output indicators included amount and characteristics of activities, and impact of coalition participation on members.
For the sake of confidentiality, each coalition received only the summary report based on interviews with members of their coalition. A final report provided a summary of findings and recommended indicators, providing a practical means for participating coalitions to evaluate and modify their practices based on those of others.
Based on the experiences of the participating coalitions, it is recommended that a formal process be implemented to handle conflict among agencies and community partners that may arise given the diversity of coalition membership.
Similarly, the final report suggests that a jointly developed mandate for the coalition promotes a strong collective identify.
The report provides guidelines for periodic self-assessment by coalitions, emphasizing the concept of benchmarking as an ongoing, consistent process. In addition the project produced interview guides and other tools to facilitate benchmarking among other coalitions and partnerships.
Feedback from participants of the project indicated that the benchmarking process provided validation of their practices, and valued opportunities for networking and learning from each other.

For more information about this project and others conducted by the Ontario Public Health Benchmarking Partnership, or for the Benchmarking Session handouts, contact Monique Stewart at Monique.Stewart@city.ottawa.on.ca or Charlene Beynon at cbeynon@julian.uwo.ca.

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F. Conclusion

Benchmarking is a tool that health promoters can use to demonstrate their effectiveness, as well as to identify ways in which to improve. While benchmarking may be challenging in the initial stages, it is a highly useful process that can be integrated into the routine of an organization, leading to an environment of continuous improvement and facilitating superior performance.

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RESOURCES on Benchmarking

Internet Resources
1) Public Sector Benchmarking Service
2) Association for Benchmarking Health Care
3) "Assisting Performance Measurement Initiatives in Health and Human Services Programs" DHHS
4) "What is Benchmarking?" The Mining Company Management - Feature: 11/04/97

Print Resources
Books:
1) Benchmarking: A practitioner's guide for becoming and staying best of the best
2) .Benchmarking for best practices in the public health sector
Guides
3) .Benchmarking Tool Kit: A Blueprint for Public Health Practice
4). Practical Benchmarking: The Complete Guide
Reports
5) Towards Benchmarking Heart Health Coalitions:
6) Introducing benchmarking to Ontario Health Units

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INTERNET RESOURCES

1) Public Sector Benchmarking Service
URL: http://www.benchmarking.gov.uk/default1.asp
The Public Sector Benchmarking Service (UK) promotes effective benchmarking in the public sector, supports benchmarking projects, brokers learning through sharing, knowledge and good practices and supplies practical advice and information on benchmarking. Their website at http://www.benchmarking.gov.uk/default1.asp provides details of the service and a searchable database of related resources (print and online).

2) Association for Benchmarking Health Care
URL: http://www.abhc.org/
ABHC identifies leading industry practices and processes for exchange with member companies performance improvement.

3) "Assisting Performance Measurement Initiatives in Health and Human Services Programs" DHHS
URL: http://aspe.hhs.gov/progsys/perfmeas/index.htm
Online document: "The U.S. Department of Health and Human Services (DHHS) has embarked on a process to establish performance measures for all of its health and human service programs. Performance measurement is needed as a management tool to clarify goals, document the contribution toward achieving those goals, and document the benefits received from the investment in each program.The Institute of Medicine (IOM) undertook a 2-year study to examine the use of performance monitoring and develop sets of indicators that communities could use to promote the achievement of public health goals."

4) "What is Benchmarking?" The Mining Company Management - Feature: 11/04/97
URL: http://management.miningco.com/library/weekly/aa110497.htm
Online article - "Most of the early work in the area of benchmarking was done in manufacturing, like the example above. Now benchmarking is a management tool that is being applied almost anywhere."

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PRINT RESOURCES

Books

1) Balm, G.J. (1998). Benchmarking: A practitioner's guide for becoming and staying best of the best. Schaumburg, Illinois: QPMA Press.

The author's experience at IBM-Rochester provides the basis for this how-to book. This practical volume includes an explanation of the IBM benchmarking process, discusses the linkage of benchmarking to TQM, and discloses insights from the benchmarking work that helped IBM-Rochester win the Malcolm Baldrige National Quality Award. Description from http://www.apqc.org/pubs/dispPub.cfm?ProductID=1166

2) Keehley, P., Medlin, S., MacBride, S., & Longmire, L. (1997). Benchmarking for best practices in the public health sector: Achieving performance breakthroughs in federal, state and local agencies. San Francisco, CA: Jossey-Bass.

Benchmarking for Best Practices in the Public Sector is a unique practical guide that shows public officials and administrators at all levels of government how to identify best practices and implement them in their organizations.
The authors go beyond abstract concepts to bring benchmarking to life, with real case examples from federal, state, and local governments-from a county fire department to the U.S. Internal Revenue Service. They show how benchmarking methods have been adapted to the unique needs of the public sector and describe the tangible benefits gained by public agencies that have applied these techniques. Offering detailed how-to advice along with checklists, flowcharts, sample forms, a resource directory, and other tools to help managers take action quickly. Description adapted from http://www.josseybass.com/Corporate/Website/Objects/Products/0,9049,8308...

Guides

3) Sales, P.D., & Stewart, P.J. (1998). Benchmarking Tool Kit: A Blueprint for Public Health Practice. Middlesex-London and Ottawa-Carleton Public Health Research, Education and Development (PHRED) Programs.

The Benchmarking Tool Kit is a practical guide for benchmarking public health programs and services. A four-step guide to planning, conducting and using benchmarking in public health, it is intended to be used in conjunction with the Program Evaluation Tool Kit, a resource developed in 1997 by Ottawa-Carleton PHRED program to facilitate the integration of internal evaluation into the management of public health programs. The Tool Kit introduces the concept of benchmarking and guides you through the basic steps of the benchmarking project. The Benchmarking Tool Kit is available for $30.00 from the Middlesex-London Health Unit. Contact: Charlene Beynon, (519) 663-5317 ext. 2484 Description from http://www.alphaweb.org/project/index.asp?action=show&project_id=12

4) Zairi, M., & Leonard, P. (1994). Practical Benchmarking: The Complete Guide. London: Chapman & Hall.

This book provides a practical guide to the application of benchmarking in any business context. Benchmarking is viewed as a continuous process of measurement and its relationship to continuous improvement and business results is clearly established. Numerous examples and case studies of specific application are presented. Description from http://www.amazon.com/exec/obidos/ISBN%3D0412574101/qualityorgsqualiA/10...

Reports

5) Public Health Research, Education & Development Program (2001). Towards Benchmarking Heart Health Coalitions: Developing a Systematic Process for Documenting and Enriching Community/Health Unit Partnerships.

This report describes the process and accomplishments of the 2000 Heart Health Coalition Benchmarking Pilot Project. A brief summary of benchmarking followed by a description of the pilot process and a detailed description of the Heart Health Coalition Project is included. Available online at http://www.alphaweb.org/project/index.asp?action=show&project_id=22

6) Wilson, V., & Beynon, C. (1998). Introducing benchmarking to Ontario Health Units. Public Health and Epidemiology Report Ontario. 9(8), 183-186..

In the fall of 1997, the Public Health Issues Committee of the Association of Local Public Health Agencies (alPHa) identified the need to benchmark public health programs and services as a priority issue. This communiqué details the background research, plan and pilot test to address this need. Available at http://www.gov.on.ca/health/english/program/pubhealth/phero/phero_199808...