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BY: ED GIGANTI

Mr. Giganti is senior associate, Mission Services, Catholic Health Association, St. Louis.

CHA's Benchmarking Project Will Identify The Core Characteristics of Catholic Healthcare

In the lobbies, waiting rooms, and administrative corridors of Catholic healthcare facilities, a visitor is likely to find the organizations' mission statements displayed. Carefully composed, these statements articulate the organizations' commitments to continuing Jesus' mission of healing. But frequently, when these commitments are communicated in the healthcare marketplace, consumers ask for proof — visible, tangible evidence that the organizations are living out their commitments.

A major project of the Catholic Health Association (CHA), under way since fall 1998, will help CHA member organizations demonstrate in measurable terms how they fulfill their identity. The project has two parts:

• The articulation of a clear, compelling, and shared statement of Catholic identity for the health ministry
• The development of an ongoing system of benchmarking performance linked to the Ethical and Religious Directives for Catholic Health Care Services

"We are living in a very challenging operating environment," says William Schoenhard, executive vice president/chief operating officer, SSM Health Care, St. Louis. "With greater pressures to cut costs and more and more people going without access to healthcare, frequently we are asked how we can respond to these challenges while remaining faithful to our Catholic mission and values. As this project provides key measures by which to ensure our Catholic identity, it will enable us to meet these challenges in a manner consistent with our mission."

This article describes the benchmarking part of the project.

Purpose and History
At the 1998 Catholic Health Assembly in New Orleans, system leaders and sponsors, in a special-issues forum, called for a more explicit articulation of the ministry's Catholic identity, and identification of actions to help organizations understand and demonstrate that ministry identity.

Later that year, in regional meetings, groups of system leaders and sponsors identified core commitments of the Catholic health ministry, responding to the questions, What do we mean when we identify ourselves as Catholic health ministry? And what core characteristics or commitments does that identity entail? At the Chicago regional meeting, participants concluded that a statement of the qualities and commitments that characterize the ministry, shared ministrywide, would be tremendously useful.

In fall 1998, acting on the input from these meetings, the CHA Board of Trustees approved a two-part project on Catholic identity, described above, as part of the association's three-year strategic plan. A task force (see "Benchmarking Task Force" at the end of this article) was appointed to develop and implement the project, supported by CHA staff.

Development of a statement of Catholic identity in the healthcare ministry is progressing with help from the benchmarking task force. Draft statements were presented at the member strategy sessions in October and November 1999.

The benchmarking project has a threefold purpose:

• To convert descriptions of Catholic identity into measurable and accountable outcomes
• To identify best practices as hallmarks of the healthcare ministry of the Catholic Church
• To provide measures for ongoing performance improvement

Three Phases of the Project
The Benchmarking Task Force, working with healthcare consultant Bob Gift, designed the work in three phases.

In phase 1, the task force created a measurement system that will be used throughout the project. At its first meeting, the task force identified the constitutive elements of Catholic healthcare ministry (see "The Constitutive Elements" at the end of this article), drawing on the normative principles articulated by the U.S. bishops in the Ethical and Religious Directives for Catholic Health Care Services, the core commitments identified in the 1998 regional meetings, and elements from CHA members' documents on Catholic identity. The next step was to connect the directives with the appropriate constitutive elements.

During the ensuing months, task force members, CHA staff, and work groups from Sisters of Charity of Leavenworth Health Services Corporation, Leavenworth, KS; Providence Portland Medical Center; Catholic Health Services of Long Island; Unity Health System, St. Louis; and the Center for Ethics and Ministry, Clifton, NJ, studied various directives to identify organizational behaviors and quantitative measures that would demonstrate their fulfillment. (These behaviors and measures apply only to acute care facilities; a future phase of the project will identify behaviors and measures for long-term care facilities.)

Finally, at its meeting in September 1999, the task force organized selected directives and their measures in five "critical issues" categories: Workplace Culture, Holistic Care, Care of Poor and Vulnerable Persons, Care of the Dying, and Relationship with Bishops. The resulting data-gathering instrument consists of 21 quantitative measures and numerous "characteristics," conditions that characterize or enable an organization's achievement of the level of performance measured. For example, in the category Workplace Culture, a measure related to the respectful relationships among caregivers in the facility (Directive 2) is "the percentage of employees indicating on an employee satisfaction survey that they experience mutual respect among coworkers." A characteristic is that "hiring processes articulate expectations of mutual respect among employees." All characteristics in the instrument call for yes or no responses.

Phase 2 will consist of using this instrument to gather data — first in a pilot test in November 1999, then throughout the ministry in early 2000 — and create a comparative database of performance on the measures and characteristics among ministry organizations. "We are hoping for participation of a significant number of acute care facilities in building the comparative database," says Regina M. Clifton, CHA senior associate for mission integration and staff coordinator for the benchmarking project. "The larger the number of participating organizations, the more useful the database will be for performance improvement."

A report on the database is scheduled for the 2000 Catholic Health Assembly, June 11-14, in San Francisco. Only aggregated data will be reported publicly; individual participating organizations' data will be reported only to the facility and its parent system.

The last phase of the project is the actual performance benchmarking phase. In this phase, employing a collaborative benchmarking methodology (see "What is Collaborative Benchmarking" at the end of this article), organizations will work together to improve performance. The first collaborative benchmarking cycle is planned to begin in July 2000.

Deepening Faith Commitments
For the members of the task force, the reviewers, and the many people who participated in work groups and focus groups during the benchmarking project, the in-depth reflection on the Ethical and Religious Directives has been enlightening. "It's been arduous work," says Sr. Jean deBlois, CSJ, PhD, CHA's vice president of Mission Services. "Through the process of first identifying the constitutive elements, then matching the directives to the elements, and finally breaking open the directives to imagine how they would be manifested in actual behaviors, we have all come to a much richer understanding of the distinctive character of our ministry."

A process for reflecting on and discussing specific directives, the behaviors demonstrating those directives, and how those behaviors could be examined and measured will be included with the data collection instrument when it is mailed to acute care facilities in January 2000.

Transforming Healthcare Delivery
Created to better understand and articulate the Catholic identity of the Church's health ministry, the benchmarking project is, in pure form, a performance improvement effort. As ministry organizations participate in the comparative database development and collaborative benchmarking cycles, they will be studying and improving their clinical and administrative operations to ensure greater fulfillment of their religious mission. If a majority of Catholic healthcare facilities were to improve their performance on a single measure — pain management at the end of life (Directive 61), for example — healthcare delivery in the United States would progress significantly. Incorporating Catholic identity in the ministry of healthcare in this way would bring about "radical healing" — the transforming effect of healing as Jesus did.

For more information, contact Regina M. Clifton, senior associate, mission integration, 314-253-3562.

Participation in the data gathering to assemble a comparative database is open to all CHA member acute care facilities. The data collection instrument will be sent to participating organizations in mid-January 2000. Respondents will have 30 days to report their data to CHA by completing a secure document on CHA's Web site. There is no charge. Participating organizations will receive a feedback report.

THE CONSTITUTIVE ELEMENTS

Promote and Defend Human Dignity
Because each person is created in the image of God (Gn 1:27), each one is sacred and possesses inalienable worth, and is social by nature and finds fulfillment in and through community. Catholic healthcare, therefore, treats individuals — and their families and various communities — with profound respect and utmost regard.

Attend to the Whole Person
Because each person is, in this life, an inseparable unity of body and spirit (1 Cor 15:44), Catholic healthcare responds to human need by addressing the physical, psychological, social, and spiritual dimensions of the person.

Care for Poor and Vulnerable Persons
Because Jesus had a special affection for poor and vulnerable persons (Mt 25:34-40), Catholic healthcare "distinguish[es] itself by service to and advocacy for those people whose social condition puts them at the margins of society and makes them particularly vulnerable to discrimination."^* Catholic healthcare is also characterized by its efforts to alleviate the conditions that perpetuate the structures of poverty and vulnerability in society.

Promote the Common Good
Because the health and well-being of each person is intimately related to the health and well-being of the broader community (Eph 4:15-16), Catholic healthcare promotes the "economic, political, and social conditions [that] ensure protection of the fundamental rights of all individuals and enable them to fulfill their common purpose and reach their common goals."^†

Act on Behalf of Justice
Because justice is an essential component of the Gospel of Jesus (Mt 5:1-12), Catholic healthcare strives to create and sustain right relationships both within the ministry and with those served by the ministry. Toward this end, Catholic healthcare attends to basic human needs for all (including accessible and affordable healthcare) and seeks structures that enable the full participation of all in society, the equitable distribution of societal resources, and the contribution of all to the common good.

Steward Resources
Because all creation is a gift from a gracious and loving God, Catholic healthcare is called to use all resources responsibly, and to recognize that material things and human capacities are resources for the benefit of the community and not personal or organizational possessions (Mt 25:14-30).

Act in Communion with the Church
Because it participates in the healing ministry of Jesus, Catholic healthcare is an essential element of the mission of the Church in the world. As such, Catholic healthcare acts in harmony with the institutional Church (1 Cor 12:12-13).

^*National Conference of Catholic Bishops, Ethical and Religious Directives for Catholic Health Care Services, U.S. Catholic Conference, Washington, DC, 1995, Directive 3.

^†National Conference of Catholic Bishops (NCCB), Ethical and Religious Directives for Catholic Health Care Services, Washington, DC, 1995, Part One, p. 6, paraphrasing NCCB's Economic Justice for All: Pastoral Letter on Catholic Social Teaching and the U.S. Economy, Washington, DC, United States Catholic Conference, 1986, no. 80.

WHAT IS COLLABORATIVE BENCHMARKING?

Benchmarking probably began when a prehistoric hunter noticed that his neighbor brought home more meat for the family than he did. After observing the neighbor's hunting techniques, he adapted them as his own and kept his family better fed. Benchmarking became a management tool when Robert C. Camp and Xerox introduced process and rigor to the approach. Xerox defines benchmarking as "the continuous process of measuring products, services, and practices against the toughest competitors or those companies recognized as industry leaders."^* Camp defines the term more simply as "finding and implementing best practices."^†

As healthcare organizations have adopted benchmarking to improve their performance, additional definitions have evolved. One defines healthcare benchmarking as "the continual and collaborative discipline of measuring and comparing the results of key work processes with those of the best performers. It is learning how to adapt these practices to achieve breakthrough process improvements and build healthier communities."^‡

Collaborative benchmarking involves conducting a study on a topic of mutual interest in conjunction with other organizations. It gives participants the opportunity to learn from others in the benchmarking collaborative, as well as from those outside it. In addition, it is cost effective, as members of the collaborative share in the costs of the study.

Collaborative benchmarking involves four phases:

• Select the benchmarking topic. Decisionmakers at the sponsoring organization select the topic to study by identifying criteria, enumerating possible study topics, applying the decision criteria to the topics, and discussing those topics which surface.
• Establish the benchmarking collaborative. The sponsoring organization identifies others that may be interested in studying the same topic. The sponsor solicits and encourages participation. Once formed, the collaborative identifies project stakeholders, creates a charter, forms a steering group, and drafts a work plan.
• Conduct the study within the benchmarking collaborative. The members of the benchmarking collaborative study their own performance and practices. This discovery, sharing, and learning follows a Plan-Do-Study-Act cycle.
• Conduct the study with benchmarking partners outside the collaborative. The members of the collaborative may elect to benchmark their individual and collective performance against organizations outside the collaborative, using similar tools and techniques. Again, the collaborative uses a Plan-Do-Study-Act cycle to identify the practices and adapt them in their own organizations.

Examples
A healthcare system's benchmarking study on workers' compensation that examines only the practices among its member facilities is an example of an internal benchmarking cycle. A national association of hospitals' study of the inpatient admissions process that seeks best practices from organizations outside the collaborative. illustrates an external benchmarking cycle. The two cycles may occur sequentially or simultaneously.

Bob Gift
President
Systems Management Associates
Omaha, NE

^*R. C. Camp, Benchmarking: The Search for Industry Best Practices That Lead to Superior Performance, ASQC, Milwaukee, 1989, p. 10.
^†Camp, p. 12.
^‡R. G. Gift and D. Mosel, Benchmarking in Health Care: A Collaborative Approach, American Hospital Publishing, Chicago, 1994, p. 5.