The word benchmarking is an Anglicism the Spanish translation of which can be "comparison." Benchmarking is understood to be the action of carrying out a comparison, and consists of using as comparators (or benchmarks) those products, services, and work processes that belong to organisations widely recognised as leaders in the area of interest, the purpose being to transfer knowledge of best practices and their application.1 Benchmarking involves "learning from what others are doing" and consequently adopting one's own practices based on what has been learned, whilst making the necessary changes. It is therefore not simply a matter of copying a good practice but adapting it to the circumstances and characteristics of the organisation/service itself, which implies improved outcomes.
The importance of benchmarking does not lie in the detailed mechanics of the comparison, but in measuring the impact that these comparisons can have on the behaviours of those being compared. It can be considered a useful and necessary process for achieving improvements and changes that ultimately lead to the desired optimisation. In short, by comparing process results with the teams or organisations that achieve the best results, those being compared improve their own results in addition to achieving good results in the process quality indicators.2
The main objectives of a benchmarking process would be the following: (1) To find the services/processes/projects with the best results in the defined quality indicators, to determine their relative position and ultimately promote continuous improvement. (2) To identify the best clinical practices within the sector, adopt changes in the work dynamics, and ultimately improve results until, in the best-case scenario, a leadership position in the evaluated area is achieved. (3) To promote progressive changes in all participants in the comparative process, through indirect associations, which ultimately lead to an improvement in all participants through competitive effect.3
Best-in-class benchmarks represent the level of excellence achieved at a given time, within a specific area of interest. In our sector, for example, these would be the outcomes obtained from the best surgical clinical practices. Benchmarking consists of establishing tangible and achievable objectives (through the selection of indicators) that are presented as "goals to be achieved" and, ultimately, as a means to stimulate quality improvement. These objectives should be easy to analyse, based as much as possible on databases created for this purpose or existing clinical information systems, useful and reproducible throughout the improvement process.
The paradigm of this quality process is competitive benchmarking, which is established between competing companies/organisations. In our field, this would involve comparing the results of some of the quality indicators across all hospitals in an Autonomous Community. For example, the VINCAT Programme, a programme of the Catalan Institute of Health, establishes a unified surveillance system for nosocomial infections in hospitals in Catalonia (for example, comparing the results of surgical site infections in colorectal surgery).4,5 Its mission is to contribute to reducing the rates of these infections through active and ongoing epidemiological surveillance. Another example would be comparing the results of clinical management indicators (mortality, average hospital stay, etc.) using the system provided by the Iametrics® Hospital software, promoted by IQVIA.6
Benchmarking in surgeryA clinical benchmarking project in surgery, for example, requires the involvement of managers or leaders, who must understand its scope, objectives, and methodology. At the same time, it is essential that all professionals working in a surgical department be part of the project and be appropriately involved, both in the initial phases, to define and analyse the process, and later to implement an improvement plan.
Benchmarking experiences in the healthcare sector began with purely clinical management experiences among hospitals, with little participation from specialist physicians. Following the observation of their usefulness they have recently been specifically used in various specialties such as Internal Medicine and surgical specialties (Thoracic Surgery, General and Digestive Surgery, etc.).
In the USA, the American College of Surgeons' National Surgical Quality Improvement Programme (ACS–NSQIP) is considered an international benchmarking success model. This programme has improved the results of most General and Digestive Surgery services in indicators such as hospital stay and postoperative complications. Participating services enter their clinical data into a common software programme and obtain an analysis of their results compared to the majority of hospitals and the services with the best results. It also identifies areas for improvement in those areas where the evaluated service is not achieving expected results.7,8
In some countries, such as the United Kingdom, the results of the benchmarking process are publicly available to patients and their families. This allows the public to identify the best healthcare centres with the best surgical outcomes for different conditions (for example, colorectal cancer) and thus decide where to seek care for their condition.9
Textbook Outcome (TO) is a slightly different concept, related to benchmarking because: Both seek to measure and improve the quality of care. TO can be used as a reference standard (benchmark) to compare results between hospitals, surgeons, or surgical techniques; and it is able to identify areas for improvement and the promotion of standardisation of clinical processes. Textbook Outcome (TO) in surgery is a composite indicator that assesses the quality of surgical care by achieving an "ideal" or "perfect" outcome for the patient. It is based on the combination of several clinical parameters that, if all were met, indicate that the patient has had an optimal postoperative course.10 Although it may vary depending on the type of surgery, it typically includes: absence of postoperative complications; short hospital stay (below the 75th percentile); absence of in-hospital mortality; hospital readmissions; absence of reoperation, or need for prolonged intensive care.11 The main differences between TO and benchmarking are presented in Table 1.
Key differences between Textbook outcome and benchmarking.
| Description | Textbook Outcome | Benchmarking |
|---|---|---|
| Type | Composite clinical indicator | Comparison strategy |
| Application | Evaluation of a surgical outcome | Comparison between institutions or processes |
| Objective | Measuring the perfection of the outcome | Improvement through comparison and learning |
| Scope | Individual or by procedure | Institutional or interinstitutional |
In conclusion, benchmarking is a strategic quality management tool that enables process improvement through comparative analysis of the best available results. By comparing process results with the teams or organisations that achieve the best results, those being compared improve their own results in addition to obtaining process quality indicators.
