Benchmarking blossoms in the Garden State

Benchmarking is a key way for healthcare providers to continually improve the quality of care. While medical care providers have had a wealth of benchmarking data to guide their efforts for many years, this has not been the case for behavioral healthcare providers.

Realizing this need, Behavioral Pathway Systems (BPS), a behavioral healthcare benchmarking services vendor, partnered with the New Jersey Association of Mental Health Agencies, Inc. (NJAMHA). In July 2005 we launched the Benchmarking for Best Practices Initiative, which we believe is the first statewide program of its kind.

One-third of NJAMHA's 125 provider organizations are participating in the Benchmarking Initiative. By gathering data about their performance levels, comparing this information with their peers' data, and adopting best practices, participants continually are enhancing their effectiveness.

Within minutes of data submission, providers receive individualized reports containing comparative data based on benchmarks grouped into three categories:

• Clinical benchmarks include rates of no-shows, hospitalizations, re-admissions within 30 days, homelessness, incarceration, medication errors, and outcomes (e.g., suicide).

• Financial benchmarks include current ratio, net days in accounts receivable, bad debt, and operating revenue and cost per client and per unit of service for various levels of care.

• Operational benchmarks include rates of staff retention, access to services, client-to-staff ratio, service utilization rates, and productivity levels.

We used feedback from our Benchmarking Steering Committee as well as statewide concerns, priorities, and emerging issues to select the benchmarks.

Trina Parks, senior director of adult intensive programs at the Mental Health Association of Essex County in Montclair, notes that the Benchmarking Initiative provides a larger audience and expanded sense of improvements that her organization can make. “With our performance improvement committee, we only had an in-house perspective. Now, through NJAMHA's initiative, we can compare our performance with other organizations with similar departments and programs. It broadens our horizons,” she says. In fact, the Mental Health Association of Essex County has been identified through the Benchmarking Initiative as a “Top Performer” in access to routine appointments for adults.

We reinforce benchmarking through workshops and audio conferences. Participants prepare data for specified benchmarks and engage in a structured, interactive process to identify techniques that contribute to high levels of performance. They also receive a quantified, rank-ordered listing of potential best practices to apply in their agencies.

Like the Mental Health Association of Essex, CPC Behavioral Healthcare, Inc., in Eatontown uses the Benchmarking Initiative to augment what it has been doing for years. For example, CPC has been collecting data using the Mental Health Corporations of America's (MHCA) client satisfaction survey, and now uses that information in the Benchmarking Initiative.

“We enter our MHCA survey data in addition to information we collect internally for the NJAMHA Benchmarking Initiative, which provides many indicators for evaluation and comparison,” says Maria Marinaccio, director of quality management and corporate compliance.

Both CPC and Ocean Mental Health Services in Bayville have achieved Top Performer status for client satisfaction. “We already knew that our client satisfaction numbers were high, but until we had the opportunity to benchmark, we didn’t know where we stood in relation to others,” says Jarrett Lynn, director of operations at Ocean Mental Health Services. “This benchmarking validates our high performance and provides staff with a sense of pride in the accomplishment because it is a direct reflection of how our clients feel about what we are doing. In other cases, benchmarking identifies a need for improvement. Either way, it's very valuable.”

During the benchmarking process, some participants discovered that they could not easily extract their data with their existing information technology systems. However, the successful providers overcame such challenges, albeit some reported it was a painful process. This validates the importance of having clinical, financial, and human resources software that can produce information easily, quickly, and preferably in real time. Only then can providers obtain solid measures of quality that, in turn, enable them to benchmark effectively and make substantial improvements.

This year we look forward to implementing enhancements to the initiative and recruiting more participants. With the Steering Committee, NJAMHA is determining which benchmarks to keep, modify, or remove, in part through the newly established Benchmarking Impact Project.

“The Benchmarking Impact Project will involve the identification of a performance metric that will receive special attention with respect to benchmarking, process benchmarking, and the adoption of potential best practices,” explains BPS President Paul M. Lefkovitz, PhD. “The objective is to bring about demonstrable and measurable improvement in the performance area selected, supporting the use of benchmarking as an effective performance management tool.”

When we launched our initiative, it was the nation's only statewide benchmarking project for behavioral healthcare providers. Since then, BPS has implemented other benchmarking programs with the Association for Ambulatory Behavioral Healthcare, the Alliance for Children and Families, and state associations in Michigan, Pennsylvania, Texas, and Utah. The IT Project, a part of NJAMHA that offers the Benchmarking Initiative and many other services, is starting discussions to bring the initiative to the state's community of providers for individuals with developmental disabilities.

The Benchmarking Initiative has been so well received that providers are suggesting it to their peers—not only to encourage them to achieve the same success and benefits, but also to make the initiative more valuable for current participants. After all, with a greater number of users, the benchmarking data tend to be more valuable and reliable. Based on the success of our initiative, I am very confident that New Jersey's behavioral healthcare providers continually will increase their performance levels. I look forward to having all of our members benefit from this invaluable investment, and I am sure that behavioral healthcare providers in other states will realize the same tremendous advantages by implementing similar programs.

Acknowledgment

This article was developed with the assistance of Shauna Moses, NJAMHA's director of public affairs.

June Noto is Director of the IT Project at the New Jersey Association of Mental Health Agencies, Inc.