title: All inclusive benchmarking.
abstract: OBJECTIVE
  The aim of this article is to review published descriptions of benchmarking activity and synthesize benchmarking principles to encourage the acceptance and use of Essence of Care as a new benchmarking approach to continuous quality improvement, and to promote its acceptance as an integral and effective part of benchmarking activity in health services.
  
  
  BACKGROUND
  The Essence of Care, was launched by the Department of Health in England in 2001 to provide a benchmarking tool kit to support continuous improvement in the quality of fundamental aspects of health care, for example, privacy and dignity, nutrition and hygiene. The tool kit is now being effectively used by some frontline staff. However, use is inconsistent, with the value of the tool kit, or the support clinical practice benchmarking requires to be effective, not always recognized or provided by National Health Service managers, who are absorbed with the use of quantitative benchmarking approaches and measurability of comparative performance data.
  
  
  METHODS
  This review of published benchmarking literature, was obtained through an ever-narrowing search strategy commencing from benchmarking within quality improvement literature through to benchmarking activity in health services and including access to not only published examples of benchmarking approaches and models used but the actual consideration of web-based benchmarking data. This supported identification of how benchmarking approaches have developed and been used, remaining true to the basic benchmarking principles of continuous improvement through comparison and sharing (Camp 1989). Descriptions of models and exemplars of quantitative and specifically performance benchmarking activity in industry abound (Camp 1998), with far fewer examples of more qualitative and process benchmarking approaches in use in the public services and then applied to the health service (Bullivant 1998). The literature is also in the main descriptive in its support of the effectiveness of benchmarking activity and although this does not seem to have restricted its popularity in quantitative activity, reticence about the value of the more qualitative approaches, for example Essence of Care, needs to be overcome in order to improve the quality of patient care and experiences.
  
  
  RESULTS
  The perceived immeasurability and subjectivity of Essence of Care and clinical practice benchmarks means that these benchmarking approaches are not always accepted or supported by health service organizations as valid benchmarking activity.
  
  
  CONCLUSIONS
  In conclusion, Essence of Care benchmarking is a sophisticated clinical practice benchmarking approach which needs to be accepted as an integral part of health service benchmarking activity to support improvement in the quality of patient care and experiences.
authors.affiliation: Great Ormond Street Hospital, London, UK. ellisjm@aol.com
authors.forename: Judith
authors.initials: J
authors.lastname: Ellis
mesh_terms: D019985:Benchmarking / Q000458:organization & administration*; D002983:Clinical Competence / Q000592:standards; D003299:Cooperative Behavior; D019317:Evidence-Based Medicine / Q000458:organization & administration; D006291:Health Policy; D006801:Humans; D007400:Interprofessional Relations; D007857:Leadership; D017146:Models, Organizational; D009042:Motivation; D020380:Needs Assessment / Q000458:organization & administration; D009718:Nurse Administrators / Q000458:organization & administration / Q000523:psychology; D024802:Nurse's Role / Q000523:psychology; D010043:Outcome and Process Assessment, Health Care / Q000458:organization & administration; D012107:Research Design; D013222:State Medicine / Q000592:standards; D017749:Total Quality Management / Q000458:organization & administration*