title: Hospital benchmarking: are U.S. eye hospitals ready?
abstract: BACKGROUND
  Benchmarking is increasingly considered a useful management instrument to improve quality in health care, but little is known about its applicability in hospital settings.
  
  
  OBJECTIVE
  The aims of this study were to assess the applicability of a benchmarking project in U.S. eye hospitals and compare the results with an international initiative.
  
  
  METHODS
  We evaluated multiple cases by applying an evaluation frame abstracted from the literature to five U.S. eye hospitals that used a set of 10 indicators for efficiency benchmarking. Qualitative analysis entailed 46 semistructured face-to-face interviews with stakeholders, document analyses, and questionnaires.
  
  
  RESULTS
  The case studies only partially met the conditions of the evaluation frame. Although learning and quality improvement were stated as overall purposes, the benchmarking initiative was at first focused on efficiency only. No ophthalmic outcomes were included, and clinicians were skeptical about their reporting relevance and disclosure. However, in contrast with earlier findings in international eye hospitals, all U.S. hospitals worked with internal indicators that were integrated in their performance management systems and supported benchmarking. Benchmarking can support performance management in individual hospitals. Having a certain number of comparable institutes provide similar services in a noncompetitive milieu seems to lay fertile ground for benchmarking. International benchmarking is useful only when these conditions are not met nationally.
  
  
  CONCLUSIONS
  Although the literature focuses on static conditions for effective benchmarking, our case studies show that it is a highly iterative and learning process. The journey of benchmarking seems to be more important than the destination. Improving patient value (health outcomes per unit of cost) requires, however, an integrative perspective where clinicians and administrators closely cooperate on both quality and efficiency issues. If these worlds do not share such a relationship, the added "public" value of benchmarking in health care is questionable.
authors.affiliation: Rotterdam Ophthalmic Institute, Rotterdam Eye Hospital and Institute of Health Policy and Management, Erasmus University Rotterdam, Netherlands. d.dekorne@oogziekenhuis.nl
authors.forename: Dirk F
authors.initials: DF
authors.lastname: de Korne
authors.forename: Jeroen D H
authors.initials: JD
authors.lastname: van Wijngaarden
authors.forename: Kees J C A
authors.initials: KJ
authors.lastname: Sol
authors.forename: Robert
authors.initials: R
authors.lastname: Betz
authors.forename: Richard C
authors.initials: RC
authors.lastname: Thomas
authors.forename: Oliver D
authors.initials: OD
authors.lastname: Schein
authors.forename: Niek S
authors.initials: NS
authors.lastname: Klazinga
mesh_terms: D000288:Administrative Personnel; D019985:Benchmarking / Q000706:statistics & numerical data*; D030881:Disclosure / Q000592:standards; D017598:Efficiency, Organizational; D005131:Eye Injuries / Q000628:therapy*; D006782:Hospitals, Special / Q000592:standards*; D006801:Humans; D007391:International Cooperation; D007407:Interviews as Topic; D009885:Ophthalmology / Q000592:standards*; D019982:Organizational Case Studies; D036301:Qualitative Research; D058996:Quality Improvement; D019984:Quality Indicators, Health Care; D012308:Risk Management; D014481:United States