University of Twente Student Theses


Getting insight by giving insight: development of an instrument to benchmark the integral performance of intensive care departments

Brouwer, L.M. (2007) Getting insight by giving insight: development of an instrument to benchmark the integral performance of intensive care departments.

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Abstract:Motivation: The intensive care is a relatively young department; it is only has been ten years the first ICUs were organized as stand-alone units. Intensive care is expensive: around 10 percent of the hospital budget is spend here, while only a small percentage of patients has to be treated on the ICU. With the rising pressure on hospitals to lower costs, the ICU has to deliver high quality care in an efficient way. Nevertheless, little information is available on how to optimally organize care on intensive care departments. Intensive cares do have a considerable amount of information about their patients, but they do not share information considering organizational set-up with each other. In this thesis, we develop an instrument to let the ICUs learn from each other in the area of ICU management by means of benchmarking. By giving insight in their organisational characteristics and reflecting on the provided data, the ICUs can develop more knowledge about good ICU management. Developed benchmarking methodology: The developed methodology exists of the following phases. First, benchmark partners are chosen. Then, a stakeholder analysis is conducted to develop an understanding of the stakeholder groups having an interest in and an influence on the ICU. The third phase is to identify important processes on the ICU that could fit the concept of benchmarking and make a choice for a process on which the project is aimed. With the help of a developed questionnaire, in the fourth phase, information about patient streams through and system- and control characteristics of the participating ICUs are gathered. In phase 5 a performance indicator set is developed, of which the scores are gathered in phase 6. Phase 7 involves the analysis of the scores and making the link between contingency factors and scores on performance indicators. With this information, hospitals can then write and implement improvements. At last, the benchmark cycle is evaluated by the participants. Results for benchmarking on the ICU: The partners involved in the benchmarking ICU project are all ICUs with a teaching licence, mostly part of a university medical centre. Salient stakeholders of the ICU are the IC nurses, staff, patients, referring physicians and the hospital board. The dominant coalition exists of the IC physician and the hospital board. Integral ICU management was chosen as the focus of our benchmark project, with the possibility to focus on more specific ICU processes later in the process. Through a literature review and interviews with stakeholder representatives, a unique set of performance indicators was developed. This indicator set measures, by means of structure, process, and outcome indicators, how the ICUs perform in the areas of quality of care, efficiency, and quality of work, representing the interests of the mentioned stakeholders. The remaining phases will be conducted in coming months. Conclusion and recommendations: The research delivered a benchmark methodology especially fitted to the needs of the ICU to learn from each other. New is the active identification and involvement of stakeholders, leading to a performance indicator set that measures performance as perceived important by the stakeholders. The benchmark process leaded already to fruitful discussions between ICU managers about the strategic choices made and their implications to performance. The ICUs seem to have interesting differences in organizational arrangements, which could be a basis for learning from each other. In the near future, the first benchmark cycle can be finished, and already possible areas of focus for next cycles have been identified.
Item Type:Essay (Master)
Faculty:BMS: Behavioural, Management and Social Sciences
Subject:85 business administration, organizational science
Programme:Industrial Engineering and Management MSc (60029)
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