Describe how benchmarking is used in healthcare for performance improvement. Based on the benchmark in practice.
Identify what the HIM Director did to implement best practices in benchmarking.

Evaluate the HIM Director’s  decision to send the transcriptionist home, was it  appropriate?, explain your answers
Include at least two inline citations to support your rationale.
Using Benchmarking for Performance
Improvement
This practice brief has been retired. It is made available for historical purposes only.
Benchmarking is the process of improving performance by continuously identifying and adapting outstanding
practices.
Successful benchmarking results in improvements to quality and productivity as well as positive financial outcomes.
For example, in a study conducted by the American Productivity and Quality Center in 1995, more than 30
organizations reported an average $76 million first-year payback from their most successful benchmarking project.
In addition, benchmarking promotes a “learning culture,” which is key to continuous long-term quality improvement
and competitiveness. Successful benchmarking organizations are continually looking for new ideas. They adopt the
most useful new ideas and meet and beat the best performance they can find.
Organizations with little experience in benchmarking often discover the best performance benchmark but stop short
of discovering how the best performance was achieved. Additionally, they may start their benchmarking efforts by
looking at external benchmarks while overlooking successful internal benchmarks that already exist. Further,
inexperienced benchmarking organizations often fail to measure the project’s effects in terms of its costs and benefits.
Successful Benchmarking
The prospect of benchmarking can be overwhelming. It is important, therefore, to tackle benchmarking one step at a
time. Benchmarking departments can add millions to a company’s bottom line when each becomes the best in just
one category.
In order to benchmark successfully:
1. Select a process to benchmark. Know specifically what your department’s problems are and clearly define
what you intend to study and accomplish. Choose relevant measurements.
2. Study performance-boosting best practices. Talk to colleagues inside your organization. Another department
within your own facility may be using a process that your department can adapt. Next, talk to colleagues outside
your organization. Participate in AHIMA’s Communities of Practice and appropriate listservs. Conduct a literature
search and attend educational programs to learn about best practices. Do not confine your search to your own
industry—there may be comparable processes in an entirely different industry from which you can learn. Develop a
questionnaire to guide telephone interviews and on-site visits.
3. Judge the appropriateness and adapt best practices. Consider benchmarking with organizations that are
roughly the same size as your own, because their best practices will be more likely to work in your organization. At
Copyright © 2003 by The American Health Information Management Association. All Rights Reserved.
times, it makes sense to benchmark with companies that are less than the best but whose performance is better than
your own organization’s. The very best organizations may be overwhelmed by requests for information or site visits
and unable to provide you with the assistance you need.
4. Plan and implement best practices. Discuss your findings with your staff. Decide which practices can be
adapted to your organization. With staff support, move forward, making the necessary proposals and budget
requests, developing policies and procedures, conducting required training, and implementing new technologies.
5. Measure results and do a payback analysis. Assess the progress your organization has made by comparing
baseline data with current performance. Document the costs incurred and the benefits that have resulted. Monitor
quality to make sure improvements in performance are maintained. Periodically raise the bar or change the process
for continuous improvement.
Information Sources
There are numerous sources of benchmarking information. They include:
AHIMA: The Association periodically publishes surveys and best practices in the Journal. The Communities
of Practice are available for identifying organizations with which to benchmark. Additionally, national
conventions and audio seminars provide access to educational programs and exhibits in which best practices
are showcased.
Š Other associations: Associations such as the American Hospital Association (AHA) and Medical Group
Management Association (MGMA) often provide member organizations with staffing and other information
obtained from its membership. Some of this information may be routinely forwarded to your organization’s
administration by these associations and often resides with the chief financial officer. Some associations also
conduct surveys on particular topics on request. These organizations may also publish findings in their
periodicals and on their Web sites.
Š State, federal government, and accreditation organizations: Depending on the type of benchmark data
sought, one might look to state or federal government or accreditation organizations. These organizations often
publish reports in their publications or on their Web sites.
Š Trade journals: There are numerous trade journals that publish surveys and showcase best practices.
Š Corporate information: It is important not to overlook internal benchmark sources. Potential benchmarking
partners can be identified at performance improvement or management meetings, in conversations with other
managers, and by evaluating performance figures from similar departments in affiliated organizations.
Š Potential benchmarking partners: An extremely valuable tool in benchmarking is the interview or site visit.
The information acquired from best practices can be priceless.
Š American Productivity and Quality Center: This organization has posted numerous benchmarking white
papers and a benchmarking code of conduct on its Web site (www.apqc.org).
Š The Benchmarking Exchange: For a fee, this organization provides access to benchmarking surveys and
the ability to request benchmark metrics from other organizations. Visit www.benchnet.com.
Š
Surveys of Average Performance
HIM professional organizations are occasionally asked how their organization’s performance compares with that of
other organizations. This is not benchmarking in the true sense, but rather a comparison between one’s own
performance and the average performance of other organizations.
While there is little scientific data about performance, the following information may be helpful in deciding how your
organization can make such comparisons.
Copyright © 2003 by The American Health Information Management Association. All Rights Reserved.
Staffing
AHA, MGMA, and other associations often provide staffing benchmarks to chief financial officers. Similar
information can also be obtained by calling the libraries of these associations.
Staffing levels are occasionally published in trade journals. Regardless of their source, these statistics are often
problematic. They may not adequately define what was supposed to have been measured, indicate whether low
numbers of employees reflect outsourcing, nor address the variation in the levels of services provided.
Turnaround Times
Turnaround benchmarks periodically have been published in the Journal of AHIMA as well as other trade
publications. One of the more recent turnaround time surveys was published in the February 2000 issue of the
Journal.1 This particular survey was sent to 1,000 randomly selected AHIMA members identified as HIM directors
in acute care facilities. The data compiled were based on the 200 useable surveys returned. See “Sample Production
Turnaround Times,” below, for a summary of some of the turnaround time statistics.
sample production turnaround times
Turnaround Times (for individual charts)
Assembly
Analysis
Coding
Release of information
Low Mean
1.89
Days
Mean
2.19
High Mean
2.5
2.26
3.78
2.30
3.5
5.5
5.28
5.74
6.51
11.94
Productivity Benchmarks
The chart “Sample Productivity Benchmarks,” below, summarizes anecdotal productivity and turnaround time
benchmarks collected at AHIMA. The data come from articles in the Journal and other HIM periodicals,
conversations on HIM listservs, the Communities of Practice, and personal experience. The data are not scientific,
but it is frequently requested by members and may be helpful for your organization’s benchmarking plan. Although
the figures in the chart may provide a snapshot of how your organization compares with others, it is wiser to peform
a more thorough analysis. It’s important that organizations understand the sources of data, sample size, and indicator
definitions.
sample productivity benchmarks
Productivity Benchmarks
Function
Admission processing
Assembly (charts per hour)
Inpatient
Observation/outpatient surgery/newborn/maternity
Other outpatient
Copyright © 2003 by The American Health Information Management Association. All Rights Reserved.
Low
20
5
Per Hour
Average
30
High
60
8
14
20
20
60
120
Analysis (charts per hour)
Inpatient
Observation/outpatient surgery/newborn/maternity
Other outpatient
Assembly and analysis (charts per hour)
Inpatient
Observation/outpatient surgery/newborn/maternity
Other outpatient
Coding (charts per hour)
Inpatient
Observation/outpatient surgery/newborn/maternity
Other outpatient
Coding and abstracting (charts per hour)
Inpatient
Observation/outpatient surgery/newborn/maternity
Other outpatient
Filing loose reports (sheets per hour)
Pulling/retrieving records (charts per hour)
Release of information (charts per hour)
Transcription (per hour)
Minutes of dictation
65 character lines
6
12
8
20
12
30
10
14
18
30
43
2
5
10
4
9
30
5
12
36
2
3
7
27
4
10
30
188
18
30
30
3
10
125
45
6
13
175
17
275
benchmarking in practice
An HIM director at a large physician clinic has 21 transcriptionists who average about 140 lines per
hour using conventional word processing software and cassette tapes. The transcription unit
supports 80 physicians at a cost of 15 cents per line.
The HIM director contacts the Medical Group Management Association and, with its data, is able
to determine that in similar settings one transcriptionist generally supports four physicians. She
knows transcription processes are not state of the art in her organization and wonders to what
extent departmental performance might be improved by applying best practices.
First, she conducts a literature search of transcription best practices on the AHIMA and American
Association for Medical Transcription Web sites. Then she searches AHIMA’s Communities of
Practice for best practice and transcription threads. She also talks to her peers on the local HIM
association board and posts a discussion thread on the Ambulatory Care Community of Practice.
She attends a national convention, visiting vendors and attending lectures on best practices and
transcription technology.
She identifies 10 transcription departments of similar size and scope and interviews and the HIM
director or transcription manager at each, using an interview form she developed. She finds one
department that is producing an average of 275 lines per transcriptionist per hour at a cost of 12
cents per line. During the interview, she finds out that this organization:
Copyright © 2003 by The American Health Information Management Association. All Rights Reserved.
has an incentive program
Š uses software in which abbreviations typed onto the keyboard produce phrases and entire
paragraphs
Š uses templates that can be personalized for particular patients for routine procedures
Š uses digital dictation from which to transcribe
Š does not require transcriptionists to perform any clerical duties or cover for other HIM
functions after hours
Š has several telecommuting transcriptionists
Š
On the basis of this information, the HIM director talks to her staff and decides to pursue
abbreviation software, templates, and a digital dictation system. Once those technologies and
processes are implemented, she intends to develop an incentive program and explore allowing
transcriptionists to work from home. She presents the idea to administration, they accept the idea,
and she obtains the necessary funding. As she implements each of these processes, the productivity
of the transcription unit continues to increase. She provides administration with monthly progress
reports and an annual cost-benefit analysis.
Note
1. Osborn, Carol. “Practices and Productivity in Acute Care Facilities.” Journal of AHIMA 72, no. 2 (2000): 6166.
References
Dixon Lee, Claire. “Benchmarking Healthcare Facility Performance Using External Data Resources.” Presentation at
the AHIMA Clinical Data Management Institute on September 26, 2002, at AHIMA’s 74th National Convention in
San Francisco, CA.
Dunn, Rose. “Productivity Standards: A Survey of HIM Professionals, Part II.” Journal of AHIMA 67, no. 6
(1996): 61-63.
Dunn, Rose. “Tricks of the Trade: Losing Your Mind with Loose Sheets.” For the Record 7, no. 17 (1995): 24-25.
Dunn, Rose. “Tricks of the Trade: Performance Standards for Coding Professionals.” For the Record 5, no. 23
(1993): 4-6.
Michigan Medical Record Association. “Practice Forum: Productivity Standards for Coding.” March 1990. Opus
Communications. “Benchmarking Survey: Monitoring Transcription Productivity.” Medical Records Briefing 10, no.
1 (1995).
Prepared by
Gwen Hughes, RHIA
Acknowledgments
Jill Burrington-Brown, MS, RHIA
Harry Rhodes, MBA, RHIA
Copyright © 2003 by The American Health Information Management Association. All Rights Reserved.
Article citation:
Hughes, Gwen. “Using Benchmarking for Performance Improvement (AHIMA Practice
Brief).” Journal of AHIMA 74, no.2 (2003): 64A-D.
Copyright © 2003 by The American Health Information Management Association. All Rights Reserved.