Benchmarking: A Powerful Tool for
Achieving Organizational Excellence
in Addiction Treatment
David Doty, Ph.D.
John Winslow, M.H.S., C.P.P.
Why Benchmark?
• Performance is measured in all
organizations
• Clinical, operational and financial
dimensions
• How helpful is performance data?
• Does data drive organizational decisionmaking?
• Does data drive organizational vision?
The Limitations of
Performance Data
• A thermometer
reading would
have little value as
a measure of your
health…
• If you didn't know
that 98.6 is the
“normal”
temperature!
The Role of Benchmarking
• Benchmarking provides
the vital external context
for understanding your
measured organizational
performance
• Identifies organizational
strengths and
opportunities for
improvement
Benchmarking for Organizational
Excellence in Addiction Treatment
• SAAS, NIATx, and Behavioral Pathway
Systems are partnering to sponsor an
addiction-specific national benchmarking
initiative
• BPS specializes in behavioral health and
human services benchmarking and has
numerous state and national
benchmarking initiatives underway
Objectives of
Benchmarking Initiative
• Provide SAAS with information it needs to
advocate for its members
• Provide participating organizations with
individualized comparative benchmark data
that can serve as a vital context for
understanding measured outcomes
• Provide a powerful vehicle for the identification
of best practices and organizational
improvement through process benchmarking
and the application of NIATx principles
Scope of Benchmarks
• Comprehensive range of benchmarks
• Operational, clinical, organizational
climate, and financial domains of
performance
• 21 benchmark dimensions
• Approximately 150 input metrics
Operational Benchmarks
• Initial Access
• Subsequent Access (Number of days from
intake to first treatment appt)
• Length of Stay/Utilization, by Level of Care
• Average Caseload Size of Clinician, by Level
of Care
• Outpatient Productivity
• Average Group Size
Clinical Benchmarks
•
•
•
•
Engagement/Retention, by Level of Care
Outpatient No-Show/Cancellation Rates
Client Satisfaction/Perceptions of Care
Degree of Engagement with Recovery
Support Services
• Involvement of Significant Others
Organizational Climate
• Staff Morale/Satisfaction (25 Item Measure
with automated administration and
scoring)
• Staff Retention/Turn-Over
• Percent of Staff Position Vacancies
(Counselors)
Financial Benchmarks
• Cost per Unit of Service, by Level of Care
• Salaries, by Role
• Administrative Overhead as a Percent of
Total Expenses
• Payer Mix
• Current Ratio (Assets Divided by
Liabilities)
• Net Days in Accounts Receivable
• Days of Cash on Hand
New Strategic Benchmarks
•
•
•
•
Readiness for Health Care Reform
Integration with Primary Health Care
Information Technology
Parity
Data Submission
• On-line benchmarking survey
• Aggregated anonymous data-no
complicated encounter-level data
• No software needed
• User-friendly, encrypted and secure
• Quarterly submission-Available 24/7
• Submit relevant and available data--no
reporting requirements
• State-of-the-art on-line data validation
Benchmarking Reports
•
•
•
•
Standard Report
Executive Summary Report
Organizational Climate Report
Run Charts
Standard
Benchmarking Report
• Normative Data
– Sample Size
– Mean
– Median
– Standard Deviation
• Comparative Data
– Overall Percentile Rankings
– Peer Group Comparisons (budget size,
geographic area, setting) “Apples to Apples”
– State Norms if sample size permits
• Previous Scores
Standard
Benchmarking Report
Executive Summary Report
• Designed for busy senior leaders and
boards
• Graphic representation of scores
• Brief, key highlights
Executive Summary Report
Executive Summary Report II
Organizational Climate Report
Control Chart
Re-Admissions within 30 Days
13.40
UCL (12.65)
UWL (11.05)
10.76
10.10
9.60
9.20
8.76
8.50
8.40
Mean (7.86)
7.30
6.76
6.50
6.20
5.80
5.10
4.76
LWL (4.66)
4.20
LCL (3.07)
Au
gu
st
Se
pt
em
be
r
O
ct
ob
er
N
ov
em
be
r
D
ec
em
be
r
Ju
ly
M
ay
Ap
ril
Ju
ne
M
ar
ch
2.76
Ja
nu
ar
y
Fe
br
ua
ry
Re-Admission Percentage
12.76
Reporting Period
Accommodations
for Multiple Locations
• Satellite locations easily accommodated
• Each location can be benchmarked
independently to produce a separate
report
• No limit to number of additional locations
Moving
Beyond “the Numbers”
• Benchmarking is not just about data
• When data is generated, real fun begins
• Identify potential best practices through
process benchmarking and other vehicles
• Enhance organizational performance
through NIATx principles
• Emphasis on shared learning from one
another and from “top performers”
• A learning community
Shared Activities
and Available Resources
• Monthly audio-conferences/user support
meetings
• Monthly newsletter to educate and inform
• Articles and other resources
• Telephonic and E-Mail user support
• Detailed reviews of reports
• Free telephonic consultation in interpreting your
data and developing improvement strategies
• Confidential referrals to top performers for
informal peer consultation
Benchmarking and
Organizational Improvement
• Outpatient No-Shows
– Provider discovered no-shows were high. Implemented
three Best practices that reduced no-shows by 32%.
Impact: Outpatient volume increased by 3,000, adding
approximately $180,000 to net margin
• Revenue Cycle
– Observed pattern of high Days in AR, AR Over 90 Days
and Bad Debt. Modified revenue cycle process.
Impact: Bad Debt declined from 6% to 3%, AR over 90
Days was reduced from 28% to 18% and contribution to
net margin increased by almost $300,000
Statewide
Success Stories: Access
Statewide Success Stories:
Initial No-Show Rate-PA
Statewide Success StoriesInitial No-Show Rate-NJ
One Year Subscription Fee
• Annual Subscription Fee: $1,000 per
organization
• Includes all benefits described
Benchmarking through the Eyes
of a Participant
• Local health department outpatient program
on Maryland’s Eastern Shore
• When news first appeared re: National
Benchmarking Initiative Maryland had just
begun transitioning from block grant funding to
hybrid fee-for-service system
• Murmurings of possible move to privatization
Proactive vs. Reactive
Rally the troops!
Benchmarking
Steering Committee
DCAP Supervisors then
full staff buy-in
Planning & Organization are Key!
Into Action!
Trial & Error
Various
spreadsheets
created
Allowing for (a
degree of)
autonomy
Prioritizing
“low-hanging
fruit” and prize
benchmarks
Crunching the Numbers
Clinical &
Support staff
Supervisors
Administration
Major Findings
Pleased with staff survey results
Scored high on:
Recognition & Growth
Leadership
Compensation & Benefits
Overall Satisfaction
Excelling at staff retention
High Initial No-Show Cancellation rates
Poor engagement/retention rates for Intensive
Outpatient (IOP)
Putting the Data to Use
• Develop strategies to:
– Decrease initial wait times
– Increase Intensive Outpatient attendance
– Maintain high staff retention rates
– Improve “Client Engagement & Retention” and
Reduce Premature Discharges
– Survive andThrive in Tough Economic Times
– Improve staff morale