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Scientific Inquiry provides a forum to facilitate the ongoing process of questioning and evaluating practice, presents informed practice based on available data, and innovates new practices through research and experimental learning.
Benchmarking is a term whose origins are obscure but which has become a focal point in outcomes based research. Initially "benchmark" meant "a mark on a permanent object indicating elevation and serving as a reference in topographical surveys and tidal observations" (Webster, 1988, p. 143). The definition has evolved to mean "something that serves as a standard by which others may be measured" (Webster). Benchmarking is about comparisons. When we rank athletes, we might compare one runner's performance to another's. Athletes study their performance so that they can learn and improve. Health care is beginning to follow their example.
Evidence-based decisions are becoming a driving force in healthcare research. Benchmarking is a method of collecting and monitoring key indicators that are reflective of an organization's clinical and operational performance. Additionally, external comparison groups provide an opportunity to learn from the expertise of others, to avoid making the same mistakes or "reinventing the wheel."
Regulatory Pressures
It is not entirely for altruistic self-improvement that healthcare institutions are undergoing this soul searching. Regulatory pressures increasingly mandate the use of comparative databases. In November 1999, the findings and recommendations of a report on healthcare errors produced by the Quality of Health Care in America Project from the Institute of Medicine (IOM) estimated that between 44,000 and 98,000 Americans die as a result of preventable adverse events (Kingston, 2000). In February, President Clinton presented a proposal to begin the formal monitoring of preventable medical errors that cause serious injury or death. Plans were outlined for a state-based, phased-in system that would encourage healthcare providers to voluntarily report medical errors or near errors. If a hospital's rate of errors (e.g., medication errors) was found to be much higher or lower than other hospitals, an analysis would be done to determine contributing factors. The intent of the proposal is admirable; however, issues remain regarding punishing those who fill out an incident (variance) report confidentially, and liability. Whatever the final form the proposal takes, public awareness will ensure that medical accountability is an enduring issue.
JCAHO's ORYX Initiative
A regulatory...