ASC Benchmarking (Part I): Why Does the AAAHC Require Participation in External Benchmarking?

Note: The following article (reprinted as a two-part series) is an example of an IQI Insights — a brief quarterly newsletter published by the AAAHC Institute for Quality Improvement (AAAHC Institute). The article is copyrighted and reprinted here with the express permission of the AAAHC Institute. Please note that 14 IQI Insights are being combined into one volume, entitled Quality Improvement Insights, which will be available for purchase from the AAAHC Institute ( in 2012.



From the Accreditation Association for Ambulatory Health Care (AAAHC) Accreditation Handbook for Ambulatory Health Care:


The organization's quality improvement program must include participation in external performance benchmarking activities that will allow for comparison of key performance measures with other similar organizations or with recognized best practices of national or professional targets or goals [Standard 5.II.C].

Benchmarking: a systematic comparison of products, services or work processes of similar organizations, departments or practitioners to identify best practices known to date for the purpose of continuous quality improvement. External benchmarking compares performance between different organizations. Internal benchmarking compares performance within an organization, such as by physician or department, or over time. For the purposes of accreditation, the internal benchmarking standard does not apply to organizations with fewer than 3 practitioners.

Performance measure: a clearly defined statement or question describing information to be collected for purposes of improving processes and outcomes of care.


The focus of this article is external benchmarking — why it is an important tool for health care organizations and some common problems organizations have with external benchmarking, as well as potential answers.


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Why does the AAAHC require participation in external benchmarking?

Quality improvement activities allow organizations to measure internal issues, design and implement interventions, and measure to see whether the interventions have led to desired change or resolution of problems. Internal benchmarking provides organizations with information about how their own practitioners compare with and can learn from one another. The AAAHC requires that organizations conduct internal benchmarking to support peer review activities (Standard 5.I.C) and specific quality improvement activities to support the goals of the QI program (Standard 5.II.B). Why isn't this enough? What's so special about external benchmarking? External benchmarking takes quality improvement to a higher level:


  • Often, organizations believe that their performance is equal to or better than their peers. External benchmarking activities can help organizations identify which others have achieved superior results.


Example: Organization A has completed an internal benchmarking study and providers have already reduced the wait time (the time the patient checks in to the time the patient is brought back to the exam room, prep, or operating room) from almost an hour for some practitioners to 45 minutes, on average, for each of its practitioners. Patients haven't complained; but sometimes the waiting area can still become a "little" crowded. Organization A becomes involved in an external benchmarking study and realizes some peer organizations (Organizations C, G, N, with similar provider bases and similar patient loads and services, etc.) have wait times of 20-25 minutes, on average. This shows an opportunity for improvement.


  • External benchmarking can provide ideas for interventions. Those organizations that perform better on a certain benchmark measure can share their proven techniques/processes with those who do not.


Example: Organization A has no idea, beyond the changes implemented as a result of internal benchmarking, about how it might decrease its wait time. However, through the benchmark study, Organizations C, G, and N provide information on their processes/procedures to move patients from check in to the exam room, pre-op area, or operating room. At Organization C, they pull all charts/records for their scheduled patients the day before. Organization G has based its arrival instructions (instructions to the patient on how much time prior to the scheduled surgery or appointment start time that the patient should arrive) on its study of how long each physician usually takes (for the type of visit/procedure prior to the one where the patient is seen). Organization N telephones patients to let them know if their physician/surgeon is running behind schedule, so they don't arrive too early. These different approaches can suggest new ideas for interventions for Organization A.


  • External benchmarking also offers information about realistic goals for improving performance. If a peer organization can perform at a certain level, then so can you! (Caveat: It may take a while to do this).


Example: After its internal benchmarking project, Organization A might assume that 45 minutes is the "gold standard"—Organization A would not know whether a shorter average wait time is realistic without the information from Organizations C, G, and N. Or, in the spirit of continuous quality improvement, some at Organization A might think that half an hour average wait time should be its long term goal; this sounds reasonable. Others believe wait times should not exceed 15 minutes on average, and that should be the goal. However, Organizations C, G, and N's average wait times of 20-25 minutes, suggest that 20-25 minutes is a realistic/appropriate goal for Organization A to try to accomplish.


Editor's note: View "ASC Benchmarking (Part 2): Why is Benchmarking So Hard and What Can You Do to Overcome Obstacles?" by clicking here.


More Articles Featuring the AAAHC Institute:

AAAHC Announces New Quality Improvement Studies for 2012

Choosing a Focus for a Quality Improvement Activity

Study Abstract of AAAHC Institute QI Award Winner

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