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Today's healthcare environment dictates that management decisions are clinically sound, operationally efficient, financially responsible and supportive of current health service strategic initiatives and policies.

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INTRODUCTION Today's healthcare environment dictates that management decisions are clinically sound, operationally efficient, financially responsible and supportive of current health service strategic initiatives and policies. Furthermore, it is also recognised that clinical decisions should be based on the best possible evidence of effectiveness (National Health Service Executive, NHSE 1998). However, there has been increasing recognition that many practices in health care are based on tradition or local circumstances. Some commentators assert that healthcare suffers from a lack of relevant, comparative information based on clinical outcome measures (Teisberg, Porter and Brown, 1994). The National Health Service in the United Kingdom (UK) is being encouraged to ensure uniform provision of high quality health care (Department of Health, DoH 1997). According to Ellis (2000a), the concept of quality as it relates to health care is a complex, seldom defined and requires constant analysis and clarification. Notwithstanding this, the modern health service has extended the requirements for assured quality of care by introducing the notion of clinical governance (DoH 1998) which suggests that quality can be identified, evaluated and managed (NHSE 1998). Ellis (1995) put forward the idea that clinical practice benchmarking might be one evaluative technique available to nurses that provides a quality assessment framework and a cycle of continuous quality improvement which supports the development of quality of care. With her colleagues from the University of Central Lancashire and Preston Acute Hospitals NHS Trust, Judith Ellis demonstrated the value of clinical benchmarking in paediatric services by developing a series of benchmarks to inform practice during the 1990s. The success of this work led to the development of benchmarking networks in other areas of nursing practice and health visiting. Culminating in the development of a set of national benchmarks and an accompanying toolkit which was published in 2001 (Essence of Care, DoH 2001). The benchmarking toolkit 'The Essence of Care: Patient focussed benchmarking for health care practitioners' (DoH 2001) ...read more.


No attempt was made to evaluate data from the literature identified due to the lack of comparability of the subject areas under investigation as studies were identified from benchmarking exercises in a wide range of health care settings. A total of forty-seven articles were identified using the search criteria. Of the forty-seven articles identified, three were excluded because they were duplicates, a further twenty were discounted as unsuitable for inclusion in the review because they were international publications (mainly from the United States of America, USA). Whilst the USA's experience of developing benchmarking techniques contributes the overall body of knowledge in regard to our understanding of the usefulness of benchmarking as a quality measure. The majority of articles identified in American publications dealt with the concept of benchmarking solely in terms of cost containment and cost effectiveness. The ethos behind the development of benchmarking in the UK, it could be argued, is heavily influenced by Judith Ellis' aspiration for the development of a modern health service where the provision of nursing services are evidence-based, patient centred and focussed on the continuous improvement of the structures, processes and outcomes for health care delivery. Cost effectiveness whilst important, is to a certain extent, viewed as a by-product of the delivery of health care within a framework of evidence-based practice. Four articles identified via the search strategy were unavailable at the time of writing and therefore had to also be discounted from the review. A list of the articles identified for inclusion in the review is presented in appendix two. Twenty articles were included in the final review. The studies ranged from reflections on the introduction of benchmarking as a concept in nursing to case studies of nurse's experiences of using benchmarking techniques. The literature review identified three key themes: the importance of nurse's perceptions of the benefits of benchmarking, barriers, which block success and facilitating factors which promote success. ...read more.


It is hoped that the responses of nurses in regard to their experience of benchmarking and the successes and challenges encountered during this process will be a useful contribution to the body of knowledge that currently exists concerning the evaluation of clinical practice benchmarking. Other Considerations Research studies can be costly, especially in terms of the amount of time required to undertake a project. The researcher will have to spend a considerable amount of time arranging the dispatch and follow up of questionnaires. Input the data from the returned questionnaires, analyse the data and produce a report of the findings. However, the cost of the research can be justified in that it will contribute the evaluation of NHS policy and may in the long term, influence the funding of benchmarking or the development of future quality measurement tools. There is also the issue of ethical considerations; Cormack (1996) states that research, which involves human subjects, should adequately protect them from harm and that ethical behaviour requires the researcher to seek informed consent from the study participants. How Should the Research Findings be used to Inform Practice? The participation of institutions in such a study should promote collaboration and information sharing, where it was not already established. Furthermore, the wider issues of how to embed quality improvement strategies into nursing practice should be addressed at a multidisciplinary level. To include clinical audit, effectiveness and governance personnel, as well as clinical and business managers. Using the opinions of patients as to how a service should be provided and what they think of the existing service is a strategy, which is welcomed by the current government. The NHS Plan (Department of Health, 2000) outlines the importance of service users and providers opinions to the development of high quality health care services. And how these recommendations will be used to inform the change in structure to the future NHS. Research of this nature clearly fulfils the need to include service users in the decisions made when commissioning services and evaluation of current practice. ...read more.

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