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Ask the expert: How should our surgical hospitalist program set performance objectives?

Hospitalist Leadership Connection, November 17, 2010

Once your surgical hospitalist program selects performance measurement metrics, it is important to set performance objectives or targets against which to assess actual performance. The primary reasons to undertake performance measurement are to determine whether the program is meeting the hospital’s expectations and to identify opportunities to improve performance. It is not possible to do either unless performance expectations are clearly defined in the form of objectives for the selected metrics.

The performance objective might be expressed as a fixed number or percentage (e.g., “minimum of 1,000 wRVUs per FTE per quarter” or “98% compliance with surgical infection core measures”). Alternatively, the performance objective might be expressed in terms of performance relative to a defined baseline period or comparison group (e.g., “average length of stay equal to or better than all community nonhospitalist surgeons”) or an external benchmark (e.g., professional fee charges per FTE equal to or greater than the Medical Group Management Association [MGMA] median).

Ask the following questions when setting targets:

• What is the program’s (or the organization’s) historical or baseline performance on this metric?
• Does the program desire improvement over the baseline performance?
• Is there a comparison group against which the practice’s performance on this metric should be compared? Consider both internal comparison groups (e.g., nonhospitalist surgeons practicing in the same facility) and external comparison groups (e.g., surgical performance in other similar hospitals available through clinical data repositories, such as Premier or Thomson Reuters, or survey data available through MGMA).
• Are there externally validated benchmarks or best practice standards available for this metric?

The above excerpt is adapted from The Surgical Hospitalist Program Management Guide: Tools and Strategies for Executives and Physicians, by John Nelson, MD, FACP; John Maa, MD, FACS; and foreword by Robert M. Wachter, MD, published by HCPro, Inc. Download a free sample chapter online at www.HCMarketplace.com.

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