Walden University Wk 9 Finance and Economics in Health Care Discussion Response

Jeanne Silva           

                       RE: Discussion – Week 9                           



Article: Realizing Momentum and Synergy: Benchmarking Meaningful Ambulatory Care Nurse-Sensitive Indicators 

Start, R., Matlock, A. M., Lynn, D. B., Aronow, H., & Soban, L. (2018). Realizing Momentum and Synergy: Benchmarking Meaningful Ambulatory Care Nurse-Sensitive Indicators. NURSING ECONOMICS, 36(5), 246–251. Retrieved from com.ezp.waldenulibrary.org/login.aspx?direct=true&db=edswsc&AN=000447246900009&site=eds-live&scope=site

Benchmarking Ambulatory Care

    A nurse holds a unique position in healthcare by having the ability to leverage their role and make a change in the ambulatory care setting bringing about improvement to care and decrease cost (Start, Matlock, Lynn, Aronow, & Soban, 2018).  Start and Associates (2018) state one area of emerging research and development is the ambulatory setting focuses on quality and performance measures that uniquely apprise the nurse’s contribution in the ambulatory setting. Previously only the impact of benchmarking, comparing services to similar organizations with similar demographics, of nurse-sensitive indicators (NSI) for quality measures was limited to the acute inpatient setting.  Benchmarking quality measures in the inpatient setting has long been used to develop care models, revision of staffing models to support high-quality care and promote the value of nursing (Start, Matlock, Lynn, Aronow, & Soban, 2018).

    To make a change in a care delivery model improving care and decreasing cost, the nurse must leverage NSIs and make comparisons with demographics and role information leveraging the NSIs and make comparisons illustrating the impact of nurses on patient care.

Benchmarking for Financial Appraisal 

    The development of benchmarking measures helps organizations understand the resources required, and the delivery system needs to provide patient care (Start et al., 2018).  Understanding the data to even the playing field of information into an equal comparison process requires evaluating like characteristics.   In oncology, navigation benchmarks are used to assess the impact of using a nurse to direct a patient throughout the continuum of cancer care.  Currently, the use of a nurse navigator does not directly generate revenue for an organization; research suggests oncology patient navigators effectively create positive patient outcomes by collecting data and benchmarking quality outcomes to improve the care provided.  One of the specific benchmarks captured by nurse navigators is timeliness to care.  By comparing the days from diagnosis to treatment of like facilities, the organization can determine if additional providers are needed to ensure patients receive care promptly (Crane-Okada, R., 2013).

Benchmarking Risks

    As benchmarking has evolved, so has the definition and measures.  Ettorchi, Levif & Michel (2012) describe the process as a measurement of one’s organizations performance as compared with the best-performers to learn the latest work methods and practices. However, the process comes with a risk when reviewing the quality of the data and resulting modification based on the numbers.  Gamble (2014) cautions the decisions to change care should not be solely based on benchmarking.  As an example, one healthcare system reduced their transporters to align with their peer’s model only to discover rather quickly; they did not have enough to transport the patients to the operating room and back.  Therefore, the benchmarking reductions resulting in the nurses transporting patients, which caused delays in the start times in the operating rooms.  Gamble (2014) states benchmarking can have unintentional consequences and decisions should be based on more information than provided by benchmarking. 


Agency for Healthcare Research and Quality. (2013). Measuring and benchmarking clinical performance. Retrieved from WWW.ahrq.gov

Crane-Okada, R. (2013). Evaluation and Outcome Measures in Patient Navigation. Seminars in Oncology Nursing, 29(2), 128-140. doi:10.1016/j.soncn.2013.02.008

Ettorchi-Tardy, A., Levif, M., & Michel, P. (2012). Benchmarking: A Method for Continuous Quality Improvement in Health. Healthcare policy= Politiques de sante, 7(4), e101-e119. Retrieved from

Gamble, M. (2014). The burdens of benchmarking: Benchmarking comes with its fair share of caveats and problems in healthcare, and pay for performance is making data comparison even more complex. Retrieved from

Start, R., Matlock, A. M., Lynn, D. B., Aronow, H., & Soban, L. (2018). September-October.  

Expert Solution Preview

As a medical professor responsible for creating assignments and evaluating student performance, the content provided is an article titled “Realizing Momentum and Synergy: Benchmarking Meaningful Ambulatory Care Nurse-Sensitive Indicators”. The article discusses the importance of benchmarking nurse-sensitive indicators (NSIs) in the ambulatory care setting and its potential impact on improving care and decreasing costs. Additionally, the article highlights the role of benchmarking in financial appraisal and the risks associated with solely relying on benchmarking data for decision-making.

Answer to the content:
Benchmarking has become an essential tool in healthcare to evaluate performance and compare it with best practices. It allows organizations to identify areas for improvement and learn from high-performing institutions or individuals. In the context of ambulatory care, where nurses play a crucial role in delivering quality care, benchmarking NSIs is a valuable strategy.

By comparing NSIs across similar organizations with similar demographics, healthcare providers can assess the effectiveness of nursing interventions and their impact on patient outcomes. This information can then inform the development of care models, staffing models, and resource allocation to support high-quality care.

Moreover, benchmarking can also be used for financial appraisal. In the case of nurse navigators in oncology care, benchmarking timeliness to care can help organizations identify if additional resources are needed to ensure patients receive prompt treatment. While nurse navigators may not directly generate revenue, their impact on positive patient outcomes and quality improvement is significant.

However, benchmarking comes with inherent risks that need to be considered. Decision-making based solely on benchmarking data can lead to unintended consequences. For example, reducing transporters based on benchmarked models without considering the specific needs of a healthcare system can result in delays and inefficiencies. Therefore, it is essential to use benchmarking data as one part of a comprehensive decision-making process that takes into account multiple factors.

In conclusion, benchmarking NSIs in ambulatory care is a valuable strategy to improve care and decrease costs. It allows healthcare organizations to evaluate nurse contributions, develop effective care models, and make informed decisions about resource allocation. However, it is important to consider the limitations and potential risks associated with benchmarking and use it as part of a broader decision-making process.

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