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Background Value-based healthcare (VBHC) is a conceptual framework to improve the value of healthcare by health, care-process and economic outcomes. Benchmarking should provide useful information to identify best practices and therefore a good instrument to improve quality across healthcare organizations. This paper aims to provide a proof-of-concept of the feasibility of an international VBHC benchmarking in breast cancer, with the ultimate aim of being used to share best practices with a data-driven approach among healthcare organizations from different health systems. Methods In the VOICE community—a European healthcare centre cluster intending to address VBHC from theory to practice—information on patient-reported, clinical-related, care-process-related and economic-related outcomes were collected. Patient archetypes were identified using clustering techniques and an indicator set following a modified Delphi was defined. Benchmarking was performed using regression models controlling for patient archetypes and socio-demographic characteristics. Results Six hundred and ninety patients from six healthcare centres were included. A set of 50 health, care-process and economic indicators was distilled for benchmarking. Statistically significant differences across sites have been found in most health outcomes, half of the care-process indicators, and all economic indicators, allowing for identifying the best and worst performers. Conclusions To the best of our knowledge, this is the first international experience providing evidence to be used with VBHC benchmarking intention. Differences in indicators across healthcare centres should be used to identify best practices and improve healthcare quality following further research. Applied methods might help to move forward with VBHC benchmarking in other medical conditions. [ABSTRACT FROM AUTHOR]

Summary: Despite assurances of government action, the burden of non‐communicable diseases (NCDs) and overweight and obesity is continuing to grow at an alarming rate both globally and in Europe. The NOURISHING and MOVING policy frameworks outline a comprehensive set of policy actions across 6 domains and 16 policy areas in which national governments should take action to promote healthy diets and physical activity. Monitoring and benchmarking these policies is important for assessing progress on obesity and NCD prevention. This paper describes the participatory process for developing benchmarking tools structured around the policy areas of the NOURISHING and MOVING policy frameworks. They consist of a set of indicators and policy attributes that assess government support in promoting healthy nutrition and physical activity. They are adolescent relevant as they capture policy actions that target or impact adolescents. The benchmarking tools are designed to monitor progress on national government action on nutrition and physical activity based on aspirational standards. They will be applied in 27 European countries initially and are aimed at policymakers, researchers, and civil society, to track progress, develop the research infrastructure on effectiveness of NCD prevention policies at population level, and support advocacy efforts. [ABSTRACT FROM AUTHOR]

This paper examines the principles of benchmarking in healthcare and how benchmarking can contribute to practice improvement and improved health outcomes for patients. It uses the Deepening our Understanding of Quality in Australia (DUQuA) study published in this Supplement and DUQuA's predecessor in Europe, the Deepening our Understanding of Quality improvement in Europe (DUQuE) study, as models. Benchmarking is where the performances of institutions or individuals are compared using agreed indicators or standards. The rationale for benchmarking is that institutions will respond positively to being identified as a low outlier or desire to be or stay as a high performer, or both, and patients will be empowered to make choices to seek care at institutions that are high performers. Benchmarking often begins with a conceptual framework that is based on a logic model. Such a framework can drive the selection of indicators to measure performance, rather than their selection being based on what is easy to measure. A Donabedian range of indicators can be chosen, including structure, process and outcomes, created around multiple domains or specialties. Indicators based on continuous variables allow organizations to understand where their performance is within a population, and their interdependencies and associations can be understood. Benchmarking should optimally target providers, in order to drive them towards improvement. The DUQuA and DUQuE studies both incorporated some of these principles into their design, thereby creating a model of how to incorporate robust benchmarking into large-scale health services research. [ABSTRACT FROM AUTHOR]

There is a need to measure and improve the quality of paediatric primary care in Europe where major differences in the delivery and outcomes of child health care exist. A collaborative panel of paediatric senior experts developed a Core Set of Indicators for Paediatric Primary Care in Europe by compiling 42 quality indicators in a modified consensus process following the RAND/UCLA appropriateness method. The aim of this study was to explore the feasibility of the quality indicator set in European paediatric primary care practices. Seventy-nine practices from eight countries participated in a detailed online interview. The practices rated the applicability, relevance, reliability and acceptance of the 42 quality indicator as well as the availability, technical feasibility and effort to retrieve the needed data from their medical records. Most quality indicators were considered applicable, available, reliable, acceptable and relevant for monitoring quality of care in paediatric primary care. Respondents rated feasibility and effort to retrieve the data lowest because of difficulties collecting the data from the medical records.Conclusion: European paediatric primary care practices generally agree with the proposed quality indicator set. They document most of the parameters. However, the collection of specific needed values from available routine patient-data is considered technically difficult and time-consuming. What is Known? • Paediatric primary care systems in Europe show striking differences in their performance. Pre-existing sets of quality indicators are predominantly limited to national populations, specific diseases and hospital care. • A Core Set of 42 quality indicators for paediatric primary care in Europe was developed by European paediatricians using a systematic literature review and a consensus process following a modified RAND/UCLA appropriateness method. What is New? • Paediatric primary care providers in Europe agree with the idea to use COSI-PPC-EU to monitor and improve the quality of care. The set was considered applicable, available, reliable, acceptable, and relevant for quality improvement. • The score for feasibility and effort to retrieve the data was low, because of technical reasons; the electronical or paper-based medical documentation in most cases does not allow convenient access to all necessary data. [ABSTRACT FROM AUTHOR]

Aims and objectives The aim of the Paediatric International Nursing Study was to explore the utility of key performance indicators in developing person-centred practice across a range of services provided to sick children. The objective addressed in this paper was evaluating the use of these indicators to benchmark services internationally. Background This study builds on primary research, which produced indicators that were considered novel both in terms of their positive orientation and use in generating data that privileges the patient voice. This study extends this research through wider testing on an international platform within paediatrics. Design The overall methodological approach was a realistic evaluation used to evaluate the implementation of the key performance indicators, which combined an integrated development and evaluation methodology. Methods The study involved children's wards/hospitals in Australia (six sites across three states) and Europe (seven sites across four countries). Qualitative and quantitative methods were used during the implementation process, however, this paper reports the quantitative data only, which used survey, observations and documentary review. Results The findings demonstrate the quality of care being delivered to children and their families across different international sites. The benchmarking does, however, highlight some differences between paediatric and general hospitals, and between the different key performance indicators across all the sites. Conclusions The findings support the use of the key performance indicators as a novel method to benchmark services internationally. Whilst the data collected across 20 paediatric sites suggest services are more similar than different, benchmarking illuminates variations that encourage a critical dialogue about what works and why. Relevance to clinical practice The transferability of the key performance indicators and measurement framework across different settings has significant implications for practice. The findings offer an approach to benchmarking and celebrating the successes within practice, while learning from partners across the globe in further developing person-centred cultures. [ABSTRACT FROM AUTHOR]

Purpose – Benchmarking, a method for quality assurance has not been very commonly used in higher education with regard to e-learning. Today, e-learning is an integral part of higher education, and so should also be an integral part of quality assurance systems. However, quality indicators, benchmarks and critical success factors on e-learning have not been taken seriously into consideration, nor incorporated in ordinary national or international quality assurance systems. The purpose of this paper is to describe how The European Association of Distance Teaching Universities (EADTU) initiated and developed E-xcellence+, a quality benchmarking assessment method and tool. Design/methodology/approach – This paper, which is part of a larger research project on European benchmarking, focuses on experiences from universities taking part in the E-xcellence+ valorization process. Findings – The results showed that benchmarking is a powerful tool to support improved governance and management in higher education, in alignment with national and international quality agencies. The tool can serve for quality improvements in teaching and learning. Additionally, the results showed critical success issues for e-learning. Originality/value – This original paper reports on a Europe-wide study examining benchmarking of e-learning and presents suggestions for tackling quality issues. [ABSTRACT FROM AUTHOR]

Purpose - The purpose of the research presented in this paper is to evaluate the efficiency and productivity of the European retailers. Design/methodology/approach - Applying a two-stage approach at individual and global levels, in this study the paper adopts the efficient frontier approach using the Malmquist index, based on DEA to measure productivity of European retailers. Findings - An efficiency and productivity evaluation process is developed incorporating non-parametric techniques in the European retail sector for the period of 1998-2006. The author proposes an integrated benchmarking framework illustrated in two stages. In the first stage, work is carried out in an individualized way at the country level identifying the firms that form the corresponding efficient frontier. In a second stage a benchmarking analysis is carried out starting from the selection of the best firms made in the first stage. In this case the firms belonging to different countries are compared against each other. The aim of this procedure is to seek out those best practices that will lead to improved performance throughout the whole sample. The results confirm that convergence/divergence in efficiency and productivity growth do not have the same behaviour patterns, concluding that some countries experienced improvements while others worsened. Individual scrutiny (benchmarks) in the second stage shows that there are four groups of firms that have allowed us to extract important managerial implications. Originality/value - The paper proposes an integrated benchmarking framework illustrated in two stages. With this methodology answers can be given to important questions such as, how efficient and productive is European retailing? What is the evolution of the productivity over time in Europe? Do different patterns of convergence/divergence of the efficiency exist among the analysed countries? What characteristics do the firms with the best managerial practices belonging to the European global frontier have? [ABSTRACT FROM AUTHOR]

Convention and visitors bureaux (CVBs) have become a dominant type of destination marketing organization since the very first bureau was founded in Detroit in 1895. Nowadays, about 1,000 CVBs are operating in major and secondary metropolitan and resort areas in the United States. Dozens of bureaux can he found in the rest of the world, as well. The aim of this paper is to gain a better understanding of the management and funding of CVBs especially from a European perspective. The paper is based on a benchmark survey conducted by the author among 100 bureaux throughout the world, with responses secured from 29 CVBs. The analysis of the questionnaire sheds light on several aspects of CVB operations, such as geographic scope, types of shareholders controlling the CVB, membership of individual tourist businesses in the CVB, annual budget, sources of income, main expense categories, target markets, and staffing. [ABSTRACT FROM AUTHOR]

The current context of the global economy and a shortage of capital is putting cities all over the world under great pressure and increasing competition between them. The competitive position of a city does not remain stable over time: it changes due to both internal and external factors such as the appearance of new technologies, new competitors and changes in the preferences and desires of its target groups. Cities therefore need to understand the strengths and weaknesses that influence not just their own ability to compete but also that of their competitors. This paper seeks to benchmark the competitiveness of European cities as locations for businesses and in terms of their ability to attract investment. Urban competitiveness is a complex, multidimensional issue, so a scale of measurement has been created based on a synthetic index called the Urban Competitiveness Index (UCI), which comprises various sub-indices representing its various dimensions. In the present study we focus on the basic dimension, the efficiency dimension and the innovation dimension. The study covers 159 cities located in 26 European Union countries. [ABSTRACT FROM AUTHOR]

Improving energy efficiency in order to reduce CO2 emissions is a permanent challenge in the European space. Smart metering could help for improving energy efficiency by offering information about the way in which the energy is used. Smart metering will be based on large volumes of sensor data, since energy monitoring will bring together sensor data from various critical areas. The main purpose of this paper was to present the selection mechanism for a scalable storage solution, based on the requirements of the DEHEMS (Digital Environment Home Energy Management System) project. With regular sensor readings coming at every 6 seconds, there is an impressive amount of data collected even for the minimal target of about 250 households, 10 sensors per user. With these huge data streams that are non-stationary time-series data, collected at discrete intervals, the DEHEMS project has to offer a solution for storing and retrieving sensor data in a responsive way. We have tested both collection speed and aggregation speed for reasonable data streams of sensor data. The tests were performed on various database models, with their associated representations, including relational databases, key-value stores, column stores, self-tuning databases, as well as time-series enabled database systems. These experiments confirmed that column stores and keyvalue stores perform better than relational databases, while time-series databases outperform all the others. [ABSTRACT FROM AUTHOR]

This paper summarises the main results of a European project BEQUAR (Benchmarking Exercise in Quantitative Area Risk Assessment in Central and Eastern European Countries). This project is among the first attempts to explore how independent evaluations of the same risk study associated with a certain chemical establishment could differ from each other and the consequent effects on the resulting area risk estimate. The exercise specifically aimed at exploring the manner and degree to which independent experts may disagree on the interpretation of quantitative risk assessments for the same entity. The project first compared the results of a number of independent expert evaluations of a quantitative risk assessment study for the same reference chemical establishment. This effort was then followed by a study of the impact of the different interpretations on the estimate of the overall risk on the area concerned. In order to improve the inter-comparability of the results, this exercise was conducted using a single tool for area risk assessment based on the ARIPAR methodology. The results of this study are expected to contribute to an improved understanding of the inspection criteria and practices used by the different national authorities responsible for the implementation of the Seveso II Directive in their countries. The activity was funded under the Enlargement and Integration Action of the Joint Research Centre (JRC), that aims at providing scientific and technological support for promoting integration of the New Member States and assisting the Candidate Countries on their way towards accession to the European Union. [Copyright &y& Elsevier]

The indicators developed for the open method of co-ordination (OMC) in social inclusion might, according to their authors, serve to establish a common language for the discussion of social inclusion issues, set the agenda for inclusion policies, and provide benchmarks for the identification of best practices. To examine whether ‘learning by numbers’ is taking place, this paper scrutinizes the use of the indicators in the area of child poverty and exclusion. The discussion uses a theoretical account of the institutional preconditions for the transmission of OMC-based learning into the policy processes of member states which distinguishes between ‘normal policy-making’ and ‘paradigm shifts’. The indicators are designed to contribute to the advance of knowledge about normal policy-making, but it is shown that the OMC/inclusion disseminates a new policy paradigm which bears little relationship to the indicators. [ABSTRACT FROM AUTHOR]

Background: Differences in cancer survival exist between countries in Europe. Benchmarking of good practices can assist cancer centers to improve their services aiming for reduced inequalities. The aim of the BENCH-CAN project was to develop a cancer care benchmark tool, identify performance differences and yield good practice examples, contributing to improving the quality of interdisciplinary care. This paper describes the development of this benchmark tool and its validation in cancer centers throughout Europe.Methods: A benchmark tool was developed and executed according to a 13 step benchmarking process. Indicator selection was based on literature, existing accreditation systems, and expert opinions. A final format was tested in eight cancer centers. Center visits by a team of minimally 3 persons, including a patient representative, were performed to verify information, grasp context and check on additional questions (through semi-structured interviews). Based on the visits, the benchmark methodology identified opportunities for improvement.Results: The final tool existed of 61 qualitative and 141 quantitative indicators, which were structured in an evaluative framework. Data from all eight participating centers showed inter-organization variability on many indicators, such as bed utilization and provision of survivorship care. Subsequently, improvement suggestions for centers were made; 85% of which were agreed upon.Conclusion: A benchmarking tool for cancer centers was successfully developed and tested and is available in an open format. The tool allows comparison of inter-organizational performance. Improvement opportunities were successfully identified for every center involved and the tool was positively evaluated. [ABSTRACT FROM AUTHOR]