September 2014

The Best Practice Issue“Best practice” is a concept that is used in virtually everyprofessional discipline and industry. Broadly speaking, itis establishes (and justifies) a decision-making process.At its best, a best practice describes a clear, concrete,repeatable behavior that can be consistently applied tosolve a specific problem.

A closer look raises a host of issues. What makes a bestpractice “best”? Who decides? How long is it reliable?For health care organizations, are “best practice,”“standard of care,” and “evidence-based”interchangeable? If not, do they relate—and how?Putting “best” in contextFor a grammarian, best is a superlative. While a comparativeconsiders the quality of one thing relative to another; a superlativecompares one thing to an entire category. It may seem to be a fixedpoint—the best is the best, period—but in reality, the biggest,fastest, flimsiest, or cheapest is always at risk of being supplanted.This means that “best” as used in “best practice” is relative. With

AAAHC on the roadAttending a professionalconference? Visit our boothat:California AmbulatorySurgery Association(CASA)September 3-5San DiegoNat’l Assn for HealthcareQuality (NAHQ)September 7-9NashvilleAmerican Academy ofOral MaxillofacialSurgeons (AAOMS)September 11-13HonoluluWashington AmbulatorySurgery Center Assn(WASCA)September 18-19TulalipNJ Association ofAmbulatory SurgeryCenters (NJ AASC)October 10New BrunswickAmerican Society ofPlastic Surgeons (ASPS)October 11-13ChicagoOR ExcellenceOctober 15-16New OrleansBecker’s 21st Annual ASCConferenceOctober 23-24ChicagoCalifornia Association ofHealth Plans (CAHP)October 20-22Huntington Beach

This means that “best” as used in “best practice” is relative. Withregard to a policy or practice in health care, “best” is always amoveable target to be regularly reconsidered and evaluated. It existsat a moment in time and is understood in context. Regularbenchmarking (internal and external) is one way for health careorganizations to be sure that they are not falling behind as “best” getsbetter over time.Internal benchmarking also supports an overall culture of continuousimprovement. Every health care organization tracks a variety of datapoints but many fail to do anything with the results. Comparingcurrent performance to past performance is a basic way to identifyopportunities for formal QI studies—thereby integrating multipleexamples of best practice in a robust quality program.Consensus-based vs. Evidence-basedBest practice is what highly-regarded practitioners or organizationsdo. At base level, it’s a solution that has been field-tested withsuccess in some settings and shows promise of being more widelyapplicable.Similarly, “standard of care” is a consensus-based concept. And amoving target. While it has important implications, especially inlitigation, its legal and medical definitions reflect a high degree ofsubjectivity. It’s unlikely that the standard of care is explicitly statedin any given situation. Practitioners rely instead on accepted practicewisdom, and community context.These variants of “best” practice, not necessarily supported by data,represent consensus opinion based on experience and a minimumthreshold to meet.A higher level of best practice is research-validated and evidence-based. These practices reflect the results of rigorous methodologyand well-executed, data-driven studies. The goal of evidence-basedmedicine is to bring the best available research into individualdecision making. Evidence-based practice values quantitativestudies over qualitative studies. It results in highly researchedresponses to a specific issue or problem, adding scientific rigor tothe body of knowledge of an individual team or practitioner.External benchmarking can represent evidence-based practice, or bea step toward it, depending on the nature and source of thebenchmark.

Ranking “best” practiceThe CDC, a well-known source for clinical guidelines, is explicitabout the level of evidence supporting each recommendation theymake with four clearly defined categories.

Medical GroupManagement Association(MGMA)October 26-28Las VegasMedicaid Health Plans ofAmerica (MHPA)October 27-28 Washington

*Dates reflect exhibit hall accessonly; conference dates may vary.

AAAHC Contact Information

Accreditation Association forAmbulatory Health Care5250 Old Orchard Road,Suite 200Skokie, IL 60077

P: 847.853.6060F: 847.853.9028info@aaahc.orgwww.aaahc.org

Good, Better, Best: Lessons from anantiques dealerAlbert Sack (1915-2011) wrote Fine Points of Furniture: Good,Better, Best in 1950 as a way to codify how antiques were assignedvalues. In his book, Sack explained how he, as a dealer, looked at apiece of furniture. He described the qualities of proportion, form,wood selection, and visual use of grain for the various period stylesand illustrated these descriptions with examples that he classified asgood, better and best.The notion of good, better, best, continues to inform the world ofantiques and is another example of the broad-based applicability ofbest practice, here using comparison to bring an evaluative standardto an otherwise subjective activity.

If you have questions or comments about Connection, please contact Angela FitzSimmons at afitzsimmons@aaahc.org.

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