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How are we doing? Benchmarking
basis for quality control and quality assurance. Indeed, their existence is fundamental to the ability to monitor the results of any corrective action. To this end, such events can be termed “Indicators” and confusion avoided.
How to choose indicators
As already discussed, Indicators are crucial to the development, and maintenance, of a quality system. In accordance with the maxim “You can’t control what you can’t measure,” the Indicators that are used should reflect the areas which, when controlled, will bring the most measurable benefit to the IVF program. So, for example, even though pregnancy rate is an important indicator of the overall program performance, it is not necessarily the most useful one in terms of benefit to the program’s efficiency, finances and operation. It is quite likely that the most useful Indicators will differ from one IVF program to the next, since they will depend upon the areas being targeted for improvement. This is why accreditation authorities do not provide a list of “mandatory” Indicators – it is expected that the areas of need will have been identified as part of each Center’s ongoing Quality Improvement process. From the patients’ perspective, apart from cost and location, a Center’s pregnancy rate and implantation rate are the most likely Indicators that will be sought. It is important, therefore, that everyone in the program understands that these rates are Indicators of the Center’s performance as a whole, and not simply of the laboratory’s performance. It is also important to realize that different IVF programs may have (indeed, will likely have) different definitions for their Indicators – therefore, it is essential that the definitions used for each Indicator are known before any attempt at benchmarking is made. Further discussion on the use of reference populations for reporting results as well as some general considerations of definitions of success rates and honesty in reporting pregnancy rates follows the next section.