Every multi-facility operator eventually builds a ranking: which building has the best this, the worst that. Rankings are tempting because they are simple. They are also often unfair. A 40-bed rural building and a 150-bed urban one are not playing the same game, and a list that treats them as equals teaches administrators to distrust the data.
Fair comparison is possible, and it makes dashboards far more useful. It requires a few deliberate choices about rates, peer groups and definitions.
Use rates instead of counts
The first and simplest step is converting counts into rates. Ten falls in a large building and five in a small one tell you nothing until you know how many resident days each building had. Common denominators include:
- Resident days, for events and staffing hours
- Admissions, for admission-related measures
- Total claims or billed revenue, for revenue cycle measures
- Calls or messages received, for communication measures
A rate puts buildings on a common scale and keeps size from dominating the picture.
Beware small numbers
Small buildings, small units and short time frames produce noisy rates. One event can swing a percentage dramatically. To avoid over-reading, use rolling windows such as the last 8 to 12 weeks, show counts next to rates and flag when the sample is small. Resist drawing conclusions from a single month.
Compare to the building's own history first
The fairest comparison for any building is itself. Trend lines over time show whether it is improving, steady or slipping, regardless of its starting point. A building that has steadily improved from a difficult baseline deserves recognition even if it still sits mid-pack.
Use peer comparison as a second lens, not the only one.
Build thoughtful peer groups
When you do compare across buildings, group similar ones. Consider:
- Size, by bed count
- Setting, such as skilled nursing versus assisted living
- Service mix, such as heavy short-stay rehabilitation versus mostly long-stay
- Market characteristics, including rural versus urban and local labor conditions
- Payer mix
A hypothetical group might create three peer sets, so a rural 50-bed building is compared with similar buildings rather than a large metropolitan one. Peer groups should be reviewed periodically and agreed with the administrators.
Adjust for acuity and mix where it matters
Some measures depend strongly on the characteristics of residents. Where you can, segment by unit type or by resident category, or use risk-adjusted approaches in consultation with clinical and analytics experts. When adjustment is not feasible, note the limitation next to the measure rather than pretending the comparison is perfect.
Standardize definitions rigorously
Nothing erodes trust like discovering that two buildings measure the same thing differently. Document each metric: what it counts, the data source, the time window, exclusions, and who owns the definition. When systems differ across buildings, such as different phone or call-light vendors, map them to a shared definition and test the results.
Choose presentation that avoids false precision
Rank orders imply that the first and second place are meaningfully different even when they are not. Consider showing groupings, such as above, within and below the typical range of peers, rather than a strict ranking. Show uncertainty where the sample is small.
Frame it as learning, not scoring
The best use of cross-building data is to find practices worth sharing. If one building has unusually fast referral response or consistently low overtime, ask what it does. Then help other buildings try it. Administrators who see comparisons as an opportunity to learn rather than a threat tend to engage more openly.
Conversely, when comparisons are used mostly to criticize, people may respond by managing the metric, delaying or hiding issues, or disputing the data.
A practical checklist
- Convert counts to rates with stated denominators.
- Use rolling windows and show sample sizes.
- Make each building's own trend the primary view.
- Define and review peer groups.
- Document metric definitions and keep them consistent.
- Present ranges or tiers rather than strict ranks where appropriate.
- Build a routine for sharing practices from strong performers.
Include the administrators
Invite administrators to review the definitions and peer groups before dashboards are rolled out. Their local knowledge catches problems, and their involvement builds ownership. When someone says "that does not look right," treat it as valuable information: it is either a data error you can fix or a context you can document.
Revisit regularly
Buildings change, markets change and systems change. Review your normalization approach at least annually and whenever a major change occurs, such as a new system or a large shift in a building's service mix.
Where CarePulse fits
CarePulse standardizes definitions across buildings and presents rates, trends and peer-group views, so leaders can compare fairly and administrators can trust what they see. If you would like to see a portfolio view built from your own buildings, we can set up a demo.