Table 1.

Benchmarking steps developed by van Lent and application in this study

13 steps by van Lent	Application of the steps in this study
1 Determine what to benchmark	Comprehensive cancer care, structured through the domains of the BENCH-CAN framework such as People, Process, Product & Services, and Efficient (step 6).
2 Form a benchmarking team	International consortium existing of representatives from cancer centers, health R&D organisation, biomedical innovations consultancy company, and OECI.
3 Choose benchmarking partners	Cancer centers in Europe.
4 Define and verify the main characteristics of the partners	A mapping exercise of the external environment in which the cancer centers are located was performed.
5 Identify stakeholders	Four stakeholder groups were identified: patients, management, clinicians and researchers.
6 Construct a framework to structure the indicators	The framework is based on the European Foundation for Quality Management (EFQM) Excellence Model [10] and the adapted six domains of quality of the Institute of Medicine [13].
7 Develop relevant and comparable indicators	Indicators were retrieved from literature [14] and expert opinion.
8 Stakeholders select indicators	Stakeholders from the BENCH-CAN project and other experts from cancer centers provided feedback on the indicators.
9 Measure the set of performance indicators	Indicators were first pre-piloted in three centers to check clarity of the definitions and whether indicators would yield interesting information. Data collection phase was three months. Next, the three month during data collection phase was repeated for the other centers. A team performed a center visit to each pilot center to verify the data, to grasp the context and clarify any questions arising from the provided data.
10 Analyse performance indicators	The researchers compared the performance of the pilot cancer centers. Reports of this comparison were checked by the other members of the center visit team.
11 Take action: results are presented in a report and recommendations are given	For each participating cancer centre, a report was made containing the outcomes of the benchmark for all centers. Data was anonymized. Improvement recommendations were sent in a separate document.
12 Develop relevant plans	Pilot centers were asked to develop improvement plans for recommendations that they agreed with.
13 Implement the improvement plans	Outside the scope of this study.