Investigating apparent variation in quality of care: the critical role of clinician engagement

Abstract

This article reports the experience of the Victorian Department of Health in seeking clinician engagement in the testing of 11 quality‐of‐care indicators in 20 health services in Victoria. The Department previously developed a suite of 18 core indicators and seven subindicators known as the AusPSI set. We used routinely collected administrative data from the Victorian Admitted Episodes Dataset to produce variable life‐adjusted display (VLAD) control charts for 11 selected indicators. The Department recognises that clinicians are responsible for the safety and quality of the care they provide, and therefore the necessity of engaging clinicians in the process of investigating apparent variation in patient care. Although using readily available and inexpensive routinely collected administrative data to measure clinical performance has a certain appeal, the use of administrative data and VLADs to identify apparent variations has posed significant challenges due to concerns about the quality of the data and resource requirements. When clinicians at a major Melbourne hospital were engaged, it resulted in an improvement in clinical practice. Investigating apparent variation in patient care provides an ideal opportunity for emerging clinical leaders to take local ownership and develop expertise in investigating apparent variation in processes of care and implementing change as required.

How Can Technology Support Quality Improvement? Lessons Learned from the adoption of an analytics tool for advanced performance measurement in a hospital unit.

“…The positive effects of performance measurement often do not materialize because of problems with access to data and insufficient resources for data collection (27,28). Time delays in follow-up undermine clinicians' confidence in data (29,30) and reduce the accountability for outcomes (31).…”

“…Performance measurement is a complex task and multiple stakeholders must be convinced of the relevance and motivational power of performance measurement. While health care professionals may be thought of as a homogenous stakeholder group, they often have very different views on quality of care (29). Physicians, for example, tend to concentrate on the outcomes dimension while nurses tend to concentrate on the experience dimension (16,32).…”

Development and psychometric testing of the clinical networks engagement tool

“…This was in direct comparison to the frontline stakeholders who felt much less engaged, with mean scores ranging from 1.74 to 2.69. Engaging frontline healthcare professionals in quality improvement has been an issue that remains concerning for health systems globally,[2,23,66–68] Interestingly, SCN members and support staff who work more peripherally with the SCNs did not differ in their engagement scores, although support staff more often reported that items were not applicable, particularly empower items.…”

How do stakeholders from multiple hierarchical levels of a large provincial health system define engagement? A qualitative study

“…Stakeholder engagement has been described as essential and even “critical” [ 1 – 3 ] for moving knowledge into action within healthcare [ 4 , 5 ]. Efforts to transform large systems are more successful when healthcare professionals are engaged, resulting in improvements to clinical outcomes and patient safety [ 6 – 9 ], quality of care [ 8 , 10 , 11 ], and financial performance [ 8 ].…”