Learning from practice variation to improve the quality of care

Abstract

-Modern medicine is complex and delivered by interdependent teams. Conscious redesign of the way in which these teams interact can contribute to improving the quality of care by reducing practice variation. This requires techniques that are different to those used for individual patient care. In this paper, we describe some of these quality improvement (QI) techniques. The first section deals with the identification of practice variation as the starting point of a systematic QI endeavour. This involves collecting data in multiple centres on a set of quality indicators as well as on case-mix variables that are thought to affect those indicators. Reporting the collected indicator data in longitudinal run charts supports teams in monitoring the effect of their QI effort. After identifying the opportunities for improvement, the second section discusses how to reduce practice variation. This includes selecting the `package' of clinical actions to implement, identifying subsidiary actions to achieve the improvement aim, designing the implementation strategy and ways to incentivise QI.

An analysis of patient safety incidents associated with medications reported from critical care units in the North West of England between 2009 and 2012

“…Nevertheless, we suggest that the variation may represent differences in safety cultures between different units [16]; we should at least seek to explain such variation in healthcare [17] as this is likely to suggest opportunities for improving patient care [18]. The variation is particularly worrying, as, in low-reporting units, harmful incidents were as likely to be under-reported as incidents causing no patient harm, suggesting that opportunities to learn from harm were being lost.…”

Variation in quality of primary-care services in Kenya, Malawi, Namibia, Rwanda, Senegal, Uganda and the United Republic of Tanzania

“…Analysis of variations in quality of care processes can lay the groundwork for quality improvement 44 . Equipment, staffing and management factors affected quality of care and these provide concrete areas for improvement.…”

Variation in practice: should we be standardising diabetes care to improve quality?

“…One could argue that this has eroded the traditional autonomy of prescribers to choose the treatment that they considered right for 'their' patient, but considerable variation in the quality of care delivered to patients across the NHS seems to persist. 2,3 The suggestion is that many patients experience clinical encounters having not been offered treatments for their condition for which there is high-quality evidence (grade, level 1).…”