Ep 30 is a little different! – it was originally recorded as a videocast for the Australian Safety and Quality Commission’s online program series: Better Care Everywhere, Healthcare Variation in practice – basically a conference held live online in February 2021, and later on demand. We explore ways to ‘vanish’ unwarranted clinical variation as part of your clinical governance system – picking up ASQHS Standard 1.28 on the way.
1. QUALITY QUANDARY (time 2:35)
VANISHING VARIATION: Practical Tips for Doing More of the Same
What is clinical practice variation? What we’re talking about is care practice that varies from best practice or evidence based practice or consensus practice. We discuss the why, how and what – and where it fits in the scheme of things.
S&Q Commission Atlas series and website: https://www.safetyandquality.gov.au/publications-and-resources/resource-library/nsqhs-standards-user-guide-review-clinical-variation-health-care
Clark SL, Frye DR, Meyers JA, Belfort MA, Dildy GA, Kofford S, et al. Reduction in elective delivery at <39 weeks of gestation: comparative effectiveness of 3 approaches to change and the impact on neonatal intensive care admission and stillbirth. Am J Obstet Gynecol 2010;203(5):449 e1–6.
2. DRDR (time 23:30)
In this segment we talk about anything we DID READ that you might’ve missed and we suggest you DO READ it too.
Our DRDR focus today is the ‘User Guide’ that gives practical tips and examples for working through the process of spotting and reducing variation.
Australian Commission on Safety and Quality in Health Care. National Safety and Quality Health Service Standards: User guide for the review of clinical variation in health care.Sydney: ACSQHC; 2020
3. THE POINT (time 39:15)
Today we’re talking about the consumer role in reducing variation. How do we get the consumer role happening?
Decision support tools from the AQCSQHC: https://www.safetyandquality.gov.au/our-work/partnering-consumers/shared-decision-making/decision-support-tools-patients
Llewellyn-Thomas, AM, Barry Flood, A, O’Connor HA. Modifying Unwarranted Variations In Health Care: Shared Decision Making Using Patient Decision Aids. Health Affairs, 2004. http://content.healthaffairs.org/content/early/2004/10/07/hlthaff.var.63.citation
4. TLDR (time 50:05)
Effective change is at the heart of reducing your unwarranted clinical practice variation. This Too Long Didn’t Read (or in this case, too hard!) gives some solid guidance for promoting clinical behaviour change – and it’s not what you might think.
Johnson MJ, May CR, ‘Promoting professional behaviour change in healthcare: what interventions work, and why? A theory-led overview of systematic reviews.’ BMJ Open 2015;5:e008592. doi: 10.1136/bmjopen-2015-008592
Scott IA, Kallie J, Gavrilidis A Achieving greater clinician engagement and impact in health care improvement: a neglected imperative. Medical Journal of Australia. 2020;212(1):5-7.e1.https://doi.org/10.5694/mja2.50438
5. CALL TO ACTION (time 1:02:55)
Get Going! Pick an area from our ‘get started’ list:
- something the clinicians are curious about
- monitoring data – internal and external – where you’re seeing consistent variation (is that an oxymoron?) in process or outcome data
- recurring incidents and sentinel events
- PROMs and PREMs
- risk register
- clinical areas that are high volume, high cost and high risk
- seeking HIMs guidance about variation in your organisation.
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