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Health Care Leader Action Guide: Understanding and Managing Variation

Health Care Leader Action Guide: Understanding and Managing Variation

Health Care Leader Action Guide: Understanding and Managing Variation builds upon the report of the American Hospital Association's Task Force on Variation in Health Care Spending (January 2011). The purpose of this guide is to provide hospitals with a resource to help reduce inappropriate variation within their own organizations and in conjunction with care partners. The guide includes practical steps to understanding and managing variation and a list of best practices and case studies as examples and resources for hospital leaders to use for implementing key interventions.

Variation arises from many interrelated factors, some within and some beyond the control of the health care system. Not all variation is undesirable or inappropriate. Distinguishing among the types of variation to determine what is acceptable and what is not is critical to arriving at a reasonable set of recommendations for action. Hospitals and health systems can take these action steps alone or in collaboration with others to reduce inappropriate variation within their organizations.

There are six steps to understanding and managing variation:

  1. Determine your strategic focus to reducing variation
  2. Set measurable goals
  3. Acquire and analyze data
  4. Understand your data
  5. Identify areas of focus
  6. Implement improvements

Research has shown that some of the greatest potential areas of focus include:

  • Intensity
  • End-of-life care
  • Outpatient/ambulatory services
  • Obstetrics
  • Imaging use
  • Emergency services

To address these focus areas, there are a variety of improvements to implement, including:

  1. Providing feedback of performance data at the provider level
  2. Standardizing processes of care by using checklists and other clinical and operational protocols
  3. Implementing evidence-based guidelines and pathways
  4. Utilizing evidence-based appropriateness criteria
  5. Using quality improvement interventions, such as Lean, Toyota Production System, Six Sigma, Plan-Do-Study-Act
  6. Initiating culture change toward safety, improvement, transparency, and excellence

By approaching the management and reduction of variation through a systematic improvement process in focused areas, inappropriate variation can be reduced to improve overall outcomes.

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