Variation in care delivered and health outcomes

Appropriate care means that patients are receiving the right health care, at the right time, from the right healthcare provider. The health care offered should also be informed by the best available evidence. However, healthcare interventions and outcomes vary between populations and across geographic areas, services and healthcare providers. Understanding this variation is critical to improving the quality and appropriateness of health care. Some variation is desirable and warranted, as it reflects differences in people’s healthcare needs and preferences. If variation is unwarranted, it signals that people are not getting appropriate care and presents an opportunity for changes and improvements. Figure 3 describes this concept in more detail. 

Figure 3: Understanding healthcare variation

Healthcare providers have a professional responsibility to review the care they provide and to participate in efforts to address unwarranted clinical variation to improve the quality of care.

• What areas of clinical practice has your healthcare service reviewed for variations in health care? 
• What reasons, if any, were identified for variation? 
• Was the variation warranted or unwarranted?
• What improvements were identified and how were these improvements implemented? 
• What checks and balances are in place to ensure that patients are receiving the right care, and the right amount of care according to their needs and preferences, at the right time?

• Identify the areas of clinical practice to review the care delivered against relevant best practice. This may be based on the population served, the common services provided or high-risk services. 
• Discuss or review how services are delivered against best-practice care. This could be done via continuing professional development and documented self-reflection, peer evaluation or group evaluation within a large healthcare service. 
• Where clinical variation is identified, explore the reasons for variation, determine if the variation is warranted or unwarranted and identify areas for improvement. 
• Act to improve the appropriateness of care
  • specify the desired goal for improvement 
  • explore the reasons for current practice 
  • identify the barriers or enablers for any desired change in practice
  • make changes to healthcare processes 
  • monitor progress and make further changes as necessary.
• Maintain records of reviews and actions taken as a result of examining the variation and the appropriateness of care.

• The type and comprehensiveness of evidence used is dependent on each healthcare service context, but could include:
• Records of continuing professional development and self-reflection 
• Records of clinical practice audits where service delivery was compared against best-practice guidelines and opportunities for improvement identified 
• Reports that compare clinical practice using external sources such as the Australian Atlas of Healthcare Variation, or data provided by or shared with external organisations such as Primary Health Networks or professional organisations 
• Examples of improvement activities that have been implemented and reviewed to reduce unwarranted variation, including relevant clinical care standards.

Commission resources

• User Guide for the Review of Clinical Variation in Health Care – provides practical guidance, including clinical case studies, on how health services can review clinical practice and address unwarranted variation, based on the NSQHS Standards. The principles and strategies are broadly applicable.
• Better Care Everywhere program series – explores why healthcare variation happens and what can be done about it.
• Australian Atlas of Healthcare Variation series – presents maps of variation in care, derived from information routinely gathered by the health system, which show how healthcare use differs across the country. 

Other resource

• NPS MedicineWise: Clinical case studies – supports reflective learning to inform clinical decision-making.