Reducing unnecessary variation continues to be a hot topic in healthcare. Knowing where and how your organization plans to address variation is key to measurable, sustainable improvement.
Working with leading healthcare organizations across the continuum has led our team to identify a framework for success in efforts to reduce variation in care.
1. Identify Opportunity
Understand which areas are not meeting benchmarks, and dive into what actions and procedures are driving the variation in outcomes. This effort should examine clinical outcomes and financial and operational data, along with observations and discussion amongst clinical improvement teams. Clinical outcomes are incredibly important, as patients and reimbursements are impacted, but hospitals and health systems also have to operate sustainably in order to continue to provide essential care. Between January 2010 and January 2018, 83 rural hospitals closed their doors – and the trend is not expected to slow.
As with any effort, organizations should prioritize their efforts – whether based on the expected results or system-wide goals, choosing a focus area or areas is a key component of performance improvement. Weighing clinical variation against issues that are creating a significant financial burden will allow organizations to prioritize high-impact initiatives.
2. Align Initiatives
Getting the clinicians and providers who do the work on board is essential – and their input can provide insight into where processes are breaking down. By creating specific action plans that assign accountability to care teams and providers, organizations can measurably improve outcomes and reduce variation.
Too often, system-wide initiatives diverge from what stakeholders are being asked to do, which creates conflicting priorities and decreases the chances of success. Care teams are already overwhelmed and doing the best they can, and assigning performance goals that are not aligned to organizational objectives creates an unnecessary conflict.
3. Change Behavior
Behavior change is often the hardest part of reducing variation, and in truth involves two fundamental elements (at least).
Written Standards of Care
Without written processes for normal and abnormal cases, variation is an expected outcome. This is an important data point in understanding why certain outcomes are negative and a fundamental element of empowering providers. Drilling into specific cases where variation exists often reveals that standards were not followed – if there are no clear, documented standards, then the argument can be made that whatever outcome resulted should be expected.
Care teams should also be able to reduce their cognitive load by referring to a clear standard of care. Burnout is rampant in healthcare, and asking providers and clinicians to store standard processes mentally in high-stress situations involving patient lives places additional strain with no real gain.
Understanding of Knowledge and Skill Gaps
Identifying where care teams are lacking knowledge or skills helps your organization gain insight into why variation continues to exist. With continuing education often centered around compliance or organizational goals, knowledge or skill deficits go unaddressed and can contribute to negative patient outcomes.
4. Assess Outcomes
Monitoring improvement efforts and adjusting efforts as necessary ensures that change is happening. The same data that was used to identify and prioritize improvement efforts should be used to measure the success of initiatives. As efforts to reduce variation produce sustainable improvement, organizations can reassess areas of focus and continue to deliver better patient outcomes, reduced costs of care, and improved population health.
Every team will approach these key components in their own way, but using these building blocks to approach change will help your organization to overcome common barriers and increase the likelihood of success.
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