Question

Identify one area in which data and charts can be used to illustrate a potential process improvement opportunity in your current practice area and give 2 examples of potential variation (common cause or special cause) that might occur. (It can be at a hospital or clinic or any healthcare facility)

Answer 1

Ans. Variation—in clinical workflow efficiencies, processes, and more is one of the biggest challenges healthcare organizations face in outcomes improvement work.

Today, healthcare is increasingly recognizing the relationship between reducing variation and improving outcomes. Interventions to reduce variation for a targeted process can improve care by establishing consistency based on best practices. The industry’s evolving data capabilities, such as Late-Binding technology, are expanding health systems’ ability to reduce variation in delivery.

Creating new protocols, however, such as bundles of care and care processes based on best practices, is only one step toward reduced variation. Organizations also need to develop strong analytic solutions to evaluate the effectiveness of these outcomes improvement initiatives and, perhaps just as importantly, create methods to track the decision-making process and rationale in instances when these initiatives are not followed.

The ability to identify the type of variation, as well as when it occurs and why, is fundamental for healthcare improvement. Patients frequently present to clinics or hospitals with varying degrees of complexity and other unique circumstances. For example: Two patients present to the emergency department with pneumonia. One has a history of renal failure and severe chronic obstructive pulmonary disease, while the other has no significant comorbidities. The ED physician will likely treat each patient differently. This can include the use of distinct antibiotics, based on types of bacteria associated with severe COPD. Each patient (the one with renal failure and COPD, and the one with no comorbidities) may also receive antibiotic treatment at different dosages and frequencies.

The type of variation described above in which care is altered to serve the needs of a specific patient is considered appropriate, or intended, variation. Conversely, if the above patient with renal failure and CPOD were treated in the same way as the patient without these comorbidities (with the same antibiotics at the same dose and frequency), then they might be at risk of another form of variation: unintended, or unwanted, variation. This form of variation occurs because the patient was not treated per their specific needs. As such, unwanted variation is responsible for suboptimal outcomes, including increased morbidity and mortality.

The opportunity to reduce variation in outcomes improvement work lies in unwanted variation: by working towards data-driven best practices that reduce variation, health systems further quality improvement by taking actions that support better care and reduced cost.

To improve quality and lower cost, health systems need to identify the causes of unwarranted variation in outcomes, and develop ways to manage them. A failure to combine analytics with best practices and adoption principles can result in suboptimal outcomes and higher costs which directly oppose the goals of healthcare improvement.

Control charts monitor the extent to which variation is occurring. They also determine if the variation is caused by sources common (stable and predictable) to the process, or if it’s the result of special causes (unpredicted events or processes that are significantly different from usual practices).

For example, a certain hospital is in a region participating in the CMS Comprehensive Care for Joint Replacement payment model. The hospital’s Outcomes Improvement Team is working to improve the quality of care for patients having a total hip or total knee replacement surgery. They are currently focusing on a process to ensure that patients with diabetes have a preoperative hemoglobin A1C result to confirm that their diabetes is being controlled (otherwise, surgery should be postponed).