Unwarranted variation remains one the greatest challenges for NHS leaders, but it also represents one of the biggest saving opportunities. It is therefore no surprise that it is the source of considerable debate.
HSJ recently compiled an online guide, to showcase case studies of work being done to tackle variation and to highlight views of NHS leaders. It’s clear from reading that a number of beneficial programmes are in use, and savings however small are being realised.
Medway Foundation Trust
One of the case studies included highlights how Medway Foundation Trust have transformed their A&E department to tackle unwarranted variation. Dr Sandip Banerjee, a Consultant Physician at Medway hospital reveals how the introduction of an ‘Ambulatory Unit’ has reduced patient waiting times in A&E, reduced the average time patients spend in hospital and limited the level of variation between different physicians, consultants and doctors.
The Ambulatory Unit reviews GP referrals (to A&E), actively transfers patients from A&E, and facilitates discharge of patients who may require further assistance, by setting appropriate follow up appointments in 48-72 hours. In doing so it improves upon the previous system, which would frequently see patients waiting until the following day to be assessed by a specialist doctor. Most importantly however, it limits the frequent handover of patients and reduces the risk of unwarranted variation.
This case study demonstrates just one of the many areas that tackling unwarranted variation can lead to tangible benefits for a health organisations. Substantial blockers remain however, and to make durable progress we must address the fundamental causes of unwarranted variation.
First and foremost, Trusts and individual clinicians must be made aware of possible variation, particularly where it is leading to worse outcomes for their patients. As suggested by Jane Matcalf, Deputy Medical Director at North Tees and Hartlepool Foundation Trust, good data may exist but it is not currently accessed by everyone. ‘I only heard of the Atlas of Variation through my CCG work. My colleagues in the trust are not aware of it. If people are not aware of what variation is how can they compare themselves?’ (Jane Matcalf).
psHEALTH’s referral management system drives actionable real-time data, that can be used to analyse individual practice and GP behaviour. In doing so it is quickly possible to identify outliers and abnormalities, which may indicate unwarranted variation in primary care. To find out more about psHEALTH’s referral management system please contact firstname.lastname@example.org.