k. visvanathan - exploring variation in clinical practice

Let’s get it together!

Exploring variation in clinical practice

Let’s get it together!

Exploring variation in clinical practice

Kishore Visvanathan, MD FRCSC

Clinical Professor, University of Saskatchewan

Division Head, Urology, Saskatoon Health Region

Variation = Loss of confidenceVariation = Loss of confidence

Get your act together!Get your act together!

Office manager Nurses Cancer clinic pharmacist

Office manager Nurses Cancer clinic pharmacist

Variation = ConfusionVariation = Confusion

Average patient recall rate (%) May - August 2008

0.00

5.00

10.00

15.00

20.00

25.00

30.00

C D I F E B G A H

Doctor

Variation = WasteVariation = Waste

Dartmouth Atlas - Variation in Care Delivery

TURP for enlarged prostateTURP for enlarged prostate

9.5 per 1,000 males Idaho Falls, Idaho

1.7 per 1,000 Medicare beneficiaries Terre Haute, Indiana

9.5 per 1,000 males Idaho Falls, Idaho

1.7 per 1,000 Medicare beneficiaries Terre Haute, Indiana

Surgery for prostate cancerSurgery for prostate cancer

3.8 per 1,000 men over 65 San Luis Obispo, California

0.3 per 1,000 men over 65 Albany, Georgia

More than 12X different!

3.8 per 1,000 men over 65 San Luis Obispo, California

0.3 per 1,000 men over 65 Albany, Georgia

More than 12X different!

Prostate cancer treatment

2 XSurgery vs.

Radiation

Tu, J. et al, CMAJ Feb 7, 2012

Variation = Inappropriate care (?)Variation = Inappropriate care (?)

Reduce VariationReduce Variation^

Unwanted

Sources of variationSources of variation

System

Provider

Disease process

Patient preference

System

Provider

Disease process

Patient preference

Average patient recall rate (%) May - August 2008

0.00

5.00

10.00

15.00

20.00

25.00

30.00

C D I F E B G A H

Doctor

Sooner, Safer, Smarter

Prostate cancer surgery

2 X

Variation is a symptom, not the disease

Variation is a symptom, not the disease

…Variation is a thief.

It robs from processes, products and services the qualities they are

intended to have.

…Variation is a thief.

It robs from processes, products and services the qualities they are

intended to have.

Unintended variation is stealing healthcare blind today.

…recover a bounty in wasted resources that would dwarf the

puny rewards of cost-containment to date.

Unintended variation is stealing healthcare blind today.

…recover a bounty in wasted resources that would dwarf the

puny rewards of cost-containment to date.

Berwick, 1991

Controlling Variation in Health Care

Donald M. BerwickMedical Care

December 1991, 29(12)pp 1212-25

Controlling Variation in Health Care

Donald M. BerwickMedical Care

December 1991, 29(12)pp 1212-25