Reducing Clinical Variation As Healthcare Business Strategy

It’s not always easy for healthcare executives to find actionable content and prescriptive advice about the complex and costly clinical supply chain. This is a space we know well, and we want to help with challenges you face.?

This piece is broken down into three areas of guidance for healthcare leaders around the important topic of clinical variation and your business strategy.

What Leaders Should Know About Clinical Variation?

Clinical variation is defined as differences in practices and outcomes among patients with similar conditions. Additionally, variations can be warranted or unwarranted. These thoughts are about the business opportunity with unwarranted clinical variation.?

The Journal of Precision Medicine lists the following examples of the root causes of unwarranted clinical variation:

• Sense of craftsmanship: “This was how I was trained.”
• Complexity: “Modern medicine exceeds the capacity of the brightest clinical mind.”
• Diagnosis variation: “I’ve seen this kind of patient before.” This hospital does it like XYZ.”

Reducing clinical variation requires strong leadership, because compliance with evidence-based best practices is not automatic. Minute 13 in this video presentation describes a study where less than 4% of 350 German ICU physicians followed established best practices on effective use of medical ventilators. People’s behavior varies, and it takes strong and consistent leadership to ensure clinical variation reduction efforts stay on track.

Take a look at one of Curvo’s Executive Views discussing how healthcare leaders can influence behavioral change within their organization’s physician community.?

What Healthcare Can Learn From the Scientific Method?

Critical-to-quality (CTQ) is a key concept in reducing variation and waste. The CTQ concept is constantly asking “Is this required? When using the CTQ method, we must first identify characteristics critical to the customers’ perception of quality. What does the provider really need? What does the payer really need? What does the patient really need?

The healthcare industry needs to move away from the idea that “more” is better. More tests, more medication, etc. We should focus on meeting the clinical requirement. There is no need to go beyond.

A simple example of CTQ is asking if another round of lab tests on a patient is necessary. Will the additional lab test be valuable to the patient, provider or payer? If the answer is unclear, the clinical requirements have likely already been met.?

Ideally, the approach to healthcare should utilize the scientific method. We should test what works, then do that every time, without unwarranted variation.

Below are some useful frameworks to begin your journey of reducing unwarranted deviations of clinical processes.There are 8 types of waste organizations can target. They are referred to by the acronym TIMWOODS:

1. Transportation: Moving around unnecessarily
2. Inventory: Any unused materials is wasted capital
3. Motion: Excessive bending, turning, reaching, etc.
4. Waiting: Time wasted
5. Over-processing: Doing more than is necessary
6. Overproduction: Making more than is necessary
7. Defects: Imperfect production, requires re-work
8. Skills: Under-utilizing capability, lack of delegation

Another key building block in reducing clinical variation is establishing trust with your physicians. Read Curvo’s blog post on tactics and strategies you can use to build trust with your surgeons.

Lastly, here is an excellent book on quality improvement for healthcare: Memory Jogger.?

Physician-Led Process to Reduce Variation

While reducing variation is difficult, it is achievable. This article on Intermountain Healthcare is an excellent example.

Intermountain Healthcare has a physician-led process to create / refine standard protocols. Here are some highlights:

• Alan Morris, MD launched this effort in the early 1980s.
• They have gone through this process for 50 conditions, covering 50% of patients.
• Adverse drug events were cut by 50% in the 1990s.
• Acute respiratory distress (ARDS) survival rates are 10%, vs. 40% at Intermountain.
• Death rate for coronary-bypass surgery is 3% in the US vs. 1.5% at Intermountain.

As a strategic business topic, clinical variations might not have been on your radar before. Now, it may have moved up the priority list. Reach out if you have any questions about a solution.