Investigating apparent variation in quality of care: the critical role of clinician engagement

Abstract

This article reports the experience of the Victorian Department of Health in seeking clinician engagement in the testing of 11 quality-of-care indicators in 20 health services in Victoria. The Department previously developed a suite of 18 core indicators and seven subindicators known as the AusPSI set. We used routinely collected administrative data from the Victorian Admitted Episodes Dataset to produce variable life-adjusted display (VLAD) control charts for 11 selected indicators. The Department recognises that clinicians are responsible for the safety and quality of the care they provide, and therefore the necessity of engaging clinicians in the process of investigating apparent variation in patient care. Although using readily available and inexpensive routinely collected administrative data to measure clinical performance has a certain appeal, the use of administrative data and VLADs to identify apparent variations has posed significant challenges due to concerns about the quality of the data and resource requirements. When clinicians at a major Melbourne hospital were engaged, it resulted in an improvement in clinical practice. Investigating apparent variation in patient care provides an ideal opportunity for emerging clinical leaders to take local ownership and develop expertise in investigating apparent variation in processes of care and implementing change as required.