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Working in Concert: A How-To Guide to Reducing Unwarranted Variations in Care

California Improvement Network, Action Group on Variations in Care

Patients should receive the appropriate level of care — no more and no less. But how is that sweet spot determined? This guide helps organizations get started on reducing unwarranted variations in care.

Unwarranted variation in care can result in negative health outcomes for the patient and wasted dollars. Working in Concert: A How-To Guide to Reducing Unwarranted Variations in Care is a collection of lessons from pioneers in the field — clinical and organizational leaders who have addressed practice and practi­tioner variation within their own organizations. This guide is intended to help organizations get started in their work to identify and reduce unwarranted variations in care.

An action group of CHCF's California Improvement Network (CIN) developed this overview based on nine months of discussions about how each organization approaches variation reduction projects. This guide includes practical tips, case studies, and the voices of field experts. It focuses on the following key elements of addressing variation in a health care organization:

  • Make the case. Addressing variation may be unfamiliar to organizational leaders, including executives, board members, and respected thought leaders in primary and specialty care. To gain the support of leadership so that it provides the resources necessary to make the variation-reduction work possible, your team will need to set the stage.
  • Create a core team. At the heart of any effort to address variation is a dedicated core team of content experts, facili­tators, and support staff.
  • Work with clinicians. A bottom-up, physician-led approach is key to creating a robust, meaningful, and sustainable variation-reduction effort. A clinician's motiva­tion to participate is strongly influenced by the degree to which the clinician feels involved in selecting areas on which to focus attention, the provision of accurate peer-comparison data, and the freedom to develop approaches to improve outcomes.
  • Facilitate effective meetings. Thoughtful meeting facilitation helps create a safe space for physicians and other clinical staff to discuss their roles in addressing variation. The facili­tator's role is to keep the meeting participants focused on the data, stimulate a discussion on why the differences exist, and move the group to a decision on an aspect of their practice that would benefit from further examination.
  • Measure value. Value is the balance between quality and afford­ability. To measure value, plan to track both from the outset.

The guide is available as a Document Download below.

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