Abstract
Presentation Managing variation is essential to quality improvement. Quality improvement is primarily concerned with two types of variation – common-cause variation and specialcause variation. Common-cause variation is random variation present in stable healthcare processes. Special-cause variation is an unpredictable deviation resulting from a cause that is not an intrinsic part of a process. By careful and systematic measurement, it is easier to detect changes that are not random variation. The approach to managing variation depends on the priorities and perspectives of the improvement leader and the intended generalizability of the results of the improvement effort. Clinical researchers, healthcare managers, and individual patients each have different goals, time horizons, and methodological approaches to managing variation; however, in all cases, the research question should drive study design, data collection, and evaluation. To advance the field of quality improvement, greater understanding of these perspectives and methodologies is needed [1].
Highlights
Clinical researcher perspective The primary goal of traditional randomized controlled trials (RCTs) is to determine treatment or intervention efficacy in a specified population when all else is equal
Patient perspective While the clinical researcher and healthcare manager are interested in understanding and managing variation at a population level, the individual patient wants to know if a particular treatment will allow one to achieve health outcomes similar to those observed in study populations
The findings of RCTs help form the foundation of evidence-based practice and managers utilize these findings in population management, they provide less guidance about the likelihood of an individual patient achieving the average benefits observed across a population of patients
Summary
Clinical researcher perspective The primary goal of traditional randomized controlled trials (RCTs) (ie a comparison of treatment A versus placebo) is to determine treatment or intervention efficacy in a specified population when all else is equal. Healthcare manager perspective Healthcare managers seek to understand and reduce variation in patient populations by monitoring process and outcome measures. Patient perspective While the clinical researcher and healthcare manager are interested in understanding and managing variation at a population level, the individual patient wants to know if a particular treatment will allow one to achieve health outcomes similar to those observed in study populations.
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