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Variation Monitoring

Monitoring Variation in Clinical Practice and Health Outcomes ... Western Health systematically monitors the quality (appropriateness and effectiveness of health care) by routinely collecting, analysing and reporting health-related information.

Clinical practice and health outcome variation monitoring is a critical component of the cycle of monitoring, improving and evaluating our provision of Best Care and supporting care that is person-centred, co-ordinated, right and safe for every patient, every time, everywhere. 

Click here to view the Monitoring Variation in Clinical Practice and Health Outcomes Procedure.  

Western Health’s approach to clinical practice and health outcome variation monitoring is outlined in the graphic to the left. The process  is to collect data on clinical practice and outcomes and use Internal and External Registries / Databases to generate reports that include trending and benchmarks to identify variation in clinical outcomes and outliers. Clinicians, through operational and committee lines, review this variation data to identify and adopt/apply appropriate clinical practices that are aimed at improvement.  The feedback loop provides a process for measuring the impact of adopting/applying these clinical practices on clinical outcomes.   

Data collection methods utilised within Western Health to support the routine collection, analysis and reporting of health-related information include:

Clinical Audit
An audit is a systematic, critical review of the quality of clinical care against explicit criteria or recognised standards. Types of clinical audits used at Western Health include:

  • Point prevalence – this is an observational audit across the organisation to determine the prevalence of the care standard in question, at a single point in time. This is supported by manual audit processes, as well as real-time data drawn from Western Health’s Electronic Medical Record (EMR).
  • Best Practice clinical audit of care process – this is a regular collection of data that indicates compliance with a process.
  • Sampling – where a small number of observations or reviews of clinical records are conducted to get a sense of whether an issue might be occurring.
  • Healthcare Event Surveillance – incident review, infection surveillance.
  • Patient and Staff Feedback / Engagement – surveys, complaint review, staff engagement in training.

Click on this link to access a listing of scheduled Audits aligned with the NSQHS Standards.

Clinical Quality Registries
Clinical quality registries are organisations that routinely collect, analyse and report on health-related information. The data collected is used to identify benchmarks and variation in clinical outcomes. The clinical registry organisations feed this information back to clinicians to inform clinical practice and decision making.

Western Health contributes data to a number of established clinical registries, with specialist clinical groups using information generated from these registries as part of their data analysis.

Click here to access Western Health’s Clinical Registry Listing

Monitoring against Clinical Care Standards
A Clinical Care Standard is a small number of quality statements that describe the care patients should be offered by health professionals and health services for a specific clinical condition or defined clinical pathway in line with current best evidence. Clinical Care Standards can play an important role in delivering appropriate care and reducing unwarranted variation, as they define the care people should expect to be offered or receive. Click on this link to view WH Monitoring practice against Clinical Care Standards published by the Australian Commission on Safety and Quality in Health Care.

Principles Guiding Clinical Variation Monitoring
The principles guiding clinical variation monitoring within Western Health include:

  • Priorities for monitoring variation in clinical practice are based upon clinical risk, performance indicators, and external requirements.
  • Patient safety and quality of care are regularly monitored, reflecting identified best practice clinical care standards, clinical risks and targeted improvements.
  • Resources available to collect and utilise data are used efficiently and electronic methods are utilised where possible.
  • Roles and responsibilities for variation method commissioning are articulated within the quality and operations teams to improve processes and outcomes for patients.
  • Data collected is accurate, timely, and used to improve patient care and outcomes.

Clinical Variation Monitoring Register
The Western Health Clinical Variation Monitoring Register outlines the breadth of data collected on clinical practice/outcome and data transferred to and analysed through the use of data collection methods. 

Staff Feedback

The annual Systems Supporting Best Care Survey includes questions on supporting and engaging staff engagement in monitoring variation in clinical practice and health outcomes.  The following is the 2019 response to these questions: