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A MASTER CLASS IN UNDERSTANDING VARIATIONS IN HEALTHCARE
Author(s) -
Mohammed M.
Publication year - 2006
Publication title -
cytopathology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.512
H-Index - 48
eISSN - 1365-2303
pISSN - 0956-5507
DOI - 10.1111/j.1365-2303.2006.00392_9_1.x
Subject(s) - variation (astronomy) , statistical process control , health care , operations research , league , cusum , corporate governance , quality (philosophy) , process (computing) , computer science , law , management , statistics , political science , economics , epistemology , mathematics , philosophy , physics , astronomy , astrophysics , operating system
That there is wide‐spread variation in healthcare outcomes cannot be denied. The question is what does the variation mean and what can we do about it? Using a series of well‐known case‐studies, which include data from the Bristol and Shipman Inquiries, fundamental limitations of traditional methods of understanding variation will be highlighted. These methods, which include comparison with standards, league tables and statistical testing, have flaws and they offer little or no guidance on how to re‐act to the variation. Fortunately, there is a theory of variation that overcomes these limitations and provides useful guidance on re‐acting to variation, which was developed by Walter Shewhart in the 1920s in an industrial setting. Shewhart's theory of variation found widespread application and won him the accolade ‘Father of modern quality control’. His work is central to philosophies of continual improvement. Application of Shewhart's theory of variation, also known as Statistical Process Control (SPC), to case‐studies from healthcare will be demonstrated, whilst highlighting the implications and challenges for performance management/monitoring and continual improvement in the healthcare. References: 1. M A Mohammed, KK Cheng, A Rouse, T Marshall. “Bristol, Shipman and clinical governance: Shewhart's forgotten lessons” The Lancet 2001; 357: 463–7. 2. P Adab, A Rouse, M A Mohammed, T Marshall. “Performance league tables: the NHS deserves better” British Medical Journal 2002; 324: 95–98