Every system has variations and variations are part of our daily practice. Describing and analyzing variability over a period of time will helps us understand how the system is working and how to predict performance and improvement.

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Introduction:
Every system has variations and variations are part of our daily practice. Describing and analyzing variability over a period of time will helps us understand how the system is working and how to predict performance and improvement. Understanding the variations through data analysis and trends provides healthcare providers key to improve delivery of care.
Variations are a major cause of quality problems and consequently many process or quality improvement activities focus on identifying and reducing variations. It is important to understand as much about variations as possible in the healthcare setting both in the micro and macro level and reducing variations in practice and in healthcare starts with collection of data. This module will discuss the basic principles of variation from standard of practice and quality improvement perspective.
Objectives:
Define variation and describe tools that measure variations
Differentiate common cause and special cause variations
Examine a histogram to uncover how process variations are revealed in central tendencies (mean, median, mode and standard deviation). (Course Objective #5)
Share examples of how variations in data:
Can be misinterpreted.
Are used to assess both the need for and the impact of improvement efforts.
Aid in the prediction of outcomes.
Cost the healthcare system in terms of resources and efficiency
Are expected in healthcare delivery
Identify differences between a flow chart, run chart, control chart
Use a run chart and a control chart to make inferences from data
Appreciate the impact of professional culture on the variability of quality at an organizational level
Explain and define what is a common cause and special cause and describe an example of how these types of variations impact your work practice. Include materials from the required readings in your discussions. Use proper APA citations.
Describe how you would apply the concept of variation in daily nursing practice.
Discussion forum:
Explain how variations in standard of practice can impact delivery of care. Provide examples.
Discuss how can these variations are detected, what are tools and methods used to detect them and use to improve process and practice
Post your findings in the Discussion Forum: Variations in Practice.
References:
Spath, P. (Ed.). (2018). Evaluating Performance. In Introduction to Health Care Quality Management (3rd ed). Health Administration Press. (Chapter 4, pp. 79-115).
Banja, J. (2011). The normalization of deviance in healthcare delivery. Business Horizon. DOI: 10.1016/j.bushor.2009.10.006 .
Nolan, T. & Provost, L. (1990). Understanding variations. Quality Progress. Pp. 70-78. Retrieved from: http://www.ihi.org/knowledge/Pages/Publications/Understandingvariation.aspx
Ferguson, J. (2017). Reducing unwanted variation in healthcare clears the way for outcomes improvement. [web] https://www.healthcatalyst.com/Reducing-Variation-in-Healthcare-to-Boost-Improvement
Bowen, M. & Neuhauser, D. (2013). Understanding and managing variation: three different perspectives. Implementation Science. Retrieved from: http://www.implementationscience.com/content/8/51/51
Recommended Supplemental videos:
IHI Quality Improvement Games: Learning about Variation by Counting Candy https://www.youtube.com/watch?v=Z5hLrwG10m8
Debrief – IHI Quality Improvement Games: Learning about Variation by Counting Candy https://www.youtube.com/watch?v=9liODQlozWQ
HSE: Run Charts in Quality Improvement https://www.youtube.com/watch?v=ySbhsX-y8zE

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