As a healthcare professional, you strive to provide care in accordance with the latest evidence-based medicine. But reducing variability of care within your healthcare organization is also important not only to improve patient outcomes, but for the benefit of the entire organization and its employees, as well.
Variability of care, or inconsistent care practices, affects multiple aspects of healthcare delivery. By reducing variability of care, you can help in improving patient safety, reducing healthcare costs, and improving key performance indicators (KPIs) for both individuals and the healthcare system as a whole. A team approach can help you find viable solutions that can be easily implemented within your organization.
Variability of care often boils down to two separate issues: operational variability and knowledge variability. Inconsistencies can occur in both of these areas and can span various practice areas and healthcare providers, including nursing staff.
Operational variability refers to differences in care delivered directly by nurses, doctors, pharmacists, and any other patient care providers. While each provider delivers care based on an understanding of the patient’s diagnosis and treatment plan, there can be significant differences in the way care is actually delivered. In many cases, irregularities occur around a single activity somewhere along the care-delivery process.
In contrast, knowledge variability refers to differences in expertise among medical staff. This type of variability is often difficult to assess because it’s based on an individual provider’s educational and experience level. Knowledge variability can also be traced to the wealth of medical research occurring each year. It’s hard to stay on top off the latest trends when recommendations for evidence-based practice change frequently.
When care is standardized, patient outcomes improve. Recent research involving the implementation of care bundles to prevent surgical site infections (SSIs) demonstrated a significant reduction in SSI rates, compared with patients receiving non-standardized care. The study showed that SSIs occurred in 7% of patients receiving care according to a specific care bundle, compared with infections in 15.1% of cases in which care bundles weren’t used.
In addition, delivering standardized care based on evidence helps keep costs down — for both patients and healthcare organizations. It’s estimated that inconsistencies in care account for 14–16% of total healthcare spending within the United States. Developing methods for delivering consistent care could save hospitals anywhere from $50 million to $150 million.
In addition to care bundles, nurses and other clinical leaders can take further steps to reduce variability of care. In general, these efforts shouldn’t be targeted at individual clinicians because individual performance indicators can be difficult to measure reliably. Instead, these efforts should be implemented on a system-wide level.
Developing — and following — specific clinical practice guidelines helps providers make important care decisions in a uniform manner while still accounting for variety among patients. Other tools, such as process checklists, can benefit staff by ensuring certain procedures, such as blood draws, are followed in the same manner every time care is delivered.
If your organization needs to reform practice procedures and guidelines, it can help to focus on one improvement effort at a time. Some hospital systems focus on one disease process when developing clinical care pathways that standardize treatment. For example, your hospital may have high rates of admissions related to atrial fibrillation (AFib). Identifying areas in which your organization can improve its treatment of AFib patients and implementing changes to the delivery of that care based on the latest research is achievable with a focused team effort. Once improvements are made and performance measures improve, a new area of care can be targeted for standardization.
It can be very helpful to employ clinical consensus groups, which may include care providers from multiple medical and nursing disciplines. These groups help effectively ensure procedures and processes are standardized according to the needs of specific patient populations and the organization itself. Within these groups, nurses are in prime position to advocate for reducing variability of care. By interviewing nurses and utilizing nursing research through such means as patient outcome statistics, patient case studies, and patient interviews, you can gather ample information to help you identify areas that can be improved with evidence-based standardized processes.