Is Variation the Enemy of Quality?

by | Mar 22, 2019 | NSQHS

Early in my career I thought of it like this. If things differ then outcomes also must differ so if we standardise care then quality follows. Neat, easy and of course as luck would have it, this turns out to be right – and wrong.

Some standardisation often helps but only up to a point.

Does it matter?

Well it does if it means we miss some important insights that can help us.

When we look at things from an overall healthcare value perspective some providers are clearly safer and more efficient. Natural experiments are going on every day with different ways of doing most things. When we start to look around interesting possibilities often emerge.

Actually Dr E Demming said “Uncontrolled variation is the enemy of quality”.

Once an organisation is continuously measuring care in a stable way, varying something consciously and constructively to see what happens helps us learn how to improve it.

Our use of analytics allows us to control that variation. To look through a lens of value because within that variation there often lies excellence.

In my experience there is some variation that delivers low-value care but in other areas variation can also be the source of many new innovations and improvements. In the end it’s about how we can harness variation to be our friend while understanding its limitations.

I would be greatly interested to hear your thoughts?



Dr Chris Farmer

Clinical Director, Metrixcare