Exposing variation can inspire investigation, learning, improvement, or excuses. Which will you choose?
A few years ago, when I started writing and organizing my upcoming book, "Navigating to Value in Healthcare," the first outlines I imagined involved starting off with big, bold concepts to address challenges in healthcare and then finally drilling down to detailed explanations of key pieces of building value within an organization. The more I wrote, the more I came to see that I had it backwards.
As it turned out, all of the big-picture healthcare concepts I had thought should be at the front eventually found themselves at the back of the book. The key pieces of building value that needed to be at the front were less flashy but undeniable. And the first element that called for the most attention, was variation.
The major emphasis of my academic and consulting work is helping healthcare organizations create clinical and financial success in a new payer environment that is based on providing value rather than relying on volume. To do this requires instilling a deep understanding into the organization of how the quantity and quality of their services compare to similar organizations, and by driving their performance toward outcomes that matter most to patients.
Variation looms heavy over everything you try to do to get there, and at times can be seen as a dark nemesis. Instead, I would like to suggest it is a shining opportunity. It is an opportunity because the answers you need are frequently “right there” in the data. Best practices within an organization can be identified and by simply asking and listening you can find what is needed to achieve those best results.
While I believe that almost everyone in healthcare wants to provide the best outcomes, and safest, highest-quality care at the lowest cost, reality does not match those lofty goals. Unwarranted variation in healthcare delivery has been studied for nearly a century for its negative effects. It has been consistently shown there are variations in the outcomes, quality, and costs associated with the delivery of healthcare services everywhere, much of which is not easily explained between healthcare organizations that are considered “best in the world.” Moreover, a great deal of variation exists even within “best in the world” organizations and when these findings are revealed it creates fear and anger.
We need to talk about the fear variation can create in organizations because we have to get past that fear so we can do our good work.
The biggest thing people fear about exposing variation is that the organizations or individuals involved will be ranked, and then those on the “bad end” will be spanked—called out for their underperformance and punished. Next, they are often left in the dark by their leaders about how all of this data they are collecting will be used in the end. This creates anxiety around how the data is collected, retrieved, organized, and displayed. This can raise hostility because people can come to feel as if they are unfairly evaluated.
If you want your organization to evolve into one that is characterized by anger, fear, cynicism, and resistance, just dump in a bunch of data without explanation and start “ranking and spanking.”
If you would rather create a transformative, agile learning organization that exceeds the expectations and needs of the people it serves, you need to harness variation and use it to create greater value. To harness variation, wise leaders must inspire people to collaborate, innovate, and adapt, in order to harness the opportunity that variation presents. In the next article, I will offer a few techniques and tips for making that happen.