8. Innovations in Healthcare: Doing the Wrong Things Righter Management Improvement Encyclopedia: Variationby admin on 08/12/2019 1:30 AM
Variation – difference in the output of a process (or inputs to a process) over time. Variation consists of common cause variation, special cause variation and structural variation (and some include tampering).
Shewart provide the control chart as a tool to use when managing processes. The reduction of variation has profound impacts on the reduction of costs and increase in customer satisfaction.
The control chart helps identify what improvement strategy to use. This is done by helping identify when to try special cause thinking (identify the assignable cause) and when to apply common cause thinking (system improvements). It is possible to make up “assignable causes” for common cause variation. This is what we often do. The control chart is meant to help us avoid looking to that form of thinking and instead in cases where a special cause is not indication to use system improvement thinking instead.
Special cause thinking should be used when point is outside the control limits (more than 3 standard deviations away from the mean) of there is a pattern in the data that indicates a special cause. These patterns are often known as the western electric rules.
- common cause variation – variation resulting from the system. Every system will have some amount of variation of results. The way to improve common cause variation is to change the system.
- special cause variation – variation resulting from an assignable cause. Special causes should be addressed by finding the special cause and taking action. Special Causes can be beneficial, in which case identify the cause and seek to incorporate it in the standard practice.
This is very complicated and points out why TOP DOWN healthcare management will never process all the variables in the healthcare system appropriately. Therefore, vertical healthcare will never benefit all the components of the Healthcare system. Beneficence will only happen when all elements of health care are on the same or horizontal level. But none of the stakeholders in the Healthcare Industry Complex will give up their turf. Hence, there will never be an appropriate reform of healthcare that is dependent on the stakeholders.
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The majority of alleged innovations do NOT improve healthcare.
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