“Variation is a thief. It robs from processes, products and services the qualities that they are intended to have… Unintended variation is stealing healthcare blind today.” Don Berwick
A core tenet of the Oxford AHSN Children’s Clinical Network was reducing variation in children’s outcomes across the region. Between 2014 and 2017 we produced three Variation Reports focusing on a range of common childhood conditions which have led to a number of locally-driven initiatives designed to reduce children’s hospital attendances and admissions.
The first two variation reports identified that, for a range of common childhood conditions, variation exists both in admission rates and length of stay. A further condition – epilepsy – was added to the 2017 report.
It is hoped that this third report will help to engender discussion between primary and secondary care providers and commissioners of children’s healthcare regarding the management of childhood conditions and continue to stimulate ideas for alternative models of paediatric care to hospital-based treatment.
In the three years since publication of the first Variation Report, the Children’s Clinical Network has begun to identify the reasons behind variation, as well as embarking on work to address variation, focusing on audit, engagement, education and guideline harmonisation. We have also explored the potential for innovations in addressing unwarranted variation, especially point-of-care testing devices that may reduce both admissions to hospital and diagnostic times in Children’s emergency departments and clinical decision units.
The Children’s Clinical Network engaged with children’s commissioners, hospital paediatric departments and primary care to identify opportunities to tackle unwarranted variation and, where possible, explore new models of care to allow children to be treated in out-of-hospital settings.
A Clinical Guideline Group, consisting of paediatric consultant leads from the five hospitals in the region with child inpatients, was established. It met quarterly, drafting and sharing guidelines for a range of conditions which are now being commonly adopted in each hospital, leading to an increased commonality of approach to diagnosis and treatment.
Funding for the Oxford AHSN Children’s Clinical Network ends from July 2017 so no further variation reports are planned.