To address the vast “know-do” gap in healthcare—the gap between what is known and what actually happens in practice —providers must consistently apply knowledge-based practices across the care continuum.
By 2020, global spending on healthcare is projected to reach $8.7 trillion – and closer examination reveals approximately one-fifth of healthcare investments are “wasted” on clinically ineffective care delivery. Some of these wasted expenditures trickle down from the clinical choices made by providers.
A focus on evidence-based practices and clinical decision-making has emerged in recent years, as the industry takes cautious steps toward improving existing workflow and management processes to reduce unwarranted care variations, and deliver more effective care. However, in order to support these changes, it’s vital to recognize why care variations in healthcare delivery occur in the first place.
5 Factors for variations in care
- Textbook variations. Clinicians may embrace a broader scope of treatment practice and approach that falls in line with their initial training, and/or in accordance to how fellow clinicians would handle a similar scenario. One example is the use of beta-blockers after acute myocardial infarction (MI). According to Dartmouth Atlas of Health Care data, in 37 hospital referral regions, the range of beta-blocker use varied from 40% to 83%.
- Options, overload. when there are too many options for treating a particular illness or condition. Even when taking into account the importance of a patient-centric approach, patients may not be equipped with the appropriate information, or have the capacity to make informed decisions.
- Medication mistreatment. From inappropriate therapies, adverse drug events and dosing problems, medication errors can have a devastating impact on patients, and can occur across all stages of a treatment process (i.e. prescribing, order entry, dispensing, administration and instructional processes.)
- Biased bedside access. Even limited bed-count supply can contribute to discrepancies in patient care delivery and appropriate treatment/service options.
- Circumventing evidence. Even providers who incorporate evidence-based research aren’t necessarily delivering evidence-based medicine. These gaps arise when these important steps aren’t followed: finding the research or evidence; appraising the evidence; implementing the evidence; and evaluating practice changes and patient outcomes.
Looking to the future
To improve quality while managing costs, healthcare organizations must do their part and take measures to improve service delivery and operations, while clinicians must consistently apply best practices based on evidence and experience and work with patients to achieve optimum care. Only when healthcare systems commit to achieving clinical effectiveness within broad-scale practice across all institutions will we begin making progress on balancing the quality/cost equation.
2017 Global Health Care Outlook – Making Progress Against Persistent Challenges, Deloitte.
Unwarranted variation in healthcare delivery: implications for academic medical centres, Wennberg, JE, Health Affairs.