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9 Clinical governance of unwarranted variation in hospital care – findings from a regional audit in Norway
  1. Hans Petter Eide1,
  2. Paul Barach2,3,4,
  3. Eldar Søreide5,6,
  4. Ulrich Spreng1,
  5. Christian Thoresen1,
  6. Ole Tjomsland1
  1. 1South-Eastern Norway Regional Health Authority, Hamar, Norway
  2. 2Department of Pediatrics, Wayne State University, Detroit, Michigan, USA
  3. 3Jefferson College of Population Health, Philadelphia, Pennsylvania, USA
  4. 4Sigmund Freud University, Vienna, Austria
  5. 5University of Stavanger, Stavanger, Norway
  6. 6Stavanger University Hospital, Stavanger, Norway


Objectives There has been an increasing focus over the past decades on defining, identifying and reducing unwarranted variation in clinical practice. Several attempts to monitor and reduce unwarranted variation in utilization rates and outcomes have shown mixed results. An audit was performed to evaluate the compliance of the regional strategy for reducing unwarranted variation in outcome and utilization rates in the hospitals of South-Eastern Norway Health Authority (HSO).

Method Seventy-five mid- to senior-division and department leaders (level 2 and 3) from 8 hospital trusts in South-Eastern Norway Regional Authority were invited to participate in evaluating the compliance of the regional strategy for reducing unwarranted variation in outcome and utilization rates.

Results The audit revealed that the aim of reducing unwanted variation was not always clearly communicated by senior management. There is varying uses of data from the national quality registers and health atlases for quality improvement. Many clinical leaders experience lack of scrutiny of their work and were insufficiently aware of HSO’s top-management and hospital boards strategic expectations on the importance of reducing unwarranted hospital utilization variation.

Conclusions In conclusion, hospital top management and boards should focus on reducing unwarranted variation in hospital outcomes and utilization rates of medical interventions. The hospitals included in the audit need to strengthen their efforts to reduce their unwarranted variation in utilization rates as a key element in improving health care quality and patient safety. We believe that the findings of the audit may be relevant for other healthcare organizations when trying to improve quality and reduce unnecessary interventions.

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