Monitoring and Learning from Variation in the Process

AFTER THE LAUNCH OF YOUR ORDER SETS AND PROTOCOLS: JUST THE BEGINNING!

At this point you should have launched your protocols/order sets at your center. What you do after this point is at least as important as what you did before you launched your order set. The team needs to devise a way to track deviation from your protocol and learn why it occurs. Practice that varies from your protocol may occur for any of several reasons:

• The protocol does not adequately address the special needs of a given patient.
• Old habits/ignorance/unwillingness to change.
• The order set/protocol is too hard to use.
• More familiar, well-known, or simpler routes to provide care are available.
• End users may not agree with standardized approach to care.

As you track variation, it will become important to determine which variation is appropriate variation and which is not. There will be patients who do not fit in your protocol. If you are finding that this is occurring more frequently than expected, it may be worth building in methods for end users to clearly document why their patients are “different.” This documentation will allow you to more easily identify appropriate variation as well as to assure that the reasons given for being “different” are appropriate. If you find that the protocol is too difficult to use, your team then needs to change the protocol so that it can be used effectively. Some behaviors, though, will require incentives to bring care into compliance with your standardized approach. A combination of positive and negative incentives may be required to improve compliance. Improving compliance also may require increased educational efforts by your team to improve understanding of the rationale behind the standardized recommendations.

However, if you do not look for variation, you will not find it. Similarly, if you do not determine why there is variation, you will not be able to adequately address issues that will improve compliance. With ongoing monitoring of the use of protocols and tools, you will be able to better respond to valid issues by adjusting your protocols and to inappropriate variability by a combination of correction methods.

TASK

Devise methods to track deviation from your protocol. Revise your protocol on the basis of feedback from users and patient needs.

Download the Task Sheet