Unwarranted Clinical Variation

Unwarranted clinical variation (UCV) is an ongoing barrier to providing safe and effective care for patients. Recognising and addressing UCV has been identified as a shared priority across the NSW Health system.

By definition unwarranted clinical variation is 'variation that cannot be explained by the condition or the preference of the patient; it is variation that can only be explained by differences in health system performance'.[1] It can reduce safety, quality, performance effectiveness and efficiency outcomes.

The ACI has been working with clinical networks and local teams to build a robust approach to investigating clinical variation. This includes a method which uses several data sources that flag variation in inpatient care may exist. These sources include service utilisation data from the admitted patient data collection and Bureau of Health Information (BHI) ‘Healthcare in Focus’, reports.

Given these initial flags indicating variation across the system ACI has subsequently been partnering with clinical teams to investigate variation using clinical audit tools. The audit tools have been designed to benchmark care against evidence based guidelines. Clinical audit data empowers individual sites to assess their clinical practice and identify areas for improvement.

The ICV project will be evaluated using linked patient level data including patient reported experience and outcome measures. Staff experience and process measures will also be used to evaluate impact of the ICV project on the health system.

Investigating Clinical Variation

Kate Lloyd, A/Director, Acute Care, ACI, talks about the why, what and how of the Investigating Clinical Variation project. The project focuses on chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHR)

Chronic Heart Failure

Professor Andrew Sindone, Co-Chair ACI Cardiovascular Clinical Expert Reference Group, talks about chronic heart disease

Chronic Obstructive Pulmonary Disease

Darren Pulleyblank, CNC Respiratory, discusses Chronic Obstructive Pulmonary Disease

The ACI approach to investigating clinical variation

Process Diagram - Local Decision - Data Triangulation - Quality Improvement Collaborations - Evaluation

ACI Support Model

The following can be tailored according to the local needs:

Kate Lloyd, A/Director, Acute Care, ACI, talks about the process and support from the ACI available to implement the Investigating Clinical Variation project.


  1. Australian Commission on Safety and Quality in Health Care. 2017. Clinical Care Standards. Available from: https://www.safetyandquality.gov.au/our-work/clinical-care-standards
Last updated: 5 Apr 2018

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Olivia Hibbitt
UCV Program Lead, ACI
02 9464 4624