Feature Quality of Care

On the origin of variation

BMJ 2009; 339 doi: https://doi.org/10.1136/bmj.b5071 (Published 02 December 2009) Cite this as: BMJ 2009;339:b5071
  1. Nigel Hawkes, freelance journalist
  1. 1London
  1. nigel.hawkes1{at}btinternet.com

    Are differences in practice an indication of wasted resources or the key to innovation? Many voters at the recent King’s Fund debate, were persuaded that the answer depends on the underlying evidence, as Nigel Hawkes reports

    Variety may be the spice of life, but does it enhance the flavour of health care? To some, it is intolerable that patient A is treated one way while patient B (with the same condition) gets different care; to others, this very difference is what drives improvement. In a vigorous and entertaining debate at the annual conference of the King’s Fund at the Royal College of Physicians on 24 November, both sides were given their say.

    If it wasn’t for variation, we would all still be single celled amoebae in the primeval swamp, said Robert Lechler, vice-principal (health) of King’s College, London, calling on Darwin’s On the Origin of Species on the 150th anniversary of its publication. He was opposing the motion that “This house believes the NHS should strive to eradicate all unexplained variations.” To do so meant mediocrity, asserted Professor Lechler.

    On the contrary, said Jag Ahluwalia, medical director of Cambridge University Hospitals NHS Foundation Trust. Huge variations in care were an affront to medicine, and it was a doctor’s clinical and professional duty to eliminate them. “Ethically, variations in care …

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