Standard 38: The information gathered through regular review of ICPs and from analysis of variance is leading to practice and service change.

Criteria
38a The multi-agency and multidisciplinary care team reviews individual and grouped variances.

38b The local management team reviews grouped variances to identify areas where service re-design can improve service delivery.

38c The NHS board and local authority care governance structures receive collated ICP variance reports.

38d All stakeholders are given feedback on the actions taken in response to variances.

Structured system:
For variances to be recorded and tracked, a structured system needs to be in place. The method devised should be:
- quick
- intuitive
- accessible
- meaningful
- part of routine record keeping, and
- clearly linked to the relevant activity.

Suggested steps to implement service improvement standard 38:

1. It is important to first agree what key variance points will be collated and how often they will be analysed.
2. The key variances should be agreed and communicated to the full care team to ensure that everyone records this information in the first place.
3. One individual should be allocated the task of collating the variances for each client group. This task needs to be part of their job plan with appropriate time designated to fulfil this role.
4. Data should be presented in graphical format for easier communication of numerical information. Training may be required in data extraction, graphical presentation and communication skills.
5. When these data are presented, reasons for deviation from ICP care should be stated and discussed. These may be due to individual clinical judgement, operational / system unavailability or service user choice.
6. Information on what should happen next needs to be fed back to individual care teams to rectify any elements of care that may have been missed out.
7. In cases of aggregated variances that cannot be rectified by the care team alone, these should be discussed at a local management level to identify areas where service redesign can improve service delivery.
8. In cases where the local management team alone is not able to implement improvements, the variance information should be escalated up to NHS board and local authority care governance structures for action.
9. A record of the action taken and the outcome should then be recorded and fed back to front-line staff.