Systems for reviewing and analysing variances
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.
For variances to be recorded and tracked, a structured system needs
to be in place. The method devised should be:
- part of routine record keeping, and
- clearly linked to the relevant activity.
Suggested steps to implement service improvement standard
- It is important to first agree what key variance points will be
collated and how often they will be analysed.
- The key variances should be agreed and communicated to the full
care team to ensure that everyone records this information in the
- 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
- Data should be presented in graphical format for easier
communication of numerical information. Training may be required in
data extraction, graphical presentation and communication
- 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
- 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.
- 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.
- 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.
- A record of the action taken and the outcome should then be
recorded and fed back to front-line staff.