How do you define “scale-up”?
Scale up is ‘deliberate efforts to increase the impact of successfully tested health innovations so as to benefit more people and to foster policy and programme development on a lasting basis.’ (World Health Organization & ExpandNet. (2010). Nine steps for developing a scaling‑up strategy. Geneva: World Health Organization. ISBN: 978 92 4 150031 9)
How do you define “innovation”?
“Innovation” refers to service components, other practices or products. Typically the innovation consists of a “set of interventions” including not only a new technology, clinical practice, educational component, but also the managerial processes necessary for successful implementation. (World Health Organization & ExpandNet. (2010). Nine steps for developing a scaling‑up strategy. Geneva: World Health Organization. ISBN: 978 92 4 150031 9)
How do you define unwarranted clinical variation (UCV)?
Reducing unwarranted clinical variation is one of the priority challenges set out in the ACI Strategy 2023-2026. UCV describes patient care that differs in ways that are not a direct and proportionate response to available evidence; or to the healthcare needs and informed choices of patients. It cannot be explained by the condition or preference of the consumer and signals an opportunity to improve the quality of healthcare.
What is ACI’s approach to reducing UCV?
Reducing UCV is key to promoting high value care and reducing low value care. It aligns with NSW Health’s value-based healthcare approach in that it aims to deliver the right care to enable the best care and experience outcomes with the appropriate allocation of resources. Left unchecked, UCV has the potential to reduce safety, quality, patient experience, performance effectiveness and efficiency outcomes. ACI’s approach to reducing UCV as part of our strategy is as follows:
- build a common understanding and language
- assess data availability and methods
- visualisations
- risk adjustment
- sense-making, determine if warranted
- understand underlying reasons
- reporting
- identify appropriate levers
- evidence for innovations
- re-design
- co-design
- implementation
- monitor progress
- give timely feedback
Where can I find more information about NSW Health’s focus on unwarranted clinical variation?
There are a few key NSW Health documents that mention UCV. In the NSW research and innovation strategy, mentions “Strategic Outcome 6: Research and innovation for all”. key objective 6.10 is to “Reduce unwarranted clinical variation through alternate models of care.”
In the ACI Strategy 2023-2026, UCV is mentioned in a few places:
- As one of our priority challenges: “Reducing unwarranted clinical variation and promoting high-value care - using analytics to show variation in whether, how, and how well care is delivered; and novel approaches to identify, assess and propose innovations to address variation.”
- In the “Bringing the strategy to life” section, in “managing the pipeline of clinical innovation” part, UCV is mentioned under the “Refine: Continuous improvement” phase, in the “informing” action: “Data is used to assess clinical practice and variation in care.”
More recently in the NSW Special Commission of Inquiry, UCV is mentioned under “Recommendation 39: There must be strong leadership (at the Ministry of Health and executive management levels) that empowers clinical and non-clinical staff to reduce unwarranted clinical practice variation, withhold low value care, and prevent over investigation, over diagnosis, and over treatment.” There are multiple places were UCV is mentioned in the report.
What other resources are available to understand UCV?
A good starting point is the journal paper by Sutherland K, Levesque J‐F. “Unwarranted clinical variation in health care: Definitions and proposal of an analytic framework.” J Eval Clin Pract. 2020;26:687–696. https://doi.org/10.1111/jep.13181
People can also search for examples of UCV and redesign projects in the Innovation Exchange. Searching with the “variation” keyword and Centre for Healthcare Redesign program filter, showed at least 30 projects. Example projects include:
- WNSWLHD. 2017. “Testing Times: Reducing Variation in Pathology Testing”
- SNSWLHD. 2018. “Breathe Easy: eliminating unwarranted clinical variation for patients with chronic obstructive pulmonary disease”
- SESLHD. 2023. “Medication management matters”
- SESLHD. 2025. “Raise the BAR (BreastScreen Assessment Redesign) project”