Improvement and Innovation Showcase Series 16: Creating Excellence by Reducing Unwarranted Clinical Variation

Our Improve­ment and Inno­va­tion Show­case brings togeth­er teams from across the health sys­tem to con­nect, share and explore their expe­ri­ences of work­ing towards bet­ter health­care for all South Australians. 

In line with our Strate­gic Direc­tion (2024−2027), reduc­ing unwar­rant­ed clin­i­cal vari­a­tion is cru­cial for improv­ing patient out­comes, health­care equi­ty and sys­tem effi­ca­cy. Clin­i­cal vari­a­tion — whether war­rant­ed or unwar­rant­ed — aris­es when health­care prac­tices or out­comes dif­fer from evi­dence-based stan­dards. The Showcase’s 16^th Series aims to high­light South Australia’s efforts to cre­ate excel­lence by reduc­ing unwar­rant­ed clin­i­cal variation. 

This four-part series explores unwar­rant­ed clin­i­cal vari­a­tion through state and nation­al per­spec­tives, show­cas­ing cur­rent projects across our health­care sys­tem. The episodes will present a range of projects which demon­strate how reduc­ing unwar­rant­ed vari­a­tion is essen­tial in cre­at­ing excel­lence in health­care.

The show­case is a free, tick­et­ed online webi­nar held week­ly over con­sec­u­tive weeks in the month of Sep­tem­ber. The first episode is sched­uled to pre­mière on Wednes­day, 3 Sep­tem­ber 2025. 

Episode 48: Set­ting the Scene — Unwar­rant­ed Clin­i­cal Vari­a­tion — Nation­al Pat­terns and Reduc­tion Strategies 

Date: 3 Sep­tem­ber 2025 

Time: 1.00 pm — 2.00 pm (ACST)

The first episode will explore how the Aus­tralian Com­mis­sion on Safe­ty and Qual­i­ty in Health Care (the Com­mis­sion) and the Mater­nal, Neona­tal & Gynae­col­o­gy Strate­gic Exec­u­tive Lead­er­ship Com­mit­tee are inves­ti­gat­ing and address­ing unwar­rant­ed clin­i­cal variation. 

We will first hear from Myu Aru­mu­ganathan, whose pre­sen­ta­tion will high­light the work of the Com­mis­sion, cov­er­ing a decade of progress of the Aus­tralian Atlas of Health­care Vari­a­tion, aimed at improv­ing patient out­comes and reduc­ing harm. This is achieved through evi­dence-based and data-dri­ven inves­ti­ga­tion, explor­ing causative fac­tors and pro­vid­ing rec­om­men­da­tions for action. 

Fol­low­ing this, Rebec­ca Smith and Belin­da Nitschke will share prac­ti­cal strate­gies to reduce health­care vari­a­tion in devolved gov­er­nance sys­tems. Draw­ing on real-world exam­ples from their work in mater­nal and neona­tal care, this pre­sen­ta­tion will demon­strate how these strate­gies can be applied across a vari­ety of settings. 

Don’t miss this episode, which will set the scene for the series ahead. 

Speak­er Bios:

Myu Aru­mu­ganathan (Act­ing Direc­tor — Health­care Vari­a­tion, Aus­tralian Com­mis­sion on Safe­ty and Qual­i­ty in Health Care) 

Myu Aru­mu­ganathan is the Act­ing Direc­tor of the Health­care Vari­a­tion team at the Aus­tralian Com­mis­sion on Safe­ty and Qual­i­ty in Health Care (the Com­mis­sion). The Health­care Vari­a­tion pro­gram is part of a pri­or­i­ty area of work for the Com­mis­sion focussing on appro­pri­ate and sus­tain­able health care. As a part of this work, the Com­mis­sion pro­duces the Aus­tralian Atlas of Health­care Vari­a­tion that iden­ti­fies marked vari­a­tions in nation­al health­care use, and oppor­tu­ni­ties for health sys­tem improve­ments. Myu has a BSc (Exer­cise Phys­i­ol­o­gy) and a Mas­ters in Pub­lic Health and has pre­vi­ous­ly held lead­er­ship roles at the NSW Min­istry of Health, Aus­tralian Coun­cil on Health­care Stan­dards and Exec­u­tive Health Solutions.

Rebec­ca Smith (Prin­ci­pal Project Man­ag­er, Mater­nal, Neona­tal & Gynae­col­o­gy Strate­gic Exec­u­tive Lead­er­ship Committee) 

Rebec­ca Smith (Bec) (MMid, Dipl. High­er Educ Mid, Dipl. Applied Sci­ence of Nurs­ing) has over 30 years’ expe­ri­ence work­ing in both Ade­laide and the Unit­ed King­dom in clin­i­cal care, edu­ca­tion, research, projects, statewide guide­lines and poli­cies, and health ser­vice man­age­ment. As the Prin­ci­pal Project Man­ag­er for the SA Health Mater­nal, Neona­tal & Gynae­col­o­gy Strate­gic Exec­u­tive Lead­er­ship Com­mit­tee, she is involved in sys­tem improve­ment to advance mater­ni­ty care strate­gies. Bec has pre­sent­ed at nation­al con­fer­ences on still­birth research activ­i­ties and oth­er aspects of mater­ni­ty care, includ­ing edu­ca­tion of mid­wives and com­plex preg­nan­cy care. Bec is the South Aus­tralian rep­re­sen­ta­tive on sev­er­al nation­al bod­ies relat­ing to mater­ni­ty care and women’s health. 

Belin­da Nitschke (Mid­wife, Women’s and Children’s Health Network) 

Belin­da Nitschke (Bel) (BMid) is an accom­plished mid­wife with near­ly a decade of clin­i­cal prac­tice. She has sig­nif­i­cant expe­ri­ence work­ing along­side women with com­plex social and health needs, includ­ing those using sub­stances in preg­nan­cy. As Project Man­ag­er for the South Aus­tralian Preterm and Ear­ly Term Birth Pre­ven­tion Project, Bel has pro­vid­ed strate­gic lead­er­ship for statewide imple­men­ta­tion of key evi­dence-based strate­gies to reduce ear­ly birth. Nation­al­ly, she plays a piv­otal role on the Aus­tralian Preterm and Ear­ly Term Birth Pre­ven­tion Pro­gram project team, con­tribut­ing to the design and coor­di­na­tion of sys­tem-wide approach­es to mater­ni­ty care improve­ment. Bel is a val­ued con­trib­u­tor to the South Aus­tralian Peri­na­tal Prac­tice Guide­lines, active­ly involved in author­ing and facil­i­tat­ing the devel­op­ment and imple­men­ta­tion of clin­i­cal guidance. 

Reg­is­ter for the event.

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Episode 49: From Emer­gency Depart­ment to Ward — Clin­i­cal Vari­a­tion in Front­line Care

Date: 10 Sep­tem­ber 2025 

Time: 1.00 pm — 2.00 pm (ACST)

This episode high­lights two impact­ful CEIH-sup­port­ed ini­tia­tives, both of which focus on reduc­ing unwar­rant­ed clin­i­cal vari­a­tion in front­line care. 

To start, Daniel Sofia and Danieka Mar­shall will intro­duce HIRAID® — a val­i­dat­ed, evi­dence-based frame­work that empow­ers emer­gency nurs­es to sys­tem­at­i­cal­ly assess and man­age emer­gency depart­ment (ED) patients after triage. This pre­sen­ta­tion will exam­ine how HIRAID® has been imple­ment­ed in the Cen­tral Ade­laide Local Health Net­work (CAL­HN) EDs and has reduced unwar­rant­ed clin­i­cal vari­a­tion in nurs­ing assessments. 

Up next, Pro­fes­sor Toby Gilbert will present the work of the ​‘Gen Med Project’ that is util­is­ing data-dri­ven and clin­i­cian-led approach­es to iden­ti­fy and assess clin­i­cal vari­a­tion in gen­er­al med­i­cine. This pre­sen­ta­tion will overview the stake­hold­er engage­ment tac­tics used, and high­light that not all vari­a­tion is iden­ti­fi­able, unwar­rant­ed or solv­able by machine learning. 

Join us to dis­cov­er more about these projects and their impact from emer­gency depart­ment to ward. 

Speak­er Bios:

Danieka Mar­shall (Nurse Edu­ca­tor — Emer­gency Depart­ment, Roy­al Ade­laide Hospital)

Danieka Mar­shall (Dani) is a Nurse Edu­ca­tor at the Roy­al Ade­laide Hos­pi­tal Emer­gency Depart­ment, bring­ing over a decade of expe­ri­ence in emer­gency nurs­ing. Dani has worked in both clin­i­cal and lead­er­ship roles in the ED con­tribut­ing to emer­gency nurs­ing prac­tice and inform­ing devel­op­ment of clin­i­cal treat­ment path­ways. Dani holds post­grad­u­ate qual­i­fi­ca­tions in both Emer­gency Nurs­ing and Nurse Edu­ca­tion and is pas­sion­ate about fos­ter­ing clin­i­cal excel­lence, deliv­er­ing out­stand­ing patient- cen­tred care and sup­port­ing the pro­fes­sion­al growth of ED nurs­ing staff.

Daniel Sofia (Advanced Nurse Unit Man­ag­er — Emer­gency Depart­ment, The Queen Eliz­a­beth Hospital) 

Daniel Sofia (BNurs, GDipEmeg­Nurse, GradCertNurs(NursEd)) has been work­ing for CAL­HN since start­ing as an AIN in 2006. Daniel spent the first 10 years of his career in the ED at TQEH, with a short sab­bat­i­cal to work in Lon­don, at St Thomas’ A&E. Daniel then worked as a Clin­i­cal Nurse Edu­ca­tor and then Nurse Edu­ca­tor at TQEH and RAH, with port­fo­lios includ­ing grad­u­ate nurs­es, and Gen­er­al Med­i­cine and Geri­atrics. Daniel returned to TQEH ED in 2022 in a nurse con­sul­tant role and is now one of the Advanced Nurse Unit Man­agers. Daniel is cur­rent­ly work­ing towards a Mas­ters in Health Admin­is­tra­tion at Flinders University.

Pro­fes­sor Toby Gilbert (Divi­sion­al Direc­tor for the Divi­sion of Med­i­cine, North­ern Ade­laide Local Health Network) 

Pro­fes­sor Toby Gilbert (MB BCh BAO MHSM MRCPI FRACP FRAC­MA) is a Gen­er­al Physi­cian at North­ern Ade­laide Local Health Net­work, where he is cur­rent­ly the Divi­sion­al Direc­tor for the Divi­sion of Med­i­cine. Toby has a keen inter­est in dig­i­tal health with a pas­sion for qual­i­ty improve­ment. He believes that the future of med­i­cine will involve greater face­time between doc­tor and patient, and that bet­ter use of dig­i­tal tools will remove cog­ni­tive load and facil­i­tate enhanced patient-physi­cian interaction. 

Reg­is­ter for the event.

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Episode 50: South Aus­tralia Lead­ing Change — Clin­i­cal Vari­a­tion in Stroke and Car­diac Care 

Date: 17 Sep­tem­ber 2025 

Time: 12.00 pm — 1.00 pm (ACST)

This episode focus­es on two South Aus­tralia-based projects that are address­ing clin­i­cal vari­a­tion in stroke and car­diac care. 

First­ly, Pro­fes­sor Tim­o­thy Kleinig will talk us through his decade-long jour­ney to improve the qual­i­ty of stroke care in South Aus­tralia, as well as around the coun­try. This pre­sen­ta­tion will high­light how South Australia’s stroke care per­for­mance has shift­ed from being ranked one of the worst nation­al­ly to becom­ing the best-per­form­ing state in Aus­tralia, and how South Aus­tralia is now lead­ing nation­al qual­i­ty improve­ment efforts. 

Sec­ond­ly, Pro­fes­sor John Bel­trame will show­case the Per­son­al­is­ing Acute Myocar­dial Infarc­tion Care to improve Out­comes (PAM­I­CO) Project. While mod­ern heart attack man­age­ment has sig­nif­i­cant­ly improved sur­vival rates, not all patients receive opti­mal care, result­ing in vari­a­tion in qual­i­ty and health out­comes. In his pre­sen­ta­tion, John will explain how the PAM­I­CO Project aims to bridge this gap by per­son­al­is­ing man­age­ment of acute myocar­dial infarc­tion with the use of clin­i­cal risk pre­dic­tion mod­els. This has shown to be effec­tive by improved patient out­comes, includ­ing reduced angiogram com­pli­ca­tions and 30-day car­dio­vas­cu­lar events. 

Tune in to learn more about these projects and dis­cov­er how South Aus­tralia is lead­ing change nation­al­ly and internationally. 

Speak­er Bios:

Pro­fes­sor Tim­o­thy Kleinig (Head of Com­pre­hen­sive Stroke Cen­tre, Roy­al Ade­laide Hos­pi­tal)

Pro­fes­sor Tim­o­thy Kleinig is the cur­rent Aus­tralian and New Zealand Stroke Organ­i­sa­tion Pres­i­dent, Co-Chair of the Aus­tralian Stroke Coali­tion, Chair of the South Aus­tralian Stroke Com­mu­ni­ty of Prac­tice and Head of the Roy­al Ade­laide Hos­pi­tal Com­pre­hen­sive Stroke Cen­tre. He chairs Nation­al Stroke Tar­gets and Stroke Unit Cer­ti­fi­ca­tion Task­forces. He has active research inter­ests across the con­tin­u­um of stroke and has led local and nation­al efforts to max­imise the chances of health out­come equi­ty for all stroke patients.

Pro­fes­sor John Bel­trame (Michell Pro­fes­sor in Med­i­cine, Uni­ver­si­ty of Ade­laide; Senior Con­sul­tant Car­di­ol­o­gist, Cen­tral Ade­laide Local Health Network) 

Pro­fes­sor John Bel­trame (AM, BSc, BMBS, FRACP, PhD, FESC, FACC, FCSANZ, FAHA) is the Michell Pro­fes­sor in Med­i­cine at the Uni­ver­si­ty of Ade­laide, Aus­tralia and Senior Con­sul­tant Car­di­ol­o­gist at CALHN. 

He has strong clin­i­cal and research inter­ests in the diag­no­sis and man­age­ment of coro­nary artery dis­ease estab­lished from his post­grad­u­ate train­ing at renowned insti­tu­tions in Rome, Kyoto and Boston. His inter­est in clin­i­cal qual­i­ty reg­istries has been facil­i­tat­ed by his asso­ci­a­tion with the Amer­i­can Heart Asso­ci­a­tion Qual­i­ty of Care and Out­comes Research Coun­cil, the Amer­i­can Col­lege of Car­di­ol­o­gy Nation­al Car­dio­vas­cu­lar Data Reg­istry, and ICHOM (Inter­na­tion­al Con­sor­tium for Health Out­comes Mea­sures). He is the Chair of the Coro­nary Angiogram Data­base of South Aus­tralia (CADOSA) Reg­istry Steer­ing Com­mit­tee and Lead Inves­ti­ga­tor in the Per­son­al­is­ing Acute Myocar­dial Infarct Care to improve Out­comes (PAM­I­CO) Project. 

Reg­is­ter for the event.

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Episode 51: Advanc­ing Equi­ty in the APY Lands — Clin­i­cal Vari­a­tion in Remote Tuber­cu­lo­sis Care 

Date: 24 Sep­tem­ber 2025 

Time: 1.00 pm — 2.00 pm (ACST)

The final episode will exam­ine how reduc­ing unwar­rant­ed clin­i­cal vari­a­tion is pos­i­tive­ly impact­ing remote com­mu­ni­ties in South Aus­tralia, specif­i­cal­ly those expe­ri­enc­ing tuber­cu­lo­sis (TB) in the Anan­gu Pit­jan­t­jat­jara Yankun­yt­jat­jara (APY) Lands. 

Asso­ciate Pro­fes­sor Simone Bar­ry will show­case her team’s work on a spe­cial­ist-led, com­mu­ni­ty-based TB pro­gram in the APY Lands. In her pre­sen­ta­tion, she will high­light how their pro­gram embeds con­sis­tent clin­i­cal pro­to­cols, intro­duces on-site diag­nos­tics, and part­ners with Abo­rig­i­nal health ser­vices to reduce diag­nos­tic delays, improve treat­ment out­comes, and address long-stand­ing inequities in care. 

Don’t for­get to reg­is­ter for this episode, which will draw a close to our series. 

Speak­er Bio:

Asso­ciate Pro­fes­sor Simone Bar­ry (Head, SA TB Ser­vices | Tho­racic and Sleep Physi­cian, Roy­al Ade­laide Hospital) 

Asso­ciate Pro­fes­sor Simone Bar­ry (B.Med, MPH&TM, MPH (Epi­demi­ol­o­gy), PhD, FRACP, AFRAC­MA, FThor­Soc) is a tho­racic and sleep physi­cian and clin­i­cal epi­demi­ol­o­gist, cur­rent­ly lead­ing South Australia’s tuber­cu­lo­sis pro­gram. With over a decade of expe­ri­ence work­ing in remote Abo­rig­i­nal com­mu­ni­ties, she is nation­al­ly recog­nised for her lead­er­ship in cul­tur­al­ly ground­ed mod­els of care that inte­grate spe­cial­ist res­pi­ra­to­ry ser­vices into under-served settings. 

Simone has pio­neered inno­v­a­tive out­reach strate­gies to reduce unwar­rant­ed clin­i­cal vari­a­tion in tuber­cu­lo­sis care across the Anan­gu Pit­jan­t­jat­jara Yankun­yt­jat­jara (APY) Lands, includ­ing the intro­duc­tion of mobile IGRA test­ing, stan­dard­ised chest X‑ray – based screen­ing, and the first use of week­ly short-course TB treat­ment in Aus­tralia. Her team’s work has led to improved time­li­ness of diag­no­sis, enhanced treat­ment adher­ence, and a mea­sur­able reduc­tion in com­mu­ni­ty transmission. 

Her broad­er work focus­es on the inter­sec­tion of clin­i­cal excel­lence, health equi­ty, and sys­tem-lev­el reform — ensur­ing that high-qual­i­ty care is acces­si­ble regard­less of geog­ra­phy or back­ground. Simone is also active­ly engaged in res­pi­ra­to­ry and sleep health pol­i­cy, Indige­nous health equi­ty, and cross-juris­dic­tion­al pub­lic health coordination. 

Reg­is­ter for the event.

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Please note: This event will be record­ed and pub­lished, how­ev­er we will ensure none of the attendee details will be revealed.