Commission on Excellence and Innovation in Health

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.

Aligned 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—occurs when healthcare practices or outcomes differ from evidence-based standards. The Showcase’s 16th Series highlighted South Australia’s efforts to achieve excellence by reducing unwarranted clinical variation at a state and national level.

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

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

Myu presented a decade of progress from the ACSQH’s Australian Atlas of Healthcare Variation, showing how evidence-based, data-driven approaches can improve patient outcomes and reduce harm. His presentation explored the underlying causes of clinical variation and offered actionable recommendations.

Rebecca Smith (Principal Project Manager, Maternal, Neonatal, Gynaecology Strategic Executive Leadership Committee, SA Health)
Belinda Nitschke (Project Manager, SA Preterm and Early Term Birth Prevention Project, SA Health)

Rebecca and Belinda shared practical strategies to reduce healthcare variation within devolved governance systems. Using real-world examples from their work in maternal and neonatal care, they demonstrated how these strategies can be applied across different healthcare settings.

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

Daniel Sofia (Advanced Nurse Unit Man­ag­er — Emer­gency Depart­ment, The Queen Eliz­a­beth Hos­pi­tal)
Danieka Mar­shall (Nurse Edu­ca­tor — Emer­gency Depart­ment, Roy­al Ade­laide Hospital)

Daniel and Danieka intro­duced HIRAID® — a val­i­dat­ed, evi­dence-based frame­work that empow­ers emer­gency nurs­es to sys­tem­at­i­cal­ly assess and man­age emer­gency depart­ment (ED) patients after triage. This pre­sen­ta­tion exam­ined how HIRAID® has been imple­ment­ed across the Cen­tral Ade­laide Local Health Net­work EDs, reduc­ing unwar­rant­ed clin­i­cal vari­a­tion in nurs­ing assessments.

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

Asso­ciate Pro­fes­sor Toby Gilbert dis­cussed the Gen Med Project’ which uses data-dri­ven and clin­i­cian-led approach­es to iden­ti­fy and assess clin­i­cal vari­a­tion in gen­er­al med­i­cine. This pre­sen­ta­tion high­light­ed that not all vari­a­tion is iden­ti­fi­able, unwar­rant­ed or solv­able by machine learn­ing, and cov­ered the stake­hold­er engage­ment tac­tics used.

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

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

Pro­fes­sor Tim­o­thy Kleinig shared his decade-long jour­ney to improve the qual­i­ty of stroke care in South Aus­tralia and nation­al­ly. This pre­sen­ta­tion high­light­ed how South Australia’s stroke care per­for­mance has trans­formed from one of the low­est in the coun­try to the top-per­form­ing state, now lead­ing nation­al qual­i­ty improve­ment efforts.

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

Pro­fes­sor John Bel­trame show­cased 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. The PAM­I­CO Project per­son­alis­es acute myocar­dial infarc­tion man­age­ment using clin­i­cal risk pre­dic­tion mod­els, result­ing in improved patient out­comes, includ­ing few­er angiogram com­pli­ca­tions and reduced 30-day car­dio­vas­cu­lar events.