Medical practice variation: public reporting a first necessary step to spark change

Int J Qual Health Care. 2018 Nov 1;30(9):731-735. doi: 10.1093/intqhc/mzy092.


From previous work, we know that medical practice varies widely, and that unwarranted variation signals low value for patients and society. We also know that public reporting helps to create awareness of the need for quality improvement. Despite the availability of rich data, most Western countries have no routine surveillance of the geographic distribution of utilization, costs, and outcomes of healthcare, including trends in variation over time. This paper highlights the role of transparent public reporting as a necessary first step to spark change and reduce unwarranted variation. Two recent examples of public reporting are presented to illustrate possible ways to reduce unwarranted variation and improve care. We conclude by introducing the Value Improvement Cycle, which underscores that reporting is only a necessary first step, and suggests a path toward developing a multi-stakeholder approach to change.

MeSH terms

  • Analgesics, Opioid / administration & dosage
  • Geography
  • Humans
  • Intervertebral Disc Displacement / surgery
  • Netherlands
  • New Zealand
  • Outcome and Process Assessment, Health Care*
  • Practice Patterns, Physicians' / statistics & numerical data*
  • Quality Improvement*
  • Quality Indicators, Health Care / statistics & numerical data*


  • Analgesics, Opioid