The document discusses variations in health care, emphasizing the importance of maximizing positive variations while minimizing negative ones. It highlights the challenges in distinguishing between harmful and beneficial variations, as well as the implications of overuse and underuse of medical services. This report aims to provide insights into how professional knowledge and its application can influence patient-centered care.

1. Variations in health care: The good, the bad and the inexplicable Maximising the good and minimising the bad in health care John Appleby Chief Economist, The King’s Fund April 2011

2. Figure 1: Mapping the causes of variation

3. Figure 3: Distribution of crude rates and age–gender standardised rates for primary hip replacement (English PCTs, 2009/10)

4. Figure 6: Age–gender standardised ratios for selected elective procedures (2009/10), England=100

5. Figure 9: Variation over time: SCVs for hip replacement, cataract removal and tonsillectomy 2005/06, 2009/10

6. Figure 11: Audit Commission basket of 25-day case procedures, 2009/10 Per cent carried out as day cases by PCT, ordered on size of coefficient of variation low = black medium = grey high = white

7. Figure 12: Measures of variation: selected low effectiveness procedures, 2009/10

8. ‘ If all variation were bad, solutions would be easy. The difficulty is in reducing the bad variation, which reflects the limits of professional knowledge and failures in its application, while preserving the good variation that makes care patient-centred. ‘ When we fail, we provide services to patients who don’t need or wouldn’t choose them, while we withhold the same services from people who do or would, generally making far more costly errors of overuse than of underuse.’ Al Mulley Director of the Dartmouth Center for Health Care Delivery Science at Dartmouth College and Professor of Medicine at Dartmouth Medical School

9. Download the full report: www.kingsfund.org.uk/variation