Unbeknownst to me whilst I was extolling the virtues of looking for variation to identify where improvements might be likely to succeed, in another part of the blog-o-sphere Professor Alan Maynard was penning his commentary on the same topic for Health Policy Insight . Tess Harris chair of the PKD sent it through to me – Thanks Tess.
Suffice to say that he has a different opinion from me. Professor Maynard points out that productivity variations are universal. I was pleased to see that he started at the same place as me from the famous Glover work, about variations in tonsillectomy. The interesting thing about tonsillectomy is of course that very few people ever benefited from a tonsillectomy – certainly high rates were never good!! Thankful the rates have plummeted over the past 50 years.
Maynard makes some good points, do click and read it , but I still think if I had kidney disease I would rather be managed in a unit with higher rates of live kidney donations, higher rates of arteriovenous fistulae, lower rates of MRSA infection and higher scores on patient activation. That is also the sort of unit I would like to work in. The trick is to measure the right thing.