Value based health and care action plan: measurement framework

Action 6

The Scottish Government and delivery partners will continue to develop and promote the Scottish Atlas of Healthcare Variation.

Progress to date and future priorities

A targeted test of change, informed by survey data, has been conducted to determine awareness of the Scottish Atlas of Healthcare Variation (SAoHV) and whether health and care professionals view it as a useful tool to help identify and tackle unwarranted variation. A review of the pilot, and survey findings identified low awareness and uptake, and as a result, a decision taken to pause further development of the Atlas.^[10]

Tackling unwarranted variation remains a priority of Realistic Medicine and Value Based Health and Care. Other tools have been developed and are being used to identify and tackle unwarranted variation such as Active Clinical Referral Triage (ACRT), Discharge PIR (Patient Initiated Review) and CfSD best practice pathways.^[11] The Discovery Dashboard produced and maintained by PHS is used regularly to support waiting times improvement work and will also support boards to implement the new National Referral Protocol (NRP), which aims to ensure access to appropriate care through adherence to agreed access criteria.

Monitoring metrics

The monitoring metrics for Action 6 draw primarily on survey data from health and care professionals, with additional qualitative evidence from open‑text survey responses. These metrics assess awareness, use and perceived barriers related to the Scottish Atlas of Healthcare Variation.

Metric 6.1: 8% of health and care professionals surveyed have used the Scottish Atlas of Healthcare Variation to help them look for unwarranted variation in access to healthcare, treatment and outcomes often or occasionally.

Metric 6.2: Health and care professionals surveyed identified the most common barriers to using the Scottish Atlas of Healthcare Variation as:

• ‘lack of awareness about the Atlas’ (72%)
• ‘insufficient training or knowledge on how to use the Atlas’ (23%)
• ‘insufficient time to learn or integrate the Atlas into practice’ (20%).

Metric 6.3: 66% of Orthopaedics, Ophthalmology, and Dentistry health and care professionals surveyed had not used the recently updated paediatric dental extraction and hip, knee and cataract surgery Atlas maps, whilst the remainder had occasionally (19%) or a very small number of times (15%).

Metric 6.4: Qualitative Evidence from the Value Based Health and Care survey relating to health and care professionals’ views of the Atlas:

Many noted low awareness of the SAoV maps and viewed the Atlas data as outdated and incomplete, reducing its usefulness.

“I have not used this, nor heard of it.”

“Outdated, not granular enough to be useful.”