So we begin.

I will start with the outcome: I want you to think about the entire issue of variances in the context of an overall clinical (and organizational) performance improvement model. We call this model Next Generation Quality because it goes beyond the traditional quality assurance and JCAHO compliance model of quality. Next Generation Quality is based on the Malcolm Baldrige Criteria for Organizational Excellence.

We will discuss Next Generation Quality only in the context of clinical processes and - especially clinical pathways. Within this simplified version of the model the variance management system takes on renewed importance. I believe that variance management systems, as I define them, are the mother lode of performance data and the key to clinical performance excellence.

First, a little background. The key components of the model, and our definition of them, are:

• Clinical Pathways: An explicitly designed care process for a defined patient population.
• Continuous Improvement: A process for evaluating and improving care processes.
• Patient Documentation: Any information collected before, during, or after a patient encounter.
• Variance Management System: A system for collecting process and outcome data for designing, managing, evaluating, and improving patient care.

These are somewhat broader definitions than you might currently use. As we work through the material, these definitions will help integrate these components into a coherent system.