Background
Unwarranted variation in healthcare delivery can signal inequities in care and highlight opportunities for service improvement. The North Eastern Melbourne Integrated Cancer Service (NEMICS) plays a key role in facilitating data-driven cancer care improvement and stakeholder engagement across its member health services. In 2025 the Optimal Care Summits (OCS) program, hosted by NEMICS, delivered a Head and Neck (H&N) summit that identified potential unwarranted variation in H&N cancer care within the NEMICS region, prompting the need for a structured and transparent local investigation approach.
Aim
To develop and implement a robust approach to identify, validate, and investigate unwarranted variation, while strengthening health service engagement to support meaningful equity-focused improvement.
Methods
Findings from the H&N OCS indicated potential unwarranted variation across the NEMICS region, prompting targeted investigation at health service levels. A statewide linked dataset identified potential outliers and quantified variation across the care pathway. Identified outliers underwent rigorous validation, including manual review of patient records from 2018 to 2023. Further audit of 2024 to 2025 cases was requested to ensure findings reflected current clinical practice. Active engagement with health services, including clinicians and executive stakeholders, was central to validating findings, interpreting results, and understanding local context.
Results
One health service demonstrated both critical and non-critical validated outliers within the H&N care pathway related to timeliness to care and post-operative ICU length of stay. Ongoing collaboration with health service stakeholders has enabled detailed exploration of potential drivers, including clinical practice variation, system-level constraints, and data quality considerations. This process supports the co-development of targeted recommendations for service improvement.
Conclusion
This work highlights the importance of analysing variation at the health service level to understand the context underpinning performance differences. A transparent, evidence-based approach, combined with strong stakeholder engagement, is essential to build trust, support interpretation, and enable credible and sustainable service improvement.