Managing variation is essential to quality improvement. Quality improvement is primarily concerned with two types of variation–common-cause variation and specialcause variation. Common-cause variation is random variation present in stable healthcare processes. Special-cause variation is an unpredictable deviation resulting from a cause that is not an intrinsic part of a process. By careful and systematic measurement, it is easier to detect changes that are not random variation. The approach to managing variation depends on the priorities and perspectives of the improvement leader and the intended generalizability of the results of the improvement effort. Clinical researchers, healthcare managers, and individual patients each have different goals, time horizons, and methodological approaches to managing variation; however, in all cases, the research question should drive study design, data collection, and evaluation. To advance the field of quality improvement, greater understanding of these perspectives and methodologies is needed [1].

Clinical researcher perspective The primary goal of traditional randomized controlled trials (RCTs)(ie a comparison of treatment A versus placebo) is to determine treatment or intervention efficacy in a specified population when all else is equal. In this approach, researchers seek to maximize internal validity. Through randomization, researchers seek to balance variation in baseline factors by randomizing patients, clinicians, or organizations to experimental and control groups. Researchers may also increase understanding of variation within a specific study using approaches such as