Variable Life Adjusted Display (VLAD)
The VLAD methodology was introduced to Queensland Health to aid the monitoring of quality of services provided. It provides an easily understood graphical overview of clinical outcomes over time and plots the cumulative difference between expected and actual outcomes. Selected Private hospitals are also provided with VLADs for certain indicators. The use of VLAD within Queensland Health is governed by the VLAD Implementation Standard.
The data that is used to construct the VLAD is sourced from the corporately submitted patient data set. This data is updated monthly, and as such, the VLAD technique allows timely detection of potential problems or improved performance. The VLAD technique includes a mechanism of signalling when further investigation of performance is warranted. Hospital staff can then investigate peformance using The Pyramid Model of Investigation. This structured investigation approach assists staff to identify reasons for variations in clinical outcomes.
VLAD Updates
- September 2009
VLAD Indicators
The clinical indicators monitored by the VLAD were developed in association with clinical expert groups. There are four categories of indicators monitored by the VLAD: medical, mental health, obstetrics & gynaecology, and surgical.
The Statewide Maternity and Neonatal Network VLAD Working Group revised and developed new indicators to be monitored using the VLAD methodology from October 2009. As a result, a Summary of Activities was delivered.
The Clinical Monitoring Team are interested in working collaboratively to update and revise clinical indicators to ensure they remain clinically relevant.
Provide feedback about existing indicators
Do you want to know more about VLADs?
“VLADs for Dummies – A Reference for the Rest of Us” covers everything you need to know about VLADs. It provides an explanation of the statistics behind the VLAD, but also includes practical advice about how to make the most of VLADs in your hospital.
To request a free copy of VLADs for Dummies, send an email to:
- VLAD_Queries@health.qld.gov.au or call the Clinical Monitoring Team on 3636 9889
- VLADs for Dummies Presentation is also available to view.
Technical information about VLADs
- VLAD Coding Query Flow Chart
- How Control Limits Are Worked Out
- A Case Control Method for Clinical Audit
Publications about VLADs
- Coory M, Duckett S, Sketcher-Baker K, ‘Using control charts to monitor quality of hospital care
with administrative data’, International Journal for Quality in Health Care 2007:1–9.
- Duckett SJ, Coory M and Sketcher-Baker, K (2007) Identifying variations in quality of care in
Queensland Hospitals, Medical Journal of Australia, (187) p 571-5.
- Iezzoni L, 1997, ‘Assessing quality using administrative data’, Annals Internal Medicine, vol 127, pp 666–674.
- Mohammed M A, Rathbone A, Myers P, Patel D, Onions H, Stevens A, 2004, ‘An investigation
into general practitioners associated with high patient mortality flagged up through the Shipman
inquiry: retrospective analysis of routine data’, British Medical Journal, vol 328, pp 1474–7.
- Sherlaw-Johnson, C (2005) A method for detectign runs of good and bad clinical outcomes on
variable life-adjusted display (VLAD) charts, Health Care Management Science (8) 61-5.
- Woodall W, 2006, ‘The use of control charts in health-care and public-health
surveillance’, Journal of Quality Technology, vol 38, pp 89–104.
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