English lessons: can publishing an atlas of variation stimulate the discussion on appropriateness of care?

NHS England has published series of atlases to highlight variation in costs, outcomes and intervention rates as part of a large scale transformational program to increase value and close the quality gap in health care. The NHS Atlas of Variation series has stimulated the search for unwarranted variation, an important step in the quest to improve quality and reduce harm. This article describes how the series was conceived, shares some of the lessons of preparing and publishing an atlas of variation, and considers how it can stimulate the discussion on appropriate care.