Measurement for Improvement and Statistical Process Control (SPC) as an approach

Transcription

1 Measurement for Improvement and Statistical Process Control (SPC) as an approach Caroline Angel Improvement Director

2 Measurement for Improvement All improvement will require change, but not all change will result in improvement Langley et al, The Improvement Guide, 996 How do we know that a change is an improvement? Its not: Measurement for Judgement Measurement for Research

3 Model for Improvement & 7 Steps to Measurement Aims Measures Interventions

4 Types of Measures Type Description Example Outcome Process Balancing Impact on a patient and show the result of improvement work How systems and processes work to deliver the outcomes Unexpected/Unintended impacts elsewhere in the system (can be positive or negative) Sepsis mortality rates Rate of MRSA Number of falls Survey of staff confidence using SBAR % patients with NEWS calculated % hand hygiene compliance Number of training sessions delivered 999 call outs from a residential home Staff sickness Staff turnover

5 Step. Decide your aim Decide aim Choose measures Define measures Specific Measurable Achievable Realistic Time-bound Can you write your aim in a sentence? 6 Review measures 7 Repeat steps Analyse & present 4 Collect data Adapted from Tom Nolan in The Improvement Guide A worthwhile topic Outcome focused Measurable Specific population Clear timelines Succinct but clear

6 Step. Choose measures Decide aim Choose measures Define measures 6 Review measures 7 Repeat steps Collect data 5 Analyse & present

7 Step. Define measures Decide aim Choose measures Define measures An operational definition is a description, in quantifiable terms, of what to measure and the steps to follow to measure it consistently 6 Review measures 7 Repeat steps Collect data 5 Analyse & present

8 Step 4. Collect data Decide aim 6 Review measures Choose measures Define measures 7 Repeat steps Collect data What all people/patients, a portion or a sample? Who collects the data? When is it collected real time or retrospective? Where is it collected? How is it obtained computer system or audit? 5 Analyse & present

9 Step 5. Analyse and present Decide aim Choose measures Define measures The type of presentation you use has a crucial effect on how you and others react to data 6 Review measures 7 Repeat steps Collect data 5 Analyse & present

10 Questions you may be asked Why are you showing me this? What was the sample size? Over what period was the data collected? Is this all of the data? (what did you leave out?) If a target is shown, how was it established? How was the data collected? Who collected the data? Did you encounter any problems gathering the data? If the data is aggregated, have you got the real data anywhere? What conclusions have you drawn? How? What do we need to do next?

11 How we assess performance: RAG ratings Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Why has performance deteriorated so badly. What decision are you going to make?

12 Two numbers Something very important! Last month This month

13 So what does three points give you is it a trend? "Upward Trend"? 0 4 "Setback"? 0 4 "Downturn"? 0 4 "Turnaround"? 0 4 "Rebound"? 0 4 "Downward Trend"? 0 4

14 The real use for a pie chart. It s a snapshot Doesn t give you any idea of movement over time, or variation

15 Data should always be presented in such a way that preserves the evidence in the data Walter Shewhart

16 What is SPC (Statistical Process Control)? About understanding a process and the variation within that process It s ultimately a line graph with a bit extra The centre line is the average It s a way of easily seeing variation special or common cause Includes upper and lower control limits that show 99.7% confidence intervals Meaning that based on the data, 99.7% of the time, the process will fall between the upper and lower control limits eg 99.7% of the time, hand hygiene compliance will fall between 84% and 98%.

17 Special cause (unpredictable) vs Common cause (predictable) variation Special cause variation Data triggers one of the four rules Common cause variation Within range of upper and lower control limits

18 Four rules for special cause Any point outside of the control limits (upper and lower) A run of seven points all above or all below the central line, or all increasing/decreasing Any unusual patterns or trends within the control limits The number of points within the middle third of the region between the control limits differs markedly from twothirds of the total number of points

19 Life QI Platform how it does SPC

20 And how it get more detailed

21 And even more

22 So lets do an SPC

23 Thank you Caroline Angel Improvement Director