Using Control Charts for Improving Healthcare Quality The National Health Service (NHS) in the United Kingdom makes extensive use of SPC charts to improve service delivery to patients. SPC charts are frequently developed using Excel spreadsheets. Employees throughout NHS attend a two-day training course where they learn about X- and R-charts and their application. They also learn about Deming’s 14 points and principles of quality management and how to improve processes in their own operation. The number of possible applications of SPC charts for a healthcare facility is very high, with many applications relating to waiting times (as is the case with many service organizations); for example, the time to see a doctor, nurse, or other medical staff member, or to get medical results. One specific example in the NHS is “door to needle” times, which is the time it takes after a heart attack patient is registered into the hospital to receive an appropriate injection. The systemwide government-mandated target value for this process is that 75% of heart patients receive treatment within 20 minutes of being received into the hospital. Control charts are also used to monitor administrative errors. Bellin Health System is an integrated healthcare organization serving Green Bay, Wisconsin, and the surrounding region. It specializes in cardiac care and its 167-bed hospital is known as the region’s heart center. In addition it operates a psychiatric center, 20 regional clinics, and a college of nursing. Bellin’s quality-management program is based on improving processes by identifying measures of success, setting goals for improvement that can be measured, applying Deming’s PDCA cycle (see Chapter 2) for improving processes, and using statistical process control charts to monitor processes for stability and to see if improvement efforts are successful. Bellin has over 1250 quality indicators reported monthly, quarterly, or annually, and over 90% are monitored with SPC charts. For example, one such quality indicator is for compliance with the Centers for Disease Control guidelines on healthcare hand hygiene, which Bellin measures across its entire system. The lack of hand hygiene is a leading cause of fatal hospital-borne infections and thus a very important quality indicator. The quality resource department (QRD) at Bellin uses a p-chart to monitor hand hygiene for system nursing care, where the control measure is the portion of hand opportunities that meet the criteria divided by the total number of opportunities available to meet the criteria. Using SPC charts, Bellin was able to improve the hand hygiene process such that a 90% target level was achieved. Throughout the Bellin Health System, control charts are employed to identify special cause variations outside the norm in processes that require improvement. SPC has become an essential part of the continuous quality-improvement program at Bellin used by all members of the organization to improve service and healthcare and reduce costs.Sources: Based on M. Owen, “From Sickness to Health,” Qualityworld 29 (8: August 2003), pp. 18–22; and C. O’Brien and S. Jennings, Quality Progress 41 (3; March 2008), pp. 36–43.
1) Identify and discuss other applications of SPC charts in a healthcare facility that you think might improve processes.
Statistical Process Control (SPC) charts can be used for following applications in healthcare industry:
1. In measuring the consistency of medications in treatment for a given stage of treatment of disease. The number of days required for the patient to get better should be within range specified.
2. In measuring the variability in recovery of patients post a particular operation and if anomalies were there were beyond acceptable limits.
3. In measuring the waiting time for patients and whether that process is in control within stipulated time limits.
4. In measuring the complaint of patients and whether the number of complaints were within permissible limits.
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