Application of statistical process control in healthcare improvement: systematic review

Abstract

Objective: To systematically review the literature regarding how statistical process control-with control charts as a core tool-has been applied to healthcare quality improvement, and to examine the benefits, limitations, barriers and facilitating factors related to such application. Methods: A standardised data abstraction form was used for extracting data relevant to the review questions, and the data were analysed thematically. Results: Statistical process control was applied in a wide range of settings and specialties, at diverse levels of organisation and directly by patients, using 97 different variables. The review revealed 12 categories of benefits, 6 categories of limitations, 10 categories of barriers, and 23 factors that facilitate its application and all are fully referenced in this report. Statistical process control helped different actors manage change and improve healthcare processes. It also enabled patients with, for example asthma or diabetes mellitus, to manage their own health, and thus has therapeutic qualities. Its power hinges on correct and smart application, which is not necessarily a trivial task. This review catalogues 11 approaches to such smart application, including risk adjustment and data stratification. Conclusion: Statistical process control is a versatile tool which can help diverse stakeholders to manage change in healthcare and improve patients' health.

Statistical process control part 1: a primer for using statistical process control in health care process improvement

“…10 Yet despite the evidence that SPC can be successfully applied in health care practice to improve the quality of patient care, 3,5-9 SPC is still not widely adopted. In a recent review, 2 only 57 studies published between 1990 and 2004 applied SPC methods for the improvement of clinical or patient care processes in a health care organisation; perhaps indicating a lack of knowledge or understanding as to the value of, or the inability to apply, SPC methods. 10 If the full potential of SPC methods is to be realised, educating and training health care professionals in the theory and tools behind these methods, but also developing SPC skills and establishing the value of applying SPC in health care, is essential.…”

“…In line with SPC theory, when a quality improvement intervention changes the underlying process, this will flag as a special cause. 1,2 The ability of the control chart to place this change in performance (special cause variation) and the intervention in close temporal proximity allows clinicians and researchers to differentiate between variation in a process due to random fluctuations and improvements in a process due to process redesign. For this reason, control charts can be used to assess the impact of quality improvement interventions.…”

“…But changing a process does not always result in an improvement. 1,2 For this reason, a key component of any quality improvement effort is the robust measurement, analysis, and interpretation of appropriate clinical outcomes and processes, to ensure beneficial changes occur.…”

Using research to make health care safer

“…Statistical process control charting is an important method for routinely presenting and tracking safety and quality data, 36 and while use is increasing, 37 it is still unfamiliar to many clinicians. The traditional randomised double blind controlled trial, familiar to, and therefore expected by clinicians, does not work well for safety and quality issues (as noted by the anonymous reviewer).…”

Control charts for health care monitoring under overdispersion

“…Woodall (2006); Thor et al (2007); Shaha (1995) and Sonesson and Bock (2003)], the use of SPC methods is strongly advocated, with special emphasis on control charts as the key tools. Now a standard choice for controlling attribute data is a p-chart, based on the number of failures in a series of given sampling intervals.…”