Scientifically based process improvement in health care with statistical process control
Abstract
Background: For better performance, it is crucial to continuously improve quality and patient safety based on the science of quality and patient safety and the usage of appropriate tools such as statistical process control. The aim of this article is to describe statistical process control in the continuous improvement of healthcare processes.
Methods: Patient falls and surgical site infections were studied using a run chart, u-chart, and g-chart.
Results: In the case of patient falls special causes of variation were depicted.
However, these are only statistical conclusions, whereas the content of the causes can be found only by those who work in the process of fall prevention.
In the case of surgical site infection, the use of a new wound covering material was abandoned because the g-chart showed failure to improve the process. The g-chart showed that a different type of preparation of the surgical site with hair cutting instead of shaving showed a decrease in infection rates.
Conclusion: Statistical process control can differentiate between common and special causes of process variability. The importance of this distinction is in the employment of different strategies for process improvement.
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References
Wyszewianski L. Defining, measuring, and improving quality of care. Clinics in Family Practice. 2003; 5: 807–12.
McGlynn, et al. The quality of health care delivered to adults in the United States. N Engl J Med 2003; 348: 2635–2645.
Leskošek B, Pajntar M. Kakovost v zdravstvu Slovenije. Infor Med Slov 2004; 9: 41–7.
Podrugovac M, Simčič B. Primerljivost kazalnikov kakovosti, ki se spremljajo na nacionalni ravni med izvajalci zdravstvenih storitev. Kakovostna zdravstvena obravnava skozi izobraževanje, raziskovanje multiprofesionalno povezovanje – prispevek k zdravju posameznika in družbe–5. mednarodna konferenc; Visoka šola za zdravstveno nego Jesenice; 2012; junij 7–8; Ljubljana;
Langley GK, Moen RD, Nolan KM, Nolan TW, Norman CL, Provost LP. The improvement guide. San Francisco: Jossey- Bass; 2009)
Verdenik I, Pajntar M. Perinatologia Slovenica 1987–1996. Ljubljana: Združenje za perinatalno medicino SZD, 1998.
Pajntar M, Leskošek B. Rezultati projekta: »Kakovost v zdravstvu Slovenije.« Zdrav Vestn 2002; 71: 765–71.
Robida A. Opozorilni nevarni dogodki: kakovost v zdravstvu. Zdrav Vestn 2004; 73:, 681–7.
Brinovec RP, Masten-Cuznar O, Ivanuša M, Leskošek B, Pajntar M, Poldrugovac M, Simčič B, Tušar S. (2010). Priročnik o kazalnikih kakovosti. Ljubljana: Ministrstvo za zdravje; 2010.
Bulc M, Kersnik J, Boerma WGW, Pelny M. Raziskava o zagotavljanju kakovosti v slovenskem osnovnem zdravstvu. Zdrav Var. 2009; 48:1–17.
Albreht T. Analiza skladnosti odpustnih diagnoz z mednarodno klasifikacijo bolezni 9. revizije in ustreznost kodiranja le-teh na internističnih in pljučnih oddelkih nekaterih slovenskih bolnišnic. Zdrav Var. 2000; 39:69–77.
Robida A. Pot do odlične zdravstvene prakse : vodnik za izboljševanje kakovosti in presojo lastne zdravstvene prakse. Ljubljana: Planet GV, 2009.
Carey R. Improving health care with control charts: basic and advanced SPC methods and case studies. Milwaukee: ASQ Quality Press, 2003.
Nelson EC et al. Microsystems in health care: Part 1. Learning from high-performing front-line clinical units. Jt Comm J Qual Improv. 2002;28:472–91.
Mohammed M. Using statistical process control to improve the quality of health care. Qual Saf Health Care 2004; 13: 243–5.
Benneyan J, Lloyd R, Plesk P. Statistical process control as a tool for research and health care improvement. Qual Saf Health Care 2003; 12: 458–64.
Perla, R.J., Provost, L.P. & Murray, S.K. (2011). The run chart: a simple analytical tool for learning from variation in healthcare processes. BMJ Qual Saf 2011 20: 46–51.
Provost L, Murray S. The healthcare data guide: Learning from data for improvement. San Francisco: Jossey-Bass Publication, 2011.
Rožman J. Stroški zdravljenja poškodb zaradi padcev bolnikov: primer slovenske splošne bolnišnice [diplomsko delo]. Ljubljana; Univerza v Ljubljani, Ekonomska fakulteta; 2012
Swed FS, Eisenhart C. Tables for testing randomness in grouping in a sequencwe of alternatives.Annals of mathematical statistics. 1943; 14:66–87.
Benneyan JC. Number-between g-type statistical control charts for monitoring adverse events. Health Care Manage Sci 2001;4:305–18.
Ryckman FC, Schoettker PJ, Hays KR, Connelly BL, Blacklidge RL, Bedinghaus CA, et al. Reducing surgical site infections at a pediatric academic medical center. Jt Comm J Qual Improv.2009;35:192–8.
Schwab R, Del Sorbo S, Cunningham M, et al. Using statistical process control to demonstrate the effect of operational interventions on quality indicators in the emergency department. J Healthc Qual 1999; 21 (4):38–41.
Fasting S, Gisvold S. Statistical process control methods allow the analysis and improvement of anesthesia care. Can J Anesth 2003; 50: 767–74.
Norberg A, Christopher C, Ramundo M, et al. Contamination rates if blood cultures obtained by dedicated phlebotomy vs intravenous catheter. JAMA 2003; 289: 726–9.
Sorokin R, Gottlieb J. Enhancing patient safety during feeding-tube insertion: a review of more than 200 insertions. J Parenter Enteral Nutr 2006; 30:440–5.
Wilson T, Holt T, Greenhalgh T. Use of Shewhart’s technique (letter). Lancet 2001;357:1528–9.
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