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. 2023 Feb;32(2):100-108.
doi: 10.1136/bmjqs-2021-013514. Epub 2022 Jun 24.

Retrospective evaluation of an intervention based on training sessions to increase the use of control charts in hospitals

Laura Kudrna  1 , Paul Bird  2   3 , Karla Hemming  4 , Laura Quinn  4 , Kelly Schmidtke  5 , Richard Lilford  4
Affiliations

Retrospective evaluation of an intervention based on training sessions to increase the use of control charts in hospitals

Laura Kudrna et al. BMJ Qual Saf. 2023 Feb.

Abstract

Background: Statistical process control charts (SPCs) distinguish signal from noise in quality and safety metrics and thus enable resources to be targeted towards the most suitable actions for improving processes and outcomes. Nevertheless, according to a recent study, SPCs are not widely used by hospital boards in England. To address this, an educational training initiative with training sessions lasting less than one and a half days was established to increase uptake of SPCs in board papers. This research evaluated the impact of the training sessions on the inclusion of SPCs in hospital board papers in England.

Methods: We used a non-randomised controlled before and after design. Use of SPCs was examined in 40 publicly available board papers across 20 hospitals; 10 intervention hospitals and 10 control hospitals matched using hospital characteristics and time-period. Zero-inflated negative binomial regression models and t-tests compared changes in usage by means of a difference in difference approach.

Results: Across the 40 board papers in our sample, we found 6287 charts. Control hospitals had 9/1585 (0.6%) SPCs before the intervention period and 23/1900 (1.2%) after the intervention period, whereas intervention hospitals increased from 89/1235 (7%) before to 328/1567 (21%) after the intervention period; a relative risk ratio of 9 (95% CI 3 to 32). The absolute difference in use of SPCs was 17% (95% CI 6% to 27%) in favour of the intervention group.

Conclusions: The results suggest that a scalable educational training initiative to improve use of SPCs within organisations can be effective. Future research could aim to overcome the limitations of observational research with an experimental design or seek to better understand mechanisms, decision-making and patient outcomes.

Keywords: medical education; quality improvement; statistical process control; statistics; team training.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Drawn from real hospital data presented in Schmidtke et al. Time series chart showing the number of unplanned readmissions within 48 hours of discharge from April 2012 until July 2013 at a single hospital.
Figure 2
Figure 2
Drawn from real hospital data presented in Schmidtke et al. SPC showing the number of unplanned readmissions within 48 hours of discharge from April 2012 until July 2013 at a single hospital. SPC, statistical process control chart.
Figure 3
Figure 3
Results of systematic review seeking studies on training interventions to increase the use of SPCs for routine monitoring within institutions. SPC, statistical process control chart.
Figure 4
Figure 4
Selected board papers for preintervention and postintervention periods, and month of training intervention, for 10 acute hospitals that received ‘Making Data Count’ training sessions.
Figure 5
Figure 5
Use of SPCs—premeasurements and postmeasurements by group. SPC, statistical process control chart.
See this image and copyright information in PMC

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