The Problem: 

Statistical Process Control (SPC) charts are generic tools for Safety and Quality improvement. In Health Care they are the basis for improvement methods such as Plan-Do-Study-Act Cycles. In contrast to simple line charts, SPCs distinguish signal from noise. They therefore enable decision makers to identify where action is needed, and a recent trial in France shows that they improve safety for patients. Yet we had anecdotal evidence that SPC charts were not widely used in NHS organisations. Working with our local Academic Health Research Network (AHSN) we conducted a project to determine prevailing use of SPC methodology and, if necessary, improve uptake.

Our project:

First, we surveyed NHS hospitals to measure use of SPC charts. This provided empirical confirmation that SPC methodology was seldom used and that, when used, the methodology did not comply with best practice. Our published findings were selected as an ‘Editors’ Favourite’ (Schmidtke, et al. BMJ Qual Saf. 2017;26:61-9Link opens in a new window). Yet this resulted in no effect on uptake of SPCs in England.

Impact:

We therefore embarked on a programme of active dissemination and engagement at including engagement sessions with quality assurance staff within the AHSN footprint, publication of a synopsis of our academic paper in the Health Service Journal (Bird. Health Serv J. 14-02-2017Link opens in a new window),and a social media campaign led by NHS Improvement (NHSI; #plotthedots). With NHSI we designed a scalable educational programme, focussing on hospitals in the first instance. The programme involved members of Hospital Boards (to stimulate demand) and Quality and Safety staff (to stimulate supply). To date the programme has been delivered in over 100 NHS hospitals.

We evaluated the programme by means of a non-randomised controlled comparison of hospitals that received or did not receive it (Kudrna, et al. BMJ Qual Saf. 2022Link opens in a new window). We selected a series of 20 hospitals that received the training intervention, and identified similar controls matched on hospital characteristics. We measured the proportion of charts that used SPC methodology before and after the intervention period. We observed a nine-fold increase over base line in SPC usage in the intention hospitals versus control hospitals. We plan to examine SPC chart usage in other types of organisation and, if successful in this application, we will work with health and social care organisations to optimise the investigation of signals on SPC charts and to ensure that safety is improved where necessary.