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- Herausgeber: John Wiley & Sons
- Kategorie: Fachliteratur
- Sprache: Englisch
An Essential text on transforming raw data into concrete health care improvements Now in its second edition, The Health Care Data Guide: Learning from Data for Improvement delivers a practical blueprint for using available data to improve healthcare outcomes. In the book, a team of distinguished authors explores how health care practitioners, researchers, and other professionals can confidently plan and implement health care enhancements and changes, all while ensuring those changes actually constitute an improvement. This book is the perfect companion resource to The Improvement Guide: A Practical Approach to Enhancing Organizational Peformance, Second Edition, and offers fulsome discussions of how to use data to test, adapt, implement, and scale positive organizational change. The Health Care Data Guide: Learning from Data for Improvement, Second Edition provides: * Easy to use strategies for learning more readily from existing health care data * Clear guidance on the most useful graph for different types of data used in health care * A step-by-step method for making use of highly aggregated data for improvement * Examples of using patient-level data in care * Multiple methods for making use of patient and other feedback data * A vastly better way to view data for executive leadership * Solutions for working with rare events data, seasonality and other pesky issues * Use of improvement methods with epidemic data * Improvement case studies using data for learning A must read resource for those committed to improving health care including allied health professionals in all aspects of health care, physicians, managers, health care leaders, and researchers.
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THE HEALTH CARE DATA GUIDE
Learning from Data for Improvement
Second Edition
LLOYD P. PROVOSTSANDRA K. MURRAY
WEBSITE FOR INSTRUCTORS:
www.wiley.com\go\provost\healthcaredata2e
This edition first published 2022
© 2022 John Wiley & Sons, Inc.
Edition History
John Wiley & Sons, Inc. (1e, 2011)
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Library of Congress Cataloging-in-Publication Data
Names: Provost, Lloyd P., author. | Murray, Sandra K., author. Title: The health care data guide : learning from data for improvement / Lloyd P. Provost, Sandra K. Murray. Description: Second edition. | Hoboken, NJ : John Wiley & Sons, 2022. | Includes bibliographical references and index. Identifiers: LCCN 2021053032 (print) | LCCN 2021053033 (ebook) | ISBN 9781119690139 (paperback) | ISBN 9781119690153 (pdf) | ISBN 9781119690122 (epub) Subjects: LCSH: Medical care--Quality control--Statistical methods. | Medical care--Quality control--Data processing. Classification: LCC RA399.A3 P766 2022 (print) | LCC RA399.A3 (ebook) | DDC 362.10727--dc23/eng/20211123 LC record available at https://lccn.loc.gov/2021053032LC ebook record available at https://lccn.loc.gov/2021053033
Cover image: Provost & Murray
Cover design by Wiley
Set in 10.5/13pt ITCNewBaskervilleStd by Integra Software Services Pvt. Ltd, Pondicherry, India
Contents
Cover
Title page
Copyright
Figures, Tables, and Exhibits
Preface
Acknowledgments
The Authors
About the Companion Website
Part I Using Data for Improvement
Chapter 1
Improvement Methodology
Fundamental Questions for Improvement
What Are We Trying to Accomplish?
How Will We Know that a Change is an Improvement?
What Changes Can We Make That Will Result in Improvement?
The PDSA Cycle for Improvement
Tools and Methods to Support the Model for Improvement
Designing PDSA Cycles for Testing Changes
Analysis of Data from PDSA Cycles
Summary
Key Terms
Chapter 2
Using Data for Improvement
What Does the Concept of Data Mean?
How are Data Used?
Types of Data
Using A Family of Measures
The Importance of Operational Definitions
Data for Different Types of Studies
Sampling
Sampling Strategies
What About Sample Size?
Stratification of Data
What about Case-Mix Adjustment?
Transforming Data
Analysis and Presentation of Data
Summary
Key Terms
Chapter 3
Understanding Variation Using Run Charts
Introduction
What Is a Run Chart?
Use of a Run Chart
Constructing a Run Chart
Examples of Run Charts for Improvement Projects
Rules to Aid in Interpreting Run Charts
Special Issues in Using Run Charts
Stratification with Run Charts
Using the Cumulative Sum Statistic with Run Charts
Summary
Key Terms
Chapter 4
Learning from Variation in Data
The Concept of Variation
Introduction to Shewhart Charts
Depicting and Interpreting Variation Using Shewhart Charts
The Role of Annotation with Shewhart Charts
Establishing Limits for Shewhart Charts
Revising Limits for Shewhart Charts
Stratification with Shewhart Charts
Shewhart Charts and Targets, Goals, or Other Specifications
Special Cause: Is It Good or Bad?
Summary
Key Terms
Chapter 5
Understanding Variation Using Shewhart Charts
Selecting the Type of Shewhart Chart
Shewhart Charts for Continuous Data
I Charts
Examples of Shewhart Charts for Individual Measurements
Rational Ordering with an I Chart
Example of I Chart for Deviations from a Target
Xbar S Shewhart Charts
Shewhart Charts for Attribute Data
Subgroup Size for Attribute Charts
The P Chart for Classification Data
Examples of P Charts
Creation of Funnel Limits for a P Chart
Shewhart Charts for Counts of Nonconformities
C Charts
U Chart
Creation of Funnel Limits for a U Chart
Alternatives for Attribute Charts for Rare Events
G Chart for Opportunities Between Rare Events
T Chart for Time Between Rare Events
Process Capability
Process Capability from an I Chart
Capability of a Process from Xbar and S Charts
Capability of a Process from Attribute Control Charts
Capability from a P Chart
Capability from a C or U Chart
Summary
Key Terms
Appendix 5.1
Calculating Shewhart Limits
I Chart (For Individual Values Of Continuous Data)
Xbar S Chart (For Continuous Data In Subgroups)
P Chart (For Classification Data)
C Chart (Count Of Incidences)
U Chart (Incidences Per Area Of Opportunity)
G Chart (Cases Between Incidences)
T Chart
Chapter 6
Additional Tools For Understanding Variation In Data
Depicting Variation
Additional Tools for Learning from Variation
Frequency Plots
Frequency Plot Construction
Frequency Plots Used with Shewhart Charts
Frequency Plots and Stratification
Pareto Charts
Pareto Chart Construction
Pareto Charts Used with Shewhart Charts
Pareto Chart and Stratification
Scatterplots
Scatterplot Construction
Scatterplots Used with Shewhart Charts
Scatterplots and Stratification
Radar Charts
Constructing a Radar Chart
Radar Charts Used with Shewhart Charts
Radar Charts and Stratification
Summary
Key Terms
Chapter 7
Shewhart Chart Savvy: Dealing with Common Issues
Creating Effective Shewhart Charts
Tip 1: Type of Data and Subgroup Size
Tip 2: Rounding Data
Tip 3: Formatting Charts
Tip 4. Decisions for Recalculating limits, or Rephasing, on a Shewhart Chart
Extending Centerline and Limits Backward
Typical Problems with Software for Calculating Shewhart Charts
Characteristics to Consider When Purchasing SPC Software
Another Caution with I Charts and Chart Selection
Guidelines for Shewhart Charts in Research Studies and Publications
Use of Shewhart Charts in Research Studies
Shewhart Charts in Publications
Shewhart’s Theory versus Statistical Inference
Summary
Key Terms
Part II Advanced Theory and Methods with Data For Improvement
Chapter 8
More Shewhart-Type Charts
Other Shewhart-Type Charts
The NP Chart
Xbar Range (Xbar R) Chart
Median Chart
Attribute Charts with Large Subgroup Sizes (P’ and U’)
Prime Charts (P’ and U’)
Negative Binomial Chart
Some Adaptations to Shewhart Charts
MA Chart
CUSUM Chart
Exponentially Weighted Moving Average (EWMA) Chart
Standardized Shewhart Charts
Multivariate Shewhart-Type Charts
Summary
Key Terms
Chapter 9
Special Uses for Shewhart Charts
Shewhart Charts with a Changing Centerline
Shewhart Charts with a Sloping Centerline
Shewhart Charts with Seasonal Effects
Adjusting Shewhart Charts for Confounders
Transformation of Data with Shewhart Charts
Shewhart Charts for Autocorrelated Data
Risk-Adjusted or Case-Mix Adjusted Shewhart Charts
Comparison Charts
Confidence Intervals and Confidence Limits
Summary
Key Terms
Chapter 10
Drilling Down into Aggregate Data for Improvement II
What are Aggregate Data?
What is the Challenge Presented by Aggregate Data?
Introduction to the Drill Down Pathway
Stratification
Sequencing
Rational Subgrouping
An Illustration of the Drill Down Pathway: Adverse Drug Events
Drill Down Pathway Step One
Drill Down Pathway Step Two
Drill Down Pathway Step Three
Drill Down Pathway Step Three, Continued
Drill Down Pathway Step Four
Drill Down Pathway Step Five
Drill Down Pathway Step Six
Summary
Key Terms
Part III Applications of Shewhart Charts in Health Care
Chapter 11
Learning from Individual Patient Data
Examples of Shewhart Charts for Individual Patients
Example 1: Asthma Patient Use of Shewhart Charts
Example 2: Prostate-Specific Antigen (PSA) Screening for Prostate Cancer
Example 3: Monitoring Patient Measures in the Hospital
Example 4: Bone Density for a Patient Diagnosed with Osteoporosis
Example 5: Temperature Readings for a Hospitalized Patient
Example 6: Shewhart Charts for Continuous Monitoring of Patients
Example 7: Monitoring Weight
Example 8: Monitoring Blood Sugar Control for Patients with Diabetes
Example 9: Using Shewhart Charts in Pain Management
Summary
Chapter 12
Learning from Patient Feedback to Improve Care
Summarizing Patient Feedback Data
Presentation of Patient Satisfaction Data
Using Patient Feedback for Improvement
The PDSA Cycle for Testing and Implementing Changes
Improvement Team Working on Clinic Satisfaction
Improvement Team Working on Pain
Feedback from Employees
Using Patient Satisfaction Data in Planning for Improvement
Special Issues with Patient Feedback Data
Are There Challenges When Summarizing and Using Patient Satisfaction Survey Data?
Does Survey Scale Matter?
Summary
Key Terms
Chapter 13
Using Shewhart Charts in Health Care Leadership
A Health Care Organization’s Vector of Measures
Developing a VOM
So How do We Best Display a VOM?
Administrative Issues with a VOM
Some Examples of Measures for Other VOMs
Emergency Department
Primary Care Center
System Flow Measures
Health Authority
Large Urban Hospital
IHI Whole System Measures
Summary
Key Terms
Chapter 14
Shewhart Charts for Epidemic Data
Shewhart Charts in Epidemiology
Development of Shewhart Charts for Epidemic Data
C Charts (Epoch 1)
Charts of Epoch 2
Charts for Epoch 3
Charts for Epoch 4
Some Issues with the Hybrid Chart for COVID-19 Deaths
Data Quality
Day-of-the-Week Adjustment
Application of the Hybrid Charts to Cases, Hospitalizations, and Intensive Care Unit Admissions
Summary
Key Term
Chapter 15
Case Studies
Case Study A: Improving Access to a Specialty Care Clinic
Case Study B: Radiology Improvement Projects
Case Study C: Reducing Post-Cabg Infections
Case Study D: Drilling Down into Percentage of C-Sections
Case Study E: Reducing Length of Stay After Surgery
Case Study F: Reducing Hospital admissions
Case Study G: Accidental Puncture/Laceration Rate
Case Study H: Improving Telemedicine Failed Calls and No Shows
Case Study I: Variation in Financial Data
Index
Shewhart Chart Selection Guide
End User License Agreement
List of Figures
Chapter 1
Figure 1.1 Model for Improvement
Figure 1.2 The PDSA cycle
Figure 1.3 Sequential PDSA Cycles for Learning and Improvement
Figure 1.4 PDSA Cycles from Testing to Implementation13
Figure 1.5 Results of a Before-and-After Test: Case 1
Figure 1.6 Other Possible Run Charts...
Figure 1.7 Analysis of Data from...
Figure 1.8 Run Charts of Key...
Chapter 2
Figure 2.1 Sources of Data...
Figure 2.3 Moving from Judgment to...
Figure 2.4 Using Percentile Rankings...
Figure 2.6 Simple Scales for Turning Personal Experience into Data
Figure 2.22 Graphs of Fall Rate and Number of Falls
Figure 2.7 Percentage of DRG Exceeding...
Figure 2.8 Percentage of Unplanned Readmissions...
Figure 2.9 Multiple Measures on a...
Figure 2.10 Surgical Safety FOM
Figure 2.11 Image Reflective of an Enumerative Study
Figure 2.12 Image Reflective of an Analytic Study
Figure 2.13 Large Sample Compared to Small Sample
Figure 2.14 Sample Size and Ability to Detect Change
Figure 2.15 Stratification Involves Separation and Classification
Figure 2.16 Shewhart Chart of Post...
Figure 2.17 Post-CABG Complication Rate...
Figure 2.18 Little Difference Between Risk...
Figure 2.19 Large Differences Between Risk...
Figure 2.20 Run Chart of Number of Falls
Figure 2.21 Run Chart of Rate of Falls
Figure 2.23 Patient Waiting Time
Figure 2.24 Tools to Learn from Variation in Data
Figure 2.25 Scatter Plots for Data in Table 2.18
Chapter 3
Figure 3.1 Historical Example of a Run Chart
Figure 3.2 Run Chart Example
Figure 3.4 Run Chart with Labels and Median
Figure 3.3 Run Chart Leading to Questions
Figure 3.5 Run Chart with Goal...
Figure 3.6 Stat Lab Run Chart...
Figure 3.7 Improvement Evident Using a...
Figure 3.8 Run Charts Used as...
Figure 3.9 Run Chart Displaying Multiple...
Figure 3.10 Run Chart Displaying a...
Figure 3.11 Run Chart Displaying Multiple...
Figure 3.12 Run Chart with Little...
Figure 3.13 Run Chart with Clinic...
Figure 3.14 Four Rules for Identifying...
Figure 3.15 Run Chart Evaluating Number...
Figure 3.16 Measure with Too Few...
Figure 3.17 Run Chart with Too...
Figure 3.18 Run Charts of Clinic...
Figure 3.19 Average Time to Administer...
Figure 3.20 Three Key Uses of...
Figure 3.21 Beginning a Run Chart...
Figure 3.22 Run Charts for Waiting...
Figure 3.23 Delay Detecting Signal with...
Figure 3.24 Detecting Signal with Proper...
Figure 3.25 Detecting Signal of Improvement...
Figure 3.26 Two Cases When Median...
Figure 3.27 Run Chart of Incidents...
Figure 3.28 Run Chart of Cases...
Figure 3.29 Starting and Updating Chart...
Figure 3.30 Mature Run Charts Tracking...
Figure 3.31 Use of Data Line...
Figure 3.32 Data from Unequal Time...
Figure 3.33 Data From Unequal Time...
Figure 3.34 Run Chart from Figure...
Figure 3.35 Run Chart with Inappropriate...
Figure 3.36 Run Chart of Autocorrelated...
Figure 3.37 Run Chart with Percentage...
Figure 3.38 Shewhart Control Chart (P...
Figure 3.39 Infant Mortality Data Stratified...
Figure 3.40 Harm Data Stratified Using...
Figure 3.41 Multi-Vari Chart...
Chapter 4
Figure 4.1 Using Shewhart Charts to...
Figure 4.2 Example of Shewhart Chart...
Figure 4.3 Example of Shewhart Chart...
Figure 4.4 Rules for Detecting a...
Figure 4.5 Detecting “Losing the...
Figure 4.6 Depicting Variation Using a...
Figure 4.7 Shewhart Charts Common Cause...
Figure 4.8 Shewhart Chart Revealing Process...
Figure 4.9 Shewhart Chart Using Rational...
Figure 4.10 Shewhart Chart Using Stratification...
Figure 4.11 Shewhart Charts Depicting a...
Figure 4.12 Run Charts and Shewhart...
Figure 4.13 Improper and Proper Extension...
Figure 4.14 Dealing with Special Cause...
Figure 4.15 Recalculating Limits After Special...
Figure 4.16 Recalculating Limits after Exhausting...
Figure 4.17 Stratification of Laboratory Data...
Figure 4.18 Disaggregation of ADEs Data...
Figure 4.19 ADE Rate Rationally Subgrouped...
Figure 4.20 Shewhart Chart Meeting Goal...
Figure 4.21 Shewhart Chart Stable but...
Figure 4.22 Special Cause in Desirable...
Figure 4.23 Shewhart Chart with Special...
Figure 4.24 Shewhart Chart for LOS...
Figure 4.25 Percentage of Patients with...
Chapter 5
Figure 5.1 Shewhart Chart Selection Guide162...
Figure 5.2 I Chart for Volume...
Figure 5.3 I Chart Extended and...
Figure 5.4 Rational Ordering for an...
Figure 5.5 I Chart for Budget...
Figure 5.6 Xbar S Chart for...
Figure 5.7 Xbar S Chart for...
Figure 5.8 Xbar S Chart for...
Figure 5.9 Xbar and S Chart...
Figure 5.10 Xbar S Chart Showing...
Figure 5.11 P Chart for Percentage...
Figure 5.12 Extended P Chart for...
Figure 5.13 P Chart Showing Second...
Figure 5.14 P Chart for Percentage...
Figure 5.15 P Chart for Percentage...
Figure 5.16 Funnel Plot of P...
Figure 5.17 P Chart with Funnel...
Figure 5.18 C Chart for Employee...
Figure 5.19 C Chart for Issues...
Figure 5.21 U Charts Showing the...
Figure 5.20 U Chart for Flash...
Figure 5.22 U Chart for Complaints...
Figure 5.23 Comparison of G Chart...
Figure 5.24 G Chart for ADEs202...
Figure 5.25 T Chart for Number...
Figure 5.26 Different Formats for Displaying...
Figure 5.27 T Chart for Retained...
Figure 5.28 Process Capability: Typical Situations...
Figure 5.29 Capability From an I...
Figure 5.30 Capability Analysis from an...
Chapter 6
Figure 6.1 Tools to Learn from...
Figure 6.2 Histogram, Dot Plot, and...
Figure 6.3 Frequency Plot (Dot Plot...
Figure 6.4 Age of Children with...
Figure 6.5 Shewhart Chart of Average...
Figure 6.6 Histogram of Minutes to...
Figure 6.7 Stable Shewhart Chart of...
Figure 6.8 Histogram of Age of...
Figure 6.9 Distribution of Data without...
Figure 6.10 Frequency Plot of Clinic...
Figure 6.11 Stratified Histograms of Patient...
Figure 6.12 Histogram of Antibiotic Start...
Figure 6.13 Shewhart Chart of Average...
Figure 6.14 Histograms Stratified by Common...
Figure 6.15 Example of a Pareto...
Figure 6.16 Pareto Chart with Cumulative...
Figure 6.17 Stable Shewhart Chart of...
Figure 6.18 Pareto Chart of Cited...
Figure 6.19 Factors Noted with Late...
Figure 6.20 Shewhart Chart of Hospital...
Figure 6.21 Pareto of Opportunities to...
Figure 6.22 Unweighted Pareto Chart of...
Figure 6.23 Weighted Pareto Chart of...
Figure 6.24 Stratified Pareto Charts of...
Figure 6.25 Stratified Pareto Charts of...
Figure 6.26 Stratified Pareto Charts of...
Figure 6.27 Shewhart Chart of Adverse...
Figure 6.28 Stratified Pareto Charts of...
Figure 6.29 Stratified Pareto Charts Contrasting...
Figure 6.30 Scatterplot of Time with...
Figure 6.31 Scatterplot of Wait Related...
Figure 6.32 Scatterplot with Trend Line...
Figure 6.33 Interpreting Patterns on the...
Figure 6.34 Shewhart Chart of Patient...
Figure 6.35 Scatterplots Related to Willingness...
Figure 6.36 Scatterplot Relating Arrival Time...
Figure 6.37 Scatterplot Relating Days between...
Figure 6.38 Stratified Scatterplots Case Load...
Figure 6.39 Stratified Scatterplots Relating Case...
Figure 6.40 Stratified Scatterplots Relating Wait...
Figure 6.41 Radar Chart of Satisfaction...
Figure 6.42 Patient Satisfaction with Urgent...
Figure 6.43 Radar Chart of Satisfaction...
Figure 6.44 Patient Satisfaction with Urgent...
Figure 6.45 Radar Charts of Satisfaction...
Figure 6.46 Radar Charts of Patient...
Chapter 7
Figure 7.1 Showing Data Points: (a...
Figure 7.2 Vertical Scale: (a) Just...
Figure 7.3 (a) Inappropriate Vertical Scale...
Figure 7.4 Including 0% and 100...
Figure 7.5 Overuse of Gridlines and...
Figure 7.6 Example of Shewhart Chart...
Figure 7.7 Extending Limits “Backward...
Figure 7.8 Importance of Freezing Limits...
Figure 7.9 I Charts with Limits...
Figure 7.10 I Chart Compared to...
Figure 7.11 I Chart Compared to...
Figure 7.12 I Chart Compared to...
Figure 7.13 Published Shewhart Chart Using...
Figure 7.14 Deductive and Inductive Statistical...
Figure 7.15 Comparison of Shewhart Chart...
Figure 7.16 Comparison of Shewhart Chart...
Chapter 8
Figure 8.1 Expanded Chart Selection Guide...
Figure 8.2 Example of an NP...
Figure 8.3 Example of an Xbar...
Figure 8.4 Example of a Median...
Figure 8.5 P Chart with Limits...
Figure 8.6 Same Data as Figure...
Figure 8.7 U Chart and U...
Figure 8.8 Improper Use of P...
Figure 8.9 Percentage of State Populations...
Figure 8.10 Comparison of Negative Binomial...
Figure 8.11 C Chart and Negative...
Figure 8.12 Weighting Schemes for Alternative...
Figure 8.13 MA Charts Compared to...
Figure 8.14 CUSUM Run Chart of...
Figure 8.15 CUSUM Charts for Patient...
Figure 8.16 CUSUM Chart and Run...
Figure 8.17 Comparison of a C...
Figure 8.18 EWMA Chart for Patient...
Figure 8.19 EWMA Chart for HbA1c...
Figure 8.20 EWMA Chart with Two...
Figure 8.21 Regular and Standardized Xbar...
Figure 8.22 Regular and Standardized P...
Figure 8.23 Regular and Standardized U...
Figure 8.24 General Form of Multivariate...
Figure 8.25 T2 Chart for First...
Figure 8.26 T2 Chart for Three...
Figure 8.27 I Charts for Three...
Chapter 9
Figure 9.1 Shewhart Chart with Slanted...
Figure 9.2 I Chart with Regression...
Figure 9.3 Shewhart Chart with Nonlinear...
Figure 9.4 Shewhart Chart for Wait...
Figure 9.5 Wait Times for Appointment...
Figure 9.6 Individual Chart for Adjusted...
Figure 9.7 Wait Time Chart with...
Figure 9.8 P Chart for Emergency...
Figure 9.9 P Chart to Study...
Figure 9.10 Asthma P Chart—...
Figure 9.11 Initial I Chart for...
Figure 9.12 Scatterplot of Wait Time...
Figure 9.13 I Chart for Average...
Figure 9.14 Monthly Electric Bill Before...
Figure 9.15 Scatterplots Exploring the Relationship...
Figure 9.16 Adjusted Monthly Electric Bill...
Figure 9.17 Ineffective I Chart for...
Figure 9.18 Frequency Plots for Data...
Figure 9.19 Alternative Displays of I...
Figure 9.20 Xbar S Chart for...
Figure 9.21 Frequency Plots for Original...
Figure 9.22 Xbar S Chart Based...
Figure 9.23 Chart for Average HbA1c...
Figure 9.24 Scatter Plot to Evaluate...
Figure 9.25 I Charts for Visit...
Figure 9.26 Scatterplot Implying Spurious Autocorrelation...
Figure 9.27 Including Case-Mix Adjustments...
Figure 9.28 Example of Comparison Chart...
Figure 9.29 Xbar S Chart for...
Figure 9.30 95% Confidence Intervals for...
Chapter 10
Figure 10.1 Shewhart Chart Revealing Improvement...
Figure 10.2 The Drill Down Pathway...
Figure 10.3 Comparison of Aggregated and...
Figure 10.4 Mortality Rate Using a...
Figure 10.5 Rational Subgrouping Strategy for...
Figure 10.6 Shewhart Chart at the...
Figure 10.7 Shewhart Chart Displaying All...
Figure 10.8 Separate Shewhart Chart for...
Figure 10.9 Separate Shewhart Chart for...
Figure 10.10 ADE Rate Subgrouped by...
Figure 10.11 Aggregate Shewhart Chart Rationally...
Figure 10.12 ADE Rate Subgrouped by...
Figure 10.13 Pareto Chart of ADE...
Figure 10.14 Pareto Chart of ADEs...
Figure 10.15 Shewhart Chart Used to...
Chapter 11
Figure 11.1 Xbar S Charts for...
Figure 11.2 Run Chart for PSA...
Figure 11.3 PSA Test Results for...
Figure 11.4 Run Chart of Ultrasound...
Figure 11.5 Run Charts for Patient...
Figure 11.6 I Charts for Patient...
Figure 11.7 Run Chart of Temperatures...
Figure 11.8 I Chart for Temperature...
Figure 11.9 Xbar S Chart for...
Figure 11.10 CUSUM Chart for Patient...
Figure 11.11 Run Chart of Patient...
Figure 11.12 I Charts for Patient...
Figure 11.13 Run Chart/I Chart...
Figure 11.14 I Chart for Monitoring...
Figure 11.15 I Chart for Patient...
Chapter 12
Figure 12.1 Excerpts from HCAHPS Survey...
Figure 12.2 Excerpt from NHS Survey...
Figure 12.3 Shewhart Charts for One...
Figure 12.4 Patient Satisfaction Data Summarized...
Figure 12.5 Patient Satisfaction Percentile Ranking...
Figure 12.6 Pareto Chart of Types...
Figure 12.7 Small Multiples of Patient...
Figure 12.8 Pareto Chart of Clinic...
Figure 12.9 Clinic Patient Feedback Shewhart...
Figure 12.10 Scatterplots for Three Areas...
Figure 12.11 Shewhart Chart of Willingness...
Figure 12.12 Xbar S Chart of...
Figure 12.13 P Chart Summarizing Patient...
Figure 12.14 Employee Feedback Upon Exit...
Figure 12.15 Importance and Satisfaction Matrix...
Figure 12.16 Using an Interim of...
Figure 12.17 Data Not Used When...
Chapter 13
Figure 13.1 Tabular VOM Using Green...
Figure 13.2 Shewhart Chart of Safety...
Figure 13.3 Percentage of Perfect Care...
Figure 13.4 Shewhart Chart of Percentage...
Figure 13.5 Infection Rate Data Color...
Figure 13.6 Average Physician Satisfaction...
Figure 13.8 Graph with Appropriate Space...
Figure 13.9 Graph with Excessive Number...
Figure 13.10 Graph Updated to Provide...
Figure 13.11 Graph with Historical Data...
Chapter 14
Figure 14.1 Example of Typical Epidemiological...
Figure 14.2 Example of Hybrid Shewhart...
Figure 14.3 Initial C Charts for...
Figure 14.4 C Chart of COVID...
Figure 14.5 Initial Attempt at Charts...
Figure 14.6 Charts for Epoch 2...
Figure 14.7 Hybrid Shewhart Chart for...
Figure 14.8 Chart for COVID-19...
Figure 14.9 Chart of US COVID...
Figure 14.10 Italy Daily COVID-19...
Figure 14.11 Bar Chart Showing Variation...
Figure 14.12 Comparison of Raw Data...
Figure 14.13 COVID-19 Daily Reported...
Figure 14.14 Family of Measures for...
Figure 14.15 Family of Measures for...
Chapter 15
FIGURE 15A.1 Baseline Data for Clinic...
FIGURE 15A.2 24-Week Data for...
FIGURE 15A.3 Urology Services Regional Demand...
FIGURE 15A.4 One Year Data for...
FIGURE 15B.1 Significant Revisions Project: P...
FIGURE 15B.2 Turnaround Time Project: Xbar...
FIGURE 15B.3 Start Time Project: Xbar...
FIGURE 15B.4 Scatterplot of Turnaround Time...
FIGURE 15B.5 Significant Revisions Project: T...
FIGURE 15B.6 Significant Revisions Project: G...
FIGURE 15B.7 Significant Revisions Project: Updated...
FIGURE 15B.8 Turnaround Time Project: Xbar...
FIGURE 15B.9 Turnaround Time Project: Frequency...
FIGURE 15B.10 Start Time Project: Updated...
FIGURE 15C.1 Shewhart Chart of Post...
FIGURE 15C.2 Shewhart Chart of CABG...
FIGURE 15C.3 Shewhart Chart of CABG...
FIGURE 15C.4 Shewhart Chart of CABG...
FIGURE 15C.5 Stratified Histograms: Common Versus...
FIGURE 15C.6 Shewhart Chart of CABG...
FIGURE 15C.7 CABG Infection Rates after...
FIGURE 15C.8 Shewhart Chart of CABG...
FIGURE 15D.1 The Drill Down Pathway...
FIGURE 15D.2 P Chart of Aggregate...
FIGURE 15D.3 Percentage of C-Section...
FIGURE 15D.4 Percentage of C-Sections...
FIGURE 15D.5 Shewhart Chart for Each...
FIGURE 15D.6 Pareto Chart of Documented...
FIGURE 15D.7 Monthly Versus Quarterly Aggregate...
Figure 15E.1 Xbar S Chart for...
Figure 15E.2 Xbar S Chart for...
Figure 15E.3 Balancing Measures: Complications and...
Figure 15E.4 Scatterplot of Length of...
Figure 15E.5 Funnel Plots (U Charts...
Figure 15E.6 Funnel Plot for Length...
Figure 15E.7 Length of Stay Subgrouped...
Figure 15E.8 Length of Stay Subgrouped...
Figure 15E.9 Length of Stay Subgrouped...
Figure 15E.10 Xbar S Chart for...
Figure 15E.11 Analysis of Factorial Study...
Figure 15E.12 Xbar S Chart for...
Figure 15E.13 Xbar S Chart for...
Figure 15E.14 U Charts for Complications...
Figure 15F.1 P Chart of Monthly...
Figure 15F.2 Funnel Plot of Hospitals...
Figure 15F.3 P Chart of Hospital...
Figure 15F.4 P Chart of Hospital...
Figure 15F.5 P Chart of Hospital...
Figure 15G.1 The Drill Down Pathway...
Figure 15G.2 Aggregate APL Rate per...
Figure 15G.3 Aggregate APL Rate per...
Figure 15G.4 APL Rate Disaggregated by...
Figure 15G.5 Separate Shewhart Charts of...
Figure 15G.6 Rational Subgrouping Scheduled Versus...
Figure 15G.7 Rational Subgrouping Laparoscopic Versus...
Figure 15H.1 P Charts of Outcome...
Figure 15H.2 Telemedicine Data Charted Weekly...
Figure 15H.3 P’ Charts of...
Figure 15H.4 Percentage of No Shows...
Figure 15H.5 Percentage of Failed Calls...
Figure 15H.6 Percentage of Failed Calls...
Figure 15H.7 Percentage of Failed by...
Figure 15H.8 Scatterplot of SES Score...
Figure 15H.9 Percentage of Failed Calls...
Figure 15H.10 Daily Percentage of Failed...
Figure 15H.11 Daily Percentage of No...
Figure 15H.12 Telemedicine Family of Measures...
Figure 15I.1 Run Chart of Pneumonia...
Figure 15I.2 I Chart of Pneumonia...
Figure 15I.3 I Chart of Pneumonia...
Figure 15I.4 Xbar S Chart for...
Figure 15I.5 Xbar S Chart for...
Figure 15I.6 Scatterplot for Pneumonia Charges...
Figure 15I.7 Run Chart for Charges...
Figure 15I.8 Xbar and S Charts...
Figure 15I.9 Xbar S Charts (Funnel...
Figure 15I.10 Scatterplots for Comorbidities versus...
List of Tables
Chapter 1
Table 1.1 Overview of Methods for Improvement
Table 1.2 Overview of Tools for Improvement
Table 1.3 Initial Team Plan for PDSA Cycles
Table 1.4 Some Additional Plans for PDSA Cycles
Chapter 2
Table 2.1 Data for Improvement, Accountability, Research
Table 2.2 Useful Characteristics When Developing Measurement for Improvement
Table 2.3 Traditional Data Typologies
Table 2.4 Traditional Data Categories with Science of Improvement Categories
Table 2.5 Forms of Data
Table 2.6 Outcome, Process, and Balancing Measures
Table 2.7 Dimensions of System Performance
Table 2.8 FOM Including Outcome, Process, and Balancing Measures
Table 2.9 IOM’s Six Dimensions of Care
Table 2.10 Operational Definition Percentage...
Table 2.11 Asthma Severity Operational Definition
Table 2.12 Examples of Enumerative and Analytic Studies
Table 2.13 Judgment Sampling Data Collection Strategy
Table 2.14 Deciding the Scale of a Test
Table 2.15 Number of Falls
Table 2.16 Data for Rate...
Table 2.17 Examples of Useful Ratios
Chapter 3
Table 3.1 Run Chart Data
Table 3.2 Percentage of On-Time Appointments in Clinic by Month
Table 3.3 Method 1: Run Chart Data Reordered and Median Determined
Table 3.4 Runs Rule Guidance...
Table 3.5 Data for Percentage of Unplanned Returns to OR
Table 3.6 Harm Rate Data for Multi-Vari Chart
Table 3.7 Patient Satisfaction CUSUM Using Process Average as Target
Chapter 4
Table 4.1 Balancing the Mistakes Made in Attempts to Improve
Chapter 5
Table 5.1 Applications of Shewhart Charts for Continuous Data in Health Care
Table 5.2 Five Types of Attribute Shewhart Charts
Table 5.3 Minimum Subgroup Size for an Effective P Chart
Table 5.4 Examples of Common P Chart Applications in Health Care
Table 5.5 Example of Area of Opportunity for Count Data
Table 5.6 Applications of a C Chart and U Chart
Table 5.7 Data on Number of ADEs by Month
Table 5.8 Data on Infections From ICU
Table 5.9 Methods Used to Obtain Limits Based Solely on Common Cause
Chapter 6
Table 6.1 Paired Samples for a Scatterplot
Chapter 7
Table 7.1 Characteristics to Consider When Selecting SPC Software
Chapter 8
Table 8.1 Symbols Used with NP Charts
Table 8.2 Symbols and Factors Used with Xbar and R Charts
Table 8.3 Symbols Used with Median Charts
Table 8.4 Symbols Used with P’ or U’ Charts
Table 8.5 Symbols Used with Negative Binomial Charts
Table 8.6 Example of Calculated MAs of Three and Five
Table 8.7 Factors Used with MA Chart
Table 8.8 Calculation of CUSUM Statistic and Limits
Table 8.9 Creating Standardized Statistics...
Table 8.10 Monthly Hospital System...
Chapter 9
Table 9.1 Average Deviations from...
Chapter 10
Table 10.1 Clinical Quality Measures Comparative Summary
Table 10.2 Excerpt from Long-Term Care Report Card
Table 10.3 Excerpt from Medical Center Balanced Scorecard
Table 10.4 Aggregate Monthly ADE Data
Table 10.5 Initial Drill Down Log for Aggregate ADE Data
Table 10.6 Completed Drill Down Log for Aggregate ADE Data
Table 10.7 Initial Drill Down...
Table 10.8 ADE Data Disaggregated...
Table 10.9 Completed Drill Down...
Table 10.10 Initial Drill Down...
Table 10.11 Completed Drill Down...
Table 10.12 Initial Drill down...
Table 10.13 Completed Drill Down...
Table 10.14 Initial Drill Down...
Table 10.15 Completed Drill Down...
Table 10.16 Initial Drill Down...
Table 10.17 Completed Drill Down...
Table 10.18 Initial Drill Down...
Table 10.19 Completed Drill Down...
Table 10.20 Initial Drill Down...
Table 10.21 Completed Drill Down...
Table 10.22 Initial Drill Down...
Table 10.23 Completed Drill Down...
Chapter 12
Table 12.1 Summary Statistics, Issues...
Table 12.2 Shewhart Charts for...
Table 12.3 Mankoski Pain Scale...
Chapter 13
Table 13.1 A Summary of...
Table 13.2 Concepts for Measures...
Table 13.3 WSM 2.0...
Chapter 15
Table 15.1 Summary of Use...
Table 15C.1 Post CABG Infection...
Table 15C.2 CABG Infection Data...
Table 15C.3 CABG Infection Data...
Table 15C.4 CABG Infection Data...
Table 15C.5 CABG Infection Rates...
Table 15D.1 C-Section Data...
Table 15E.1 Format of Database...
Table 15E.2 Study Design for...
Table 15F.1 Baseline Data for...
Table 15G.1 Clinical Quality Measures...
Table 15G.2 APL Data Monthly...
Table 15I.1 Data for Comorbidities...
List of Exhibits
Chapter 1
Exhibit 1.1 Documentation for Initial Self-Management PDSA Cycle
Chapter 2
Exhibit 2.1 Operational Definition Aspirin at Arrival
Chapter 3
Exhibit 3.1 Constructing a Run Chart
Exhibit 3.2 On-Time Appointments: Run Chart Example
Guide
Cover
Title page
Copyright
Table of Contents
Figures, Tables, and Exhibits
Preface
Acknowledgments
The Authors
About the Companion Website
Begin Reading
Index
Shewhart Chart Selection Guide
End User License Agreement
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FIGURES, TABLES, AND EXHIBITS
FIGURES
FIGURE 1.1 Model for Improvement
FIGURE 1.2 The PDSA cycle
FIGURE 1.3 Sequential PDSA Cycles for Learning and Improvement
FIGURE 1.4 PDSA Cycles from Testing to Implementation
FIGURE 1.5 Results of a Before-and-After Test: Case
FIGURE 1.6 Other Possible Run Charts Associated with Before-and-After Graph
FIGURE 1.7 Analysis of Data from a PDSA Cycle
FIGURE 1.8 Run Charts of Key Measures for Diabetes Improvement Project
FIGURE 2.1 Sources of Data
FIGURE 2.2 Measurement for Judgment versus Improvement
FIGURE 2.3 Moving from Judgment to Improvement Measures
FIGURE 2.4 Using Percentile Rankings
FIGURE 2.5 Measure Based on an Index Instead of Actual Units
FIGURE 2.6 Simple Scales for Turning Personal Experience into Data
FIGURE 2.7 Percentage of DRG Exceeding LOS Guidelines Indicating Improvement
FIGURE 2.8 Percentage of Unplanned Readmissions Worsening
FIGURE 2.9 Multiple Measures on a Single Graph
FIGURE 2.10 Surgical Safety FOM
FIGURE 2.11 Image Reflective of an Enumerative Study
FIGURE 2.12 Image Reflective of an Analytic Study
FIGURE 2.13 Large Sample Compared to Small Sample
FIGURE 2.14 Sample Size and Ability to Detect Change
FIGURE 2.15 Stratification Involves Separation and Classification
FIGURE 2.16 Shewhart Chart of Post-CABG Complication Rate Without Stratification
FIGURE 2.17 Post-CABG Complication Rate Stratified by Protocol
FIGURE 2.18 Little Difference Between Risk-Adjusted and Non-Risk-Adjusted Data
FIGURE 2.19 Large Differences Between Risk-Adjusted and Non-Risk-Adjusted Data
FIGURE 2.20 Run Chart of Number of Falls
FIGURE 2.21 Run Chart of Rate of Falls
FIGURE 2.22 Graphs of Fall Rate and Number of Falls
FIGURE 2.23 Patient Waiting Time
FIGURE 2.24 Tools to Learn from Variation in Data
FIGURE 2.25 Scatter Plots for Data in Table 2.18
FIGURE 3.1 Historical Example of a Run Chart
FIGURE 3.2 Run Chart Example
FIGURE 3.3 Run Chart Leading to Questions
FIGURE 3.4 Run Chart with Labels and Median
FIGURE 3.5 Run Chart with Goal Line and Tests of Change Annotated
FIGURE 3.6 Stat Lab Run Chart with No Evidence of Improvement
FIGURE 3.7 Improvement Evident Using a Set of Run Charts Viewed on One Page
FIGURE 3.8 Run Charts Used as Small Multiples
FIGURE 3.9 Run Chart Displaying Multiple Measures
FIGURE 3.10 Run Chart Displaying a Different Measure for Each Axis
FIGURE 3.11 Run Chart Displaying Multiple Statistics for the Same Measure
FIGURE 3.12 Run Chart with Little Data
FIGURE 3.13 Run Chart with Clinic Team Uncertain About Improvement
FIGURE 3.14 Four Rules for Identifying Nonrandom Signals of Change
FIGURE 3.15 Run Chart Evaluating Number of Runs
FIGURE 3.16 Measure with Too Few Runs
FIGURE 3.17 Run Chart with Too Many Runs
FIGURE 3.18 Run Charts of Clinic Cycle Time
FIGURE 3.19 Average Time to Administer Antibiotics
FIGURE 3.20 Three Key Uses of Run Charts in Improvement Initiatives
FIGURE 3.21 Beginning a Run Chart as Soon as the First Data Are Available
FIGURE 3.22 Run Charts for Waiting Time Data
FIGURE 3.23 Delay Detecting Signal with Proper Median Technique
FIGURE 3.24 Detecting Signal with Proper Median Technique
FIGURE 3.25 Detecting Signal of Improvement with Two Medians
FIGURE 3.26 Two Cases When Median Ineffective on Run Chart
FIGURE 3.27 Run Chart of Incidents Resulting in Too Many Zeros
FIGURE 3.28 Run Chart of Cases between an Incident
FIGURE 3.29 Starting and Updating Chart of Cases between Undesirable Rare Events
FIGURE 3.30 Mature Run Charts Tracking Cases Between Rare Events
FIGURE 3.31 Use of Data Line on Run Chart
FIGURE 3.32 Data from Unequal Time Intervals Displayed in Usual Run Chart
FIGURE 3.33 Data From Unequal Time Intervals Displayed to Reveal Impact of Time
FIGURE 3.34 Run Chart from Figure 3.22 With Seventh Week Added
FIGURE 3.35 Run Chart with Inappropriate Use of Trend Line
FIGURE 3.36 Run Chart of Autocorrelated Data from a Patient Registry
FIGURE 3.37 Run Chart with Percentage Doubled in Most Recent Month
FIGURE 3.38 Shewhart Control Chart (P Chart) Adjusting Limits Based on Denominator Size
FIGURE 3.39 Infant Mortality Data Stratified Using a Run Chart
FIGURE 3.40 Harm Data Stratified Using a Run Chart
FIGURE 3.41 Multi-Vari Chart
FIGURE 3.42 Run Chart and CUSUM Run Chart of Patient Satisfaction Data
FIGURE 4.1 Using Shewhart Charts to Give Direction to an Improvement Effort
FIGURE 4.2 Example of Shewhart Chart with Equal Subgroup Size
FIGURE 4.3 Example of Shewhart Chart with Unequal Subgroup Size
FIGURE 4.4 Rules for Detecting a Special Cause
FIGURE 4.5 Detecting “Losing the Gains” For an Improved Process
FIGURE 4.6 Depicting Variation Using a Run Chart versus a Shewhart Chart
FIGURE 4.7 Shewhart Charts Common Cause and Special Cause Systems
FIGURE 4.8 Shewhart Chart Revealing Process or System Improvement
FIGURE 4.9 Shewhart Chart Using Rational Subgrouping
FIGURE 4.10 Shewhart Chart Using Stratification
FIGURE 4.11 Shewhart Charts Depicting a Process or System “Holding the Gain”
FIGURE 4.12 Run Charts and Shewhart Charts for Waiting Time Data
FIGURE 4.13 Improper and Proper Extension of Baseline Limits on Shewhart Chart
FIGURE 4.14 Dealing with Special Cause Data in Baseline Limits
FIGURE 4.15 Recalculating Limits After Special Cause Improvement
FIGURE 4.16 Recalculating Limits after Exhausting Efforts to Remove Special Cause
FIGURE 4.17 Stratification of Laboratory Data with a Shewhart Chart
FIGURE 4.18 Disaggregation of ADEs Data
FIGURE 4.19 ADE Rate Rationally Subgrouped in Different Ways
FIGURE 4.20 Shewhart Chart Meeting Goal but Unstable
FIGURE 4.21 Shewhart Chart Stable but Not Meeting Goal
FIGURE 4.22 Special Cause in Desirable Direction
FIGURE 4.23 Shewhart Chart with Special Cause in Undesirable Direction
FIGURE 4.24 Shewhart Chart for LOS
FIGURE 4.25 Percentage of Patients with an Unplanned Readmission
FIGURE 5.1 Shewhart Chart Selection Guide
FIGURE 5.2 I Chart for Volume of Infectious Waste
FIGURE 5.3 I Chart Extended and Updated with New Limits
FIGURE 5.4 Rational Ordering for an I Chart for Intake Process
FIGURE 5.5 I Chart for Budget Variances
FIGURE 5.6 Xbar S Chart for Radiology Test Turnaround Time
FIGURE 5.7 Xbar S Chart for LOS
FIGURE 5.8 Xbar S Chart for LOS by Provider
FIGURE 5.9 Xbar and S Chart Subgrouped by Provider and Quarter
FIGURE 5.10 Xbar S Chart Showing Improvement in Deviation from Start Times
FIGURE 5.11 P Chart for Percentage of Patients Harmed
FIGURE 5.12 Extended P Chart for Percentage of Patients Harmed
FIGURE 5.13 P Chart Showing Second Phase After Improvement
FIGURE 5.14 P Chart for Percentage of Unplanned Readmissions
FIGURE 5.15 P Chart for Percentage of MRSA for Hospital System
FIGURE 5.16 Funnel Plot of P Chart for Percentage of MRSA for Hospital System
FIGURE 5.17 P Chart with Funnel Limits for Systemwide Medication Compliance
FIGURE 5.18 C Chart for Employee Needlesticks
FIGURE 5.19 C Chart for Issues by Surgeon
FIGURE 5.20 U Chart for Flash Sterilization
FIGURE 5.21 U Charts Showing the Effect of Choosing the Standard Area of Opportunity
FIGURE 5.22 U Chart for Complaints by Clinic with Funnel Limits
FIGURE 5.23 Comparison of G Chart to U Chart
FIGURE 5.24 G Chart for ADEs
FIGURE 5.25 T Chart for Number of Days between ADEs
FIGURE 5.26 Different Formats for Displaying a T Chart
FIGURE 5.27 T Chart for Retained Foreign Objects
FIGURE 5.28 Process Capability: Typical Situations and Actions
FIGURE 5.29 Capability From an I Chart
FIGURE 5.30 Capability Analysis from an Xbar S Chart
FIGURE 6.1 Tools to Learn from Variation in Data
FIGURE 6.2 Histogram, Dot Plot, and Stem-and-Leaf Plot for Age at Fall
FIGURE 6.3 Frequency Plot (Dot Plot) of Patient Satisfaction Data
FIGURE 6.4 Age of Children with Head Injury
FIGURE 6.5 Shewhart Chart of Average Minutes to Initiate Antibiotics for Sepsis Patients
FIGURE 6.6 Histogram of Minutes to Antibiotic Start for Patients with Sepsis
FIGURE 6.7 Stable Shewhart Chart of Patient Fall Rate
FIGURE 6.8 Histogram of Age of People Who Fell
FIGURE 6.9 Distribution of Data without and with Skew
FIGURE 6.10 Frequency Plot of Clinic Patient Wait Time
FIGURE 6.11 Stratified Histograms of Patient Falls by Time of Day
FIGURE 6.12 Histogram of Antibiotic Start Time Stratified by Location
FIGURE 6.13 Shewhart Chart of Average Patient Satisfaction
FIGURE 6.14 Histograms Stratified by Common Cause and Special Cause Timeframes
FIGURE 6.15 Example of a Pareto Chart
FIGURE 6.16 Pareto Chart with Cumulative Percentage Line
FIGURE 6.17 Stable Shewhart Chart of SMC Readmission
FIGURE 6.18 Pareto Chart of Cited Reasons for SMC Adult Readmission
FIGURE 6.19 Factors Noted with Late Antibiotic Administration on Nursing Units
FIGURE 6.20 Shewhart Chart of Hospital Mortality Percentage
FIGURE 6.21 Pareto of Opportunities to Improve
FIGURE 6.22 Unweighted Pareto Chart of Nosocomial Infections
FIGURE 6.23 Weighted Pareto Chart of Nosocomial Infections
FIGURE 6.24 Stratified Pareto Charts of Health Status Stratified by Race
FIGURE 6.25 Stratified Pareto Charts of Factors Associated with Pediatric Head Injuries
FIGURE 6.26 Stratified Pareto Charts of Factors Associated with Patient Falls
FIGURE 6.27 Shewhart Chart of Adverse Drug Event Rate
FIGURE 6.28 Stratified Pareto Charts of Medications Associated with ADEs
FIGURE 6.29 Stratified Pareto Charts Contrasting Common Cause to Special Cause Timeframe
FIGURE 6.30 Scatterplot of Time with Provider Related to Patient Satisfaction
FIGURE 6.31 Scatterplot of Wait Related to Patient Satisfaction
FIGURE 6.32 Scatterplot with Trend Line and Statistics Added
FIGURE 6.33 Interpreting Patterns on the Scatterplot
FIGURE 6.34 Shewhart Chart of Patient Willingness to Recommend the Clinic
FIGURE 6.35 Scatterplots Related to Willingness to Recommend the Clinic
FIGURE 6.36 Scatterplot Relating Arrival Time and Time to Start Antibiotic
FIGURE 6.37 Scatterplot Relating Days between Case Worker Visits and QL Scores
FIGURE 6.38 Stratified Scatterplots Case Load and Sick Leave Use
FIGURE 6.39 Stratified Scatterplots Relating Case Worker Visits and QL Scores
FIGURE 6.40 Stratified Scatterplots Relating Wait Time to Satisfaction
FIGURE 6.41 Radar Chart of Satisfaction with Health Care
FIGURE 6.42 Patient Satisfaction with Urgent Care
FIGURE 6.43 Radar Chart of Satisfaction with Urgent Care by Element
FIGURE 6.44 Patient Satisfaction with Urgent Care Showing Special Cause
FIGURE 6.45 Radar Charts of Satisfaction with Health Care Stratified by Common and Special Cause Timeframes
FIGURE 6.46 Radar Charts of Patient Satisfaction Stratified by Race
FIGURE 7.1 Showing Data Points: (a) With Dots, (b) No Dots
FIGURE 7.2 Vertical Scale: (a) Just Right, (b) Too Wide, (c) To Narrow
FIGURE 7.3 (a) Inappropriate Vertical Scale, (b) Appropriate Scale
FIGURE 7.4 Including 0% and 100% on Vertical Scale
FIGURE 7.5 Overuse of Gridlines and Illegible Data Display
FIGURE 7.6 Example of Shewhart Chart with Appropriate Annotations
FIGURE 7.7 Extending Limits “Backward” on a Shewhart Chart
FIGURE 7.8 Importance of Freezing Limits on Shewhart Charts
FIGURE 7.9 I Charts with Limits Calculated Both with and without Screening
FIGURE 7.10 I Chart Compared to C Chart for Stable Count Measure
FIGURE 7.11 I Chart Compared to C Chart for Unstable Count Measure
FIGURE 7.12 I Chart Compared to P Chart for Unstable Classification Data
FIGURE 7.13 Published Shewhart Chart Using a Descriptive Strategy for Phasing
FIGURE 7.14 Deductive and Inductive Statistical Approaches
FIGURE 7.15 Comparison of Shewhart Chart and Statistical Inference
FIGURE 7.16 Comparison of Shewhart Chart with Special Cause and Statistical Inference
FIGURE 8.1 Expanded Chart Selection Guide to Include Alternative Charts
FIGURE 8.2 Example of an NP Chart
FIGURE 8.3 Example of an Xbar R Chart
FIGURE 8.4 Example of a Median Chart
FIGURE 8.5 P Chart with Limits that Appear “Very Tight”
FIGURE 8.6 Same Data as Figure 8.5 On a P’ Chart
FIGURE 8.7 U Chart and U’ Chart for Medication Errors
FIGURE 8.8 Improper Use of P Prime Chart for Self-Management Goals
FIGURE 8.9 Percentage of State Populations Fully Vaccinated for COVID-
FIGURE 8.10 Comparison of Negative Binomial Chart to C Chart
FIGURE 8.11 C Chart and Negative Binomial Chart for Infections
FIGURE 8.12 Weighting Schemes for Alternative Charts
FIGURE 8.13 MA Charts Compared to I Chart
FIGURE 8.14 CUSUM Run Chart of Patient Satisfaction Data from Figure 3.42
FIGURE 8.15 CUSUM Charts for Patient Satisfaction
FIGURE 8.16 CUSUM Chart and Run Chart of HbA1c Values
FIGURE 8.17 Comparison of a C Chart and CUSUM Chart for the Same Data
FIGURE 8.18 EWMA Chart for Patient Satisfaction Data
FIGURE 8.19 EWMA Chart for HbA1c Values for Diabetic Patient
FIGURE 8.20 EWMA Chart with Two Phases for HbA1c Values for Diabetic Patient
FIGURE 8.21 Regular and Standardized Xbar Chart
FIGURE 8.22 Regular and Standardized P Chart
FIGURE 8.23 Regular and Standardized U Chart
FIGURE 8.24 General Form of Multivariate Control Chart (T2 Chart for Five Measures)
FIGURE 8.25 T2 Chart for First Two Years’ Financial Data
FIGURE 8.26 T2 Chart for Three Financial Measures—Baseline Limits Extended to Phase
FIGURE 8.27 I Charts for Three Financial Measures (Limits Based on 2018–2019 Data)
FIGURE 9.1 Shewhart Chart with Slanted Centerline for Obesity Data
FIGURE 9.2 I Chart with Regression Centerline for Opioid Deaths
FIGURE 9.3 Shewhart Chart with Nonlinear Regression Centerline
FIGURE 9.4 Shewhart Chart for Wait Times for the Next Appointment
FIGURE 9.5 Wait Times for Appointment Subgrouped by Month of Year
FIGURE 9.6 Individual Chart for Adjusted Wait Times
FIGURE 9.7 Wait Time Chart with Centerline and Limits Adjusted for Monthly Effects
FIGURE 9.8 P Chart for Emergency Asthma Visits
FIGURE 9.9 P Chart to Study Monthly Effects
FIGURE 9.10 Asthma P Chart—Adjusted Data and Adjusted Centerline and Limits
FIGURE 9.11 Initial I Chart for Average Monthly Wait Times in an ED
FIGURE 9.12 Scatterplot of Wait Time vs. Volume
FIGURE 9.13 I Chart for Average Monthly Wait Times in an ED with Adjusted Data
FIGURE 9.14 Monthly Electric Bill Before and After Solar Installation
FIGURE 9.15 Scatterplots Exploring the Relationship between the Electric Bill and Temperature
FIGURE 9.16 Adjusted Monthly Electric Bill Before and After Solar Installation
FIGURE 9.17 Ineffective I Chart for Time to Complete Weekly Report
FIGURE 9.18 Frequency Plots for Data and Transformations (Time for Weekly Task)
FIGURE 9.19 Alternative Displays of I Charts for Transformed Data
FIGURE 9.20 Xbar S Chart for ED Times from Arrival to Treatment
FIGURE 9.21 Frequency Plots for Original and Log10 Transformed Time to Treatment
FIGURE 9.22 Xbar S Chart Based on Log10 Transformed ED Times
FIGURE 9.23 Chart for Average HbA1c Values from Registry
FIGURE 9.24 Scatter Plot to Evaluate Autocorrelation of Registry Data
FIGURE 9.25 I Charts for Visit Cycle Time in Specialty Clinic
FIGURE 9.26 Scatterplot Implying Spurious Autocorrelation
FIGURE 9.27 Including Case-Mix Adjustments on Shewhart Chart
FIGURE 9.28 Example of Comparison Chart for Perioperative Mortality
FIGURE 9.29 Xbar S Chart for LOS
FIGURE 9.30 95% Confidence Intervals for Average LOS by Month
FIGURE 10.1 Shewhart Chart Revealing Improvement Not Sustained
FIGURE 10.2 The Drill Down Pathway
FIGURE 10.3 Comparison of Aggregated and Disaggregated Mortality Data
FIGURE 10.4 Mortality Rate Using a Different Sequencing Strategy
FIGURE 10.5 Rational Subgrouping Strategy for Mortality Data
FIGURE 10.6 Shewhart Chart at the Aggregate Level
FIGURE 10.7 Shewhart Chart Displaying All Eight Hospitals on the Same Chart
FIGURE 10.8 Separate Shewhart Chart for Each Hospital Special Cause to the System
FIGURE 10.9 Separate Shewhart Chart for Each Hospital Common Cause to the System
FIGURE 10.10 ADE Rate Subgrouped by Day of the Week
FIGURE 10.11 Aggregate Shewhart Chart Rationally Subgrouping Common Cause Data by Shift
FIGURE 10.12 ADE Rate Subgrouped by Shift for Common Cause Hospitals
FIGURE 10.13 Pareto Chart of ADE Occurrence by Medication Name
FIGURE 10.14 Pareto Chart of ADEs Associated with Various Factors
FIGURE 10.15 Shewhart Chart Used to Determine Impact of Changes Implemented
FIGURE 11.1 Xbar S Charts for Peak Flow Readings from Patient with Asthma
FIGURE 11.2 Run Chart for PSA Test Results for a Colleague
FIGURE 11.3 PSA Test Results for One of the Authors
FIGURE 11.4 Run Chart of Ultrasound Measures on Whiteboard in Patient Room
FIGURE 11.5 Run Charts for Patient Bone Density Test
FIGURE 11.6 I Charts for Patient BMD Tests at Two Locations
FIGURE 11.7 Run Chart of Temperatures for Hospitalized Patient with Fever
FIGURE 11.8 I Chart for Temperature Readings for Patient with Fever
FIGURE 11.9 Xbar S Chart for Temperature Readings for Patient with Fever
FIGURE 11.10 CUSUM Chart for Patient Temperatures
FIGURE 11.11 Run Chart of Patient Monitoring Data (Half-Hour Averages)
FIGURE 11.12 I Charts for Patient Heart Function Variables Monitored in the ICU
FIGURE 11.13 Run Chart/I Chart for an Individual’s Weighings—Two Horizontal Scales
FIGURE 11.14 I Chart for Monitoring HbA1c for Patient with Diabetes
FIGURE 11.15 I Chart for Patient Pain Assessments during Hospital Stay
FIGURE 12.1 Excerpts from HCAHPS Survey
FIGURE 12.2 Excerpt from NHS Survey
FIGURE 12.3 Shewhart Charts for One Question from Patient Satisfaction Survey
FIGURE 12.4 Patient Satisfaction Data Summarized with Multiple Negative Replies
FIGURE 12.5 Patient Satisfaction Percentile Ranking
FIGURE 12.6 Pareto Chart of Types of Patient Complaints
FIGURE 12.7 Small Multiples of Patient Satisfaction Data
FIGURE 12.8 Pareto Chart of Clinic Patient Feedback
FIGURE 12.9 Clinic Patient Feedback Shewhart Charts for Three Areas of Focus
FIGURE 12.10 Scatterplots for Three Areas of Focus
FIGURE 12.11 Shewhart Chart of Willingness to Recommend the Clinic
FIGURE 12.12 Xbar S Chart of Average Self-Reported Patient Pain Assessment
FIGURE 12.13 P Chart Summarizing Patient Feedback Regarding Pain
FIGURE 12.14 Employee Feedback Upon Exit Interview
FIGURE 12.15 Importance and Satisfaction Matrix
FIGURE 12.16 Using an Interim of Surrogate Measure to Avoid Lag Time
FIGURE 12.17 Data Not Used When Treating Continuous Data as Classification
FIGURE 13.1 Tabular VOM Using Green, Yellow, and Red Formatting
FIGURE 13.2 Shewhart Chart of Safety Error Rate
FIGURE 13.3 Percentage of Perfect Care Displayed on a Shewhart Chart
FIGURE 13.4 Shewhart Chart of Percentage of Areas Meeting Appointment Goal
FIGURE 13.5 Infection Rate Data Color-Coded Monthly
FIGURE 13.6 Average Physician Satisfaction
FIGURE 13.7 Appropriate Display of VOM
FIGURE 13.8 Graph with Appropriate Space for Future Data
FIGURE 13.9 Graph with Excessive Number of Data Points
FIGURE 13.10 Graph Updated to Provide More Readable Number of Data Points
FIGURE 13.11 Graph with Historical Data Summarized
FIGURE 14.1 Example of Typical Epidemiological Curve with Four Epochs
FIGURE 14.2 Example of Hybrid Shewhart Chart for Epidemic Data
FIGURE 14.3 Initial C Charts for COVID-19 Deaths in Three Countries
FIGURE 14.4 C Chart of COVID-19 Deaths for Maine (First Half of 2021)
