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Call 5PDSA Cycles and SPC Software WebEx
Improvement Advisor Professional Development Program
Wave 42
Please have your SPC software open and ready to use,along with the Excel file containing our data.
If you need to download this file again it is on the Extranet under Resources...Action Period Call Assignments....SPC assignment.
AgendaTime Topic Leader
3:00 BST Welcome and Check-In (including project scores) Rebecca
3:10 Assignments:• Paired Leadership Report Review• Senior Leader Project Scoring• Project Presentations at WS42.2• 2-3 Volunteers Needed for Next WebEx Sharing
PDSA Cycles/Project Presentations
Jane
3:20 PDSA Cycle report Rajesh/Richard
3:30 Run Charts in Review Jane
3:55 P Charts on Parade Richard
4:20 Optional As Time Allows: Review of Extra Charts Jane
4:30-5:00 Close and office hours
Please Check In…
IA IA IA
Akhnuwkh Jones Harald Stordahl Rachael Leaton
Anna Smith Helen O'Kelly Rachel Fletcher
Barbara Grey Helle Bak Rajesh Pai
Blake Pritchard Iyoni Ranasinghe Sandra McConnell
Breid O'Brien Jimmy Noak Sian Martin
Cecilie Lund Murray Margaret Rennocks Stephen O'Connor
Emma Binley Mukesh Thakur Suzanne Morton
Geetika Singh Polly Ragoobar Suzie Bailey
Hanne Miang Tammy Naidu
Where are you?
IA Programme Faculty and Staff Team: Wave 425
Lloyd ProvostFaculty
Jane TaylorFaculty
Robert LloydFaculty
Brandon BennettFaculty
Sandy MurrayFaculty
Jerry LangleyLead Faculty
Richard ScovilleFaculty
Rebecca SteinfieldProgramme Director/
Faculty
Mark BradshawEvent Coordinator
James Innes
IA Grads
Amar Shah
Jo Inge Myhre
Purpose
Deepen our skills in running PDSA cycles
Learn from one another’s run and P charts
related to:
– Software skills
– Understanding what the charts are saying
– Good graphical display
August Assignment: Paired Reviews
Paired Leadership Report Assignment:Purpose: Strengthen one another’s Leadership Reports
How did it go? What
was your take away?
Monthly Reporting
• September Report due today
• Include your project sponsor and advocate
progress assessment scorePurpose: Raise awareness of project, remove barriers, gain leadership guidance and support
Step 1: Share leadership report, assessment scale and any other info with your Sponsor and
Advocate so they can assess project.
Step 2: Note their assessment score on your next Leadership Report (if you are using the
PowerPoint template, there is a space at the top of the first page).
October Report: Upload your WS2 presentation
Improvement Advisor Project Progress Assessment ScaleApply these criteria to your IA improvement Project. Select the definition that best describes the progress of your project.
Please note that assessments are progressive. All elements of a 3 must be satisfied before rating your project with an
assessment of a 3.5 or 4. Evidence for your assessment must be documented in your monthly report.
Project Progress Score Operational Definition of Project Progress Score
0.5 - Intent to Participate Project has been identified, but the charter has not been completed nor team formed.
1.0 -Charter and team established A charter has been completed and reviewed. Individuals or teams have been assigned, but no work
has been accomplished.
1.5 - Planning for the project has
begunOrganization of project structure has begun (such as: what resources or other support will likely be
needed, where will focus first, tools/materials needed gathered, meeting schedule developed).
2.0 - Activity, but no changes Initial cycles for team learning have begun (project planning, measurement, data collection, obtaining
baseline data, study of processes, surveys, etc.). 2.5 - Changes tested, but no
improvementInitial cycles for testing changes have begun. Most project goals have a measure established to track
progress. Measures are graphically displayed with targets included.
3.0 - Modest improvement Successful tests of changes have been completed for some components of the change package
related to the team’s charter. Some small scale implementation has been done. Anecdotal evidence
of improvement exists. Expected results are 20% complete. See note 1.
3.5 - Improvement Testing and implementation continues and additional improvement in project measures towards
goals is seen.4.0 - Significant improvement Expected results achieved for major subsystems. Implementation (training, communication, etc.) has
begun for the project. Project goals are 50% or more complete. See note 2.
4.5 - Sustainable improvement Data on key measures begin to indicate sustainability of impact of changes implemented in system.
5.0 - Outstanding sustainable results Implementation cycles have been completed and all project goals and expected results have been
accomplished. Organizational changes have been made to accommodate improvements and to
make the project changes permanent.
Note 1: This may mean either that a) 20% of project numeric goals have been met or b) each
measure is showing 20% improvement towards goal.
Note 2: This may mean either that a) 50% of your numeric goals have been met or b) each measure
is showing 50% improvement towards target
Testing! Measurement!
Workshop 2 Project Presentation Assignment
Workshop 2 is October 10-13; Bob and Jane are faculty.IA Project Presentation Guidelines: 20 min. for each IA for presentation and discussion
Purpose: to hone our skills related to designing and running PDSA cycles Start your presentation by sharing aim of your team (usually from DD) and your current project progress score (on 0.5 to 5 scale) and predicting what your PPS will be by WS 3. (Sept 2015) 30 seconds or less
Share your Family of Measures (One slide: List of Outcome, Process, and Balancing Measures, don’t need to show data here) (2 Min)
Show us your PDSA strategy (e.g. ramp of PDSA cycles planned/and or completed) One slide only (2 Min)
Present one or more completed PDSAs on your project using PDSA form (need 12 paper copies of completed PDSA form you are sharing) (10-15 Min)
– The PDSAs can focus on learning, developing, testing or implementing a change
– Testing a change preferred!
– Tell us which change concepts you used in your test(s) of change (IG page 359)
Faculty and other IAs will use a PDSA evaluation form to provide feedback to the presenter. PDSA Feedback Form is on the Extranet.
Project Presentation Example: 3 Slides and a PDSA
Form
1: Driver Diagram
(plus current and
predicted progress
scores)
2: Project Measures
(outcome, process,
balancing)
3: PDSA Strategy (a
ramp, for example)
4: Completed PDSA
Form (at least 1)
IHI IA Development Program - PDSA CYCLE FEEDBACK
PURPOSE: To provide helpful feedback on Workshop 2 project presentations focusing on use of PDSA cycles.
Presenter: ______________________ Reviewer: _______________________ Date ____________
Project (short aim): ________________________________________________________________________
Project (0-5 scale) Assessment: Now: ______ at Workshop 3______
Family of Measures for the project
Was the total number of measures appropriate?
Suggestions on balance between outcome, process, and balancing measures
Do these measures make the project aim tangible?
Linking Series of PDSA Cycles
What is the strategy for this series of linked, multiple cycles (replication, scale-up, wide-scale testing, multiple
changes, etc.)?
Comment on the time frame for the series of PDSA cycles.
What other suggestions do you have on the series of PDSA Cycles planned for the project?
See specific PDSA Cycle on back
Specific PDSA presented (please add suggestions in the appropriate step of PDSA)
PLAN: Was the objective for this PDSA cycle clear to you? Is this cycle designed to build knowledge, develop a change, test a
change, or implement a change?
Were the questions they were trying to answer stated clearly? How could the predictions be improved?
What change concepts were used in the plan for the PDSA?
What would you suggest they do to strengthen their plan for this cycle?
Will the planned data collection (qualitative and quantitative) answer the questions for the cycle?
Suggestions about the scale/scope of this PDSA?
DO: Did they attempt to carry out their plan?
Did they document any problems or unexpected events?
Were they able to collect the data they planned?
STUDY: Did they complete the analysis of the data (including qualitative feedback and observations)?
Did they compare the results to their prediction and summarize what they learned?
Did they update their theories for this project?
ACT: Did they say what will happen in the next PDSA cycle (develop change further, test, implement?)
What suggestions do you have for scale, scope, sequencing of their next PDSA cycle(s)?
Subject Matter knowledge: Do you have an ideas they should test in this project?
Next WebEx: October 6, 2016
Looking for 2 volunteers to present Project
Presentation PDSA cycle(s) early.
– These volunteers will not present at Workshop 2.
– Will have 20 minutes
All IAs should download the PDSA Feedback
Form prior to the call so we can use it as a guide
to asking good questions and providing
feedback (Resource Tab “Forms”).
Rajesh Pai, MD
Deputy Medical Superindendent
Amrita Institute of Medical Sciences
Project: proper medication reconciliation to reduce readmission (and hence cost of care) caused by drug-related problems
SPC Exercise Review
While we are talking about this if question occurs to you …
– Ask it please…
– Or- type it in chat box…
Pe
rce
nt
Percent Unplanned Returns to OR
27
984
20
982
25
996
23
998
31
1070
17
1031
21
886
28
964
24
1128
22
960
19
1193
24
998
30
1070
22
895
15
852
18
963
12
956
22
1001
8
956
2
995
9
987
6
943
20
965
6
980
2
923
6
1106
# Pts Return
# Surgeries
Run chart
Median line = 2.05
Goal = 0.5
Chg 1
Chg 2 & 3
Chg 4 & 5
Chg 7 & 8
Chg 9
Chg 10 & 11
Chg 12 & 13
Chg 14
Implement
F 04 M A M J J A S O N D J 05 F M A M J J A S O N D J 06 F M A M
0.0
0.5
1.0
1.5
2.0
2.5
3.0
3.5
4.0
Note from Rebecca:
I was only able to put the graphs
into the slide deck that were
posted on-time; if anyone has a
question about their particular
homework, you can ask in the
“office hours” (or any other time)
Run Charts in Review!!
Run Charts
Graphical display of data over time
First means of analysis is visual
– What is our degree of belief that we see evidence of
improvement
Can be analyzed using probability-based rules
to detect non-random patterns called “signals”
– Signals can be evidence of Improvement or
degradation
– DG Chapter 3
0
0.5
1
1.5
2
2.5
3
3.5
% Unplanned Returns
Median
Akhnuwkh
1. Run chart
0
0.5
1
1.5
2
2.5
3
3.5
1/1
/12
2/1
/12
3/1
/12
4/1
/12
5/1
/12
6/1
/12
7/1
/12
8/1
/12
9/1
/12
10/1
/12
11/1
/12
12/1
/12
1/1
/13
2/1
/13
3/1
/13
4/1
/13
5/1
/13
6/1
/13
7/1
/13
8/1
/13
9/1
/13
10/1
/13
11/1
/13
12/1
/13
1/1
/14
2/1
/14
3/1
/14
4/1
/14
Run ChartMedian
Measure
Blake
1/1/12 2/1/12 3/1/12 4/1/12 5/1/12 6/1/12 7/1/12 8/1/12 9/1/12 10/1/12 11/1/12 12/1/12 1/1/13 2/1/13 3/1/13 4/1/13 5/1/13 6/1/13 7/1/13 8/1/13 9/1/13 10/1/13 11/1/13 12/1/13 1/1/14 2/1/14
Subgroup 2.74 2.04 2.51 2.30 2.90 1.65 2.37 2.90 2.13 2.29 1.59 2.40 2.80 2.46 1.76 1.87 1.26 2.20 0.84 0.20 0.91 0.64 2.07 0.61 0.22 0.54
Median 2.1 2.1 2.1 2.1 2.1 2.1 2.1 2.1 2.1 2.1 2.1 2.1 2.1 2.1 2.1 2.1 2.1 2.1 2.1 2.1 2.1 2.1 2.1 2.1 2.1 2.1
0
0.5
1
1.5
2
2.5
3
3.5
Percentage
Percentage unplanned returns to OR
Median
Stephen
August homework – SPC assignment
1/1/12 2/1/12 3/1/12 4/1/12 5/1/12 6/1/12 7/1/12 8/1/12 9/1/12 10/1/12 11/1/12 12/1/12 1/1/13 2/1/13 3/1/13 4/1/13 5/1/13 6/1/13 7/1/13 8/1/13 9/1/13 10/1/13 11/1/13 12/1/13 1/1/14 2/1/14
Subgroup 27 20 25 23 31 17 21 28 24 22 19 24 30 22 15 18 12 22 8 2 9 6 20 6 2 6
Median 20.0 20.0 20.0 20.0 20.0 20.0 20.0 20.0 20.0 20.0 20.0 20.0 20.0 20.0 20.0 20.0 20.0 20.0 20.0 20.0 20.0 20.0 20.0 20.0 20.0 20.0
27
20
25
23
31
17
21
28
24
22
19
24
30
22
15
18
12
22
8
2
9
6
20
6
2
6
20.0 20.0 20.0 20.0 20.0 20.0 20.0 20.0 20.0 20.0 20.0 20.0 20.0 20.0 20.0 20.0 20.0 20.0 20.0 20.0 20.0 20.0
Change implemented
20.0 20.0 20.0
0
5
10
15
20
25
30
35
Num
ber
of patie
nts
Time
Run Chart - Unplanned return to ORMedian
Measure
Suzanne
Chg 1
Chg 2,3Chg 7,8
Chg 4,5,6
Chg 9
Chg 10,11
Chg 12,13Chg 14
Change implemented
0
0.5
1
1.5
2
2.5
3
3.5
Jan
-12
Feb
-12
Mar
-12
Ap
r-1
2
May
-12
Jun
-12
Jul-
12
Au
g-1
2
Sep
-12
Oct
-12
No
v-1
2
De
c-1
2
Jan
-13
Feb
-13
Mar
-13
Ap
r-1
3
May
-13
Jun
-13
Jul-
13
Au
g-1
3
Sep
-13
Oct
-13
No
v-1
3
De
c-1
3
Jan
-14
Feb
-14
Pe
rce
nt
Un
pla
nn
ed
Re
turn
Percent unplanned return to OR - Run chart
median
Hanne
-0.07
0.43
0.93
1.43
1.93
2.43
2.93
3.43
Jan
-12
Feb
-12
Mar
-12
Ap
r-1
2
May
-12
Jun
-12
Jul-
12
Au
g-1
2
Sep
-12
Oct
-12
No
v-1
2
De
c-1
2
Jan
-13
Feb
-13
Mar
-13
Ap
r-1
3
May
-13
Jun
-13
Jul-
13
Au
g-1
3
Sep
-13
Oct
-13
No
v-1
3
De
c-1
3
Jan
-14
Feb
-14
Un
pla
nn
ed
Re
turn
s (%
)
Months
Percent Unplanned Returns
Percent Unplanned Returns
Median
RUN CHART
Months
Percent Unplanned
Returns
Jan-12 2.74
Feb-12 2.04
Mar-12 2.51
Apr-12 2.30
May-12 2.90
Jun-12 1.65
Jul-12 2.37
Aug-12 2.90
Sep-12 2.13
Oct-12 2.29
Nov-12 1.59
Dec-12 2.40
Jan-13 2.80
Feb-13 2.46
Mar-13 1.76
Apr-13 1.87
May-13 1.26
Jun-13 2.20
Jul-13 0.84
Aug-13 0.20
Sep-13 0.91
Oct-13 0.64
Nov-13 2.07
Dec-13 0.61
Jan-14 0.22
Feb-14 0.54
Rachel L and Iyoni
Jan-12 Feb-12 Mar-12 Apr-12 May-12 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Apr-13 May-13 Jun-13 Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13 Jan-14 Feb-14 Mar-14 Apr-14
Subgroup 2.74 2.04 2.51 2.30 2.90 1.65 2.37 2.90 2.13 2.29 1.59 2.40 2.80 2.46 1.76 1.87 1.26 2.20 0.84 0.20 0.91 0.64 2.07 0.61 0.22 0.54
Median 2.1 2.1 2.1 2.1 2.1 2.1 2.1 2.1 2.1 2.1 2.1 2.1 2.1 2.1 2.1 2.1 2.1 2.1 2.1 2.1 2.1 2.1 2.1 2.1 2.1 2.1 2.1 2.1
Chg 1
Chg 2, 3
Chg 4, 5, 6
Chg 7, 8
Chg 9
Chg 10, 11
Chg 12, 13
Chg 14
Implementation Start
0
0.5
1
1.5
2
2.5
3
3.5
Month and year
Percentage Unplanned Return to OR (Run Chart)
Median
Perc
enta
ge o
f patients
unpla
nned r
etu
rn
to O
R
Geetika
Run Chart with Changes and Data Table
Sandra
2.1
0
0.5
1
1.5
2
2.5
3
3.5
Ja
nua
ry 2
01
2
Feb
ruary
20
12
Ma
rch
201
2
Ap
ril 20
12
Ma
y 2
012
Ju
ne 2
012
Ju
ly 2
01
2
Au
gu
st 2
012
Se
pte
mb
er
20
12
Octo
be
r 2
01
2
No
ve
mb
er
20
12
De
ce
mb
er
20
12
Ja
nua
ry 2
01
3
Feb
ruary
20
13
Ma
rch
201
3
Ap
ril 20
13
Ma
y 2
013
Ju
ne 2
013
Ju
ly 2
01
3
Au
gu
st 2
013
Se
pte
mb
er
20
13
Octo
be
r 2
01
3
No
ve
mb
er
20
13
De
ce
mb
er
20
13
Ja
nua
ry 2
01
4
Feb
ruary
20
14
Run Chart - Percent Unplanned Returns (monthly)Percent unplanned returns
Change 9
Change 2 & 3
Change 4, 5 & 6
Change 7 & 8
Change 10 & 11
Change 12 & 13
Change 14
Implementation starts
Change 1
Emma
2.1
0
0.5
1
1.5
2
2.5
3
3.5
Jan
-12
Fe
b-1
2
Ma
r-12
Ap
r-12
Ma
y-1
2
Jun
-12
Jul-1
2
Au
g-1
2
Se
p-1
2
Oct-
12
Nov-1
2
Dec-1
2
Jan
-13
Fe
b-1
3
Ma
r-13
Ap
r-13
Ma
y-1
3
Jun
-13
Jul-1
3
Au
g-1
3
Se
p-1
3
Oct-
13
Nov-1
3
Dec-1
3
Jan
-14
Fe
b-1
4
Ma
r-14
Ap
r-14
Run Chart - Percent unplanned returns to OR
Median
Unplanned returnsas a percentage of number of surgeries
Chg4,5,6
Unplanned returnsas a percentage of number of surgeries
Chg7,8
Chg 9
Chg10,11
Chg12.13
Unplanned returnsas a percentage of number of surgeries
Chg 14Chg2,3
Implementation start
Chg 1
Cecilie
A. Run chart using the column labelled "Percent" as your measure (your data). See if you can place a median on the run chart.
Rachel Fletcher
Some things to explore….
Labeling median
Add empty rows at start to be able to add new
data to the chart.
P Charts on Parade
Shewhart P-charts
Uses numerator and denominator and lets computer
figure our percent
Center line is weighted average of the percents
Upper and lower limits very important
Enables us to detect special cause in data
– More on that in WS 2!
Are a number of different kinds of Shewhart charts
– We just build the P chart for this exercise
– Will use wide range of Shewhart charts in WS 2
CL 0.0178
UCL 0.0309
LCL 0.0047
0.000
0.005
0.010
0.015
0.020
0.025
0.030
0.035
# P
ts U
np
lan
ned
Retu
rn t
o O
R -
# S
urg
eri
es
Months
# Pts Unplanned Return to OR / # Surgeries p Chart
Akhnuwkh
2. P chart
UCL
LCL
0%
1%
1%
2%
2%
3%
3%
4%
1/1
/12
2/1
/12
3/1
/12
4/1
/12
5/1
/12
6/1
/12
7/1
/12
8/1
/12
9/1
/12
10/1
/12
11/1
/12
12/1
/12
1/1
/13
2/1
/13
3/1
/13
4/1
/13
5/1
/13
6/1
/13
7/1
/13
8/1
/13
9/1
/13
10/1
/13
11/1
/13
12/1
/13
1/1
/14
2/1
/14
P ChartPercent
Blake
1/1/12 2/1/12 3/1/12 4/1/12 5/1/12 6/1/12 7/1/12 8/1/12 9/1/12 10/1/12 11/1/12 12/1/12 1/1/13 2/1/13 3/1/13 4/1/13 5/1/13 6/1/13 7/1/13 8/1/13 9/1/13 10/1/13 11/1/13 12/1/13 1/1/14 2/1/14
Subgroup 2.74% 2.04% 2.51% 2.30% 2.90% 1.65% 2.37% 2.90% 2.13% 2.29% 1.59% 2.40% 2.80% 2.46% 1.76% 1.87% 1.26% 2.20% 0.84% 0.20% 0.91% 0.64% 2.07% 0.61% 0.22% 0.54%
Center 1.78% 1.78% 1.78% 1.78% 1.78% 1.78% 1.78% 1.78% 1.78% 1.78% 1.78% 1.78% 1.78% 1.78% 1.78% 1.78% 1.78% 1.78% 1.78% 1.78% 1.78% 1.78% 1.78% 1.78% 1.78% 1.78%
UCL 3.04% 3.05% 3.04% 3.04% 2.99% 3.02% 3.11% 3.06% 2.96% 3.06% 2.93% 3.04% 2.99% 3.11% 3.14% 3.06% 3.06% 3.03% 3.06% 3.04% 3.04% 3.07% 3.06% 3.05% 3.09% 2.97%
LCL 0.52% 0.51% 0.52% 0.52% 0.57% 0.54% 0.45% 0.50% 0.60% 0.50% 0.63% 0.52% 0.57% 0.45% 0.42% 0.50% 0.50% 0.53% 0.50% 0.52% 0.52% 0.49% 0.50% 0.51% 0.47% 0.59%
UCL
LCL
0%
1%
1%
2%
2%
3%
3%
4%
Unplanned Returns to OR - P Chart
Percent
chg1
chg2,3
chg4,5,6
Stephen
1/1/12 2/1/12 3/1/12 4/1/12 5/1/12 6/1/12 7/1/12 8/1/12 9/1/12 10/1/12 11/1/12 12/1/12 1/1/13 2/1/13 3/1/13 4/1/13 5/1/13 6/1/13 7/1/13 8/1/13 9/1/13 10/1/13 11/1/13 12/1/13 1/1/14 2/1/14
Subgroup 2.74% 2.04% 2.51% 2.30% 2.90% 1.65% 2.37% 2.90% 2.13% 2.29% 1.59% 2.40% 2.80% 2.46% 1.76% 1.87% 1.26% 2.20% 0.84% 0.20% 0.91% 0.64% 2.07% 0.61% 0.22% 0.54%
Center 1.78% 1.78% 1.78% 1.78% 1.78% 1.78% 1.78% 1.78% 1.78% 1.78% 1.78% 1.78% 1.78% 1.78% 1.78% 1.78% 1.78% 1.78% 1.78% 1.78% 1.78% 1.78% 1.78% 1.78% 1.78% 1.78%
UCL 3.04% 3.05% 3.04% 3.04% 2.99% 3.02% 3.11% 3.06% 2.96% 3.06% 2.93% 3.04% 2.99% 3.11% 3.14% 3.06% 3.06% 3.03% 3.06% 3.04% 3.04% 3.07% 3.06% 3.05% 3.09% 2.97%
LCL 0.52% 0.51% 0.52% 0.52% 0.57% 0.54% 0.45% 0.50% 0.60% 0.50% 0.63% 0.52% 0.57% 0.45% 0.42% 0.50% 0.50% 0.53% 0.50% 0.52% 0.52% 0.49% 0.50% 0.51% 0.47% 0.59%
2.51%
1.78% 1.78% 1.78% 1.78% 1.78% 1.78% 1.78% 1.78% 1.78% 1.78% 1.78% 1.78% 1.78% 1.78% 1.78% 1.78% 1.78% 1.78% 1.78% 1.78% 1.78% 1.78%
Change implemented
1.78% 1.78% 1.78%
UCL
LCL
0%
1%
1%
2%
2%
3%
3%
4%P
erc
eta
ge o
f R
etu
rned p
atie
nts
Time
Unplanned return to OR - P Chart
Percent
Suzanne
Chg 1
Chg 2,3 Chg 7,8
Chg 4,5,6
Chg 9
Chg 10,11
Chg 12,13
Chg 14
Change implemented
0
5
10
15
20
25
30
35
Nu
mb
er
og
pat
ien
tsP Chart - Unplanned return to OR
Average
Hanne
Jan-12 Feb-12 Mar-12 Apr-12 May-12 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Apr-13 May-13 Jun-13 Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13 Jan-14 Feb-14 Mar-14 Apr-14
Subgroup 2.74% 2.04% 2.51% 2.30% 2.90% 1.65% 2.37% 2.90% 2.13% 2.29% 1.59% 2.40% 2.80% 2.46% 1.76% 1.87% 1.26% 2.20% 0.84% 0.20% 0.91% 0.64% 2.07% 0.61% 0.22% 0.54% 0.00% 0.00%
Center 1.78% 1.78% 1.78% 1.78% 1.78% 1.78% 1.78% 1.78% 1.78% 1.78% 1.78% 1.78% 1.78% 1.78% 1.78% 1.78% 1.78% 1.78% 1.78% 1.78% 1.78% 1.78% 1.78% 1.78% 1.78% 1.78% 1.78% 1.78%
UCL 3.04% 3.05% 3.04% 3.04% 2.99% 3.02% 3.11% 3.06% 2.96% 3.06% 2.93% 3.04% 2.99% 3.11% 3.14% 3.06% 3.06% 3.03% 3.06% 3.04% 3.04% 3.07% 3.06% 3.05% 3.09% 2.97%
LCL 0.52% 0.51% 0.52% 0.52% 0.57% 0.54% 0.45% 0.50% 0.60% 0.50% 0.63% 0.52% 0.57% 0.45% 0.42% 0.50% 0.50% 0.53% 0.50% 0.52% 0.52% 0.49% 0.50% 0.51% 0.47% 0.59%
Chg 1
Chg 2,3
Chg 4, 5, 6
Chg 7, 8
Chg 9
Chg 10, 11
Chg 12, 13
Chg 14
Implementation Start
UCL
LCL
0%
1%
2%
3%
4%
Month and Year
Patients unplanned return to OR(P Chart)
Perc
enta
ge o
f patients
unpla
nned r
etu
rn to O
R
Geetika
“P” Chart with Changes and Data Table
Sandra
CL 0.0178
UCL0.0297
LCL0.0059
0.000
0.005
0.010
0.015
0.020
0.025
0.030
0.035
Jan
-12
Feb
-12
Mar
-12
Ap
r-1
2
May
-12
Jun
-12
Jul-
12
Au
g-1
2
Sep
-12
Oct
-12
No
v-1
2
De
c-1
2
Jan
-13
Feb
-13
Mar
-13
Ap
r-1
3
May
-13
Jun
-13
Jul-
13
Au
g-1
3
Sep
-13
Oct
-13
No
v-1
3
De
c-1
3
Jan
-14
Feb
-14
# P
ts U
np
lan
ne
d R
etu
rn t
o O
R -
# Su
rge
rie
s
Months
# Pts Unplanned Return to OR / # Surgeries p Chart
P CHART
Months
# Pts Unplanned Return to
OR # Surgeries
Jan-12 27 984
Feb-12 20 982
Mar-12 25 996
Apr-12 23 998
May-12 31 1070
Jun-12 17 1031
Jul-12 21 886
Aug-12 28 964
Sep-12 24 1128
Oct-12 22 960
Nov-12 19 1193
Dec-12 24 998
Jan-13 30 1070
Feb-13 22 895
Mar-13 15 852
Apr-13 18 963
May-13 12 956
Jun-13 22 1001
Jul-13 8 956
Aug-13 2 995
Sep-13 9 987
Oct-13 6 943
Nov-13 20 965
Dec-13 6 980
Jan-14 2 923
Feb-14 6 1106
Rachel L and Iyoni
1.78%
UCL
LCL
0%
1%
2%
3%
4% J
an
ua
ry 2
01
2
Feb
ruary
20
12
Ma
rch
201
2
Ap
ril 20
12
Ma
y 2
012
Ju
ne 2
012
Ju
ly 2
01
2
Au
gu
st 2
012
Se
pte
mb
er
20
12
Octo
be
r 2
01
2
No
ve
mb
er
20
12
De
ce
mb
er
20
12
Ja
nua
ry 2
01
3
Feb
ruary
20
13
Ma
rch
201
3
Ap
ril 20
13
Ma
y 2
013
Ju
ne 2
013
Ju
ly 2
01
3
Au
gu
st 2
013
Se
pte
mb
er
20
13
Octo
be
r 2
01
3
No
ve
mb
er
20
13
De
ce
mb
er
20
13
Ja
nua
ry 2
01
4
Feb
ruary
20
14
P Chart - Percent Unplanned Returns (Monthly)Percent unplanned returns
Change 2 & 3
Change 4, 5 & 6
Change 7 & 8
Change 10 & 11
Change 12 & 13
Change 14
Implementation starts
Change 1Change 9
Emma
1.8 %
UCL
LCL
0.0 %
0.5 %
1.0 %
1.5 %
2.0 %
2.5 %
3.0 %
3.5 %Jan
-12
Fe
b-1
2
Ma
r-1
2
Ap
r-12
Ma
y-1
2
Jun
-12
Jul-
12
Au
g-1
2
Se
p-1
2
Oct-
12
Nov-1
2
Dec-1
2
Jan
-13
Fe
b-1
3
Ma
r-1
3
Ap
r-13
Ma
y-1
3
Jun
-13
Jul-
13
Au
g-1
3
Se
p-1
3
Oct-
13
Nov-1
3
Dec-1
3
Jan
-14
Fe
b-1
4
P Chart - Unplanned returns to ORPercent
Chg
4,5,6 Chg
7,8Chg
9
Chg
10,11
Chg
12.13 Chg 14Chg
2,3
Implementatio
n start
Chg
1
Cecilie
B. A "P"chart (a type of control chart for attribute data) with # patients returning to OR as the numerator (often called count of errors) and the # surgeries as the denominator (often called # inspected).
Rachel Fletcher
Pe
rce
nt
Percent Unplanned Returns to OR P chart
984
27
982
20
996
25
998
23
1070
31
1031
17
886
21
964
28
1128
24
960
22
1193
19
998
24
1070
30
895
22
852
15
963
18
956
12
1001
22
956
8
995
2
987
9
943
6
965
20
980
6
923
2
1106
6
# Surgeries
# Pts Return
p chart
UCL = 3.54
Mean = 2.16
LCL = 0.78
Goal = 0.5
Chg 1
Chg 2 & 3
Chg 4 & 5
Chg 7 & 8
Chg 9
Chg 10 & 11
Chg 12 & 13
Chg 14
Implement
F 04 M A M J J A S O N D J 05 F M A M J J A S O N D J 06 F M A M
0.0
0.5
1.0
1.5
2.0
2.5
3.0
3.5
4.0
The way I’d handle it
Other Charts…thank you!!!
Month Revenue $k Margin $k
Mar-12 213 160
Apr-12 174 160
May-12 190 163
Jun-12 220 172
Jul-12 182 174
Aug-12 208 180
Sep-12 210 182
Oct-12 163 190
Nov-12 160 197
Dec-12 230 200
Jan-13 180 208
Feb-13 197 210
Mar-13 225 210
Apr-13 160 213
May-13 172 220
Jun-13 210 225
Jul-13 227 227
Aug-13 200 230
Sep-13 232 232
Oct-13 241 240
Nov-13 260 241
Dec-13 263 243
Jan-14 247 247
Feb-14 252 250
Mar-14 250 252
Apr-14 261 256
May-14 240 258
Jun-14 258 260
Jul-14 270 260
Aug-14 243 261
Sep-14 256 263
Oct-14 260 270
Nov-14
Dec-14
Jan-15
Feb-15
I
Chart
Data
Profit Margin I chart(Not convinced I understand this)
Sandra
Individual (xmr) charts
3/1/12 4/1/12 5/1/12 6/1/12 7/1/12 8/1/12 9/1/12 10/1/12 11/1/12 12/1/12 1/1/13 2/1/13 3/1/13 4/1/13 5/1/13 6/1/13 7/1/13 8/1/13 9/1/13 10/1/13 11/1/13 12/1/13 1/1/14 2/1/14 3/1/14 4/1/14 5/1/14 6/1/14 7/1/14 8/1/14 9/1/14 10/1/14
Subgroup 31 54 60 55 78 42 35 56 36 25 34 14 56 57 22 12 31 22 17 24 16 26 35 28 69 64 95 83 64 73 61 78
Center 45.4 45.4 45.4 45.4 45.4 45.4 45.4 45.4 45.4 45.4 45.4 45.4 45.4 45.4 45.4 45.4 45.4 45.4 45.4 45.4 45.4 45.4 45.4 45.4 45.4 45.4 45.4 45.4 45.4 45.4 45.4 45.4
UCL 87.4 87.4 87.4 87.4 87.4 87.4 87.4 87.4 87.4 87.4 87.4 87.4 87.4 87.4 87.4 87.4 87.4 87.4 87.4 87.4 87.4 87.4 87.4 87.4 87.4 87.4 87.4 87.4 87.4 87.4 87.4
LCL 3.5 3.5 3.5 3.5 3.5 3.5 3.5 3.5 3.5 3.5 3.5 3.5 3.5 3.5 3.5 3.5 3.5 3.5 3.5 3.5 3.5 3.5 3.5 3.5 3.5 3.5 3.5 3.5 3.5 3.5 3.5
UCL
LCL
0
10
20
30
40
50
60
70
80
90
100
Pro
fit M
arg
in $
K
Profit Margin $KMeasure
Stephen
3/1/12 4/1/12 5/1/12 6/1/12 7/1/12 8/1/12 9/1/1210/1/1
211/1/1
212/1/1
21/1/13 2/1/13 3/1/13 4/1/13 5/1/13 6/1/13 7/1/13 8/1/13 9/1/13
10/1/13
11/1/13
12/1/13
1/1/14 2/1/14 3/1/14 4/1/14 5/1/14 6/1/14 7/1/14 8/1/14 9/1/1410/1/1
4
Subgroup 23.0 6.0 5.0 23.0 36.0 7.0 21.0 20.0 11.0 9.0 20.0 42.0 1.0 35.0 10.0 19.0 9.0 5.0 7.0 8.0 10.0 9.0 7.0 41.0 5.0 31.0 12.0 19.0 9.0 12.0 17.0
Center 15.8 15.8 15.8 15.8 15.8 15.8 15.8 15.8 15.8 15.8 15.8 15.8 15.8 15.8 15.8 15.8 15.8 15.8 15.8 15.8 15.8 15.8 15.8 15.8 15.8 15.8 15.8 15.8 15.8 15.8 15.8
UCL 51.5 51.5 51.5 51.5 51.5 51.5 51.5 51.5 51.5 51.5 51.5 51.5 51.5 51.5 51.5 51.5 51.5 51.5 51.5 51.5 51.5 51.5 51.5 51.5 51.5 51.5 51.5 51.5 51.5 51.5 51.5
LCL 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0
0.0
10.0
20.0
30.0
40.0
50.0
60.0
Change in p
rofit m
arg
in $
K
Monthly change in profit margin $K
Stephen
3/1/12 4/1/12 5/1/12 6/1/12 7/1/12 8/1/12 9/1/1210/1/1
211/1/1
212/1/1
21/1/13 2/1/13 3/1/13 4/1/13 5/1/13 6/1/13 7/1/13 8/1/13 9/1/13
10/1/13
11/1/13
12/1/13
1/1/14 2/1/14 3/1/14 4/1/14 5/1/14 6/1/14 7/1/14 8/1/14 9/1/1410/1/1
4
Subgroup 213 174 190 220 182 208 210 163 160 230 180 197 225 160 172 210 227 200 232 241 260 263 247 252 250 261 240 258 270 243 256 260
Center 220.4 220.4 220.4 220.4 220.4 220.4 220.4 220.4 220.4 220.4 220.4 220.4 220.4 220.4 220.4 220.4 220.4 220.4 220.4 220.4 220.4 220.4 220.4 220.4 220.4 220.4 220.4 220.4 220.4 220.4 220.4 220.4
UCL 282.0 282.0 282.0 282.0 282.0 282.0 282.0 282.0 282.0 282.0 282.0 282.0 282.0 282.0 282.0 282.0 282.0 282.0 282.0 282.0 282.0 282.0 282.0 282.0 282.0 282.0 282.0 282.0 282.0 282.0 282.0
LCL 158.9 158.9 158.9 158.9 158.9 158.9 158.9 158.9 158.9 158.9 158.9 158.9 158.9 158.9 158.9 158.9 158.9 158.9 158.9 158.9 158.9 158.9 158.9 158.9 158.9 158.9 158.9 158.9 158.9 158.9 158.9
UCL
LCL
0
50
100
150
200
250
300
Revenue $kMeasure
Stephen
3/1/12 4/1/12 5/1/12 6/1/12 7/1/12 8/1/12 9/1/1210/1/1
211/1/1
212/1/1
21/1/13 2/1/13 3/1/13 4/1/13 5/1/13 6/1/13 7/1/13 8/1/13 9/1/13
10/1/13
11/1/13
12/1/13
1/1/14 2/1/14 3/1/14 4/1/14 5/1/14 6/1/14 7/1/14 8/1/14 9/1/1410/1/1
4
Subgroup 39.0 16.0 30.0 38.0 26.0 2.0 47.0 3.0 70.0 50.0 17.0 28.0 65.0 12.0 38.0 17.0 27.0 32.0 9.0 19.0 3.0 16.0 5.0 2.0 11.0 21.0 18.0 12.0 27.0 13.0 4.0
Center 23.1 23.1 23.1 23.1 23.1 23.1 23.1 23.1 23.1 23.1 23.1 23.1 23.1 23.1 23.1 23.1 23.1 23.1 23.1 23.1 23.1 23.1 23.1 23.1 23.1 23.1 23.1 23.1 23.1 23.1 23.1
UCL 75.6 75.6 75.6 75.6 75.6 75.6 75.6 75.6 75.6 75.6 75.6 75.6 75.6 75.6 75.6 75.6 75.6 75.6 75.6 75.6 75.6 75.6 75.6 75.6 75.6 75.6 75.6 75.6 75.6 75.6 75.6
LCL 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0Monthly Change in Revenue $K
Stephen
UCL
0
20
40
60
80
100
120
Ma
rch,
201
2
Ap
ril, 2
01
2
Ma
y, 2
012
Jun
e, 2
012
July
, 2
01
2
Au
gu
st, 2
012
Se
pte
mb
er,
20
12
Octo
be
r, 2
01
2
Nove
mbe
r, 2
01
2
Dece
mbe
r, 2
01
2
Jan
uary
, 2
01
3
Fe
bru
ary
, 20
13
Ma
rch,
201
3
Ap
ril, 2
01
3
Ma
y, 2
013
Jun
e, 2
013
July
, 2
01
3
Au
gu
st, 2
013
Se
pte
mb
er,
20
13
Octo
be
r, 2
01
3
Nove
mbe
r, 2
01
3
Dece
mbe
r, 2
01
3
Jan
uary
, 2
01
4
Fe
bru
ary
, 20
14
Ma
rch,
201
4
Ap
ril, 2
01
4
Ma
y, 2
014
Jun
e, 2
014
July
, 2
01
4
Au
gu
st, 2
014
Se
pte
mb
er,
20
14
Octo
be
r, 2
01
4
XMR Chart - Margin $KMargin
0.0
10.0
20.0
30.0
40.0
50.0
60.0
Ma
rch
201
2
Ap
ril 20
12
Ma
y 2
012
Ju
ne 2
012
Ju
ly 2
01
2
Au
gu
st 2
012
Se
pte
mb
er…
Octo
be
r 2
01
2
No
ve
mb
er
20
12
De
ce
mb
er
20
12
Ja
nua
ry 2
01
3
Feb
ruary
20
13
Ma
rch
201
3
Ap
ril 20
13
Ma
y 2
013
Ju
ne 2
013
Ju
ly 2
01
3
Au
gu
st 2
013
Se
pte
mb
er…
Octo
be
r 2
01
3
No
ve
mb
er
20
13
De
ce
mb
er
20
13
Ja
nua
ry 2
01
4
Feb
ruary
20
14
Ma
rch
201
4
Ap
ril 20
14
Ma
y 2
014
Ju
ne 2
014
Ju
ly 2
01
4
Au
gu
st 2
014
Se
pte
mb
er…
Octo
be
r 2
01
4
Moving Range
Emma
UCL
LCL
100
120
140
160
180
200
220
240
260
280
300
Ma
rch
201
2
Ap
ril 20
12
Ma
y 2
012
Ju
ne 2
012
Ju
ly 2
01
2
Au
gu
st 2
012
Se
pte
mb
er…
Octo
be
r 2
01
2
No
ve
mb
er…
De
ce
mb
er…
Ja
nua
ry 2
01
3
Feb
ruary
20
13
Ma
rch
201
3
Ap
ril 20
13
Ma
y 2
013
Ju
ne 2
013
Ju
ly 2
01
3
Au
gu
st 2
013
Se
pte
mb
er…
Octo
be
r 2
01
3
No
ve
mb
er…
De
ce
mb
er…
Ja
nua
ry 2
01
4
Feb
ruary
20
14
Ma
rch
201
4
Ap
ril 20
14
Ma
y 2
014
Ju
ne 2
014
Ju
ly 2
01
4
Au
gu
st 2
014
Se
pte
mb
er…
Octo
be
r 2
01
4
XMR Chart - Revenue $KRevenue
0.0
20.0
40.0
60.0
80.0
100.0
120.0
Ma
rch
201
2
Ap
ril 20
12
Ma
y 2
012
Ju
ne 2
012
Ju
ly 2
01
2
Au
gu
st 2
012
Se
pte
mb
er…
Octo
be
r 2
01
2
No
ve
mb
er
20
12
De
ce
mb
er
20
12
Ja
nua
ry 2
01
3
Feb
ruary
20
13
Ma
rch
201
3
Ap
ril 20
13
Ma
y 2
013
Ju
ne 2
013
Ju
ly 2
01
3
Au
gu
st 2
013
Se
pte
mb
er…
Octo
be
r 2
01
3
No
ve
mb
er
20
13
De
ce
mb
er
20
13
Ja
nua
ry 2
01
4
Feb
ruary
20
14
Ma
rch
201
4
Ap
ril 20
14
Ma
y 2
014
Ju
ne 2
014
Ju
ly 2
01
4
Au
gu
st 2
014
Se
pte
mb
er…
Octo
be
r 2
01
4
Moving Range
Emma
"Individual (xmr)"Rachel Fletcher
Month # ADEs Doses Doses/1000 Note
3/1/2012 50 17110 17.11
4/1/2012 44 12140 12.14
5/1/2012 47 17990 17.99
6/1/2012 32 14980 14.98xxx
7/1/2012 51 21980 21.98
8/1/2012 57 15320 15.32
9/1/2012 43 12990 12.99
10/1/2012 61 19760 19.76
11/1/2012 30 8670 8.67
12/1/2012 32 12680 12.68
1/1/2013 41 20330 20.33yyy
2/1/2013 47 18550 18.55
3/1/2013 31 14310 14.31
4/1/2013 11 9730 9.73
5/1/2013 3 11470 11.47
6/1/2013 11 21390 21.39
7/1/2013 9 13370 13.37
8/1/2013 3 6370 6.37
9/1/2013 10 10300 10.3
10/1/2013 8 11170 11.17
11/1/2013 9 10910 10.91
12/1/2013 4 8760 8.76
1/1/2014 9 11140 11.14
2/1/2014
3/1/2014
4/1/2014
U
Chart
Data
"U -revising Limits" Rachel Fletcher
UCL
LCL
0
0.5
1
1.5
2
2.5
3
3.5
4
4.5
5 M
arc
h 2
01
2
Ap
ril 20
12
Ma
y 2
012
Ju
ne 2
012
Ju
ly 2
01
2
Au
gu
st 2
012
Se
pte
mb
er
20
12
Octo
be
r 2
01
2
No
ve
mb
er
20
12
De
ce
mb
er
20
12
Ja
nua
ry 2
01
3
Feb
ruary
20
13
Ma
rch
201
3
Ap
ril 20
13
Ma
y 2
013
Ju
ne 2
013
Ju
ly 2
01
3
Au
gu
st 2
013
Se
pte
mb
er
20
13
Octo
be
r 2
01
3
No
ve
mb
er
20
13
De
ce
mb
er
20
13
Ja
nua
ry 2
01
4
U chart - No of ADE per 1000 doses Rate
Emma
U chart with phasingI have assumed (maybe incorrectly) that XXX and YYY mark the initiation of a successful change
phase 1 3/2/12 – 6/1/12phase 2 7/1/12 – 1/1/13phase 3 2/1/13 – 1/1/14
3/1/12 4/1/12 5/1/12 6/1/12 7/1/12 8/1/12 9/1/12 10/1/12 11/1/12 12/1/12 1/1/13 2/1/13 3/1/13 4/1/13 5/1/13 6/1/13 7/1/13 8/1/13 9/1/13 10/1/13 11/1/13 12/1/13 1/1/14
Subgroup 2.9 3.6 2.6 2.1 2.3 3.7 3.3 3.1 3.5 2.5 2.0 2.5 2.2 1.1 0.3 0.5 0.7 0.5 1.0 0.7 0.8 0.5 0.8
Center 2.8 2.8 2.8 2.8 2.8 2.8 2.8 2.8 2.8 2.8 2.8 1.1 1.1 1.1 1.1 1.1 1.1 1.1 1.1 1.1 1.1 1.1 1.1
UCL 4.0 4.2 4.0 4.1 3.9 4.1 4.2 4.0 4.5 4.2 3.9 1.8 1.9 2.0 2.0 1.7 1.9 2.3 2.0 2.0 2.0 2.1 2.0
LCL 1.6 1.3 1.6 1.5 1.7 1.5 1.4 1.7 1.1 1.4 1.7 0.3 0.2 0.1 0.1 0.4 0.2 0.0 0.1 0.1 0.1 0.0 0.1
UCL
LCL
0
0.5
1
1.5
2
2.5
3
3.5
4
4.5
5
AD
E's
/ 1
000 d
oses
ADE's / 1000 doses - U Chart with phasingRate
Stephen
?With PhasingSandra
Software Heads-Up….In Workshop 2 you will have case studies or real data and be asked to
jump in to building appropriate graphs:
•Run charts
•Shewhart control charts—5 types (individuals, X bar S, P, C, U charts)
•Pareto charts
•Histograms (frequency plot)
•Scatter plots
Use the excel database (SPC Exercises
2016) posted on the Extranet for practice.
If you are using QI charts, the Pareto,
Histogram and Scatter Plot are built
using Excel so you will need to know
how to create those charts using basic
Excel functions.
Load add in: Data Analysis Toolpack
Instructional Video:
• Richard Scoville walks through creating a P Chart in QI Charts –
including how to add a useful data table:
https://www.youtube.com/watch?v=H3m3QCeec1M
Other Useful Resources
Next Call
October 6, 2016
PDSA Presentations – Prep for Workshop 2
3:00-4:30 pm BST