Control, compare and communicate: designing control charts to summarise efficiently data from multiple quality indicators

Summarising the complex data generated by multiple cross sectional quality indicators in a way that patients, clinicians, managers and policymakers find useful is challenging. A common approach is aggregation to create summary measures such as star ratings and balanced score cards, but these may conceal the detail needed to focus quality improvement. We propose an alternative way of summarising and presenting multiple quality indicators, suitable for use for quality improvement and governance. This paper discusses (1) control charts for repeated measurements of single processes as used in industrial statistical process control (SPC); (2) control charts for cross sectional comparison of many institutions for a single quality indicator (rarely used in industry but commonly proposed for health care); and (3) small multiple graphics which combine control chart signal extraction with efficient graphical presentations for multiple indicators.

[1]  D. Boyle,et al.  The diabetes audit and research in Tayside Scotland (darts) study: electronic record linkage to create a diabetes register , 1997, BMJ.

[2]  John S. Oakland,et al.  Statistical Process Control , 2018 .

[3]  Tom Marshall,et al.  Performance league tables: the NHS deserves better , 2002, BMJ : British Medical Journal.

[4]  Tom Marshall,et al.  Bristol, Shipman, and clinical governance: Shewhart's forgotten lessons , 2001, The Lancet.

[5]  S. Kirk,et al.  Assessing the quality of care of multiple conditions in general practice: practical and methodological problems , 2003, Quality & safety in health care.

[6]  John L. Adams,et al.  Report Cards for Health Care: Is Anyone Checking Them? , 2002 .

[7]  David J Spiegelhalter,et al.  Funnel plots for comparing institutional performance , 2005, Statistics in medicine.

[8]  D. Adu,et al.  Interleukin-2 receptor monoclonal antibodies in renal transplantation: meta-analysis of randomised trials , 2003, BMJ : British Medical Journal.

[9]  S. Pathak The way I see it: Working in the Caribbean in the gap between basic and higher surgical training , 2002 .

[10]  D. Asch,et al.  The unintended consequences of publicly reporting quality information. , 2005, JAMA.

[11]  Edward R. Tufte,et al.  The Visual Display of Quantitative Information , 1986 .

[12]  B. Bridgewater Mortality data in adult cardiac surgery for named surgeons: retrospective examination of prospectively collected data on coronary artery surgery and aortic valve replacement , 2005, BMJ : British Medical Journal.

[13]  Douglas C. Montgomery,et al.  Introduction to Statistical Quality Control , 1986 .

[14]  E. McGlynn,et al.  What Cognitive Science Tells Us about the Design of Reports for Consumers , 2002, Medical care research and review : MCRR.

[15]  Harvey Goldstein,et al.  League Tables and Their Limitations: Statistical Issues in Comparisons of Institutional Performance , 1996 .

[16]  S. Bird,et al.  Performance indicators: good, bad, and ugly , 2004 .

[17]  D. Spiegelhalter,et al.  The legacy of Bristol: public disclosure of individual surgeons' results , 2004, BMJ : British Medical Journal.

[18]  T. Fahey,et al.  Quality measurement of care for people with type 2 diabetes in Tayside, Scotland: implications for the new UK general practice contract. , 2003, The British journal of general practice : the journal of the Royal College of General Practitioners.

[19]  Peter McCulloch,et al.  Jan using hospital mortality data performance of surgical units : validation study Mortality control charts for comparing , 2003 .

[20]  T. Tucker,et al.  Development of an AIDS vaccine: perspective from the South African AIDS Vaccine Initiative , 2004, BMJ : British Medical Journal.

[21]  Tom Marshall,et al.  A randomized controlled trial of league tables and control charts as aids to health service decision-making. , 2004, International journal for quality in health care : journal of the International Society for Quality in Health Care.

[22]  D. Henry,et al.  The effects of information framing on the practices of physicians , 1999, Journal of General Internal Medicine.

[23]  Paul Slovic,et al.  Strategies for reporting health plan performance information to consumers: evidence from controlled studies. , 2002, Health services research.

[24]  W. Edwards Deming,et al.  Out of the Crisis , 1982 .

[25]  Eugene H Blackstone,et al.  Monitoring surgical performance. , 2004, The Journal of thoracic and cardiovascular surgery.