NES IA Wave 33 PDSA Cycles and SPC Software...

Copyright © Institute for Healthcare Improvement

NES IA Wave 33PDSA Cycles

and SPC Software WebEx

Wednesday, 23rd April, 201410-12 pm ET/3-5 pm GMT

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.

Copyright © Institute for Healthcare ImprovementSlide 2

Please Check In IA Wave 33:

IA IA IA

April MassonEYC – East Ayrshire CPP

Gavin RussellEYC – East Renfrewshire CPP

Michelle AffleckEYC -NHS Greater Glasgow and Clyde

David MaxwellHealthcare Improvement Scotland

Graham MacKenzieEYC – NHS Lothian

Michelle CochlanEYC - Perth

Dawn MossEYC – NHS Borders

Hamish FraserEYC – Midlothian CPP

Penny BondHealthcare Improvement Scotland

Diana BeveridgeScottish Government

Judith CainEYC – North Lanarkshire Council

Sacha WillEYC – Aberdeen City Council

Donna MurrayEYC – City of Edinburgh Council

Kerstin JornaEYC – Dundee City Council

Sally HallNHS Scotland

Eileen McGinleyNHS Lanarkshire

Kirsty EllisHealthcare Improvement Scotland

Shalani RaghavanScottish Government

Emma LevyNHS Education Scotland

Marie-Claire StallardEYC – East Dunbartonshire CPP

Stephanie FrearsonNHS Ayrshire & Arran

Fiona MontgomeryScottish Government

Marsha ScottEYC – West Lothian Council

Stephanie MottramNHS Dunfries and Galloway Royal Infirmary

Gareth AdkinsHealthcare Improvement Scotland

Michele DowlingEYC – South Lanarkshire Council

Wendy TonerEYC – NHS Greater Glasgow and Clyde D


N

1. NHS Ayrshire & Arran

2. NHS Borders

3. NHS Dumfries & Galloway

4. NHS Fife

10. NHS Lothian

9. NHS Lanarkshire

8. NHS Highland

7. NHS Greater Glasgow & Clyde

6. NHS Grampian

5. NHS Forth Valley

14. NHS Western Isles

13. NHS Tayside

11. NHS Shetland

12. NHS Orkney

12

3

45

6

7

8

9

10

11

13

14

12

15. Golden Jubilee National Hospital

D


IA Program Faculty and Staff Team: NES Wave 33

Lloyd ProvostFaculty WS3

NHS Education for Scotland

Dr. Robert LloydLead Faculty

Brandon BennettFaculty WS1

IHI Faculty and Staff

D

Sandy MurrayFaculty WS2

Debbie RayFaculty/Director

Dr. Lesley Anne SmithQI Programme Director

Dr. Elaine PacittiEducational Projects Mgr.

Louise CavanaghQI Project Officer

Samantha SmithQI Administrator

Leigh CarrollProject

CoordinatorStrategic Partners


IHI Support Staff for Wave 33

Brian Sanderson,

Project Assistant

bsanderson@ihi.

org

Tom Charlton,

Project Assistant

[email protected]


IA Graduates and Their Role during the Program

Bernadette McCullochScottish Patient Safety Programme

Maternity & Children Quality

Improvement Collaborative

IA Wave 28

Laura AllisonDG Health and Social Care

Scottish Government

IA Wave 15

Assist your professional development by serving as teacher, coach,

and fellow learner.

B


Agenda – Wednesday, 23 April 2014

Time Topic Leader

3:00 pm GMT Welcome and Check-In (including project

scores)

Sandy

3:10 pm GMT 3 Assignments:•Paired Leadership Report Review•Senior Leader Project Scoring•Project Presentations at WS33.2

Debbie

3:20 pm GMT 2 Volunteers Needed for Next WebEx Sharing PDSA Cycles

Sandy

3:25 pm GMT PDSA Cycle Review -Wendy Debbie

3:40 pm GMT Run Charts in Review Sandy

3:55 pm GMT Run Chart Software Demo (IAs) Gareth

4:00 pm GMT P Charts on Parade Sandy

4:15 pm GMT P Chart Software Demos (IAs) Emma

4:20 pm GMT Review of Extra Charts and U Chart Software Demo

Sandy and Diana

4:40 pm GMT Some Software Tutorial Sandy

4:55 pm GMT Close Debbie


May 2014 IA Assignments

1. Paired Leadership Report Assignment: Purpose: Strengthen one another’s Leadership Reports

Time estimate: 45 minutesDue Date: Wednesday, 21st May 2014

Step 1: Download your partner’s May (or most recent leadership report) by going to the following Extranet location:

www.ihi.org/extranetng Resource Tab “Monthly Reports” Folder “your partners name” folder.

Step 2: Review your partner’s report and comment on strengths and suggest improvements to their report using the attached feedback form.

Step 3: Post the feedback form or report with comments to your own team extranet page under:

www.ihi.org/extranetng --> Your team resources tab “Paired Leadership Report Assignment” folder. Send an email to your partner that you have completed your review.

http://www.ihi.org/extranetng

http://www.ihi.org/extranetng


Paired Leadership Report Feedback Form

Some Attributes of a Helpful Leadership Report

Aspect Strengths Suggested Improvements

Clearly identifies IA, Executive Project

Champion, Sponsor, Date of report

Aim of Project is clear: what they intend to

accomplish

Business Case - why do this project? How

the project supports the strategic objectives

of the organization

List of Changes proposed, tested, and

implemented

Key project measures exist and data is

graphed (at least annotated run chart) for

each measure so results are visible

Lessons Learned – interesting story or

anecdote

Senior leader role: what is needed from

them right now if anything

Next Steps, predictions for next reporting

period

Contact Info


Leadership Report Review Partners


May 2014 IA Assignments

B. Project Sponsor and Advocate use assessment scale (0.5-5) to rate Project Progress. Due Date: Wednesday, 21st May 2014

Purpose: 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: Enter their assessment score on your Extranet homepage:

− Go to your team page − Look under Data Entry (on the right hand side of Extranet team page)

and select “Project Progress”− Select “Add Data” next to “sponsor”− Select date from “Time Period” drop down menu (i.e. 1 – 2014)− Enter your “Assessment Score” under Project Rating− Press “Save”


Role of Your Sponsor related to the IA Program

The Sponsor: Is the senior leader responsible and accountable to the

organization for the specific project that the participant will be working on during the IA Program.

This is the leader the participant will report project progress to (such as Chief Medical Officer, or COO, etc.)

We expect that: Your Sponsor is senior in the organization and views your IA

project as strategically important. The Sponsor actively supports the project throughout its entire

lifecycle by finalizing the charter, providing appropriate resources, maintaining priority of the project in the face of competing events, removing barriers to testing and implementation of changes, and communicating the project story to multiple levels of the organization.

Sponsor communication:− Letter after each WS to Sponsor and Project Advocate− Ask Sponsor to rate project’s progress 3 times during Program

using assessment scale we provide− IA or Sponsor can enter it onto extranet


Workshop II Project Presentation Assignment

Workshop 2 is Mon. thru Thurs., 2-5 June, 2014 in Edinburgh;Sandy and Bob are faculty.

IA Project Presentation Guidelines: 15 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 and your current project progress score (on 0.5 to 5 scale) 30 seconds or less

Present one or more completed PDSAs on your project using PDSA short or long form (on Extranet)

The PDSAs can focus on learning, developing, testing or implementing a change Testing a change preferred! Sharing a series of small PDSA cycles is very desirable Tell us which change concepts you used in your test(s) of change (IG

page 359)

End your presentation by predicting what your project progress score will be by WS 3 (Oct 2014) 30 seconds or less

Faculty and other IAs will use a PDSA evaluation form to provide feedback to the presenter. PDSA Feedback Form is on the Extranet.


Improvement Advisor Project Progress Assessment Scale

Apply these criteria to your IA improvement Project. Select the definit ion 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 begun

Organization of project structure has begun (such as: what resources or other support will likely be needed, where wil l 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 improvement

Initial cycles for testing changes have begun. Most project goals have a measure established to track progress. Measures are is 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!


IHI Improvement Advisor Development Program PDSA CYCLE FEEDBACK

PURPOSE: To provide helpful feedback to those presenting PDSA cycles designed to develop, test or implement a change

Presenter: __________________________ Reviewer: _____________________

Project: ________________________________________________________________

PLAN: Was the objective for this PDSA cycle clear to you? If not, what would you suggest?

Were the questions they were trying to answer stated clearly? If not, what would you suggest?

Did they state their predictions? How could the predictions be improved?

Did they address WHO, WHAT, WHERE, WHEN? If not, what would you suggest they do to strengthen this part of their plan?

Did they describe plan to collect the data required to answer questions? Will they be able to evaluate the predictions

using these data?

What did you think of the scale/scope of this PDSA? (Too: large, small, complex, simple, etc.?) What do you think

would have been a more useful size/scope for this PDSA cycle?

DO: Did they attempt to carry out their plan?

Did they document any problems or unexpected events?

Did they collect the data they planned to collect?

Did they capture feedback or observations from those conducting the plan?

What are your suggestions to improve in the DO phase of their PDSA cycles?

<OVER>


STUDY: Did they complete the analysis of the data?

Did they analyze feedback or observations?

Did they compare the data and feedback or observations to their prediction and summarize what they learned?

Did they update their theories about the objective of the cycle?

What are your suggestions?

ACT: Did they say what will happen in the next PDSA cycle (develop change further, test, implement?)

What are your suggestions for them for their next PDSA cycle(s)? (What suggestions do you have for scale, scope, sequencing of next PDSA cycle(s)?

Do you have an idea you’d suggest they test? (Anything you know about this subject you could share with them?)

Linking Series of PDSA Cycles

Were plans identified to link multiple tests of change?

If so, what suggestions do you have on the series of PDSA Cycles planned for the project?

Additional Comments:


Next WebEx: Weds, 28th May, 201410-11:30 am ET 3-4:30 pm GMT

Looking for 2 volunteers to present Project Presentation PDSA cycle(s) early.

These 2 volunteers will not present at Workshop 2.

All IAs need to download the PDSA Feedback Form prior to the call so we can use it as a guide to asking good questions and providing feedback.


PDSA Cycle Sharing

Planning and Testing Changes


Wendy Toner19

NHS Greater Glasgow and Clyde

Increase Uptake of Attendance to

Evidenced Based, Group Parenting

Interventions.


Aim: (overall goal you wish to achieve) By October 2014, 50% of parents in area x, identified as having a moderate issue with

parenting, as identified through the 30 month assessment, will attend a Level 4 Group based parenting intervention. (Within an identified team location to be agreed : area x) Every goal will require multiple smaller tests of change

Describe your first (or next) test of change: Person responsible

When to be done

Where to be done

To identify and persuade a children and family team to take part in this project.

Wendy 28/3/14 Office

Plan

List the tasks needed to set up this test of change Person responsible

When to be done

Where to be done

Speak to service manager for permission to use approach teams in area Copies of project aim, project charter and driver diagram available Scrutinise activity of teams and identify possible locations Email relevant team leads and email Arrange meeting with team lead to plan next steps Meet with team to explain and agree timescales

Wendy Wendy Wendy Wendy Wendy Wendy

14/3/14 14/3/14 14/3/14 14/3/14 21/3/14 28/3/14

Office Office Office Office Office Team Office

Predict what will happen when the test is carried out

Measures to determine if prediction succeeds

One team lead will be identied as suitable and will agree to be involved in this work.

How many team leads will respond How many will respond agreeing to commit further Level of commitment and enthusiasm from team members


Do Describe what actually happened when you ran the test I spoke with the Head of Community Planning and discussed how I should identify a team to work on with the project as agreed. She advised I contact the Service Manger in the North East of the city, as a courtesy to approach one of the team leads to pitch the project to them. I emailed the service manager with a brief overview of the Improvement Advisor Course, the aim of the project and the expected inputs required from the team involved. She was on holiday and so didn’t reply for a week. When she did reply she was very positive and was happy for me to approach the 2 team leads I had identified as working in the targeted geographical areas. I telephoned these two team leads, left voice mails and followed up with emails. From these approaches I received one response. This response was positive and requested more information. I followed this up with a pohobe call in which I further outlined the project and aims and expectations of the wider teams involvement. We agreed to meet to look at more fully and discuss the potential barriers to the team engagement as identified by the team leader and how we might address these when pitching this project to the team.

Study Describe the measured results and how they compared to the predictions

I predicted that I would be able to engage with one team leader but I did not manage to influence with email and phone call but a face to face meeting needed to be set up. No response from the other was not unforeseen but surprising nevertheless. I recognize that my initial email pitch needs to be more focused and clearer and also to anticipate more of the issues and to address them head on, in the initial communications may be helpful. It would also be preferable to speak in person directly as the first point of contact but due to time and geographical restraints this wasn’t possible on this occasion.

Act Describe what modifications to the plan will be made for the next cycle from what you learned

Need to allow much more time to achieve agreement due to the scale and complexity of teams involved and volume of workloads. Speaking to team leaders directly and face to face would be more time efficient and enable me to influence more directly. Approaching bigger number of potential teams would give greater opportunities. Being very well versed and prepared with my ‘pitch’ including anticipating any barriers to their own and teams engagement and selling the benefits to them.

Worksheet For Testing Change (Stephanie Motram)

Aim: (overall aim) To reduce the number of joint orthoptic / ophthalmology paediatric out-patient return appointments waiting more than eight weeks by 30% by December 2014

Describe your first (or next) test of change Person Responsible

When to be done

Where to be done

To introduce weekly huddle between Orthoptist and Ophthalmologist and key nursing staff.

Helen Cameron

18/03/14

Orthoptic Room

What Questions do we want answered?

Will this improve communication between Teams?

Will this help identify patients who do not need to be seen by Ophthalmology?

Will this lead to a better understanding regarding timetabling joint clinics?

Will the Team come up with solutions to timetabling issues?

Plan

List the tasks needed to set up this test of change Person Responsible

When to be done

Where to be done

1. Suitable weekly date identified 2. Date to be diarised in Orthoptic and Opthalmology diaries 3. All relevant parties notified of date, time and place 4. Set structured Agenda 5. Case Notes available for huddle 6. De-brief with team

HC DT DT HC DT SM

Predict what will happen when the test is carried out Measures to determine if prediction succeeds

1. Ophthalmologist may not be able to attend due to clinic pressures

2. Will not focus on structured agenda 3. Case notes may not be available

1- Everyone attended at meeting 2- Number of patients identified as not requiring to be

seen in joint clinic 3- Timetabling issues identified 4- Timetabling issues resolved


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

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Run Charts in Review!!


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Months

Percent Unplanned Returns (Run Chart)

Median

Measure

Dawn


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Run Chart

Median

Pts returning

Marsha


Kirsty


Median = 2.1

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3.5F

eb-0

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% of unplanned returns to OR

Median

PercentDavid


Sally


April


3/6/06 4/6/06 5/6/06 6/6/06 7/6/06 8/6/06 9/6/06 10/6/06 11/6/06 12/6/06 1/6/07 2/6/07 3/6/07 4/6/07 5/6/07 6/6/07 7/6/07 8/6/07 9/6/07 10/6/07 11/6/07 12/6/07 1/6/08 2/6/08 3/6/08

Subgroup 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

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Run Chart

Median

Pts returned to OR

Marsha


Judith Cain - Wave 33Assignment A – Run Chart

2/6/06 3/6/06 4/6/06 5/6/06 6/6/06 7/6/06 8/6/06 9/6/06 10/6/06 11/6/06 12/6/06 1/6/07 2/6/07 3/6/07 4/6/07 5/6/07 6/6/07 7/6/07 8/6/07 9/6/07 10/6/07 11/6/07 12/6/07 1/6/08 2/6/08 3/6/08

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

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3.5

Unplanned Returns

Median

%

Shalani

2/6/06 3/6/06 4/6/06 5/6/06 6/6/06 7/6/06 8/6/06 9/6/06 10/6/06 11/6/06 12/6/06 1/6/07 2/6/07 3/6/07 4/6/07 5/6/07 6/6/07 7/6/07 8/6/07 9/6/07 10/6/07 11/6/07 12/6/07 1/6/08 2/6/08 3/6/08 4/6/08 5/6/08

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

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PE

RC

EN

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NP

LA

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ED

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TU

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MONTHS

Michelle Cochlan's Run Chart

Median


Percent

Unplanned

Returns

Month

s

2.74

02/06/0

6

2.04 3/6/06

2.51 4/6/06

2.30 5/6/06

2.90 6/6/06

1.65 7/6/06

2.37 8/6/06

2.90 9/6/06

2.13 10/6/06

2.29 11/6/06

1.59 12/6/06

2.40 1/6/07

2.80 2/6/07

2.46 3/6/07

1.76 4/6/07

1.87 5/6/07

1.26 6/6/07

2.20 7/6/07

0.84 8/6/07

0.20 9/6/07

0.91 10/6/07

0.64 11/6/07

2.07 12/6/07

0.61 1/6/08

0.22 2/6/08

0.54 3/6/08

Donna


6/2/06 6/3/06 6/4/06 6/5/06 6/6/06 6/7/06 6/8/06 6/9/066/10/0

66/11/0

66/12/0

66/1/07 6/2/07 6/3/07 6/4/07 6/5/07 6/6/07 6/7/07 6/8/07 6/9/07

6/10/07

6/11/07

6/12/07

6/1/08 6/2/08 6/3/08

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

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

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3.5

Gavin Russell IA33 - Unplanned Returns Run-Chart


Sacha Will, Wave 33, SPC Assignment

Run Chart

Percentage of Unplanned Returns


Chg 14

Chg 12,13

Chg 10,11

Chg 9

Chg 7,8

Chg 4,5,6

Chg 2,3Chg 1

0

0.5

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Date

Percen

tag

e

Median

Subgroup 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 2.0 2.0 2.0 2.0 2.0 2.0 2.0 2.0 2.0 2.0 2.0 2.0 2.0 2.0 2.0 2.0 2.0 2.0 2.0 2.0 2.0 2.0 2.0 2.0 2.0

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71/ 6/ 08

2/ 6/ 0

8

3/ 6/ 0

8

Measure

Marie-Claire Stallard, Wave 33, SPC Assignment: Unplanned Return to Operating Room


0.00

0.50

1.00

1.50

2.00

2.50

3.00

3.50Fe

b-0

6

Mar

-06

Ap

r-0

6

May

-06

Jun

-06

Jul-

06

Au

g-0

6

Sep

-06

Oct

-06

No

v-0

6

De

c-0

6

Jan

-07

Feb

-07

Mar

-07

Ap

r-0

7

May

-07

Jun

-07

Jul-

07

Au

g-0

7

Sep

-07

Oct

-07

No

v-0

7

De

c-0

7

Jan

-08

Feb

-08

Mar

-08

Ap

r-0

8

May

-08

Pe

rce

nt

% Unplanned Returns to OR

Percent Unplanned Returns

Median 2.05Chg 7, 8

Chg 4,5,6

Chg 9

Chg 1

Chg 2, 3

Chg 10,11

Chg 12,13

Chg 14


April

2/6/06 3/6/06 4/6/06 5/6/06 6/6/06 7/6/06 8/6/06 9/6/06 10/6/06 11/6/06 12/6/06 1/6/07 2/6/07 3/6/07 4/6/07 5/6/07 6/6/07 7/6/07 8/6/07 9/6/07 10/6/07 11/6/07 12/6/07 1/6/08 2/6/08 3/6/08 4/6/08 5/6/08

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

Median = 2.1

0

0.5

1

1.5

2

2.5

3

3.5

% of unplanned returns to ORMedian

Percentage

Chg 2,3

Chg 4,5,6

Chg 7,8

Chg 9

Chg 10,11

Chg 12,13

Chg 14

Implementation start

David

David


2/6/06 3/6/06 4/6/06 5/6/06 6/6/06 7/6/06 8/6/06 9/6/06 10/6/06 11/6/06 12/6/06 1/6/07 2/6/07 3/6/07 4/6/07 5/6/07 6/6/07 7/6/07 8/6/07 9/6/07 10/6/07 11/6/07 12/6/07 1/6/08 2/6/08 3/6/08 4/6/08 5/6/08

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

Chg1

Chg 2,3

0

0.5

1

1.5

2

2.5

3

3.5

Months

Run Chart

MedianPer Cent

Chg 4,5,6

Chg7,8

Chg 9

Chg 10,11

Chg 12,13

Chg 14


Stephanie F


2/6/06 3/6/06 4/6/06 5/6/06 6/6/06 7/6/06 8/6/06 9/6/06 10/6/06 11/6/06 12/6/06 1/6/07 2/6/07 3/6/07 4/6/07 5/6/07 6/6/07 7/6/07 8/6/07 9/6/07 10/6/07 11/6/07 12/6/07 1/6/08 2/6/08 3/6/08

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

Chg 1

Chg 2,3

Chg 4,5,6

Chg 7,8

Chg 9

Chg 10,11

Chg 12,13

Chg 14


0

5

10

15

20

25

30

35

# p

atie

nts

un

pla

nn

ed

re

turn

to

op

era

tin

g r

oo

m

Run Chart# Pts Unplanned Return to OR by month

Graham


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

0.5

1

1.5

2

2.5

3

3.5F

eb-0

6

Ma

r-0

6

Ap

r-06

Ma

y-0

6

Jun

-06

Jul-

06

Au

g-0

6

Se

p-0

6

Oct-

06

Nov-0

6

De

c-0

6

Jan

-07

Fe

b-0

7

Ma

r-0

7

Ap

r-07

Ma

y-0

7

Jun

-07

Jul-

07

Au

g-0

7

Se

p-0

7

Oct-

07

Nov-0

7

Dec-0

7

Jan

-08

Fe

b-0

8

Ma

r-0

8

Perc

enta

ge

Percentage of Unplanned Returns per number of Surgeries between February 2006 and March 2008

Median

Chg 1

Chg 2,3

Chg 4,5,6

Chg 7,8

Chg 9

Chg 10,11

Chg 12,13

Implementation

Kerstin


2/6/06 3/6/06 4/6/06 5/6/06 6/6/06 7/6/06 8/6/06 9/6/06 10/6/06 11/6/06 12/6/06 1/6/07 2/6/07 3/6/07 4/6/07 5/6/07 6/6/07 7/6/07 8/6/07 9/6/07 10/6/07 11/6/07 12/6/07 1/6/08 2/6/08 3/6/08

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

Perc

enta

ge

Percentage of Unplanned Returns per number of Surgeries between February 2006 and March 2008

Median

Chg 1

Chg 2,3

Chg 4,5,6

Chg 7,8

Chg 9

Chg 10,11

Chg 12,13

Implementation

Kerstin

0

0.5

1

1.5

2

2.5

3

3.5

01 F

eb

rua

ry 2

006

01 M

arc

h 2

00

6

01 A

pri

l 2

006

01 M

ay 2

00

6

01 J

un

e 2

00

6

01 J

uly

20

06

01 A

ug

ust

20

06

01 S

ep

tem

be

r 2

00

6

01 O

cto

be

r 2

00

6

01 N

ovem

ber

200

6

01 D

ecem

ber

200

6

01 J

an

ua

ry 2

00

7

01 F

eb

rua

ry 2

007

01 M

arc

h 2

00

7

01 A

pri

l 2

007

01 M

ay 2

00

7

01 J

un

e 2

00

7

01 J

uly

20

07

01 A

ug

ust

20

07

01 S

ep

tem

be

r 2

00

7

01 O

cto

be

r 2

00

7

01 N

ovem

ber

200

7

01 D

ecem

ber

200

7

01 J

an

ua

ry 2

00

8

01 F

eb

rua

ry 2

008

01 M

arc

h 2

00

8

01 A

pri

l 2

008

01 M

ay 2

00

8

02/06/06

3/6/06

4/6/06

5/6/06

6/6/06

7/6/06

8/6/06

9/6/06

10/6/06

11/6/06

12/6/06

1/6/07

2/6/07

3/6/07

4/6/07

5/6/07

6/6/07

7/6/07

8/6/07

9/6/07

10/6/07

11/6/07

12/6/07

1/6/08

2/6/08

3/6/08

4/6/08

5/6/08

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

Run Chart showing % unplanned returns to OR

Median

% unplanned returns

implementation start

Chg 7,8

Chg 2,3

chg 1

chg 9

chg 10,11

chg 12,13

chg 14

Penny

Gareth

Michele D

Annotating

Emma

Emma


Another Wave

% Unplanned Returns

0

0.5

1

1.5

2

2.5

3

3.5

2/6

/06

3/6

/06

4/6

/06

5/6

/06

6/6

/06

7/6

/06

8/6

/06

9/6

/06

10

/6/0

6

11

/6/0

6

12

/6/0

6

1/6

/07

2/6

/07

3/6

/07

4/6

/07

5/6

/07

6/6

/07

7/6

/07

8/6

/07

9/6

/07

10

/6/0

7

11

/6/0

7

12

/6/0

7

1/6

/08

2/6

/08

3/6

/08

4/6

/08

5/6

/08

Date


Another Wave


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


0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

4.0

Ours

2.055


Let’s Build a Run Chart

Gareth-showing us

the run chart and

how to add

annotations


P Charts on Parade


Shewhart charts

Uses numerator and denominator and lets computer figure our percent

Center line is mean

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


UCL

LCL

0%

1%

1%

2%

2%

3%

3%

4%

2/6

/06

3/6

/06

4/6

/06

5/6

/06

6/6

/06

7/6

/06

8/6

/06

9/6

/06

10/6

/06

11/6

/06

12/6

/06

1/6

/07

2/6

/07

3/6

/07

4/6

/07

5/6

/07

6/6

/07

7/6

/07

8/6

/07

9/6

/07

10/6

/07

11/6

/07

12/6

/07

1/6

/08

2/6

/08

3/6

/08

4/6

/08

5/6

/08

MONTHS

Stephanie P Chart Exercise

Percent

Stephanie M


Emma

Emma


UCL

LCL0%

0%

0%

0%

0%

0%

0%

0%

0%

2/6

/06

3/6

/06

4/6

/06

5/6

/06

6/6

/06

7/6

/06

8/6

/06

9/6

/06

10/6

/06

11/6

/06

12/6

/06

1/6

/07

2/6

/07

3/6

/07

4/6

/07

5/6

/07

6/6

/07

7/6

/07

8/6

/07

9/6

/07

10/6

/07

11/6

/07

12/6

/07

1/6

/08

2/6

/08

3/6

/08

Axis

Title

Axis Title

P Chart

P Chart

Dawn

?


Kirsty

Shalani


Sally


3/6/06 4/6/06 5/6/06 6/6/06 7/6/06 8/6/06 9/6/06 10/6/06 11/6/06 12/6/06 1/6/07 2/6/07 3/6/07 4/6/07 5/6/07 6/6/07 7/6/07 8/6/07 9/6/07 10/6/07 11/6/07 12/6/07 1/6/08 2/6/08 3/6/08

Subgroup 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 1.74% 1.74% 1.74% 1.74% 1.74% 1.74% 1.74% 1.74% 1.74% 1.74% 1.74% 1.74% 1.74% 1.74% 1.74% 1.74% 1.74% 1.74% 1.74% 1.74% 1.74% 1.74% 1.74% 1.74% 1.74%

UCL 2.99% 2.99% 2.98% 2.94% 2.96% 3.06% 3.01% 2.91% 3.01% 2.88% 2.98% 2.94% 3.05% 3.09% 3.01% 3.01% 2.98% 3.01% 2.99% 2.99% 3.02% 3.01% 3.00% 3.03% 2.92%

LCL 0.49% 0.50% 0.50% 0.54% 0.52% 0.42% 0.48% 0.57% 0.48% 0.61% 0.50% 0.54% 0.43% 0.40% 0.48% 0.47% 0.50% 0.47% 0.50% 0.49% 0.46% 0.48% 0.49% 0.45% 0.56%

UCL

LCL

0%

1%

1%

2%

2%

3%

3%

4%

P Chart

Percent

Marsha

Donna Murray SPC Assignment P Chart

UCL

LCL

0%

1%

1%

2%

2%

3%

3%

4%

2/6

/06

3/6

/06

4/6

/06

5/6

/06

6/6

/06

7/6

/06

8/6

/06

9/6

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10/6

/06

11/6

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12/6

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1/6

/07

2/6

/07

3/6

/07

4/6

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5/6

/07

6/6

/07

7/6

/07

8/6

/07

9/6

/07

10/6

/07

11/6

/07

12/6

/07

1/6

/08

2/6

/08

3/6

/08

4/6

/08

5/6

/08

P ChartPercent

Months

# Pts Unplanned

Return to OR

#

Surgeries

02/06/06 27 984

3/6/06 20 982

4/6/06 25 996

5/6/06 23 998

6/6/06 31 1070

7/6/06 17 1031

8/6/06 21 886

9/6/06 28 964

10/6/06 24 1128

11/6/06 22 960

12/6/06 19 1193

1/6/07 24 998

2/6/07 30 1070

3/6/07 22 895

4/6/07 15 852

5/6/07 18 963

6/6/07 12 956

7/6/07 22 1001

8/6/07 8 956

9/6/07 2 995

10/6/07 9 987

11/6/07 6 943

12/6/07 20 965

1/6/08 6 980

2/6/08 2 923

3/6/08 6 1106

4/6/08

5/6/08

Donna Murray SPC Assignment P Chart

UCL

LCL

0%

1%

1%

2%

2%

3%

3%

4%

2/6/

06

3/6/

06

4/6/

06

5/6/

06

6/6/

06

7/6/

06

8/6/

06

9/6/

06

10/6

/06

11/6

/06

12/6

/06

1/6/

07

2/6/

07

3/6/

07

4/6/

07

5/6/

07

6/6/

07

7/6/

07

8/6/

07

9/6/

07

10/6

/07

11/6

/07

12/6

/07

1/6/

08

2/6/

08

3/6/

08

4/6/

08

5/6/

08

P ChartPercent

Months02/06/0

6 3/6/06 4/6/06 5/6/06 6/6/06 7/6/06 8/6/06 9/6/06 10/6/06 11/6/06 12/6/06 1/6/07 2/6/07 3/6/07 4/6/07 5/6/07 6/6/07 7/6/07 8/6/07 9/6/07 10/6/07 11/6/07 12/6/07 1/6/08 2/6/08 3/6/08 4/6/08

# Pts

Unplanned

Return to

OR 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

#

Surgeries 984 982 996 99810701031 886 9641128 9601193 9981070 895 852 963 9561001 956 995 987 943 965 980 9231106


2/6/06 3/6/06 4/6/06 5/6/06 6/6/06 7/6/06 8/6/06 9/6/06 10/6/06 11/6/06 12/6/06 1/6/07 2/6/07 3/6/07 4/6/07 5/6/07 6/6/07 7/6/07 8/6/07 9/6/07 10/6/07 11/6/07 12/6/07 1/6/08 2/6/08 3/6/08

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%

Chg 1

Chg 2,3

Chg 4,5,6

Chg 7,8

Chg 9

Chg 10,11

Chg 14


Chg 12,13

UCL

LCL

0%

1%

1%

2%

2%

3%

3%

4%

Gavin Russell IA33 - Unplanned Returns P Chart

Percent


Sacha Will, Wave 33, SPC Assignment

P Chart

Percentage of Unplanned Returns

Chg 1

Chg 2,3

Chg 4,5,6Chg 7,8

Chg 9

Chg 10,11

Chg 12,13

Chg 14


UCL

LCL

0%

1%

1%

2%

2%

3%

3%

4%

Date

Percen

tag

e

Subgroup 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%

Cent er 1.74% 1.74%1.74% 1.74% 1.74% 1.74%1.74% 1.74% 1.74%1.74% 1.74% 1.74%1.74% 1.74% 1.74% 1.74%1.74% 1.74% 1.74%1.74% 1.74% 1.74%1.74% 1.74% 1.74% 1.74%1.74%

UCL 2.99%2.99%2.98%2.94%2.96%3.06%3.01% 2.91% 3.01%2.88%2.98%2.94%3.05%3.09%3.01% 3.01%2.98%3.01% 2.99%2.99%3.02%3.01%3.00%3.03%2.92%

LCL 0.49%0.50%0.50%0.54%0.52%0.42%0.48%0.57%0.48%0.61% 0.50%0.54%0.43%0.40%0.48%0.47%0.50%0.47%0.50%0.49%0.46%0.48%0.49%0.45%0.56%

3/ 6/ 0

6

4/ 6/ 0

6

5/ 6/ 0

6

6/ 6/ 0

6

7/ 6/ 0

6

8/ 6/ 0

6

9/ 6/ 0

6

10/ 6/

06

11/ 6/

06

12/ 6/

06

1/ 6/ 0

7

2/ 6/ 0

7

3/ 6/ 0

7

4/ 6/ 0

7

5/ 6/ 0

7

6/ 6/ 0

7

7/ 6/ 0

7

8/ 6/ 0

7

9/ 6/ 0

7

10/ 6/

07

11/ 6/

07

12/ 6/

07

1/ 6/ 0

8

2/ 6/ 0

8

3/ 6/ 0

8

4/ 6/ 0

8

5/ 6/ 0

8

Percent

Marie-Claire Stallard, Wave 33, SPC Assignment: Unplanned Return to Operating Room


Chg 1

Chg 2, 3

Chg 4,5,6

Chg 7, 8

Chg 9

Chg 10,11

Chg 12,13

Chg 14


April


2/6/06 3/6/06 4/6/06 5/6/06 6/6/06 7/6/06 8/6/06 9/6/06 10/6/06 11/6/06 12/6/06 1/6/07 2/6/07 3/6/07 4/6/07 5/6/07 6/6/07 7/6/07 8/6/07 9/6/07 10/6/07 11/6/07 12/6/07 1/6/08 2/6/08 3/6/08 4/6/08 5/6/08

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%

Median = 1.78%

UCL

LCL

0%

1%

2%

3%

4%

% of unplanned returns to OR

Percent

Chg 1

Chg 2,3

Chg 4,5,6

Chg 7,8

Chg 9

Chg 10,11

Chg 12,13

Chg 14Implementation start

David

David


2/6/06 3/6/06 4/6/06 5/6/06 6/6/06 7/6/06 8/6/06 9/6/06 10/6/06 11/6/06 12/6/06 1/6/07 2/6/07 3/6/07 4/6/07 5/6/07 6/6/07 7/6/07 8/6/07 9/6/07 10/6/07 11/6/07 12/6/07 1/6/08 2/6/08 3/6/08

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

0.0%

0.5%

1.0%

1.5%

2.0%

2.5%

3.0%

3.5%

P Chart showing perctage of unplanned returns to OR per number of surgeries per months from February 2006 to March 2008

Percent

Chg 1

Chg 2,3

Chg 4,5,6

Chg 7,8

Chg 9

Chg 10,11

Chg 12,13

Chg 14

Implement

Kerstin

Judith Cain - Wave 33

Assignment B – P Chart

2/6/06 3/6/06 4/6/06 5/6/06 6/6/06 7/6/06 8/6/06 9/6/06 10/6/06 11/6/06 12/6/06 1/6/07 2/6/07 3/6/07 4/6/07 5/6/07 6/6/07 7/6/07 8/6/07 9/6/07 10/6/07 11/6/07 12/6/07 1/6/08 2/6/08 3/6/08

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%

Chg 1

Chg 2,3

Chg 4,5,6

Chg 7,8

Chg 9

Chg 10,11

Chg 12,13

Chg 14


UCL

LCL

0%

1%

1%

2%

2%

3%

3%

4%

Unplanned Returns

Percent

2/6/06 3/6/06 4/6/06 5/6/06 6/6/06 7/6/06 8/6/06 9/6/0610/6/0

611/6/0

612/6/0

61/6/07 2/6/07 3/6/07 4/6/07 5/6/07 6/6/07 7/6/07 8/6/07 9/6/07

10/6/07

11/6/07

12/6/07

1/6/08 2/6/08 3/6/08 4/6/08 5/6/08

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% 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%

P Chart Unplanned return to ORPercent

Chg 1

Chg 2,3

Chg 4,5,6

Chg 7,8

Chg 9

Chg 10,11

Chg 12,13

Chg 14


Stephanie F


2/6/06 3/6/06 4/6/06 5/6/06 6/6/06 7/6/06 8/6/06 9/6/06 10/6/06 11/6/06 12/6/06 1/6/07 2/6/07 3/6/07 4/6/07 5/6/07 6/6/07 7/6/07 8/6/07 9/6/07 10/6/07 11/6/07 12/6/07 1/6/08 2/6/08 3/6/08

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%

Chg 1

Chg 2,3

Chg 4,5,6

Chg 7,8

Chg 9

Chg 10,11

Chg 12,13

Chg 14


0%

1%

1%

2%

2%

3%

3%

4%

% p

atie

nts

re

turn

ing

to

OR

po

st su

rge

ry

P ChartPercent pts with unplanned return to OR by month

Graham

Gareth

Emma

Emma

2/6/06 3/6/06 4/6/06 5/6/06 6/6/06 7/6/06 8/6/06 9/6/06 10/6/06 11/6/06 12/6/06 1/6/07 2/6/07 3/6/07 4/6/07 5/6/07 6/6/07 7/6/07 8/6/07 9/6/07 10/6/07 11/6/07 12/6/07 1/6/08 2/6/08 3/6/08 4/6/08 5/6/08

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% 1.78% 1.78%

UCL 3.77% 3.77% 3.76% 3.75% 3.69% 3.72% 3.87% 3.79% 3.64% 3.79% 3.59% 3.75% 3.69% 3.86% 3.92% 3.79% 3.80% 3.75% 3.80% 3.76% 3.76% 3.81% 3.79% 3.77% 3.83% 3.66%

LCL 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00%

UCL

LCL0%

1%

1%

2%

2%

3%

3%

4%

4%

5%

P' Chart Unplanned Return to OR

Percent

Chg 1

Chg 2,3

Chg 7,8

Chg 9

Chg 10,11

Chg 12,13

Chg 14


Stephanie F

P Prime chart

2/6/06 3/6/06 4/6/06 5/6/06 6/6/06 7/6/06 8/6/06 9/6/06 10/6/06 11/6/06 12/6/06 1/6/07 2/6/07 3/6/07 4/6/07 5/6/07 6/6/07 7/6/07 8/6/07 9/6/07 10/6/07 11/6/07 12/6/07 1/6/08 2/6/08 3/6/08 4/6/08 5/6/08

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% 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%

P Chart Unplanned return to ORPercent

Chg 1

Chg 2,3

Chg 4,5,6

Chg 7,8

Chg 9

Chg 10,11

Chg 12,13

Chg 14


Stephanie F

2/6/06 3/6/06 4/6/06 5/6/06 6/6/06 7/6/06 8/6/06 9/6/06 10/6/06 11/6/06 12/6/06 1/6/07 2/6/07 3/6/07 4/6/07 5/6/07 6/6/07 7/6/07 8/6/07 9/6/07 10/6/07 11/6/07 12/6/07 1/6/08 2/6/08 3/6/08 4/6/08 5/6/08

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%

UCL

LCL

0%

1%

1%

2%

2%

3%

3%

4%P

ER

CE

NT

UN

PL

AN

NE

D R

ET

UR

NS

MONTHS

Michelle Cochlan's P Chart


Other Waves…..


Feb-06

Mar-06

Apr-06

May-06

Jun-06

Jul-06

Aug-06

Sep-06

Oct-06

Nov-06

Dec-06

Jan-07

Feb-07

Mar-07

Apr-07

May-07

Jun-07

Jul-07

Aug-07

Sep-07

Oct-07

Nov-07

Dec-07

Jan-08

Feb-08

Mar-08

P 0.03 0.02 0.03 0.02 0.03 0.02 0.02 0.03 0.02 0.02 0.02 0.02 0.03 0.02 0.02 0.02 0.01 0.02 0.01 0.00 0.01 0.01 0.02 0.01 0.00 0.01

UCL 0.03 0.03 0.03 0.03 0.03 0.03 0.03 0.03 0.03 0.03 0.03 0.03 0.03 0.03 0.03 0.03 0.03 0.03 0.03 0.03 0.03 0.03 0.03 0.03 0.03 0.03

+2 sigma 0.03 0.03 0.03 0.03 0.03 0.03 0.03 0.03 0.03 0.03 0.03 0.03 0.03 0.03 0.03 0.03 0.03 0.03 0.03 0.03 0.03 0.03 0.03 0.03 0.03 0.03

+1 sigma 0.02 0.02 0.02 0.02 0.02 0.02 0.02 0.02 0.02 0.02 0.02 0.02 0.02 0.02 0.02 0.02 0.02 0.02 0.02 0.02 0.02 0.02 0.02 0.02 0.02 0.02

Average 0.02 0.02 0.02 0.02 0.02 0.02 0.02 0.02 0.02 0.02 0.02 0.02 0.02 0.02 0.02 0.02 0.02 0.02 0.02 0.02 0.02 0.02 0.02 0.02 0.02 0.02

-1 sigma 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01

-2 sigma 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01

LCL 0.01 0.01 0.01 0.01 0.01 0.01 0.00 0.01 0.01 0.00 0.01 0.01 0.01 0.00 0.00 0.01 0.00 0.01 0.00 0.01 0.01 0.00 0.01 0.01 0.00 0.01

Chg 1

Chg 2,3

Chg 4,5,6

Chg 7,8

Chg 9

Chg 10,11

Chg 12,13

Chg 14

Implementation start

0.02

0.00

0.01

0.01

0.02

0.02

0.03

0.03

0.04

Perc

ent

# Pts Unplanned Return to OR


UCL

LCL

0.0%

0.5%

1.0%

1.5%

2.0%

2.5%

3.0%

3.5%F

eb-0

6

Ma

r-0

6

Ap

r-06

Ma

y-0

6

Jun

-06

Jul-

06

Au

g-0

6

Se

p-0

6

Oct-

06

Nov-0

6

Dec-0

6

Jan

-07

Fe

b-0

7

Ma

r-0

7

Ap

r-07

Ma

y-0

7

Jun

-07

Jul-

07

Au

g-0

7

Se

p-0

7

Oct-

07

No

v-0

7

De

c-0

7

Jan

-08

Fe

b-0

8

Ma

r-0

8

% R

etu

rn t

o O

R

Month

P Chart - % Return to OR by month

Chg 1

Chg 2+3

Chg 4,5,6


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


0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

4.0

The way I’d handle it


Let’s Build a P Chart

Emma-showing us

how she built the P

chart


Other Charts!


Emma

Emma

UCL

LCL

0

0.5

1

1.5

2

2.5

3

3.5

4

01/0

3/2

00

6

01/0

4/2

00

6

01/0

5/2

00

6

01/0

6/2

00

6

01/0

7/2

00

6

01/0

8/2

00

6

01/0

9/2

00

6

01/1

0/2

00

6

01/1

1/2

00

6

01/1

2/2

00

6

01/0

1/2

00

7

01/0

2/2

00

7

01/0

3/2

00

7

01/0

4/2

00

7

01/0

5/2

00

7

01/0

6/2

00

7

01/0

7/2

00

7

01/0

8/2

00

7

01/0

9/2

00

7

01/1

0/2

00

7

01/1

1/2

00

7

01/1

2/2

00

7

01/0

1/2

00

8

01/0

2/2

00

8

01/0

3/2

00

8

01/0

4/2

00

8

Rate

/ 1

00

0 d

os

es

U Chart

Rate

Kirsty


Diana


Let’s Build a P Chart

Diana, showing us

how she made the

U chart and then

created two limits

Judith Cain - Wave 33

Assignment Optional Extra

1/2/08 2/15/08 2/29/08 3/14/08 3/28/08 4/11/08 4/25/08 5/9/08 5/23/08 6/6/08 6/20/08 7/4/08 7/18/08 8/1/08 8/15/08 8/29/08 9/12/08 9/26/08 10/10/08 10/24/08 11/7/08 11/21/08 12/5/08 12/19/08 1/2/09 1/16/09 1/30/09

Subgroup 50.59% 56.25% 57.89% 62.24% 56.02% 22.22% 36.47% 94.52% 58.54% 31.25% 2.27% 67.09% 67.81% 75.52% 96.77% 73.39% 80.29% 77.52% 78.45% 84.80% 89.03% 88.82% 97.14% 96.15% 98.21% 96.81% 96.67%

Center 52.12% 52.12% 52.12% 52.12% 52.12% 52.12% 52.12% 52.12% 52.12% 52.12% 52.12% 52.12% 52.12% 82.31% 82.31% 82.31% 82.31% 82.31% 82.31% 82.31% 82.31% 82.31% 96.97% 96.97% 96.97% 96.97% 96.97%

UCL 68.38% 70.86% 71.97% 67.26% 63.75% 80.96% 68.38% 69.66% 68.67% 65.37% 68.10% 68.98% 64.53% 90.57% 94.18% 92.59% 92.09% 92.39% 92.94% 92.55% 91.50% 91.33% 100.00% 100.00% 100.00% 100.00% 100.00%

LCL 35.87% 33.39% 32.27% 36.98% 40.49% 23.28% 35.87% 34.58% 35.57% 38.88% 36.15% 35.26% 39.72% 74.04% 70.43% 72.02% 72.52% 72.23% 71.68% 72.07% 73.11% 73.28% 93.09% 92.47% 92.12% 91.67% 92.78%

UCL

LCL

0%

20%

40%

60%

80%

100%

120%

P Chart

Percent

Not sure which

data

Kirsty


Another Wave

Software Heads-Up….

In Workshop 2 you will have case studies or real data

And be asked to build appropriate graphs:

-this means run chart

-Pareto chart

-Histogram (frequency plot)

-Scatter plot

-Shewhart control charts (individuals, X bar S, P, C, U charts)

Note: in QI Charts the Pareto, Histogram and Scatter

Plot are built using Excel.

NES IA Wave 33 PDSA Cycles and SPC Software...

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