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Address correspondence t o James C Benneyan. Tel: ( + 1 ) 617 373 2975; Fax: ( + 1 ) 617 373 2921; E-mail:
benneyan@coe.neu.edu
69
Methodology Matters: J. C. Benneyan
Subgroup
Statistic
Center Line (CL)
(e.g., average,
standard deviation,
rate, number,
proportion)
I •I•I•I•1•I•I • • I •1 •I •I •I •I •I . 1 •
2 4 6 8 10 12 14 16 18 20 22 24 26 28 30 32 34 36 38 40 4 2 .
Subgroup Number
70
Use of quality control charts
?50I charts are used for monitoring the number and fraction of
£ 45 -• these, respectively, that have a particular characteristic of
- 4 0 - interest (e.g. a billing error, a late patient arrival, or a Cesarean
< 35 -r
c 30 -
section birth), where the probability of occurrence is reas-
2 25 - onably the same for each event. For example, Figure 3
1 20-- illustrates a p chart of the fraction of medication errors per
Q
15-: week (with non-constant control limits due to a varying
<5 10 -
number of medications per week). Note that these data reveal
H 1 1 11 -I 1 1 1 1 h—I 1- a gradually increasing trend in the error rate (criterion seven),
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 to the point where two subgroup values fall above the upper
control limit. Again, identifying and removing the root causes
of this unnatural variation is the first step in stabilizing and
100 improving this process.
90
80
Alternately, Poisson-based c and u charts often are ap-
70 propriate for count data for which no theoretical maximum
60 exists, such as the number of some particular type of oc-
50 currence per examined area, volume, or time period. Examples
40
30
can include the number of arrivals to an emergency room
per shift, telephone calls per hour, leukocytes per CBC, or
71
Methodology Matters: J. C. Benneyan
o
c 1
'• t.
&
2
Q.
F*^—» / \ / \ w-\ j \ i \ / \ I—H^—J—it—"T"
i V i V i i i V i 'i i i '» i i V i i • i i i V i i V i i \ i i i '• 1 i I i i \ \
10 15 Z0 25 30
Week Number
6-
i u
•i i l
15 30 45 75
Occurrence of Infection
desirable statistical properties (i.e. sensitivity and specificity). (especially in cases for which any of the above charts are
Common errors in control chart selection include failing more appropriate), and using standard control charts when
to identify an appropriate chart, using an X chart alone combining data from non-homogenous processes. Related
without an J" chart, overuse of the so-called 'individuals' chart implementation concerns include reacting to natural variability
72
J
Use of quality control charts
('process tampering'), using control charts primarily to 'hold 4. Montgomery D. C. Introduction to Statistical Quality Control, 3rd edn.
the gains', and over-reliance on software. Although not the New York: Wiley, 1997.
current focus, additional information on these topics, related 5. Benneyan J. C. Statistical quality control methods in infection
quality control methods, and more advanced concepts can control. Infect. Contr. Hosp. Epidemiol, (in press).
be found in some of the listed references.
6. Gitlow H., Gitlow S., Oppenheim A., Oppenheim R. Tools and
Methods for the Improvement ofQuality. Homewood, IL: Irwin, 1989.
7. Banks J. Principles of Quality Control. New York: Wiley, 1981.
References
8. Benneyan J. C , Kaminsky F. C. Modeling discrete data in SPC:
1. Shewhart W. A. The Economic Control of Quality of Manufactured the g and h control charts. Am. Soc. Qual. Contr. (Ann. Qual. Congr.
Product. New York: D. Van Nostand and Co., 1931. Trans.) 1994; 32-42.
9. BenneyanJ. C. Design of statistical^ control charts for nosocomial
2. BenneyanJ. C , Kaminsky F. C. Another view on how to measure infection and other alternatives. In International Applied Statistics
health care quality. Qual. Progress 1995; 28: 120-124. in Medicine Conference Proceedings (in press).
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