Student Dissertation

Agency : Control Charts; Tools of Healthcare Operations; Statistical Process Control

Objective : Objectives of the study are to construct various quality control charts. In this study, Attribute based c- chart are constructed to monitor the infection rate. Attribute based p- chart to monitor the patient satisfaction level regarding delivery of services and Variable based mean and range charts to monitor the T

Background : “Statistical Process Control” is a methodology of analysis used to discover variation in a process. A “statistical quality control chart” is a tool that graphically displays the control limits on process outcomes. Attribute based c-charts are used to count bad occurrences in a process, attribute based p charts are used to monitor the proportion of defects in a process and mean and range charts are used for variables that are measured continuously. In a health care setting, quality managers can use the appropriate type of control chart to monitor the outcomes like infections, accuracy of medications, satisfaction among patients regarding hospital services and various others issues that hampers the smooth running of a hospital.

Methodology : The study was conducted in a tertiary care hospital in Bathinda. Primary data was collected through observations (using checklist) and retrospective data was collected through hospital information system. To create c-chart, data was collected from a sample of 60 patients over a period of 11months. For creating p-chart, data was collected from 50 patients monthly for a period of 3 months. To construct mean and range chart, data was collected from 5 patients daily for 10days.

Findings : Analysis of attribute based and variable based charts revealed that the many processes under study were statistically out of control as per 3sigma limits. Further, it was analyzed after calculating upper control limit and lower control limit of mean range of data that, no “special cause” was found in context of hospital acquired infection, patient satisfaction and initial assessment in emergency department. However, there were 5 months in which hospital acquired infection was found beyond the average and in 6 months’ hospital acquired infection were below the mean range. In context of patient satisfaction and initial assessment in emergency department, 1 month in which dissatisfaction of patient towards hospital was found beyond the average and in 5 days out of 10 days in which initial assessment to patient was given below the average time. Further, after measuring the variation in the processes from mean range, cause of variation were identified by using tool of fish bone diagram and recommendations were given to further improve the processes.

Recommendations : Hence it was concluded that Statistical Process Control is both a data analysis method and a process management philosophy, with important implications on the use of data for improvement in various processes, thus ensuring improved standards of healthcare. Control charts have found their applicability in various areas such as hospital performance infection rates, rates of patient falls, waiting times of various sorts, rates over time in a medical context, such as mortality rates, rates of disease ,bio –vigilance such as patient identification and non-infectious hazards of transfusion, surveillance of infectious diseases ,lab turnaround, patient satisfaction scores, medication errors, emergency service response times, post-operative lengths of stay, “door-to-needle” times, counts of adverse events and many others. Thus, they act as phenomenal tool in providing an effective method to visualize data over a period while considering for boundary conditions and helps to check if the corrective action has resulted in an improved process.