Plotting the path to improvement

All of the trusts featured in our ‘Sustaining improvement’ report have adopted Statistical Process Control as a quality control tool. Here, Samantha Riley, Deputy Director of Intensive Support at NHS Improvement, talks more about the tool and how it can encourage more sophisticated conversations about changes in performance.

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Samantha Riley, NHS Improvement

I have been really pleased to see that a common theme which emerges in all four case studies featured in the Sustaining improvement report, is the power of ‘plotting the dots’ and adopting Statistical Process Control (SPC). SPC is a really good way to understand whether things are improving — maybe as a result of an intervention being made. On the flip side, SPC can also provide an early warning when performance may be deteriorating. By detecting a worsening position sooner, action can be taken more quickly to address the situation. Increasing numbers of trusts are now understanding that while SPC is a powerful improvement tool, it is also a much more effective assurance tool than RAG reporting which, until recently, had become the tool of choice when looking at performance.

RAG reporting can mask a whole lot of things which are important for us to understand. Red can mask improvement. Equally green can mask deterioration. Even worse, use of RAG can very easily result in ‘spuddling’ — making a lot of fuss about trivial things as if they were important. A data point going in the ‘wrong’ direction can result in knee-jerk reactions and resource being deployed to explain this concerning movement in the data and put ‘solutions’ in place. But what if the movement of the data were due to natural variation? Well, all that time, energy and effort will have been wasted. Plus, tampering with a system can increase variation (the very thing we want to reduce) and make things a whole lot worse.

Trusts that have adopted SPC are reporting more sophisticated conversations about changes in performance. Spuddling has been reduced, improvement has been celebrated and deteriorating situations noticed and acted upon in a timelier way. All of this results in better care for patients.

Here’s an excerpt from the integrated performance report from Kettering, being used by their board — one of the best that I have seen.

SPC is a powerful, yet easy to understand tool. Over the past couple of years, my team have developed a range of resources which provide trusts with the knowledge and tools to enable them to create SPC charts locally, and for staff at all levels to understand SPC charts and take appropriate action. You don’t need expensive software and you don’t need to have a degree in stats. All you need to #plotthedots is here, on the NHS Improvement website.

Visit the Care Quality Commission website to read all of the case studies in the ‘Sustaining improvement’ report

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