CASE STUDY - Presented by:

STATISTICAL PROCESS Hari Singh Chandrawat (PGFB1918)

Shashank (PGFC1948)
CONTROL IN Nikhil Baweja (PGFC1932)

HEALTHCARE
 • Statistical process control (SPC) is defined as the
use of statistical techniques to control a process or
production method.

• SPC tools and procedures can help you monitor

INTRODUCTION process behavior, discover issues in internal
systems, and find solutions for production issues.

• Statistical process control is often used

interchangeably with statistical quality control
(SQC).
CASE BACKGROUND
 • How SPC can be applied to health care processes?
MAJOR FOCUS • How to construct and interpret the Control Charts?
INITIAL • Health Care Managers
AUDIENCE
CASE • Are medicines delivered in a timely manner to maximize medical
effectiveness and patient comfort?
QUESTION
 • Lack of Training and Tools to the healthcare workers
PROBLEMS • Belief of providers that QM tools developed in other industries aren’t
relevant to healthcare services
 • Lack of Specificity in defining - health care
processes, establishing performance, and
measuring compliance with standards after they
are defined
Other Major • Excess variation in medical practice
• According to McGlynn et al, patients received
Difficulties 54.9% of recommended care
• Other industries recognize that poor
performance is the result of variation
Now the • Is there too much variation in treatment and
Question will a more systematic approach to health care
delivery processes improve outcomes?
arises -
 How to
improve the • Is Root Cause Analysis or Routine monitoring
healthcare helpful?

industry
process?
 Collect Collect Data

Calculate Calculate Descriptive Statistics

Six Steps of Find Calculate Control Limits

SPC by
Shewart Graph Graph Actual and Expected Performance

Interpret Interpret Performance

Investigate Investigate when indicated and fix as appropriate

 • 6 step of SPC is followed to analyze medication
management
SPC
PROCESS IN • Medicine should be administered within 2 hour of
the prescribed time.
MEDICAL
CASE • To determine whether the system in control, is it
meeting the two-hour window or is it out of
compliance?

• 100% sample survey is not possible and also not

providing particular information
Step 1. Collect the data

• A sample of 50 medication was drawn for the day,

evening and night shift every day for a month.

• The total observation was 4650 ( 50 medication*3

shift per day* 31 days)

• Sample size of 50 will also facilitate to understand R

chart.
Step 2. Calculate descriptive statistics

• The average administered time has calculate for each shift each day.

• The average time between the prescribed medication time and the
actual administration of medicines for all 93 samples is 115 minute.

• Range between the prescribed administer time and actual

administer time for each shift each day has calculated.

• The average time between the most on time and least on time
administration for the 93 sample is 65 minute.

• Descriptive statistic provides a manager with good idea of where she

or he should devote his/her attention.

• Highest mean delivery time- Monday through Friday evening shift

• Greatest variance - day shift during the week.

• Descriptive statistics will answer many question of performance.

Step 3. Calculate control limit
• X control limit and R chart limit has calculated in this step.

• Breaches of Upper limit indicate reduction in

performance.

• Breaches of lower limit indicate improved performance.

Step 4. Graph actual and expected performance
• X bar chart and R chart has prepared in this step.

• To analyze the performance between actual and

expectation.
Step 5. Interpret graphs
• Patient are receiving their medication on average a minimum of
50 minute or up to 170 minute before or after their prescribed
time.

• More ( or less ) on timely delivery of medication reflected in the

sample average
• More (or less) consistent delivery of medicines reflected in
range.

• Many samples located around the upper and lower control

limits. ( R chart)

• On the last 3 days, there is upward movement in X chart and

downward movement in R chart.
• (show divergence between actual delivery time and prescribed
time, most on time and least on time delivery of medication)
Step 6. Investigate when indicated and fix as
appropriate
• Medication management system is out of control.

• Medicine are not routinely administered within the desired

2-hour window.

• Identify the causes which prevent the timely delivery of

medicine.

• SPC can make identify the causes easier by examining

performance on different days and shifts.
DIAGNOSING THE PROBLEM DAY SHIFT
• EVENING SHIFT
• NIGHT SHIFT
 • Average medication time clusters around 110
COMPARISO minutes on the day shift, 125 minutes on the
evening shift, and 105 minutes on the night shift.
N OF • The night shift provides medicines 20 minutes
PERFORMAN closer to their prescribed times than the evening
shift and 5 minutes closer than the day shift.
CE ACROSS • The night shift demonstrates consistently
SHIFTS superior performance as compared to others.
• Differences may occur due to distribution of
nursing and pharmacy duties between shifts, to
improve performance.
CAUSE & EFFECT
DIAGRAM
 • Identify an area for improvement
• Explore and ultimately identify the potential
IDENTIFYIN causes of substandard performance
G MAJOR • In this case the reasons for off-schedule
medication may arise from too few employees
CAUSES OF and too many patients, communication
PROBLEM problems, poor oversight, or any other factor
suggested on the fishbone diagram
 1. Improving patient care is a formidable task, which should
not be hampered by lack of misunderstanding of quality
management techniques.
2. This case basically states that the SPC can be anytime
timeliness is a factor affecting the medical outcomes
which includes discharge time, procedure time,
CONCLUSIO registration time, waiting time.
3. This case demonstrate that SPC can provide a wealth of
N information to understand how current processes are
performing a basis to institute improvement.
4. The SPC tool is specially designed for those not trained in
management science or statistics to improve the quality
of work and remains underutilized in the health care field.
5. The thing basically happen only when employee begin to
measure and analyze their performance.
THANK YOU