Retrospective evaluation of an intervention based on training sessions to increase the use of control charts in hospitals.
medical education
quality improvement
statistical process control
statistics
team training
Journal
BMJ quality & safety
ISSN: 2044-5423
Titre abrégé: BMJ Qual Saf
Pays: England
ID NLM: 101546984
Informations de publication
Date de publication:
02 2023
02 2023
Historique:
received:
29
04
2021
accepted:
29
03
2022
pubmed:
25
6
2022
medline:
24
1
2023
entrez:
24
6
2022
Statut:
ppublish
Résumé
Statistical process control charts (SPCs) distinguish signal from noise in quality and safety metrics and thus enable resources to be targeted towards the most suitable actions for improving processes and outcomes. Nevertheless, according to a recent study, SPCs are not widely used by hospital boards in England. To address this, an educational training initiative with training sessions lasting less than one and a half days was established to increase uptake of SPCs in board papers. This research evaluated the impact of the training sessions on the inclusion of SPCs in hospital board papers in England. We used a non-randomised controlled before and after design. Use of SPCs was examined in 40 publicly available board papers across 20 hospitals; 10 intervention hospitals and 10 control hospitals matched using hospital characteristics and time-period. Zero-inflated negative binomial regression models and t-tests compared changes in usage by means of a difference in difference approach. Across the 40 board papers in our sample, we found 6287 charts. Control hospitals had 9/1585 (0.6%) SPCs before the intervention period and 23/1900 (1.2%) after the intervention period, whereas intervention hospitals increased from 89/1235 (7%) before to 328/1567 (21%) after the intervention period; a relative risk ratio of 9 (95% CI 3 to 32). The absolute difference in use of SPCs was 17% (95% CI 6% to 27%) in favour of the intervention group. The results suggest that a scalable educational training initiative to improve use of SPCs within organisations can be effective. Future research could aim to overcome the limitations of observational research with an experimental design or seek to better understand mechanisms, decision-making and patient outcomes.
Sections du résumé
BACKGROUND
Statistical process control charts (SPCs) distinguish signal from noise in quality and safety metrics and thus enable resources to be targeted towards the most suitable actions for improving processes and outcomes. Nevertheless, according to a recent study, SPCs are not widely used by hospital boards in England. To address this, an educational training initiative with training sessions lasting less than one and a half days was established to increase uptake of SPCs in board papers. This research evaluated the impact of the training sessions on the inclusion of SPCs in hospital board papers in England.
METHODS
We used a non-randomised controlled before and after design. Use of SPCs was examined in 40 publicly available board papers across 20 hospitals; 10 intervention hospitals and 10 control hospitals matched using hospital characteristics and time-period. Zero-inflated negative binomial regression models and t-tests compared changes in usage by means of a difference in difference approach.
RESULTS
Across the 40 board papers in our sample, we found 6287 charts. Control hospitals had 9/1585 (0.6%) SPCs before the intervention period and 23/1900 (1.2%) after the intervention period, whereas intervention hospitals increased from 89/1235 (7%) before to 328/1567 (21%) after the intervention period; a relative risk ratio of 9 (95% CI 3 to 32). The absolute difference in use of SPCs was 17% (95% CI 6% to 27%) in favour of the intervention group.
CONCLUSIONS
The results suggest that a scalable educational training initiative to improve use of SPCs within organisations can be effective. Future research could aim to overcome the limitations of observational research with an experimental design or seek to better understand mechanisms, decision-making and patient outcomes.
Identifiants
pubmed: 35750493
pii: bmjqs-2021-013514
doi: 10.1136/bmjqs-2021-013514
pmc: PMC9887349
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Pagination
100-108Commentaires et corrections
Type : CommentIn
Informations de copyright
© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY. Published by BMJ.
Déclaration de conflit d'intérêts
Competing interests: None declared.
Références
BMJ Qual Saf. 2016 Dec;25(12):986-992
pubmed: 26369893
BMJ Qual Saf. 2017 Jan;26(1):61-69
pubmed: 27034337
BMJ. 2014 Mar 07;348:g1687
pubmed: 24609605
BMJ Qual Saf. 2023 Feb;32(2):100-108
pubmed: 35750493
Science. 1974 Sep 27;185(4157):1124-31
pubmed: 17835457
Milbank Q. 2011 Jun;89(2):167-205
pubmed: 21676020
Stat Med. 1992 Sep 30;11(13):1685-704
pubmed: 1485053
Lancet. 2001 Feb 10;357(9254):463-7
pubmed: 11273083
Q J Exp Psychol (Hove). 2017 Jul;70(7):1114-1128
pubmed: 27028900
BMJ Qual Saf. 2016 May;25(5):303-10
pubmed: 26442789
BMJ. 2010 Aug 27;341:c4413
pubmed: 20802000
Int J Qual Stud Health Well-being. 2014 Oct 16;9:26152
pubmed: 25326092
BMJ. 2020 Nov 4;371:m3840
pubmed: 33148601