http://qshc.bmj.com/cgi/content/abstract/16/5/387?etoc

Quality and Safety in Health Care 2007;16:387-399;
doi:10.1136/qshc.2006.022194

DEVELOPING RESEARCH AND PRACTICE
Application of statistical process control in healthcare improvement:
systematic review
Johan Thor, Jonas Lundberg, Jakob Ask, Jesper Olsson, Cheryl Carli, Karin
Pukk Härenstam, Mats Brommels

Medical Management Centre, Karolinska Institutet, Stockholm, Sweden


Correspondence to:
Correspondence to:
Dr Johan Thor
Medical Management Centre, Berzelius väg 3, 5th floor, Karolinska
Institutet, S-171 77 Stockholm, Sweden; johan.thor@...


ABSTRACT
Objective: To systematically review the literature regarding how statistical
process control-with control charts as a core tool-has been applied to
healthcare quality improvement, and to examine the benefits, limitations,
barriers and facilitating factors related to such application.

Data sources: Original articles found in relevant databases, including Web
of Science and Medline, covering the period 1966 to June 2004.

Study selection: From 311 articles, 57 empirical studies, published between
1990 and 2004, met the inclusion criteria.

Methods: A standardised data abstraction form was used for extracting data
relevant to the review questions, and the data were analysed thematically.

Results: Statistical process control was applied in a wide range of settings
and specialties, at diverse levels of organisation and directly by patients,
using 97 different variables. The review revealed 12 categories of benefits,
6 categories of limitations, 10 categories of barriers, and 23 factors that
facilitate its application and all are fully referenced in this report.
Statistical process control helped different actors manage change and
improve healthcare processes. It also enabled patients with, for example
asthma or diabetes mellitus, to manage their own health, and thus has
therapeutic qualities. Its power hinges on correct and smart application,
which is not necessarily a trivial task. This review catalogues 11
approaches to such smart application, including risk adjustment and data
stratification.

Conclusion: Statistical process control is a versatile tool which can help
diverse stakeholders to manage change in healthcare and improve patients'
health.



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Abbreviations: MRSA, methicillin resistant Staphylococcus aureus; PEFR, peak
expiratory flow rate; QI, quality improvement; RCT, randomised controlled
trial; SPC, statistical process control