Schmidtke Kelly Ann, Kudrna Laura, Quinn Laura, Bird Paul, Hemming Karla, Venable Zoe, Lilford Richard
Liberal Arts and Basic Sciences, University of Health Sciences and Pharmacy in St Louis, Saint Louis, Missouri, USA
Warwick Medical School, University of Warwick, Coventry, UK.
BMJ Qual Saf. 2025 Aug 18;34(9):621-630. doi: 10.1136/bmjqs-2024-017094.
The way that data are presented can influence quality and safety initiatives. Time-series charts highlight changes but do not clarify whether data lie outside expected variation. Statistical process control (SPC) charts make this distinction and have been demonstrated to be effective in supporting hospital initiatives. To improve the uptake of the SPC methodology by hospitals in England, a training intervention was created. The current study evaluates the effectiveness of that training against the background of a wider national initiative to encourage the adoption of SPC charts.
A parallel cluster randomised trial was conducted with 16 English NHS hospitals. Half were randomised to the training intervention and half to the control. The primary analysis compares the difference in use of SPC charts within hospital board papers in a postrandomisation period (adjusting for baseline use). Trainees completed feedback forms with Likert scale and open-ended items.
Fifteen hospitals participated across the study arms. SPC chart use increased in both intervention and control hospitals between the baseline and postrandomisation period (29 and 30 percentage points, respectively). There was no statistically significant difference between the intervention and control hospitals in use of SPC charts in the postrandomisation period (average absolute difference 9% (95% CI -34% to 52%). In the feedback forms, 93.9% (n=31/33) of trainees affirmed learning and 97.0% (n=32/33) had formed an intention to change their behaviour.
Control chart use increased in both intervention and control hospitals. This is consistent with a rising tide and/or contamination effect, such that the culture of control chart use is spreading across hospitals in England. Further research is needed to support hospitals implementing SPC training initiatives and to link SPC implementation to quality and safety outcomes. Such research could support future quality and safety initiatives nationally and internationally.
NCT04977414.
数据呈现方式会影响质量与安全举措。时间序列图表突出变化，但未阐明数据是否超出预期变异范围。统计过程控制（SPC）图表能做出这种区分，且已证明在支持医院举措方面有效。为提高英格兰医院对SPC方法的采用率，开展了一项培训干预。本研究在一项更广泛的全国性鼓励采用SPC图表的举措背景下，评估该培训的有效性。
对16家英国国民健康服务体系（NHS）医院进行了平行整群随机试验。一半被随机分配到培训干预组，另一半为对照组。主要分析比较随机分组后时期内医院董事会文件中SPC图表使用情况的差异（对基线使用情况进行调整）。培训学员完成了带有李克特量表和开放式问题的反馈表。
15家医院参与了各研究组。在基线期和随机分组后时期，干预组和对照组医院的SPC图表使用均有所增加（分别增加29和30个百分点）。在随机分组后时期，干预组和对照组医院在SPC图表使用方面无统计学显著差异（平均绝对差异9%（95%置信区间 -34%至52%））。在反馈表中，93.9%（n = 31/33）的学员确认有所学习，97.0%（n = 32/33）的学员有改变行为的意向。
干预组和对照组医院的控制图使用均有所增加。这与潮流上升和/或污染效应一致，即控制图使用文化正在英格兰的医院中传播。需要进一步研究以支持医院实施SPC培训举措，并将SPC实施与质量和安全结果联系起来。此类研究可为未来国内和国际的质量与安全举措提供支持。
NCT04977414。
