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Bringing 100 year old technology to Healthcare -Part 4

In part 3 I presented an alternative view of the role of SPC for healthcare. In this final part, we will look using SPC in Microsoft Excel and Power BI and conclude with whether SPC does have a place in Health.

Creating and Presenting SPC Charts

Whichever way the debate goes, SPC needs to be used with our digital technologies and data. It needs to be straightforward to create the charts needed and to update, publish and interact with them.

While there are many analytics applications available, including some dedicated for SPC, the first tool people tend to reach for when they need to store, analyse and present data is Microsoft Excel. In recognition of this, NHS Improvement provide a useful Excel template, complete with an instructional video[i] alongside other published resources[ii]. If Excel is where you are at with Business Intelligence and analytics, then it’s well worth a look.

Figure 3 NHS Improvement provide a useful Excel template

Excel is a great tool and is very competent for modelling, moderate complexity analysis and discrete charting. The later versions are even better, allowing live data feeds from your data repositories, increasingly sophisticated analysis tools, AI support, collaborative editing etc. However, Excel isn’t a dedicated Business Intelligence and dashboarding tool (though it is often used as such). It’s presentation leaves much to be desired, it lacks drill down, dashboarding and other capabilities that the current state-of-the-art offers. Excel has some SPC support, however this is too limited for advanced use. Turning to something like Power BI seems like a natural step.

Power BI

Microsoft is, according to Gartner[iii], the leading Business Intelligence and analytics platform provider, largely as a result of its rapid development of Power BI (PBI). I have personally watched PBI develop from marketing hyperbole, through contender status, to become the best tool of its type. Though it is not my intention to become an unpaid Microsoft marketing staffer, I’m happy enough to share that it offers an effortless blend of data integration, manipulation and visualisation; it’s a tool equally adept at serving the needs of analysts and data consumers. It’s a damn fine product and is increasingly used in NHS organisations and  other organisations  invested in the Microsoft cloud technology ecosystem (with which it is deeply integrated). It is somewhat surprising, therefore, that Power BI does not provide visualisations for any of the major SPC chart types. Indeed, the various PBI forums are liberally populated with requests for how to create such charts.

ELFT, with its deep investments in both SPC and the Microsoft technology stack, was already using Power BI. Pressure from the board to deliver SPC charts within the Board Pack led the trust to investigate options, including 3rd party solutions to deliver the visualisations needed, such as from Craydec[iv]. Although none met the need adequately, it was apparent that PBI is highly extensible and allows custom visuals to be developed via Visual Studio. Instead, ELFT turned to Cloud2, a leading Microsoft partner with over a decade of health-focus in the UK.

Figure 4 Gartner’s analysis shows Microsoft as the leader

A phase 1 development was put in place to develop the most commonly used charts, namely the  Run Chart, C Chart, U Chart, P chart and XmR Chart, complete with the advanced functionality needed for effective use of the charts, such as baselining and annotations. This was done using the Custom Visuals development approach with the full capability of PBI, including the ability to interact with an element of a report and see other report elements respond.

Figure 5 Features including Annotate, Baselining & Ghost points were not available in any other tool

Alom had no hesitation is supporting the approach, “Cloud2 have been instrumental in helping East London NHS Foundation Trust roll out Power BI and fully understand the potential of the platform. With their help, we were able to produce a ground-breaking SPC custom visual along with some fantastic Power BI reports”.  With this confidence, a phase 2 project is well under way to deliver a further 4 SPC chart types (XbarS, T Chart, G Chart, U’ Chart and P’ Chart)  as custom visuals and to implement the full set of IHI special cause rules. In addition, a User Experience (UX) designer is involved to ensure that both the individual visuals and a set of PBI templates incorporating the charts into an effective report have visual appeal and a best practice flow through the presented data. This UX approach goes some way to ensuring that the issues of simplicity and rapid understanding that Ridgeway has concerns about are minimised.

Recognising the value of this to the wider NHS, ELFT and Cloud2 intend to make the SPC visualisations available commercially. Meanwhile, a phase 3 project aims to introduce automated notifications for monitored processes, based on sigma rather than Standard deviation.

Through their continued quality improvement and recognised excellence, ELFT are making a difference to 1.3 million people in the south of England.

Forid Alom, the Head of Improvement Analytics, at East London NHS Foundation Trust
The Health Care Data Guide: Learning from Data for Improvement

If you really want to understand more about SPC and it’s application to Healthcare and Quality Improvement I can heartily recommend this weighty tome: The Health Care Data Guide: Learning from Data for Improvement. It’s big, detailed and reassuringly intense; thankfully it is broken out into digestible parts and is the go-to resource for informatics and change leaders in healthcare and beyond.

Also feel free to check in on the excellent ELFT Quality Improvement site: https://qi.elft.nhs.uk/

Conclusions

In my experience, there are no silver bullets. What is apparently true for were-creatures is certainly untrue in the real-world of complex challenges, spanning diverse needs, organisations, approaches and skill sets. While it is exciting to investigate the latest tools and approaches (some people make a career from that alone) it is almost certainly better to have a toolkit rather than a single tool. A Swiss Army Knife is useful precisely because it is really many tools. The skilled artisan uses their judgement to select to best tool for the job, while always looking to upgrade the quality and versality of the tools in their bag.

In the case of business processes and organisational improvement, data must lead to insight and insight to action. SPC is one of the several tools to produce tangible results within improvement orientated organisations willing to embrace it. When wielded correctly, with skill and understanding, it has the power to be a favoured tool amongst informatics and quality improvement artisans. With the use of best-in-class technology to underpin SPC, it truly can transition from its early 20th century manufacturing roots to make a difference in the NHS and wider healthcare environment. While SPC might be the bandwagon of the moment, and while new tools and approaches might supplant it in the affection of change agents within the next few years, and while it certainly should not be the only tool in the bag, there is little doubt that it is a powerful and efficacious intervention for ensuring a healthy organisation.


If you want to find out more about how Cloud2 helped ELFT then please contact them, I’m sure that they will be only too pleased to help.

References and Sources

[i] https://improvement.nhs.uk/resources/statistical-process-control-tool/

[ii] https://improvement.nhs.uk/resources/making-data-count/

[iii] https://powerbi.microsoft.com/en-us/blog/microsoft-named-a-leader-in-gartners-2020-magic-quadrant-for-analytics-and-bi-platforms/

[iv] https://craydec.com/control-chart/>

If you are interested in #SPC, #QualityImprovement and the #NHS then you might find this multipart article interesting

By Simon Hudson

Interests: Knowledge management; Information Architecture; Flexible working technologies

Passions: Physics, music, classic cars

Aspirations: To drive a V8 Vantage to the Amalfi Coast; to play guitar to a crowd of 1000+; to ski more than once a year; to make a difference

Background: From teaching to quality assurance, technical development to international marketing and from business development to business start-ups, Simon has flitted, butterfly like, learning from each experience and bringing that breadth to his client facing and business development activities. Simon is articulate, opinionated, understanding and suffers from an insatiable curiosity.

4 replies on “Bringing 100 year old technology to Healthcare -Part 4”

Following this article, I asked ELFT what the 5 benefits or outcomes from the SPC might be, for the trust and for patients.
Their view is that SPC charts are the best tool to determine:
– The variation that lives in the process
– Move away from reacting to peaks and troughs and focus attention where most important
– Predict how the process will perform in the future
– If our improvement strategies have had the desired effect
– Determine if an improvement strategy has sustained the gains

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