1. Monitoring Improvement Using a Run Chart Priscilla Swanson, RN, CCM, CHC, CPHQ Nancy Siegel, MPH, PA-C June 10, 2013 QHOC meeting

2. Difference between a Run Chart and a Control Chart Both plot a single line of data over time Run charts are the simplest of charts and show a general picture Run charts can easily show amount of variation A control chart has an upper and lower limit with a center line; the lines are calculated based on data being plotted A control chart provides more specific information and insight into your process 2

3. Why Use a Run Chart? Make your team’s aim tangible Understand process variation Analyze data for patterns Monitor progress over time Show off your results 3

4. What Is a Run? A sequence of consecutive points that all lie on the same side of the line Disregard points exactly on the line 4

5. Counting Runs 5 Source: IHI.org

6. Run Chart Decision Rules that Signal a Change Rule 1 – Shift; 6 or more consecutive points above or below the median. Skip all values that fall on the median. Rule 2 – Trend; 5 or more consecutive points all going up or all going down. Ignore repeating values. 6 Source: IHI.org

7. Run Chart Decision Rules that Signal a Change Rule 3 – Number of runs; are there too many or too few runs? Disregard the points exactly on the line. Tabled critical values are used to determine if too many or too few runs exist. Rule 4 – Astronomical point; a dramatically different value. 7 Source: IHI.org

8. Example Run Chart 8 Source: IHI.org

9. How Many Runs? How many runs should we expect if the values all come from the same unchanged process with the baseline median? If there are fewer runs (or more), we have a signal that our change has made a difference in the process. Reference a table to determine expected number of runs. 9 Source: IHI.org

10. Expected Runs Table 10 Source: IHI.org

11. How to Determine the Median Write all the values in order in a continuous list from low to high. Find the middle value by crossing off the highest value, then lowest, then next highest, etc. The one value left is the median. If two values are left (even number of values), find the halfway distance between the two. 11

12. How to Construct a Run Chart Plot time along the x-axis Plot the variable you are measuring along the y-axis Label both the x and y axes and give the graph a useful title Calculate and place a median of the data on the run chart Add other information as needed 12

13. Example of Annotated Run Chart of PDSA Cycles 13

14. Resources www.ihi.org Brassard, 2010. The Memory Jogger, Tools for Continuous Improvement and Effective Planning. Rocco J Perla, Lloyd P Provost, Sandy K Murray. “The run chart: a simple analytic tool for learning variation in healthcare processes.” BMJ Quality Safety 2011; 20:46-5. 14