1. QuEST Mental Health Data for Improvement Network Run Charts Alison Pickering Senior Information Analyst

2. By the end of this session you will… know why we use run charts in improvement work be able to construct a run chart understand how to read the run chart know when to change the median know how to find further support

3. Why Run Charts? “Data have no meaning apart from their context” W. Shewhart

4. Worked example NHS Somewhere was having trouble with their DNA rate, so they implemented a text reminder system in July 2011. Did it work? Month Number of DNAs Jan-119 Jan-126 Jan-134

5. Monthly data MonthNumber of DNAs Jan-119 Feb-118 Mar-119 Apr-116 May-117 Jun-115 Jul-116 Aug-118 Sep-119 Oct-116 Nov-117 Dec-116 Jan-126 Feb-127 Mar-129 Apr-129 May-128 Jun-126 Jul-127 Aug-128 Sep-126 Oct-128 Nov-127 Dec-125 Jan-134

6. Create a line chart

7. Find your median MonthNumber of DNAs Jan-134 Jun-115 Dec-125 Apr-116 Jul-116 Oct-116 Dec-116 Jan-126 Jun-126 Sep-126 May-117 Nov-117 Feb-127 Jul-127 Nov-127 Feb-118 Aug-118 May-128 Aug-128 Oct-128 Jan-119 Mar-119 Sep-119 Mar-129 Apr-129

8. Add the median to your chart

9. Add titles and labels

10. Annotate chart with process changes

11. Run Chart Rules There are four simple things to look for on a run chart to highlight whether there are significant changes happening: 1.A shift 2.A trend 3.The number of runs 4.An astronomical data point

12. A shift

13. A trend Total number of data pointsNumber up or down in a row to indicate special cause 5 to 85 or more 9 to 206 or more 21 to 1007 or more

14. The number of runs

15. Data points Lower limit Upper limit 15412 16512 17513 18613 19614 20615 21715 22716 23816 24817 Data points Lower limit Upper limit 25917 26918 27919 281019 291020 301120 311121 321122 331122 341223 Data points Lower limit Upper limit 351323 361324 371325 381425 391426 401526 411626 421627 431727 441728

16. The number of runs

17. Astronomical point

18. Our example

19. Another example Median = 3.9

20. Changing the median

21. Changing the median example

22. Conclusion Source: xkcd.com

23. Further learning Reading: – QI Hub - www.qihub.scot.nhs.uk/knowledge- centre/quality-improvement-tools/run-chart.aspxwww.qihub.scot.nhs.uk/knowledge- centre/quality-improvement-tools/run-chart.aspx – IHI - www.ihi.org/knowledge/Pages/Tools/RunChart.aspx www.ihi.org/knowledge/Pages/Tools/RunChart.aspx – Paper

24. Further support Alison Pickering Senior Information Analyst QuEST Mental Health 01312443284 alison.pickering@scotland.gsi.gov.uk