Bringing 100 year old technology to Healthcare -Part 3

Previously, in part 2, I described how the NHS is actively adopting Statistical Process Control for Quality Improvement and beyond. However, not everyone is sold on SPC being the silver bullet, as claimed .

The sceptics view of SPC

Back in the late noughties, Lean was the go-to productivity improvement tool the health sector co-opted from industry. Then it was Six Sigma. Business process re-engineering was knocking around at various times. So, is SPC better, or is it just another bandwagon?

You can gently rub a match against the striker dozens of times without getting it to light

Bandwagon itself is frequently used in a derogatory sense. Yet most such phenomena start with something useful and sometimes profoundly insightful. Lean^[i]revolutionised Toyota, famously transforming it from a failing organisation to a world leader. If Lean has fewer evangelists, it’s not because it was ineffectual. In order to deliver a desired transformation, all tools need to be applied correctly and within the real-world context. Organisations need to be sufficiently committed to make it work; you can gently rub a match against the striker dozens of times without getting it to light. It’s easy to completely waste investments only half doing something. Indeed, for many change activities there is an inverse Pareto at play where you get 80% of the value from the last 20% of effort.

Thomas Ridgeway, Strategy and Innovation Director at Cloud2 and formerly Head of Performance at Rotherham NHS Foundation Trust, is sceptical of SPC. He considers that SPC approach is, indeed, another bandwagon, but observes that bandwagons themselves are frequently needed. In conversation he observed that there are observable cycles in adoption of productivity improvement approaches. “’New’ QI tools come around because people grow fatigued with any approach after a time”, he remarked. The types of people most likely to promote novel approaches, those tend to drive innovation and transformation, are the same people who tend to grow bored as an activity moves from innovation to BAU. Organisations and people, especially those with an innovator mindset, need periodic initiatives to re-invigorate them.

“These things come around because people grow fatigued with any approach after a time”.

Thomas Ridgeway, Strategy and Innovation Director at Cloud2

Ridgeway, while sceptical, points out that SPC is highly appropriate in certain scenarios. For example, it’s a valuable tool to assess whether a particular metric or target is achievable, or perhaps only achievable with a re-engineered or deeply disrupted process. “SPC can tell you that, for instance, a maximum 4 hour A&E wait will only be achieved once in a blue moon”, which can introduce some realism into objectives or provide a business case for investment in a transformation project. It lets you answer questions like “Can we move our mean to the centre of our desired range? Can we then reduce the variations that take us out of range some of the time?” Ridgeway’s view is also that SPC is an excellent tool to understand whether a programmatic change results in an actual improvement as it provides a straightforward way for people to track the impact of improvement projects.

“SPC can tell you that, for instance, a maximum 4 hour A&E wait can only be achieved once in a blue moon”

However, Ridgeway goes to express several reservations, “It can be very challenging to exert high levels of control over human variables in order to establish which changes actually made the difference”, he says. Understanding SPC Charts can also be challenging when compared with RAG; sometimes a simpler tool can be as effective, simply because it’s more quickly understood and therefore easier to engage a broader group. In some circumstances, Ridgeway suggests it might be better to engage SPC to evaluate or make significant changes, then roll back to a simpler option, where the benefits of simplicity may be as effective in BAU.

Ridgeway also expresses concern that SPC can normalise the unacceptable. For example, accepting a very long A&E waiting time just because SPC shows it’s ‘within the range’. Staff can become desensitised or habituated to what should be an unacceptable level of quality and performance, and managers might use the SPC data to justify it to themselves and others; it’s a powerful tool for not changing if leaders are unwilling or unable to think beyond the current process. Using the SPC charts without understanding the implications and actions they should prompt is wasteful, at best.

Both Ridgeway and Alom agree that many organisations don’t fully embrace the depth of SPC as a tool, or apply it correctly (such as using Standard Deviations rather than Sigma). It’s easy to pay lip service to it, then blame the tool when the results aren’t achieved. Meanwhile, though Ridgeway argues that the scale of investment to ensure deep engagement may not be borne out by the results, Alom would maintain the opposite, citing their successes as proof.

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Part 4 will be available in a week and will discuss using SPC with your current data tools, namely Excel and Power BI. I’ll reach some kind of a conclusion too.

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://en.wikipedia.org/wiki/Lean_manufacturing

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

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