Using Statistical Process Control through the Making Data Count approach to visualise data in NHS Trusts: a mixed-methods study

INTRODUCTION: English National Health Service (NHS) Trust Hospital board members are collectively responsible for ensuring high-quality care and organisational performance. Integrated performance reports support boards by tracking key performance indicators, supporting quality improvement and providing assurance to NHS England. Statistical Process Control (SPC) charts can support leaders to distinguish signals (special cause variation) from natural fluctuations in data (common cause variation). The Making Data Count (MDC) Programme has effectively increased the use of SPC methodology in NHS Trusts. This study explored board members' experiences of MDC and SPC, and SPC use in public board meetings. METHODS: 14 semistructured interviews were conducted with executive directors and non-executive directors across five NHS Trusts. 13 board meetings were observed, and quantitative data were coded and extracted to evaluate if SPC outputs supported assurance and decision-making. RESULTS: Board members generally expressed positive views towards the MDC Programme and SPC, recognising their value as a supporting tool to monitor interventions, guide investigations and highlight performance issues. Board members noted insufficient training and instances of inappropriate use or overuse of SPC charts. The observations showed that of the 99 statements made by board members, 71 (72%, 95% CI 62% to 88%) were supported by a relevant SPC chart. Unsupported or unverifiable claims made by executive directors were more likely to be statements of improvement (p=0.054). Six decisions were made for further investigative work, and all six were supported by an SPC chart. CONCLUSIONS: MDC SPC charts are seen as a helpful tool, and their outputs are used reasonably effectively in a board environment. However, consistent and repetitive training is necessary to optimise SPC use and prevent misuse or overuse. Training may only partially prevent misuse of SPC charts due to managers' tendency to try to demonstrate improvement to other staff members.