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Taking a closer look: using statistical process control to identify patterns of improvement in a quality-improvement collaborative
  1. Tracey Timmerman,
  2. Tanya Verrall,
  3. Lisa Clatney,
  4. Helena Klomp,
  5. Gary Teare
  1. Health Quality Council, Saskatoon, Canada
  1. Correspondence to Mrs T Sherin, Health Quality Council, 241-111 Research Drive, Saskatoon, SK S7N 3R2, Canada; tsherin{at}


Background Published reports suggest that there is considerable variation in improvement capacity and capability among participants in quality improvement collaboratives. Generating knowledge about why these complex initiatives do or do not work in different contexts requires both qualitative and quantitative approaches. Time-series analysis using line graphs and statistical process control is a rigorous quantitative approach with relatively unexplored potential in evaluating complex quality improvement interventions.

Aim The purpose of this study was to apply and illustrate the use of line graphs and statistical process control to identify variation in improvement among practices participating in the Saskatchewan Chronic Disease Management Collaborative.

Methods The authors used line graphs and regression analysis to determine whether improvement occurred at the aggregate level, and small multiples, rational ordering and rational subgrouping to examine differences in the level and rate of improvement among practices.

Results Small multiples allowed us to observe qualitative differences in patterns of improvement among practices. Stratifying data for all subgroups on one control chart using rational subgrouping provided quantitative evidence for these differences. Stratification by administrative health region using rational ordering showed consistent differences, indicating that the health region in which the practice was located may play a role in these differences. Results from the study are being used to inform a purposive sampling strategy for interviews with participants to explore why these differences occurred.

  • Quality improvement collaborative
  • statistical process control
  • evaluation
  • healthcare quality improvement
  • collaborative
  • complexity
  • control charts
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  • Funding This project was funded through the operating budget of the Health Quality Council.

  • Competing interests None.

  • Ethics approval Ethics approval was provided by the University of Saskatchewan Behavioural Research Ethics Board.

  • Provenance and peer review Commissioned; externally peer reviewed.

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