Reporting of Statistical Process Control in Healthcare Quality Improvement Literature: A Scoping Review Room for Improvement

Abstract

Abstract Background: Quality Improvement (QI) in healthcare aims to improve the process of healthcare delivery systematically. The tools of QI are based on rapid cycle change, where different interventions are introduced to a process and followed over time to test for effects. Measurement is part of the improvement methodology that evaluates the effect of change on the process. SPC is a type of statistical analysis that is used to analyse process performance in QI; it joins time-series analysis with graphical illustrations. The quality and transparency of SPC reporting in QI varies, and it is not clear how the current reporting trends of SPC contribute to the clarity of published QI projects. Aims and Objectives: This study aimed to explore how SPC analyses in healthcare-quality improvement publications are reported. The study’s aim was achieved through three main objectives: reviewing published SPC analyses in the healthcare quality improvement literature for the rigour of reporting against a conceptual framework, identifying themes of variation in reporting of SPC in the literature, including strengths and weaknesses in the current literature, and providing recommendations on how application and reporting of SPC could be improved, based on these findings. Methods: The methodology of this scoping review had two main parts. First, the conceptual framework that has been used as a lens to examine the current state of SPC reporting in QI publications. Second, a detailed account of the study design and the methodological approach followed to answer the research question. The conceptual framework was developed based on SPC and QI development and implementation literature and parallel elements from the relevant publication guidelines. The study design was adopted from the Arksey and O’Malley’s 2005 methodological framework for scoping studies. A systematic search was done from October 1st, 2015 to June 21st, 2019, in four databases: Medline, Embase, Web of Science and Scopus. A random sample was taken from the eligible studies after the title and abstract screening. Data charting was done in two stages. The quantitative data analysis was done using Stata-IC, and the qualitative data were presented in a narrative, thematic account. Results: The search result revealed 1218 articles, of which 263 were eligible after the title and abstract screening. A random sample of 50 articles was taken. Only 41 articles -of the random sample were eligible after the full-text screening. The results of the quantitative analysis showed variable reporting patterns (e.g. Only 7 articles out of 41 stated their chart type and provided rationale for it). Based on the results of the quantitative analysis, a purposive sample was taken for the qualitative analysis. Nine main reporting themes have emerged; the ninth reporting theme was not covered by the framework. Conclusions: The results of the quantitative and qualitative analysis, showed that the reporting of SPC analyses in QI publications are variable, not standardised, lack key information, and occasionally of questionable quality. Based on the results of this study, future recommendations to improve the reporting of SPC would be to invest more SPC learning, to seek partnerships and collaborations, and to develop SPC reporting guidelines.