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Monitoring Improvement Using a Run Chart
Priscilla Swanson, RN, CCM, CHC, CPHQNancy Siegel, MPH, PA-C
June 10, 2013QHOC meeting
Difference between a Run Chart and a Control Chart
• Both plot a single line of data over time
• Run charts are the simplest of charts and show a general picture
• Run charts can easily show amount of variation
• A control chart has an upper and lower limit with a center line; the lines are calculated based on data being plotted
• A control chart provides more specific information and insight into your process
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Why Use a Run Chart?
• Make your team’s aim tangible
• Understand process variation
• Analyze data for patterns
• Monitor progress over time
• Show off your results
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What Is a Run?
• A sequence of consecutive points that all lie on the same side of the line
• Disregard points exactly on the line
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Counting Runs
5Source: IHI.org
Run Chart Decision Rules that Signal a Change
• Rule 1 – Shift; 6 or more consecutive points above or below the median. Skip all values that fall on the median.
• Rule 2 – Trend; 5 or more consecutive points all going up or all going down. Ignore repeating values.
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Source: IHI.org
Run Chart Decision Rules that Signal a Change
• Rule 3 – Number of runs; are there too many or too few runs? Disregard the points exactly on the line. Tabled critical values are used to determine if too many or too few runs exist.
• Rule 4 – Astronomical point; a dramatically different value.
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Source: IHI.org
Example Run Chart
8Source: IHI.org
How Many Runs?
• How many runs should we expect if the values all come from the same unchanged process with the baseline median?
• If there are fewer runs (or more), we have a signal that our change has made a difference in the process.
• Reference a table to determine expected number of runs.
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Source: IHI.org
Expected Runs Table
10Source: IHI.org
How to Determine the Median
• Write all the values in order in a continuous list from low to high. Find the middle value by crossing off the highest value, then lowest, then next highest, etc. The one value left is the median.
• If two values are left (even number of values), find the halfway distance between the two.
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How to Construct a Run Chart
• Plot time along the x-axis
• Plot the variable you are measuring along the y-axis
• Label both the x and y axes and give the graph a useful title
• Calculate and place a median of the data on the run chart
• Add other information as needed
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Example of Annotated Run Chart of PDSA Cycles
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Resources
• www.ihi.org
• Brassard, 2010. The Memory Jogger, Tools for Continuous Improvement and Effective Planning.
• Rocco J Perla, Lloyd P Provost, Sandy K Murray. “The run chart: a simple analytic tool for learning variation in healthcare processes.” BMJ Quality Safety 2011; 20:46-5.
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