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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