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I have recently become interested in statistical process control (SPC) and its uses in healthcare. I would like to be able to say that I first came across SPC while catching up on back issues of the British Medical Journal, but alas not so. It actually came up in conversation with a patient who works in manufacturing.
For anyone else who is new to the term, the British Standards Institute explains that SPC is “a method for achieving quality control in processes” that uses “statistical tools such as mean and variance to detect whether the process observed is under control.” Practically, it means using some sophisticated presentation techniques to make it easier to see what is happening.
Sites offering help on QoF
A few days after my conversation with my patient, one of my PCT’s commissioning mangers suggested I look at the Coast to Coast Cardiac Network website www.c2c.nhs.uk, as she knew I was a Quality and Outcomes Framework (QoF) assessor – and I was fascinated to see its funnel plots of QoF performance.
Like most people who want to find out more these days, I turned to a search engine – which produced interesting results. Using SPC as the search term produced lots of American websites and adverts.
It also brought up Wikipedia, which had lots of interesting pages referenced and linked together about SPC, Six Sigma, the Toyota way and “just in time” philosophy – although none of it related to healthcare. (I find Wikipedia useful, although you have to take everything with a pinch of salt as you can get caught out – as the BBC and other media organisations have found!)
Using funnel plots and QOF as search terms brought up some interesting sites. Primary Care Informatics has a downloadable Excel file that allows you to create your own plots. And there is an amazing slide show about one PCT’s use of QoF data at the Primary Care Contracting site.
I also came across several public health observatory (PHO) websites (which I had never heard of before) and a page from the Eastern Region PHO, which has lots of useful looking tools for analysis on it www.erpho.org.uk. And there were a number of other cardiac network and PCT websites that looked useful or interesting.
Run charts, funnel plots and some of the other SPC charts are fascinating tools to use in helping to deliver better healthcare. I am currently trying to encourage my PCT to use funnel plots as the default way of listing information from practices, as these are much better at taking list or register size into account in comparing the performance of one practice with another than a simple list of practices in alphabetical order.
However, the point of my column this week is: why did I need to do all the web searching? Why did I find it so difficult to find my information, most of which is held on NHS websites, some of which I had never heard of?
Role for a master index of NHS websites
Why isn’t there a master NHS website that links to all the others and allows you to search them and only them? A lot of the websites I found had links to other sites, but there wasn’t one clear method for creating links and there was no consistency as a result.
In the past, when I was looking for information on cardiac risk screening, I came across the Clinical Knowledge Service (CKS) website, which is part of the National Library for Health.
The NLH project is almost what I want, in that it sits at the head of other websites and links to them and explains them. Its website has a recently upgraded search system, but even more cleverly it can now be searched by the new Microsoft medical search deskbar.
Using Microsoft medical search
This is one of a set of new tools that has been created by Microsoft’s Common User Interface programme. Briefly the deskbar is something you can install and which appears on the taskbar at the bottom of your computer screen. Typing in a term and clicking “go” searches all the NLH websites (or some of them – you can choose which). You can also access the British National Formulary (BNF).
It is well worth playing with – although I think it needs some work. For example, it did fail the installation and requested that I install .Net framework; I know how to do that, but I am not sure your average user will.
NLH looks good, but surprisingly few people I have spoken to have ever looked at it or heard of it. This is a shame, and I wonder if it needs advertising more? It’s also only a clinical resource, and doesn’t reference the other websites I have mentioned, so it can’t be used as a guide to all NHS websites. Perhaps we need a master guide to them?
Why not have an NHS Wiki?
Also do we need an NHS Wiki – something that could be edited only from within the NHS net and that covered articles relevant to NHS employees?
I might create a great page on SPC and healthcare, with lots of links to existing websites. Even better, someone who knows more than me might come along and correct my mistakes and add information I didn’t know about, or links to other websites I hadn’t found.
Potentially, it wouldn’t cost much, as people would tend to add information on things they were working on to gain status and fame, either for themselves or for their departments, as they do now by writing letters to a journal. Anyone out there up for hosting one?
Dr Paul is a GP in Sandbach, Cheshire and a member of the professional executive committee for Central and East Cheshire PCT and has a lead role for IM&T and practice based commissioning. A version of this article first appeared on the Microsoft NHS Resource Centre.