Statistical Process Control (SPC) charts – simple graphical tools that enable process performance monitoring. There are different types of SPC chart depending on the type of data you have. The most common ones are:

• P chart – for classification data expressed as a % or proportion
• I chart (or Xmr chart) – for individual measurements
• C chart – count data – for numbers of incidents (or U chart if expressed as a rate)
• Xbar & S chart – for measurements data where an average can be calculated at each time point.

Scatter plot graph – A graph in which the values of two variables are plotted along two axes, the pattern of the resulting points revealing any correlation present. Use a scatter plot if you want to investigate whether or not two variables are related to each other, and also when you want to communicate the nature of a relationship between two measures.

Funnel plots – a chart that helps to understand variation within a system. A funnel plot is a useful way to show comparisons between different units to identify where there may be special cause variation. It is helpful if you have data relating to different teams, hospitals, schools, NHS boards, Local Authorities for example, which are of different sizes and you want to avoid misleading ranking that doesn’t account for this. The measure you plot would have a denominator (e.g. rate, proportion or average).

Histogram – a plot that lets you discover, and show, the underlying frequency distribution (shape) of a set of continuous data. It is useful to look at the distribution of data if you have collected a lot of data (at least 30 data items) to see whether there are any patterns occurring. For example, you might spot errors or anomalies in the data. Sometimes it is also useful to understand whether the data follows a typical ‘bell shape’ or if it is skewed or asymmetrical. When investigating your data it can also be really useful to split it into different groups and compare histograms. For example, you might be interested to see whether different teams involved in the above project have similar distributions of happiness scores. This might help you to decide whether to focus in on specific teams or take some other approach.

• To capture and visually represent all the steps in an existing process.
• To show everyone in a team how a process works in practice now, rather than what they think is happening,
• To help identify change ideas for improvement.
• To visually represent a new process.
• To assist team building as it should involve all team members in accurately capturing current process and the design of any new process.

The authors found that evidence for the reliability and validity of the RAI-MDS QIs remains inconclusive. The QIs provide a useful tool for quality monitoring and to inform quality improvement programs and initiatives. However, caution should be exercised when interpreting the QI results and other sources of evidence of the quality of care processes should be considered in conjunction with QI results.

• Building an organisation-wide approach to improvement is a journey that can take several years. It requires corporate investment in infrastructure, staff capability and culture over the long-term. 
• An essential early step is securing the support and commitment of the board for a long-term programme, including their willingness to finance the skills and infrastructure development needed to implement it.
• The report includes case studies of three English NHS trusts with an outstanding CQC rating that have implemented an organisational approach to improvement.

Read - add articles found in quality/safety or simulation journals that integrate both fields onto your reading list.

Study - seek out professional development opportunities: courses, workshops, conferences in QI methodology or simulation/debriefing.

Collaborate - identify individuals in your local institution and find ways to work (and research) together.

Engage - connect with the larger community of practice working on these topics via in-person meetings or platforms such as Twitter and LinkedIn.

• Successive governments have pursued policies to improve the quality of care in the NHS, but the many and varied initiatives failed through a lack of consistency and the distraction of other reforms.
• Efforts to improve quality of care have been hampered by competing beliefs about how improvements are best achieved.
• More than ever, the NHS must focus on delivering better value to the public. This means tackling unwarranted variations in clinical care, reducing waste, becoming more patient- and carer-focused, and ensuring that quality and safety are at the top of the health policy agenda.
• This is best done by supporting clinical leaders through education and training in quality improvement methods, and developing organisational cultures where leaders and staff focus on better value as a primary goal.
• Clarity about the role of inspection in a quality improvement system is vital. Done well, inspection has a part to pay in quality assurance – but this should not be confused with quality improvement.

• This tool kit is aimed at everyone.
• There are different sections for each target group

What will I learn?

• Kidney health
• Recognition and response to AKI
• Primary care management post AKI episode
• Embedding a holistic approach to AKI