Some Perspectives and Challenges For Control Chart Methods
Some Perspectives and Challenges For Control Chart Methods
Some Perspectives and Challenges For Control Chart Methods
IKE most successful statistical methods, control ductor and chemical process industries.
less than full statistical rank. Two multivariate pro of Group 1 have to say about the future of con
jection methods that are being applied extensively trol charts since they are characterized by their focus
by chemometricians and others in the chemical and on "classical" control chart methods that differ little
process industries are principal components analysis from Shewhart's original work. The answer is that
(PCA) and partial least squares (PLS). An excellent for this group, the key issues are the breadth and
overview of this direction was recently provided by effectiveness of application of control charts, cou
MacGregor (1995), also see Nomikos and MacGregor pled with competitive issues which motivate their
(1995) and Kourti and MacGregor (1996). use. Nowhere are these issues more evident than in
the American health care industry, where there is a
One challenge for members of Group 2 will be to rapidly emerging interest in control chart methods,
make sure that process improvement is balanced with and consequently it is worth discussing this case in
product quality. For example, data collected for pur some depth.
poses of process control may not be directly relevant
to the quality of the product leaving the process. The health care industry is driven by a desire
Even if this is the case, the data may be stored or to improve patient outcomes in the face of capi
managed in a way that makes it difficult to assess tation, cost reduction, competition, and changing
quality improvement. Also, it may be more econom health care standards. Measures of quality are be
ical to permanently remove some disturbances from ing required to demonstrate that patient care can be
maintained and improved as health care expenses are Proportion 01 C - Sections In 1995
P=.167
Committee for Quality Assurance, includes patient ..
As a result, health care managers and profes FIGURE 3. ANOM for Proportion of Caesarean Sections.
sionals are adopting continuous quality improvement
(CQI) programs, they are studying the Deming ap
Health care providers must also make simultane
proach, and they are applying SPC methods. Con
ous comparisons of rates across medical groups and
trol charts for attributes are proving especially useful
hospitals, and they have begun to apply the analy
due to the prevalence of count data. Figure 2 illus
sis of means (ANOM), a generalization of the Shew
trates a chart constructed by a health care provider
hart chart, to attribute data. (It is interesting to
to report the rate of office visits performed each
note that, by comparison, ANOM has received rel
month by a clinic. The rate charted for each month
atively little attention in manufacturing since the
is computed by dividing the number of visits by the
early 1980s, and there are very few published exam
membership for that month (expressed in thousand
ples of ANOM for attribute data; one exception is
member years).
the article by Ramig (1983).) F igure 3 displays the
results of an ANOM in which caesarean section rates
The number of visits is analogous to the number
are compared for 29 medical groups during 1995.
of defects in u charts used in manufacturing, and the
For each group, the value plotted is the number of
monthly membership is analogous to the number of
caesarean sections performed divided by the number
inspection units (both are measures of opportunity
of deliveries. The decision limits correspond to the
for an event to occur). Two sets of control limits are
ex = 0.05 level of significance. See Rodriguez (1996)
displayed in Figure 2 because a change in the system,
for further details.
resulting in a shift in the average rate of office visits,
was known to have occurred in September 1994. Although the charts in Figure 2 and Figure 3
are based on universal principles of statistical pro
U Chart lor OfIice Visits per 1,000 Members: Clinic E cess control, there are a number of special statisti
cal issues in health care applications. In the first
3000
place, deciding what to measure or count is often
a challenging problem. It is also difficult to aggre
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I sures of opportunity" for rates and proportions in
12800
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0 such a way that meaningful comparisons can be made
across groups. It is a substantial misuse of statistics
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to compare rates, collected at different locations, by
different people, and using different reporting sys
tems. Fortunately the validity of comparative per
a: 2200
formance statistics, such as survival rates for coro
nary artery bypass procedures across hospitals, is be
2000
there is a natural tendency to use control charts as tical professionals, including Balestracci and Barlow
management or industry "report cards" rather than ( 1994); Benneyan ( 1995); Benneyan and Kaminsky
for genuine quality improvement (not unlike the mis (1995); Berwick, Godfrey, and Roessner (1991); and
informed use of control charts that occurs in manu Spoeri (1991).
facturing applications).
Although Group 3 is insufficiently represented in
Formal continuous improvement and quality ini new applications of control chart methods, this group
tiatives within educational institutions also repre is potentially in the strongest position to provide
sent new frontiers for the application of quality tools. Group 1 with training and consulting. Group 3 can
Possibly five years behind the health care industry, also contribute articles and updated textbooks that
the evolution of quality within education faces many motivate and illustrate the use of control charts in
hurdles similar to those encountered by health care new application areas.
institutions. Traditional control charts and their use
currently represent a significant change in the way There are also research opportunities for Group
information is represented and used within most ed 3 within this intersection. It is not clear, for in
ucational institutions. Here innovation is in the use stance, whether the usual binomial and Poisson mod
of traditional control charts. As quality initiatives els are appropriate for the count data encountered
evolve within the educational field more sophisti in health care applications (in some cases, individ
cated and innovative control charts will result. ual measurement charts for rates appear to be at
least as effective). As the analysis of means contin
It is extremely difficult for educational institutions
ues to be applied in this area, the need for additional
to make the transition from gathering vast amounts
methods of simultaneous inference will emerge. An
of data to effectively monitoring processes and iden
opportunity for time-series methods is illustrated in
tifying changes in the process and their impact. Ed
Figure 4, which displays a control chart maintained
ucational institutions routinely gather information
by a hospital system for the monthly variation in
such as the teaching loads of faculty members, the
emergency room visits; see Rodriguez (1996). Here,
number of returns to the bookstore, the number of
distinct control limits have been used to adjust for
travel claim forms handled per month, and the num
known higher rates of emergency room visits in warm
ber of new enrollments. Few of these variables would
weather. However, improved methods for seasonality
be plotted, and none would include control limits.
adjustment and prediction can also be useful. Very
"What to measure" and "how to measure it" , in ad
little has been written about this problem in the tra
dition to the types of inferences that are possible,
ditional control chart literature since manufacturing
are issues that need to be learned as quality initia
data are typically collected over much shorter time
tives mature. In many situations these issues will be
intervals. On the other hand, health care applica
unique to the educational field.
tions are by no means the only area in which control
charts are maintained over long periods of time. In
Resources for New Applications
One of the major obstacles for Group 3 is a lack Emergency Room Visits per 1000 Member Years
the automotive industry, for instance, control charts run. From a practical standpoint, the inability to
are being used to track defect and customer satisfac manage large or even moderate amounts of data is
tion data on a monthly and yearly basis. the main obstacle to scaling up the use of control
charts, and resources tend to be allocated accord
Information Technology ingly. This is reflected in the fact that specifications
for process control systems often devote hundreds of
In many process control environments, the chief
pages to data communication and management re
impact of computer technology has been to deliver
quirements, and only tens of pages to statistical anal
on-line measurements at increasingly higher rates,
ysis requirements.
and as indicated earlier, this is a motivating factor
for Group 2. One consequence of automated data A third problem is the delivery of process and
collection is that it is now possible to recognize pro quality information that is appropriate for individ
cess autocorrelation that was previously undetected. uals throughout the organization at different levels
We will not consider this as a statistical issue since of responsibility, ranging from plant operators to the
it is addressed by other discussion teams and has CEO. Graphical displays (including control charts)
also been considered by other authors, including Box that aid operators and engineers in the interpreta
and Kramer (1992); MacGregor (1987); Schneider tion of process variability have long been regarded
and Pruett (1994); Wheeler (1991); and Woodall and as essential for this purpose; for a recent discussion,
Faltin (1993). see Roes and Does (1995). This problem can also
be addressed with graphical user interfaces to data
Standard control chart methods are used effec access, analysis, and presentation, and the develop
tively by Group 1 in a great many real-time appli ment of software to provide effective interfaces is still
cations. Often "real-time" is rather vaguely defined in an early stage.
and can mean that measurements arrive as often as
every five seconds or simply once every few hours. Figure 5 illustrates an interface development facil
Timely notification of out-of-control conditions and ity (referred to as PFD for "process flow diagram" )
rapid response are critical, and consequently infor that was introduced specifically for process control
mation technology is used to link data bases and applications in which there are many steps; see SAS
automated data collection systems to software that Institute (1995). At build time, the system developer
provides the results of statistical process control. So can represent the process as a series of nested flow
phisticated examples of these systems can be found diagrams in which the steps and their sequences are
in the semiconductor, food and beverage, automo represented as nodes and arrows. At run time, the
tive, and chemical industries. user can drill down through the diagram to the ap
propriate level or step of the process and then click on
One important problem in this arena is traceabil a box to request an analysis, such as a control chart,
ity (i.e., rapid identification of the sources of an out for that particular step. This interface is data driven
of-control condition by linking the subgroup identi in the sense that for each step, both the analysis and
fier to information about raw material and earlier the node attributes (such as color) are programmat
steps in the process that is available on-line). This ically linked to the most recent set of measurements.
can be achieved through database access and query The interface exploits the fact that a flow diagram is
techniques, and it is a major step forward in the a well-established visual metaphor for a complex pro
broad-based application of control charts. cess, and it provides the appropriate level of detail
for a variety of users, ranging from an operator who
Another problem is the management of data and
is responsible for a particular combination of steps
control limits for large numbers of processes that
to a plant manager who needs to identify the critical
are continually evolving over time. Although there
problem areas.
are significant benefits to constructing control charts
manually in training exercises and in occasional ap In organizations where Group 1 is well supported
plications, many companies have recognized that by information systems, control charts are regarded
large-scale applications require software systems that as components of information delivery technology
compute, save, update, and display the control lim rather than statistical technology, and they are of
its. This requirement is further compounded in short ten implemented by systems developers who have not
run process control, where multiple sets of control been trained in statistical process control. The risk
limits must be maintained and accessed from run to is that such systems can greatly amplify the negative
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consequences of poor statistical thinking, For ex provement with removal of out-of-control points from
ample, it has been our experience that automated a chart; and attempts to automate the detection of
process control systems rarely enforce the notions process shifts by means of complex rules that defy
of rational sampling and rational subgrouping; if subsequent diagnosis.
measurements are subgroup ed, the samples are typ
ically chosen arbitrarily or by convenience. The Again, Group 3 has the potential to deal with
consequences of incorrect subgrouping are discussed these conceptual problems. Through collaboration
by W heeler and Chambers (1992) and by Wheeler with the developers of information systems as well
(1995). Other common problems include the failure as process engineers, statisticians can contribute the
to distinguish between control limits and specifica skills needed to interpret, evaluate, and synthesize
tion limits; the failure to recognize multiple compo the flood of process data in which industry is drown
nents of process variation; confusion of process im- ing.