Statistical Process Improvement

Course Number & Title

Statistical Process Improvement


This course is based on input from a large number of instructors More

Course Description

The course covers the theory and applications of statistical process control in healthcare organizations. Included are analysis of satisfaction surveys using XMR charts, analysis of mortality data using p-chart, analysis of rare adverse events, using time between charts and analysis of comparative effectiveness of treatment programs using matched case control odds ratio.  Students also apply statistical tools to their personal lifestyle management efforts. .

Course Objectives

At the conclusion of the course participants should be able to:

  • Plan efforts to assess patients' satisfaction or health status.
  • Plan efforts to reduce adverse sentinel patient outcomes
  • Plan efforts to benchmark providers
  • Prepare process and outcome data for analysis, including measures of change in process over time
  • Analyze process outcomes using statistical process control charts
  • Benchmark clinicians
  • Measure patients risk of adverse outcomes
  • Analyze risk adjusted patient outcomes
  • Communicate analytical findings using storyboards
  • Add consumer's voice to statistical reports
  • Conduct a personal improvement project.

Required Textbooks

  • This course uses an open textbook.  Required reading are posted to the course web pages, no purchase is necessary.
  • The personal improvement project requires access to the following book:  Alemi F, Neuhauser D. et al. A Thinking Person's Step by Step Guide to Weight Loss & Exercise Program.  If you prefer not to buy the book, you can also print the book out (154 pages) or use the online version.  Buy Free Download►

Recommended Textbooks

  • Recommended readings are posted under the section titled "More" within each lecture.
  • An excellent introduction to statistics is provided through "Open Introduction to Statistics."   Free Download►

Course Prior Requirements

To benefit from this course you need to have the following:

  • Both clinicians and managers are encouraged to enroll. 
  • A bachelor or higher degree from an accredited University. The course is limited to graduate students.  Seniors can enroll with permission.
  • Familiarity with the US health care system. All examples are from the US health care system.
  • A concurrent or previous introduction to concepts in quality improvement is helpful
  • Following software are needed:
    • Computer, modem, microphone, speaker, phone line and Internet connection. A fast computer and modem will save considerable time in this course.  A stand alone microphone (that rests on the head) is needed.
    • A frame-based browser is needed.
    • Working knowledge of Microsoft Excel is needed.  If you do not have experience with use of Excel, please take free introductory courses available on the web.  Review Excel if you do not know how to create a chart   More► 
    • Microsoft Power Point is needed for viewing some portions of reading and lectures. 
    • Flash reader is needed.

Course Assignments

There are six assignments in the course that are used to evaluate student's learning:

  1. A personal improvement project
    In this project you apply concepts you have learned in the course to improve yourself, e.g. to exercise more.  You are expected to make a resolution to change a habit that you have not been able to change for sometime.  Next, you analyze your lifestyle using tools we provide and  implement a system-wide change.  In this project, you will also gather data on whether the change you have introduced has helped you succeed.  You will need to analyze the data using tools provided in the class.  Personal improvement projects are due at end of semester but you are expected to report progress on it as you go along.  The final report is a narrated storyboard.  More►
  2. Plan a satisfaction survey 
    The purpose of this project is to help you design and put in place satisfaction surveys.  The purpose is to plan for the surveys but not to do the survey.  You share your plans with a peer evaluator midway through the course.  The peer evaluator uses a rubric prepared by the instructor to provide you with feedback.  Several tools to guide you through your planning effort are available.  Students hand in a final report as well as a narrated media.  More►  
  3. Weekly assignment:  Each week, you are asked to answer questions about the reading (you can paste relevant sections into the answers) and analyze some data.  Late weekly assignments are not accepted.  If your weekly assignment is not done well, the instructor may return it to you for revisions, in which case the maximum grade you may receive is 80% of the grade for the assignment. 
  4. Class Participation:  This is an open online course and your class participation is judged in two ways. 
    • Ask or comment.  Class participation means that in each section, you should either ask a question or complete the minute evaluation for the session and rate the session.  If you ask a question, your question will be answered on the same web page within 48 hours and the question and the answer would be available for all students to read and benefit from.  How to ask?►
    • Learn one, do one, teach one.  We subscribe to the principles that the best way to learn something is to teach it.  At start of the course you select a topic in the course and you will be responsible to (a) improve the instruction in this topic by providing a narrated set of slides (this could be a video on how to solve the problem assigned in the course), (b) help five students complete the assignment for this section.
  5. Professional Activity:  You need to become a member of a professional organization and participate in at least one session of their local meeting or help organize a professional student meeting.  Many local organizations exist and welcome your participation:  HIMSS, ACHE►, IHI 
  6. Final exam:  The final exam is a comprehensive, open book, timed, take home exam that focuses on statistical process control tools. 

Course Evaluation

The six assignments in the course are graded as follows:

Distribution of the grade

Letter grades will correspond to the following numerical grades:

Take home final


Satisfaction survey plan & peer evaluation


Personal improvement project


Weekly assignments & reviews


Class participation

Participation in professional organization 5%
96+ A
90-95 A -
86-89 B +
74-85 B
70-74 C
70- F

Teaching Methods/Strategies

  • Learn one, do one, teach one.  Students learn better when they do projects and teach the concepts covered in the lectures.  For selected assignments, students are asked to comment on the work of their colleagues using a rubric provided by the instructor. 

  • Use technology. This course actively uses technology to help improve interaction among the students and the faculty.
  • Active participation.  This course requires active participation of all students.  Students are asked to complete a group project, they are asked to comment on or ask a question about every lecture. 

Course Topical Outline

Week 1:  Introduction to the Course


Take a tour of the course. More►
Read about and personal improvements  More►
Read about psychology of change  More►


Select the topic you will teach.  For the topic you have selected, randomly select the students you will be responsible for.  Describe the process of randomization you followed and how you made sure that the students selected were not already part of a different "teach one" project, finally describe how you resolved the conflict in selection of students for your topic.

Draft your semester long project in several discrete steps.  First, discuss your intent with the instructor and then update and send a letter of introduction from your instructor to the project sponsor. Let your  instructor know that you have sent the letter and to whom it has been sent.  Letter►  Email►

Complete your semester long personal improvement by following several discrete steps.  Read the Introduction in the book "A thinking person's guide to weight loss and exercise." 

For your personal improvement, make a resolution Decide what is it that you want to accomplish and why.  Start collecting data as soon as possible -- even if you do not make any changes in your life style.  You can keep  this data in your diary. To think through your resolution, use Figure 1 in Chapter 1 in the book: Thinking Person Weight Loss & Exercise Program.  Email►  

Provide your instructor with your email address.  Write in your email that you plan to check this email address on a daily basis and that you are cognizant of space limitations and will delete your email so that your email address will be operational.  More

Week 2:  Introduction to Change


Read, listen and see videos on process improvement.   Leading Change►  Improvement Cycles►  92 Examples►
Read, listen, and see videos on describing data.


For your semester long project, review the literature on satisfaction surveys (2-3 pages).  See full text articles in Medline bibliography.  Or search full text journals in online university library.   Complete a Scholar Google search on satisfaction surveys. Students can help each other in identifying relevant resources. Bibliography► Full text► H-CAPH► Google► 

Review the questionnaires available for doing satisfaction surveys (1-2 pages).  See Medline bibliography.  More about CAHPS.   Bibliography► CAHPS► Minute Survey►

For your personal improvement, put together a team.  Even though the problem focuses on you and how you can improve, the solution is likely to involve "process owners,"  people who live with you and who help you carry out daily living activities.  Read Chapter 4 to get the idea of who should help. Test if the person you have in mind is a process owner by completing Table 1 in Chapter 1 of the book Thinking Person Weight Loss & Exercise Program. Begin your unfolding storyboard.  Create the title page and start data collection before you implement any changes. Email► Storyboard

Describe life processes.  Take a scientific approach to accomplishing your resolution.  Start by understanding your habits and events that trigger them.  Make   sure you are aware of how you live and how various parts of your life are interconnected.  You can learn how to use lists and flow charts to describe your life style by reading Chapter 5. Complete Table 3 and Figure 2 in Chapter 1 of the book Thinking Person Weight Loss & Exercise Program.   Email►  

Describe data using mean, median and other parameters Analyze data►
Display time based data Analyze data►

Week 3: Assessment of Risk


Read, listen and see videos on introduction to probability and conditional probability. 
Read, listen, and see videos on risk assessment  More►
Read, listen, and see videos on Cumulative Sum Control Charts.   


In your semester long project, describe who, what, where, when the survey will be done (4-5 pages).  Think through sampling issues.  Identify source of web based data.  More►


In your personal improvement project, list possible changes & select solutions. Make sure that you come up with more than one solution.  Wait and do not rush into a decision.  Select several solutions at once and bring about multiple changes in your environment.  Keep in mind that we are   looking for system solutions and not a renewed or increased effort.  We want you to succeed by changing your environment and not your motivation.   Read about system change in chapter 3.  Check if your solutions are system changes by completing Table 4 in the book Thinking Person Weight Loss & Exercise Program.   Email►

Analyze data:  Construct a measure of severity of encounters
Analyze data:  Construct a CUSUM chart for cumulative risk of the patient in last 3 months

Week 4: Monitoring Adverse Events through Probability Charts


Read, listen and see videos on Bernoulli and Binomial distributions.  Selected readings from "Feller W. An introduction to Probability Theory and Its Applications." will be provided by the instructor 
Read,  listen, and see videos on probability charts and risk adjusted probability charts  More►


In your semester long project, obtain sample data from the instructor or from the web.  Show how the data will be analyzed.  Include the table of data, the charts produced from the table and describe the method of analysis.  Make sure that you describe time to dissatisfied customer and not average satisfaction of patients.  Add the customer's voice to your finding by using the testimonials available on the web.  Data►

In your personal improvement project monitor progress.  You need data to see if changes you have introduced have led to improvement.  Learn about data collection and analysis in Chapters 6 of the book Thinking Person Weight Loss & Exercise Program. If you relapse to old habits, keep asking yourself what led to it and what needs to change to reduce future relapses. 

Probability Charts Analyze data►

Week 5: Time to Adverse Events


Read more about, listen to lecture and see videos on Bernoulli, Binomial and Geometric distributions.  Selected readings from "Feller W. An introduction to Probability Theory and Its Applications." will be provided by the instructor 
Read more about, listen to lecture on and see video on time between charts More►


In your semester long project, prepare media that will promote your plan using the voice of the customer.  Obtain feedback from instructor and make corrections to your plans and analysis.  From now till end of semester work on soliciting feedback, improving your plans and correcting your analysis.  Rubric►

In your personal improvement, engage in cycles of improvement.  Plan for, do, check and act again.  Go through cycles of changing your environment and checking to see if it has led to better lifestyle.  For more details see workbook in Chapter 1 of the book Thinking Person Weight Loss & Exercise Program.

In your personal improvement, tell your story. By now you have made  an unfolding storyboard.  Email first draft of personal improvement storyboard.  From now till end of course work on additional cycles of improvement and additional data collection.  Storyboard Email►

Time between Charts Analyze data►

Week 6: Mid Term Sample Exam 


Review and discussion of results of open book, time based, comprehensive mid-term exam
Play a game to get ready  Jeopardy►


Download take home mid-term exam at designated time.  
Send a follow up letter from the instructor to your sponsor for your semester long project. 

Week 7: Monitoring Satisfaction with Care through Xbar Charts


Read, listen or see videos on measurement of satisfaction
Read, listen, or see videos of X-bar charts and risk adjusted Xbar charts  More►


X-bar Charts Analyze data►

Week 8: Monitor Web Sentiment Using XmR Charts


Read, listen and see videos on real time monitoring of web sentiment.
Read, listen and see videos on XmR charts  More►


Collect comments from the web and examine web sentiment towards a health care institution
XmR Charts Analyze data►

Week 9: Monitor Impact of Practice Changes on Patients Using Tukey Chart


Read more about, listen to lecture on and see videos of Tukey chart  More►


Analyze patient diaries
Tukey Charts Analyze data►

Week 10: Benchmark Clinicians, Odds Ratios and Relative Risks Ratios


Read more about and listen to lecture on benchmarking  Benchmarking► Presenting Data to Clinicians►
Read, listen and see videos on calculation of odds ratio, and relative risk ratios


Analyze data:  Calculate odds ratio, relative risk ratio

Week 11: Comparative Effectiveness and Matched Case Controls


Read, listen and see videos on lecture on comparative effectiveness More►


Organize matched case control from sample data Question 1►
Analyze data:  Complete a comparative effectiveness study of patient outcomes  Question 2►

Week 12: Rapid Analysis 


Read, listen and see videos on rapid change  More►


Select a chart Analyze data► 
Submit your final personal improvement report
Submit your final semester long project

Week 13: Final Exam Review


Open book, time based, comprehensive exam
Play a game  Jeopardy►


Download take home exam at designated time.   Previous►
Send a thank you letter from the instructor to your sponsor. Complete course exit and personal improvement exit interviews.   Letter► Course Exit► Personal Improvement Exit►

Open Environment

This is an open environment course.  Faculty and students from other universities are welcomed to use this course.  Do not assume that comments and questions you see are from your classmates.  Do not enter names in the comments you leave.  For more information send email to Farrokh Alemi, Ph.D.  More 

Disability Accommodations

If you are a student with a disability and you need academic accommodations, please contact the instructor.  We are committed to comply with the Rehabilitation Act of 1973 and the Americans with Disabilities Act of 1990 by providing reasonable accommodations for disabled students.


This page is part of the course on Statistical Process Improvement, the section on "About the course."  It was first created in 1996.  It was last edited on 08/29/2007 by Farrokh Alemi, Ph.D.  Copyright protected.