The Common Sense Guide to Improving Palliative Care > 2.6 Displaying the Data

Sick To Death book cover This extract from the online edition of The Common Sense Guide to Improving Palliative Care is used with permission.

Displaying the Data

There are two ways that many teams use to display their data, both to gain insight and to tell their stories: time series graphs and storyboards/poster boards:

Time Series Graphs

Why should I bother with a Time Series?

A well-run QI project must determine whether the changes tested resulted in improvement. The best way to do that is usually by collecting and plotting data over time. Figure 2.1 (called a time series or run chart) shows changes in a rate or tally (y-axis) over time (x-axis). Figure 2.2 displays a useful time-series chart.

Figure 2.1. Annotated time series chart.

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Figure 2.1. Annotated time series chart.

Figure 2.2. Example of a useful time series chart.

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Figure 2.2. Example of a useful time series chart.

Do the Math

Most time series charts are a simple way to show changes over time. Plot weeks or months on the x-axis and the number or percentage of patients (or whatever you are measuring) on the y-axis. For example, your team might track the percentage of exacerbations that require outside intervention and plot it on the y-axis. The x-axis could simply give the month.

Is it better to track Number or Percentage?

If your denominator varies a good deal (e.g., one month you have 20 patients and the next month, 40), percentages give the most accurate picture of change over time. For example, suppose you are testing advance care plan documentation. In Month One, 20 out of 40 patients completed plans; in Month Two, 25 out of 75 patients complete plans. By the numbers, this would seem to show a slight improvement, but the pecentages would show otherwise.

Usually the rate is the more informative figure, but it helps to keep the population size visible, for example 50% (of 40) or 33% (of 75). Sometimes, though, a tally is fine, especially when you are getting closer to ideal and tally any that fall short (e.g., the number of transfers each month without advance care plans).

How Do I Get a Percentage for My Measurement?

You need two numbers to come up with the percentage numerator and denominator.

The numerator is the actual number that you have counted that shows your result (e.g., the number of patients who have advance directives in their charts).

The denominator is the total number of patients who are in the population for whom you are implementing this change.

How to compute a percentage shows that a percentage is obtained by dividing a Numerator (# successful) by a Denominator (Total # having target characteristics) and then multiplying by 100.

How Do I Create a Time Series?

You can use a computer program like Microsoft Excel® (or similar software) to create time series graphs. However you do not need to be technically savvy; you can create a time series using paper and pencil.

How to Annotate a Time Series Chart

Annotation means adding text information in your chart that tells you when you tried each intervention. This will help you in understanding which change made the most difference in getting your results. You should annotate the chart by adding text in text boxes in the chart (see examples of a time series chart).

Storyboards

A storyboard helps you to display your project to others in the organization. The storyboard helps the team to understand its own progress, and it can also be dramatically effective for showing your results to senior leaders, other staff, other organizations, patients and families, policymakers, and the media. The storyboard should generally include the following:

  1. Team information (including the names of team members and some contact information).
  2. Brief description of the problem and the aim statement.
  3. Brief description of your measures.
  4. Time series graphs (to show your progress over time).
  5. Successful changes that you have tried.
  6. Challenges and lessons learned.
  7. Other tools and resources that people might find helpful.

A storyboard can be printed and posted on a display board to show off at meetings and conferences. You can also post it in your work area, where team members can see it (an incentive to keep enthusiasm ­going). Other staff and family members may see the storyboard and encourage you or perhaps give you ideas about other strategies that might work. Posting the storyboard in your facility also gives the administrators a little reminder of your accomplishments every time they pass by. This will make your life easier when you find that you really need a few more nursing hours each week or a consultant to help manage pain for patients with complex needs.

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