title: Statistical process control as a tool for controlling operating room performance: retrospective analysis and benchmarking.
abstract: BACKGROUND
  There is much research using statistical process control (SPC) to monitor surgical performance, including comparisons among groups to detect small process shifts, but few of these studies have included a stabilization process. This study aimed to analyse the performance of surgeons in operating room (OR) and set a benchmark by SPC after stabilized process.
  
  
  METHODS
  The OR profile of 499 patients who underwent laparoscopic cholecystectomy performed by 16 surgeons at a tertiary hospital in Taiwan during 2005 and 2006 were recorded. SPC was applied to analyse operative and non-operative times using the following five steps: first, the times were divided into two segments; second, they were normalized; third, they were evaluated as individual processes; fourth, the ARL(0) was calculated;, and fifth, the different groups (surgeons) were compared. Outliers were excluded to ensure stability for each group and to facilitate inter-group comparison.
  
  
  RESULTS
  The results showed that in the stabilized process, only one surgeon exhibited a significantly shorter total process time (including operative time and non-operative time).
  
  
  CONCLUSIONS
  In this study, we use five steps to demonstrate how to control surgical and non-surgical time in phase I. There are some measures that can be taken to prevent skew and instability in the process. Also, using SPC, one surgeon can be shown to be a real benchmark.
authors.affiliation: Institute of Health Care Organization Administration, College of Public Health, National Taiwan University, Taiwan.
authors.forename: Tsung-Tai
authors.initials: TT
authors.lastname: Chen
authors.forename: Yun-Jau
authors.initials: YJ
authors.lastname: Chang
authors.forename: Shei-Ling
authors.initials: SL
authors.lastname: Ku
authors.forename: Kuo-Piao
authors.initials: KP
authors.lastname: Chung
mesh_terms: D019985:Benchmarking / Q000706:statistics & numerical data*; D017081:Cholecystectomy, Laparoscopic; D006801:Humans; D009873:Operating Rooms / Q000592:standards*; D012189:Retrospective Studies; D013624:Taiwan