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Jeffrey E. Jarrett

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To cite this document:

Jeffrey E. Jarrett , (2016),"Total quality management (TQM) movement in public health", International

Journal of Quality & Reliability Management, Vol. 33 Iss 1 pp. 25 - 41

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movement in

Total quality management (TQM) public health

movement in public health

Jeffrey E. Jarrett 25

Management Science/Finance Department, University of Rhode Island,

Received 11 December 2013

Kingston, Rhode Island, USA Revised 8 May 2014

Accepted 10 May 2014

Downloaded by Northumbria University, Mr Jeffery Tan At 02:28 11 November 2016 (PT)

Abstract

Purpose The purpose of this paper is to suggest better methods for monitoring the diagnostic and

treatment services for providers of public health and the management of public health services.

In particular, the authors examine the construction and use of industrial quality control methods as

applied to the public providers, in both the prevention and cure for infectious diseases and the quality

of public health care providers in such applications including water quality standards, sewage many

others. The authors suggest implementing modern multivariate applications of quality control

techniques and/or better methods for univariate quality control common in industrial applications

in the public health sector to both control and continuously improve public health services.

These methods entitled total quality management (TQM) form the foundation to improve these public

services.

Design/methodology/approach The study is designed to indicate the great need for TQM

analysis to utilize methods of statistical quality control. All this is done to improve public health

services through implementation of quality control and improvement methods as part of the TQM

program. Examples of its use indicate that multivariate methods may be the best but other methods are

suggested as well.

Findings Multivariate methods provide the best solutions when quality and reliability tests show

indications that the variables observed are inter-correlated and correlated over time. Simpler methods

are available when the above factors are not present.

Research limitations/implications Multivariate methods will provide for better interpretation of

results, better decisions and smaller risks of both Type I and Type II errors. Smaller risks lead to better

decision making and may reduce costs.

Practical implications Analysts will improve such things as the control of water quality and all

aspects of public health when data are collected through experimentation and/or periodic quality

management techniques.

Social implications Public health will be better monitored and the quality of life will improve for

all especially in places where public development is undertaking rapid changes.

Originality/value The manuscript is original because it uses well known and scientific methods of

analyzing data in area where data collection is utilized to improve public health.

Keywords Auto correlated time series, Average run length (ARL), Common and special causes,

Multivariate quality control (MQC), Statistical quality control, Total quality management (TQM)

Paper type Research paper

Introduction

Public Health management involves the leveraging of channel wide integration to

better serve public needs. Increases in productivity and quality control and continuous

improvement follow when public health managers implement and coordinate

International Journal of Quality &

quality management activities upstream. Public health management should Reliability Management

recognize anew the aspects of quality control and quality assurance requires two Vol. 33 No. 1, 2016

pp. 25-41

duties to be undertaken. First, we refer to the process whereby measures are taken to Emerald Group Publishing Limited

0265-671X

make sure defects in services are not part of the final output, and that the output meets DOI 10.1108/IJQRM-12-2013-0193

IJQRM quality and acceptable health standards. Second, one may observe that quality

33,1 assurance entails overlooking all aspects, including design, development, service,

installation, as well as documentation. The quality movement is the field that ensures

that management maintains the standards set and continually improve the quality of

the output. The quality movement (Lee and Wang, 2003) offers users sound lessons

that can be very powerful to address public health lessons. Instead of final, end-service

26 source inspection, the quality movement emphasizes prevention, total quality

management (TQM), source inspection, process control and continuous improvement.

These are all ingredients for successful and effective ways to manage and mitigate the

risks in public health application such as water quality control (see Woodall, 2005 and

Papaioannon et al., 2010a, b).

Downloaded by Northumbria University, Mr Jeffery Tan At 02:28 11 November 2016 (PT)

We introduce the philosophy and methods of the quality improvement to achieve the

best results of health service operations. This manuscript focusses on TQM planning in

an environment characterized by multiple service centers and multiple customers.

We first discuss the needs for quality planning in the supply chain environment to focus

on where the notion of statistical process (or quality) control (SPC or SQC) is so vital to

the performance of a health programs environment to focus on where the notion of SPC

fits and why it is so vital to the performance of public health programs in the global

environment. In turn, we introduce and discuss the desire for more sophisticated methods

to insure that quality and continuous improvement is maintained in public health

processes including water treatment systems, sewage systems and others.

While public health programs are so crucial to the general health of society, these

health systems must be sustained by both preventative and emergency measures.

Zhang et al. (2009) propose several sophisticated strategies for dealing with SPC

strategies in an environment where service flows continue over time. Their study

presents principle agent models regarding the consumers quality evaluation and the

suppliers quality prevention level decisions. Studies such as this may produce results

not heretofore examined by the practioners of SPC in public health. In addition, threats

to public health are real and many and measures must be developed to indicate when

water quality and similar processes are not operating in an efficient and productive

manner. These measures include those of SPC which will indicate when risks are

present in the inspection processes in water treatment and public health programs.

Since public health programs are increasingly globalized, these SPC measures must be

strategically incorporated into inspection and monitoring programs and the choice of

the particular SPC procedure is critical in developing an optimal plan.

Most SPC methodologies assume a steady state process behavior where the influence

of dynamic behavior either does not exist or is ignored. The focus is on the control of only

one variable at a time and distinguishes between Phases I (analysis of historical data) and

II (monitoring quality levels). Specifically, SPC controls for changes in either the measure

of location or dispersion or both. SPC procedures as practiced in each phase may disturb

the flow of the service production process and operations. In recent years, the use of SPC

methodologies to address the process where behavior is characterized by more than one

variable is emerging. The purpose of this next section is to review the basic univariate

procedures to observe how one improves the performance of SPC to achieve better

measures in Phase II by considering run length performance.

A Shewhart control chart which is the central foundation of univariate SPC has one

major shortcoming. This control chart is considers only the last data point and does not

carry a memory of the previous data. As a result, small changes in the mean of a TQM

random variable are not likely to be detected rapidly. Exponentially weighted moving movement in

average (EWMA) charts improve upon the detection of small process shifts. Rapid

detection of relatively small changes in the quality characteristic of interest and ease of

public health

computations through recursive equations are some of the many good properties of the

EWMA chart that make it attractive.

EWMA chart achieves faster detection of small changes in the mean. The EWMA 27

chart is used extensively in time series modeling and forecasting for processes with

gradual drift. EWMA provides a forecast of where the process will be in the next

instance of time. It thus provides a mechanism for dynamic process control (Hunter,

1986). In later sections, we illustrate these methods.

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The EWMA is a statistic for monitoring the process that averages the data in a way

that gives exponentially less and less weight to data as they are further removed

in time. The procedures for developing EWMA control charts give details on implementing

this type of Phase I system. (Montgomery contains the development of the models for

finding the control limits in this for the univariate charts and need not be discussed further

at this point).

In many situations, the sample size used for process control is n 1; that is the

sample consists of an individual unit (Montgomery and Runger, 2003). In such a

situation, the individuals control chart is used. The control chart for individuals uses

the moving range of two successive observations to estimate the process variability.

Such small samples may lead to false signals which increase the likelihood of Type II

errors, i.e., the error of leaving a process alone when it should be stopped and a search

for the malfunctions should be implemented.

Often, in public health programs, the distinction between Phases I and II is not clear.

Sonesson and Bock (2003) pointed out problems and issues related to statistically based

evaluations. Researchers, often, did not examine average run length (ARL) of a

proposed method over a variety of alternative process shifts. ARL performance of

a proposed method or program for an in-control state and for a single shift in the

service process for which the proposed detection program optimizes must be evaluated.

If the system is not optimized, misplaced control limits may result. The system for

detection of quality shifts is sub-optimized and better techniques should be sought.

In the next section, we introduce methods and their possible use in processes having

dynamic inputs Yeh et al. (2004).

Alwan (1992) found that more than 85 percent of process control applications

studied resulted in charts with possibly misplaced control limits. In many instances,

the misplaced control limits result from the autocorrelation of the process observations,

which violates a basic assumption often associated with the Shewhart chart.

Autocorrelation of process observations has been reported in many industries,

including cast steel (Alwan, 1992), wastewater treatment plants (Berthouex et al., 1978),

chemical processes industries (Montgomery and Mastrangelo, 1991) and many other

service industries and programs. Several models have been proposed to monitor

processes with auto correlated observations. Alwan and Roberts (1988) suggest using

an autoregressive integrated moving average (ARIMA) residuals chart, which they

referred to as a special cause chart. For subsample control applications, Alwan and

Radson (1992) describe a fixed limit control chart, where the original observations are

plotted with control limit distances determined by the variance of the subsample mean

series. Montgomery and Mastrangelo (1991) use an adaptive (EWMA) centerline

approach, where the control limits are adaptive in nature and determined by smoothed

IJQRM estimate process variability. Lu and Reynolds (1999) investigate the steady state ARL

33,1 of cumulative sum, EWMA and Shewhart control charts for auto correlated data

modeled as a first-order AR process plus an additional random error term. Last,

Box and Luceno (1997) considering quality monitoring by feedback adjustment.

A problem with all these control models is that the estimate of the process variance

is sensitive to outliers. If assignable causes are present in the data used to fit the model,

28 the model may be incorrectly identified and the estimators of model parameters may be

biased, resulting in loose or invalid control limits (Boyles, 2000). To justify the use of

these methods, researchers have made the assumption that a period of clean data

exists to estimate control limits. Therefore, methods are needed to assure that

parameter estimates are free of contamination from assignable causes of variation.

Downloaded by Northumbria University, Mr Jeffery Tan At 02:28 11 November 2016 (PT)

Intervention analysis, with an iterative identification of outliers, has been proposed for

this purpose. The reader interested in more detail should see Alwan (2000, pp. 301-307),

Atienza et al. (1998), and Box et al. (1994, pp. 473-474, 2008). Atienza et al. (1998)

recommend the use of a control procedure based on an intervention test statistic, , and

show that their procedure is more sensitive than ARIMA residual charts for process

applications with high levels of positive autocorrelation. They limit their investigation

of intervention analysis, however, to the detection of a single level disturbance in a

process with high levels of first order autocorrelation. Wright et al. (2001) propose a

joint estimation method capable of detecting outliers in an auto correlated process

where the data available is limited to as few as nine-25 process observations. Since

intervention analysis is crucial to model identification and estimation, we investigate

varying levels of autocorrelation, AR and moving average (MA) processes, different

types of disturbances, and multiple process disturbances.

The ARIMA and intervention models are appropriate for auto correlated processes

whose input streams are closely controlled. However, there are quality applications,

which we refer to as dynamic input processes, where this is not a valid assumption.

The treatment of wastewater is one example of a dynamic process that must

accommodate highly fluctuating input conditions. In the health care sector, the

modeling of emergency room service must also deal with highly variable inputs.

The dynamic nature of the input creates an additional source of variability in the

system, namely the time series structure of the process input. For these applications,

modeling the dynamic relationship between process inputs and outputs can be used

to obtain improved process monitoring and control as discussed by Alwan (2000,

pp. 675-679). West et al. (2002) proposed the following transfer function model to solve

problems having dynamic behavior. If a process quality characteristic zt, has a time

series structure, an ARIMA model of the following general form can represent the

undisturbed or natural process variation:

F B a B zt yBat (1)

In Equation (1), B represents the back-shift operator, where B (zt) zt1. The value of

(B) represents the polynomial expression (11 (B)1Bp), which models the AR

structure of the time series. The value of the (B) represents the polynomial (1 1

(B)q Bq), which models the MA structure d of the time series. The value of

d 8

a(B) represents the expression 1B1 1B , where d d1+sd2. This quantity is

2

a polynomial in B that expresses the degree of differencing required to achieve a

stationary series and accounts for any seasonal pattern in the time series. Finally, at is

a white noise series with distribution N O2a . This model is described by Chen and Liu TQM

(1993a, b). If the series zt is contaminated by periods of external disturbances to the movement in

process, the ARIMA model may be incorrectly specified, the variability of the residuals public health

overestimated, and the resulting control limits incorrectly placed.

The following transfer function model of Box and Tiao (1975) describes the

observed quality characteristic, yt, as a function of three courses of variability:

29

wB yB

yt vB xtb It at (2)

dB fB

The first term v (B)xtb, is the dynamic input term and represents an impulse function.

Downloaded by Northumbria University, Mr Jeffery Tan At 02:28 11 November 2016 (PT)

v(B), applied to the input xtb with a lag of b time periods. If a dynamic relationship

between the input and output time series exists, lagged values of process inputs can be

modeled, resulting in considerable reduction of unexplained variance. The second term,

(w (B)/(B)It, is the intervention term and identifies periods of time when assignable

causes are present in the process. Here, It is an indicator variable with a value of zero

when the process is undisturbed and a value of one when a disturbance is present in the

process. See, for example, Box et al. (1994, p. 392, or 2008) for the development of

the transfer function term, and Box et al. (1994, p. 462, or 2008) for details of the

intervention term. The rational coefficient term if It is a ratio of polynomials that

defines the nature of the disturbance as detailed in Box et al. (1994, p. 464, or 2008).

The third term ((B)/(B)at, is the basic ARIMA model of the undisturbed process from

Equation (9). We refer to Equation (10) as the transfer function model throughout

this paper.

Different types of disturbances can be modeled by the proper design of the

intervention term. The two most common disturbances for quality applications are a

point disturbance, with an impact observed for only a single time period, and a step

disturbance, with an impact persisting undiminished through several subsequent

observations. The point disturbance is modeled as an additive outlier (AO). An AO

impacts the observed process at one observation. The AO is modeled in the form:

w B

wo (3)

d B

where wo is a constant. A step disturbance to the process is modeled as a level-shift

outlier (a form of innovational outlier or IO) in the form:

w B wo

(4)

dB 1B

Chang et al. (1988) and Chen and Liu (1993a, b) discuss both types of disturbances.

Chang et al. (1988) extended the concepts of Box and Tiao (1975) to an iterative

method for detecting the location and nature of outliers at unknown points in the time

series. The above researchers defined procedures for detecting innovational outliers

and AOs and for jointly estimating time series parameters. Their work also

demonstrates the need for future study of the nature of outliers.

Multivariate analyses utilize the additional information due to the relationships among

the variables and these concepts may be used to develop more efficient control charts

IJQRM than simultaneously operated several univariate control charts. The most popular

33,1 multivariate SPC charts are the Hotellings T2 (see Sullivan and Woodall, 1996) and

multivariate exponentially weighted moving average (MEWMA) (Elsayed and Zhang,

2007). Multivariate control chart for process mean is based heavily upon Hotellings

T2 distribution, which was introduced by Hotelling (1947). Other approaches, such as a

control ellipse for two related variables and the method of principal components, are

30 introduced by Jackson (1956) and (1959). A straightforward multivariate extension of

the univariate EWMA control chart was first introduced in Lowry et al. (1992) and

Lowry and Montgomery developed a multivariate EWMA (MEWMA) control chart.

It is an extension to the univariate EWMA:

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where I is the identity matrix, Z is the ith EWMA vector, X , is the average ith

observation vector I 1, 2,, n, is the weighting matrix. The plotting statistic is:

T i 2 Z i S1

zi Z i (6)

Lowry and Montgomery (1995) showed that the (k, 1) element of the covariance matrix

of the ith EWMA, Szi is:

where k,1 is the (k, 1) element of , the covariance matrix of the X s.

If 1 2 p , then the above expression simplifies to:

X l X

2i

k; 1 1 1l (8)

zi 2l

(where is the covariance matrix of the input data).

There is a further simplification. When I becomes large, the covariance matrix may

be expressed as:

X l X

(9)

zi 2l

Montgomery and Wadsworth (1972) suggested a multivariate control chart for process

dispersion based:

UCL jS j 1b1 b1 3b2 1=2

CL jS j (10)

UCL jS j 1b1 b1 3b2 1=2

where:

Y

P

b1 1=n1 p n1 (11)

i1

and:

2 3

P P

h iY P Y Y

6 nj 2 nj 7

b2 1=n12P n1 4 5 (12)

i1 j1 j1

In the next section, we explore how multivariate methods improve process control in

public health management.

Interpretation of multivariate process control TQM

Multivariate quality control (MPC) charts (Hotelling, 1947; Jackson, 1956, 1959, 1985; movement in

Hawkins, 1991, 1993; Kalagonda and Kulkarni, 2003, 2004; Wierda, 1994 and Jarrett

and Pan, 2006, 2007a, b; Mestik et al., 2002) have several advantages over creating

public health

multiple univariate charts for the same business situation:

(1) the actual control region of the related variables is represented. In the bivariate

case the representation is elliptical;

31

(2) you can maintain a specific probability of a Type 1 error (the risk of rejecting a

true null hypothesis); and

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(3) the determination of whether the process is out of or in control is a single control

limit.

Currently, there is a gap between theory and practice and this is the subject of this

manuscript. Many practitioners and decision-makers have difficulty interpreting

multivariate process control applications although the book by Montgomery addresses

many of the problems of understanding not discussed in the technical literature noted

before. For example, the scale on multivariate charts is unrelated to the scale of any of

the variables, and an out-of-control signal does not reveal which variable (or combination

of variables causes the signal).

Often one determines whether to use a univariate or multivariate chart by

constructing and interpreting a correlation matrix of the pertinent variables. If the

correlation coefficients are greater than 0.1, you can assume the variables correlate, and

it is appropriate to construct a multivariate quality control chart.

The development of information technology enables the collection of large-size data

bases with high dimensions and short sampling time intervals at low cost. Computational

complexity is now relatively simple for on-line computer-aided processes. In turn,

monitoring results by automatic procedures produces a new focus for quality management.

The new focus is on fitting the new environment. SPC now requires methods to monitor

multivariate and serially correlated processes existing in many time series of public health

and water treatment programs.

SPC emphasizes the properties of control for decision making while it ignores the

complex issues of process parameter estimation. Estimation is less important for

Shewhart control charts for serially independent processes because the effects of different

estimators of process parameters are nearly indifferent to the criterion of ARL. Processes

having serial correlation, estimation becomes the key to correct construction of control

charts. Adopting workable estimators is then an important issue.

In the past, researchers studied SPC for serially correlated processes and SPC

for multivariate processes separately. Research on quality control charts for

correlated processes focussed on univariate processes. Box et al. and Berthouex et al.

(1978) noticed and discussed the correlated observations in production processes.

Alwan and Roberts (1988) proposed a general approach to monitor residuals of

univariate auto correlated time series where the systematic patterns are filtered out

and the special changes are more exposed. Other studies include Montgomery

and Friedman (1989), Harris and Ross (1991), Montgomery and Mastrangelo (1991),

Maragah and Woodall (1992), Wardell et al. (1994), Lu and Reynolds (1999),

West et al. (2002) and West and Jarrett (2004), English and Sastri (1990). In addition,

Pan and Jarrett (2004) suggested state space methodology for the control of auto

correlated process. Further, additional technologies implemented by Testik (2005),

IJQRM Yang and Rahim (2005) and Yeh et al. (2004) provide newer methods for enabling

33,1 better MPC methods.

In Alwan and Roberts approach, a time series is separated into two parts that

are monitored in two charts. One is the common-cause chart and the other is the

special-cause chart. The common cause chart essentially accounts for the processs

systematic variation that is represented by an autoregressive-integrated-moving-

32 average (ARIMA) model, while the special cause chart is for detecting assignable

causes that can be assigned in the residual of the ARIMA model. That is, the special

cause chart is designed as Shewhart-type chart to monitor the residuals filtered

and whitened from the auto correlated process (with certain or estimated

parameters). In this analysis, the authors suggest methods used in conventional

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Variance control charts. These multivariate charts show how several variables

jointly influence a process or outcome. For example, you can use multivariate

control charts to investigate how the tensile strength and diameter of a fiber affect

the quality of fabric or any similar application. If the data include correlated

variables, the use of separate control charts is misleading because the variables

jointly affect the process. If you use separate univariate control charts in a

multivariate situation, Type I error and the probability of a point correctly plotting

in control are not equal to their expected values. The distortion of these values

increases with the number of measurement variables. In the next section, we will

consider an illustration.

We begin by collecting data in an emergency facility whereby a series of tests

produce data on three factors denoted X1, X2 and X3. Over a period of 20 days,

collects and processes the data by a simple univariate control chart for each variable.

In turn, the ER analyst plots the variable on three separate charts displayed

in Figure 1.

Using the individual (I) chart, one can assess whether the process center is in control

when the data are individual observations. The test for special causes determines

whether or not the observations are randomly distributed with control limits. The

control limits maybe be set at levels of 95 percent through 99.73 percent (six-sigma)

level depending of the public health analysts view of the likelihood of Type I error.

Based on the limits set and collected data we find the following:

No points appear out of control for variables X1 and X2 on either the mean or range

charts. For variable X3, we find the following for X3 for the individual value (I) and the

later the (MR):

Test results for I chart of X3

TEST 1: One point more than 3.00 standard deviations from

center line.

Test Failed at points: 10

Test results for MR chart of X3

TEST 1: One point more than 3.00 standard deviations from

center line.

Test Failed at points: 11

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5 5 UCL =4.897

UCL =4.681

4 4 _

_

X =3.295 X = 3.525

3 3

Individual Value

Individual Value

2 LCL =1.909 2 LCL = 2.153

1 3 5 7 9 11 13 15 17 19 1 3 5 7 9 11 13 15 17 19

Observation Observation

1.6

1.2 1.2

__

0.8 MR =0.521 0.8 __

0.4 MR = 0.516

0.4

Moving Range

Moving Range

0.0 LCL =0 0.0 LCL = 0

1 3 5 7 9 11 13 15 17 19 1 3 5 7 9 11 13 15 17 19

Observation Observation

5 UCL =4.897 UCL =3.702

3.6

3.2

4 _ _

X =3.525 2.8 X = 2.82

3 2.4

Individual Value

2.0

Individual Value

LCL =2.153 LCL = 1.938

2 1

1 3 5 7 9 11 13 15 17 19 1 3 5 7 9 11 13 15 17 19

Observation Observation

1

1.6 UCL =1.685 1.2 UCL =1.083

1.2 0.9

0.8 0.6

__ __

0.4 MR =0.516 0.3 MR =0.332

Moving Range

Moving Range

0.0 LCL =0 0.0 LCL = 0

1 3 5 7 9 11 13 15 17 19 1 3 5 7 9 11 13 15 17 19

Observation Observation

public health

TQM

33

I and MR charts

movement in

X2, and X3

for variables X1,

Figure 1.

IJQRM As one observes in each of the control charts for X3, one point is outside the control

33,1 limits in each chart. For the individual control chart, point 10 is below the control and

for point 11 in the MR control chart the observed value is above the upper control limit.

At these times, the conclusion in the univariate environment, special causes of variation

may be present.

To evaluate further we consider the use of the conventional multivariate quality

34 control chart originally developed by Hotelling (1947) and included in most

conventional computer software for data analysis of quality monitoring. In these

situations the monitoring analysis will consider all three variables at one. By use

Hotellings T and generalized variance control charts to determine whether or not the

mean of the process vector for the three variables and the joint process variability for

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the three variables are in control or not. Use of multivariate quality control (MQC)

software produces the two MQC control charts of Figure 2.

A process that exhibits only random variation; that is, stable over time is said to be

in-control When the performance of the process falls within statistically calculated

(a) T2

20

15 UCL = 14.69

10

2

T

5

Median = 4.03

0

1 3 5 7 9 11 13 15 17 19

Sample

Generalized Variance Chart of X1, ..., X3

1.6

1.2

Generalized Variance

1.0

0.8

0.6

"S "= 0.551

0.4

0.2

0.0 LCL = 0

Figure 2.

T2 charts 1 3 5 7 9 11 13 15 17 19

Sample

control limits and exhibits only chance, or common cause, variation. Similarly, TQM

a process is out of control when it has a nonrandom pattern of variability that may be movement in

due to special causes. We observe in Figure 2(a) the following results:

public health

T-squared Chart of X1, y, X3

Test Results for T-squared Chart of X1, y, X3

35

Point Variable P-Value

Greater Than UCL 10 X3 0.0098

18 X2 0.0000

X3 0.0000

Downloaded by Northumbria University, Mr Jeffery Tan At 02:28 11 November 2016 (PT)

19 X1 0.0000

X2 0.0000

Note, three points are jointly out of control, that is, above the upper control limit (UCL)

for the T2 control chart. The p-value indicate the probability of a Type I error at which

the analyst can reject the hypothesis on in-control. All of the p-values are less than

0.01 with four of the five being less than 0.0001. In turn, we observe in Figure 2(b)

the following:

Generalized Variance Chart of X1,y, X3

Test Results for Generalized Variance Chart of X1,y, X3

TEST. One point beyond control limits.

Test Failed at points: 19

We conclude for the test for variance that point 19 is out of control. In conclusion,

the two charts taken together indicate the process no longer was an in-control process

beginning in point 10 and becoming ever more like in points 18 and 19. Action

at that point should be taken to find and identify the malfunction in the health process.

This is not the end because MQC additional methods in software which may be

used when someone does not view that the assumptions of Hotellings MQC control

chart are fully justified.

Figure 3(a) and (b), present Multivariate EWMA analysis for the same data and

indicates the following results:

Multivariate EWMA Chart of X1,y, X3 [Figure 3A, Mean]

TEST. One point beyond control limits.

Test Failed at points: 10, 11, 13, 14, 15

Test Results for MEWMA Chart of X1,y,X3 [Figure 3B,

Variance]

TEST. One point beyond control limits.

Test Failed at points: 10, 11, 13, 14, 15, 19, 20

These results indicate that that the process was largely out of control beginning in

point 10 and extending to point 15 for the mean chart and including points 19 and 20 in

the variance chart. As with the previous set of MQC charts, we note a large difference

IJQRM (a) (Mean)

33,1 14

Multivariate EWMA Chart of X1, ..., X3

12

UCL = 10.81

10

36 MEWMA

8

4

Downloaded by Northumbria University, Mr Jeffery Tan At 02:28 11 November 2016 (PT)

0

1 3 5 7 9 11 13 15 17 19

Sample

(b) (Variance)

Multivariate EWMA Chart of X1, ..., X3

25

20

15

MEWMA

10 UCL = 10.18

Figure 3.

Multivariate EWMA 0

charts 1 3 5 7 9 11 13 15 17 19

Sample

in the results when we examine the three variables are together. Multivariate control

charts differ from the univariate chart in three ways:

(1) Multivariate charts simultaneously monitor correlated variables. To monitor

more than one variable using univariate charts, you need to create a univariate

chart for each variable.

(2) The scale on multivariate control charts is unrelated to the scale of the

individual variables.

(3) Out of control signals in multivariate charts do not reveal which variable or

combination of variables caused the signal.

Whenever the variables are correlated, multivariate control charts will achieve superior

perform. A correlation matrix will show whether the variables are cross correlated.

As we noted in the above charts, if the variables cross correlated, the use of separate

control charts is misleading because the variables jointly affect the process. If you use

separate univariate control charts in a multivariate situation, a Type I error and the

probability of a point correctly plotting in control are not equal to their expected values. TQM

The distortion of these values increases with the number of measurement variables movement in

stated differently, the results of the use of univariate analysis are biased.

When one finds the out of control point in a multivariate control chart, the solution is

public health

often not very simple. An out of control point will not easily indicate which or how

many of the variables give evidence of a special cause. When one finds out-of-control

points, one may wish to create separate univariate charts to investigate each variable. 37

However, one must interpret these charts with great caution since these charts do not

account for the multivariate nature of the process data. Last, there are additional topics

that can aid the data analysts in identifying the causes of processes being out of

control. These G and H (Benneyan, 2001) charts provide for monitoring the number

Downloaded by Northumbria University, Mr Jeffery Tan At 02:28 11 November 2016 (PT)

these methods are now included in various commercial quality control software,

i.e., Minitab, SAS and others.

We discussed the control chart usage and illustrate why better procedures are available

to supply chain managers. For example, we illustrated methods developed by Alwan

and Roberts utilizing residual chart analysis. Later we explored methods such as

West et al. transfer function application and traditional Multivariate Hotelling T2 chart

to monitor multivariate and multivariate serially correlated processes (those with

dynamic inputs). The scheme can be viewed as a generalization of Alwan and Roberts

special cause approach to multivariate cases. The guideline and procedures of the

construction of VAR residual charts are detailed in this paper. Molnau et al. (2001)

produces a method for calculating ARL for (MEWMA) charts (2001). Mastrangelo and

Forrest (2002) simulated a VAR process for SPC purposes. However, the general study

on VAR residual charts is heretofore not reported. In addition, more recent studies by

Kalagonda and Kulkarni (2003, 2004), and Jarrett and Pan, (2006, 2007a, b) indicate

additional ways in which one can improve upon the multivariate methods currently

available in commercial quality control software such as Minitab and others. These

newer techniques provide more statistically accurate and efficient methods for

determining when processes are in or not control in the multivariate environment.

When these methods become commercially available, practitioners should be able to

implant these new statistical algorithms for MPC charts using ARL measure to control

and improve output.

These new methods provide methods for MPC charts focussing on the ARL.

The purpose is to indicate how useful these techniques are in the supply chain

environment where processes are multivariate, dynamic or both. Simple SPC charts

though very useful in simple environments may have limited use in public health.

In any event, future research should focus on exploring the characteristics of the

public health and finding the best model to implement quality planning and

improvement programs. Multivariate analysis should provide many of the new tools

for adaption in improving health and water quality. The costs of, stoppages and

threats to the public health will diminish when managers explore the usefulness of

multivariate methods noted before. Last, these quality analysts much be trained,

retrained and continually trained in those methods that best fit the public health

environment. Simple Shewhart methods no longer are sufficient to manage in the

global environment of public health. The intensive use of automatic data acquisition

system and the use of computing for process monitoring have led to an increased

IJQRM occurrence of monitoring processes that utilize SPC. These analyses are performed

33,1 almost exclusively with multivariate methodologies. Often, today, analysts utilize G

charts when one desires to monitor the number of opportunities or, in many

cases, the number of days between rare events, such as infections or surgical

complications. For example, in cases of wrong-site surgeries, patient falls, infection

outbreaks, accidental needle stick and harmful medication errors. Last,

38 mathematical modelers in recent year have made great strides in predicting rare

events. This modeling method may show promise in the future to explain and

identifying rare events and is likely to produce newer and better methods for

improved quality control methods. Novak (2011) shows methods for treating the

cases of rare events in many applications that have similar statistical properties as

Downloaded by Northumbria University, Mr Jeffery Tan At 02:28 11 November 2016 (PT)

those in public health. If MPC is considered too complex for TQM, better methods

for constructing univariate control charts developed by Pan and Jarrett (2012)

may be useful.

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Further reading

Montgomery, D.C. (2005), Introduction to Statistical Quality Control, 5th ed., Wiley.

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observations, Journal of Quality Technology, Vol. 24 No. 2, pp. 88-95.

Corresponding author

Dr Jeffrey E. Jarrett can be contacted at: jejarrett@mail.uri.edu

For instructions on how to order reprints of this article, please visit our website:

www.emeraldgrouppublishing.com/licensing/reprints.htm

Or contact us for further details: permissions@emeraldinsight.com

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