Process Analysis Tools

Scatter Diagram
A scatter diagram is a graphic representation of the relationship between two variables. Scatter diagrams help teams identify and understand cause-effect relationships This tool contains: Directions for Creating a Scatter Diagram Sample Scatter Diagram: Reimbursement vs. Mortality Rate

Institute for Healthcare Improvement Boston, Massachusetts, USA

Copyright 2004 Institute for Healthcare Improvement

Scatter Diagram Directions 1. Gather the data; determine the high and low values for each factor. 2. Decide which factor will be plotted on which axis. a. Theorizing a cause and effect relationship, put the suspected cause on the horizontal axis, and the suspected effect on the vertical axis. 3. Draw and label the axes clearly. a. Make the axes roughly the same length, creating a square plotting area. b. Label each axis with increasing values from left to right, and from bottom to top. c. Label each axis to match the full range of values for that factor. In other words, make the lowest numerical label slightly less than the lowest data value, and the highest label slightly greater than the highest value. The data should fill the whole plotting area.

4. Plot the paired data. a. Use concentric circles (or offset dots) to indicate identical paired-data points. b. Differentiate distinct strata by using filled vs. unfilled symbols, or different colors. 5. Title the chart and provide necessary annotations to describe what it shows. 6. Identify and classify the pattern of correlation shown by the plotting of the data. 7. Identify what you have learned; decide on your next steps.

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Copyright 2004 Institute for Healthcare Improvement

Scatter Diagram Sample Scatter Diagram: Reimbursement vs. Mortality Rate This sample scatter diagram shows the relationship between the level of reimbursement (Xaxis) and the risk of death in the hospital (Y-axis). Standardization elements used in creating the scatter diagram include the following: Use of diagnoses that account for 80% of the deaths Development of cells related to patient-specific risk factors, for example diagnoses, age, and method of admission Comparison of the risk of death in the hospital across all cells to the risk of death in these cells for all patients in the sample (e.g., a hospital with a standardized death rate equal to the national average would have a Hospital Standardized Mortality Rate (HSMR) of 100; an HSMR greater than 100 indicates a higher than expected death rate) Adjustment of the HSMR for community factors such as the burden of illness U.S. Medicare Data (2000): Age, Diagnosis Standardized Reimbursements vs. Regression Adjusted Hospital Standardized Mortality Rate (random 250 hospital sample)

HSMR (regression adjusted)

180 160 140 120 100 80 60 40 20 0

$0 $2,000 $4,000 $6,000 $8,000 $10,000 $12,000 $14,000

Age and diagnosis directly standardized reimbursement

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Copyright 2004 Institute for Healthcare Improvement