| Course | HA 645 Quality Improvement and Patient Safety in Healthcare |
|---|---|
| Unit | Unit 6 |
| Paper type | Run chart analysis |
| Length | About 950 words, 6 pages |
| Format | APA 7 student paper |
| School | Herzing University |
| Program | MS in Healthcare Administration |
| Updated | October 2026 |
Free sample paper for HA 645 Unit 6
From 30% to 75% of Nodule Patients Notified Within 14 Days: A Run Chart Analysis of Two Changes, Read by Named Rules
Student Name
Health Care Administration, Herzing University
HA 645: Quality Improvement and Patient Safety in Healthcare
Instructor Name
February 19, 2026
From 30% to 75% of Nodule Patients Notified Within 14 Days: A Run Chart Analysis of Two Changes, Read by Named Rules
Process, Measure and Interval
Process: notifying a patient's primary care physician, or the patient directly when there is none, of an incidental lung nodule found on an emergency department chest CT, with the recommended follow-up, a step that published work shows often fails even when the report is clear (Blagev et al., 2016). Measure: the leading measure from the specification written earlier this term, the percentage of emergency department patients with a follow-up recommendation for an incidental nodule whose physician or who themselves received written notice within 14 days of the final report. Because the structured report statement was not yet required, cases were identified by a weekly search of final chest CT reports for a nodule with a follow-up recommendation. Interval: weekly, by week of the final report, reported 14 days after the week closes. Each weekly point rests on 5 to 8 patients, so single points move by 15 to 20 percentage points with one patient, and the analysis relies on rules that look at patterns rather than at any one week.
The Data and the Changes
Twelve baseline weeks from September 8 to November 30, 2025 set the median. Change 1, introduced December 1: the emergency department callback nurse sends a templated letter to the primary care physician and the patient for every identified nodule. Change 2, introduced January 5, 2026: the nurse navigator telephones every identified patient who has no primary care physician, schedules the follow-up scan and arranges a primary care appointment.
| Week | Patients | Notified within 14 days | Percent | Phase |
|---|---|---|---|---|
| 1 to 12 (Sept 8 to Nov 30) | 6, 6, 5, 8, 6, 5, 6, 7, 6, 6, 5, 8 | 2, 1, 2, 2, 2, 1, 3, 2, 1, 2, 2, 2 | 33, 17, 40, 25, 33, 20, 50, 29, 17, 33, 40, 25 | Baseline |
| 13 to 17 (Dec 1 to Jan 4) | 6, 7, 7, 5, 6 | 3, 4, 3, 3, 3 | 50, 57, 43, 60, 50 | Change 1: letters |
| 18 to 22 (Jan 5 to Feb 8) | 6, 7, 6, 8, 5 | 4, 5, 5, 6, 4 | 67, 71, 83, 75, 80 | Change 2: navigator calls added |
| Phase totals | 74 / 31 / 32 | 22 / 16 / 24 | 29.7 / 51.6 / 75.0 |
The Run Chart
Plotted in time order, the 22 weekly percentages sit on a horizontal axis of weeks, with the baseline median of 31% drawn across the whole chart. The baseline median is the middle of the 12 baseline values, between 29% and 33%. A vertical annotation marks week 13, labeled "Change 1: letters," and a second marks week 18, labeled "Change 2: navigator calls." In the baseline, points scatter above and below the median between 17% and 50%. From week 13, every point sits above the median, first in a band from 43% to 60%, then from week 18 in a higher band from 67% to 83%.
Reading the Chart by Named Rules
The analysis applies the standard run chart rules, which are designed to detect signals of change while holding the chance of a false signal low (Perla et al., 2011).
Shift: a signal requires an unbroken string of six or more points on one side of the median line. Weeks 13 through 22, ten consecutive points, all lie above the median. This is a signal, and it begins at the week Change 1 started.
Trend: a signal requires at least five points in a row, each higher than the last or each lower. The longest run of increases is weeks 17 to 20 (50, 67, 71, 83), four points, which does not meet the rule; week 21 fell to 75. No trend signal.
Runs: a run is any stretch of points that stays above the median, or stays below it, before crossing. The chart has 11 runs across 22 points. For 22 points, chance alone would commonly produce a run count of that size, so the runs rule gives no separate signal; the shift rule already captures the change.
Astronomical point: none. No single week is dramatically different from all others.
Common cause variation is left alone. In the baseline, the swing from 17% to 50% reflects chance at five to eight patients a week and is not investigated week by week. After Change 2, the dip from 83% to 75% is also within the noise of a small sample and is not treated as a problem.
Which Movement Belongs to Which Change
The shift begins at week 13, when letters began, and the phase totals rise from 29.7% to 51.6%. The second rise, to 75.0%, begins at week 18, when the navigator began calling patients without a primary care physician. Of the 32 patients in the third phase, 9 had no primary care physician; 7 of them were reached and notified. The letters alone could not reach those patients, because a letter to a patient with no physician often goes unread. The pattern is consistent with each change doing what it was designed to do, though a run chart can show only association in time, not prove cause.
Balancing Measure
Letters added work for the callback nurse, the same role whose worklist volume contributed to the missed follow-up in the safety event review. The average time for the callback nurse to close the worklist each morning rose from 3.1 hours in the baseline to 4.4 hours in December and January. That is a real cost, and on a heavy morning it could reproduce the conditions that caused the original event.
Decision: Adapt
The test is adapted rather than adopted as it stands. Both changes worked and will continue. But letters will move from the callback nurse to the nurse navigator from March 2, so that the gain does not come at the cost of the worklist that failed before. When the structured incidental-finding statement becomes mandatory in June, the weekly keyword search will be replaced by the structured list, and the run chart will continue on the same median to see whether the gain holds through the handoff of work. This follows the plan, do, study, act sequence of the Model for Improvement, in which a successful test is often adapted before it spreads (Langley et al., 2009). The completion measure, whether follow-up scans actually happen, will not be known for the December cohort until early 2027.
References
Blagev, D. P., Lloyd, J. F., Conner, K., Dickerson, J., Adams, D., Stevens, S. M., Woller, S. C., Evans, R. S., & Elliott, C. G. (2016). Follow-up of incidental pulmonary nodules and the radiology report. Journal of the American College of Radiology, 13(2), R18-R24. https://doi.org/10.1016/j.jacr.2015.12.008
Langley, G. J., Moen, R. D., Nolan, K. M., Nolan, T. W., Norman, C. L., & Provost, L. P. (2009). The improvement guide: A practical approach to enhancing organizational performance (2nd ed.). Jossey-Bass.
Perla, R. J., Provost, L. P., & Murray, S. K. (2011). The run chart: A simple analytical tool for learning from variation in healthcare processes. BMJ Quality & Safety, 20(1), 46-51. https://doi.org/10.1136/bmjqs.2009.037895
The Herzing HA 645 Unit 6 instructions
Unit 6 asks you to analyze a run chart for a quality improvement test. Expect to define the process, measure and interval, describe the data and changes, present the chart, apply named rules, link movement to changes, report a balancing measure and decide whether to adopt, adapt or abandon. Students often ask which rules to use and how many baseline points are needed. Use the standard shift, trend, runs and astronomical point rules, and state each threshold before applying it. Aim for at least ten to twelve baseline points. Annotate the chart where each change began. Check a balancing measure, since gains can create strain elsewhere. Tie the decision to what the chart and the balance together show.
How this HA 645 Unit 6 example is built
The analysis opens with the notification process and why it often fails even when reports are clear. The data section lists the baseline period and the dates of both changes. The chart section describes the axis, the median line at 31% and annotations marking each change. The rules section applies each rule in turn, showing a shift of ten consecutive points above the median and explaining why no trend or astronomical point signal was claimed. The attribution section shows the first rise when letters began and the second when navigator calls started, with most patients lacking a physician now reached. The balancing section reports the callback nurse's worklist time rising from 3.1 to 4.4 hours. The decision moves letters to the navigator.
Where the points sit in the HA 645 Unit 6 rubric
Herzing's rubric for a run chart analysis usually covers the process and measure, data and changes, the chart, application of rules, attribution, balancing measures and the decision. Applying named rules with stated thresholds weighs most, because reading a chart by eye invites seeing improvement that is only noise. Measure points reward a clear definition and interval. Data criteria look for enough baseline points and dated changes. Chart credit goes to a median line and annotations. Attribution points reward linking each shift to a specific change. Balancing measures are often credited when they reveal hidden costs. The decision should follow from both signal and balance. Perla, Provost and Murray on run charts, Langley's improvement guide and Blagev's nodule study support the analysis.
HA 645 Unit 6 help: mistakes that cost points
Run chart analyses in HA 645 Unit 6 often come up short by declaring success from a few high points. Another frequent problem is applying rules without stating their thresholds. Students often use too few baseline points. Changes are not annotated, so attribution is guesswork. Two changes are credited as one. No balancing measure is checked. The decision ignores strain created by the change. The median is calculated from all points instead of the baseline. Percentages are plotted without the counts behind them, which hides how small some weeks are. Finally, name each rule before you use it, because graders reward an analysis that would reach the same conclusion if someone else read the chart.
Get a HA 645 Unit 6 example written to your instructions
Send the Unit 6 instructions and the rubric from your HA 645 classroom, plus the process and the change you are testing, with any data points you are allowed to share. We write a custom example with an annotated chart, the run rules applied by name and an adopt, adapt or abandon decision, returned in 24 to 48 hours. The first custom sample is free.
More HA 645 papers and healthcare administration samples
- HA 645 Unit 1: Public reporting brief
- HA 645 Unit 2: Measure specification
- HA 645 Unit 3: Event reporting system audit
- HA 645 Unit 4: Safety event review
- HA 645 Unit 5: Quality improvement analysis
- HA 645 Unit 7: Safety culture assessment
- HA 645 Unit 8: Quality dashboard specification
- HA 630 Unit 6: Digital campaign plan
- HA 635 Unit 6: Discipline case file
- HA 640 Unit 6: Decision matrix
- HA 695 Unit 6: Post-implementation evaluation plan
HA 645 Unit 6 questions, answered
Run chart or control chart for this unit?
Read the instructions first, since some sections name one. Where the choice is yours, a run chart needs fewer points and supports the shift, trend and run rules well enough for a small test, while a control chart adds limits and tells you when a process is stable in a stricter sense. Pick one, say why it fits your data, and apply its rules rather than borrowing from both.
How many data points does the analysis need?
More than most drafts collect. Ten to twelve baseline points give the median something to stand on, and the pattern rules need a comparable stretch after the change before they can fire. If you have only a handful, say so, present the chart as an early look and argue for continued collection rather than declaring a result the points cannot carry.
Can I use figures I made up for the chart?
In many sections illustrative data is expected, and the instructions will usually say whether real numbers are required. Where you construct the series, label it as illustrative and keep it plausible: real processes wobble, and a clean staircase toward the target tells a grader nothing was measured. Never present constructed figures as your organization's actual performance.
Where can I find a free HA 645 Unit 6 sample paper?
The full HA 645 Unit 6 run chart analysis is free on this page, nodule notification rising from 30% to 75% with named rules and a balancing measure. An analysis of another improvement test can be written to order.
What are the run chart rules?
Common rules are a shift of six or more points on one side of the median, a trend of five or more points rising or falling, too few or too many runs and an obviously unusual point. This sample applies each.