Measuring quality of medical practice is a key component in improving efficiency in health care.It is becoming increasingly prominent in quality management. At present, risk-adjusted monitoring tools are only used to monitor clinical failures. By using a sensitivity analysis, real life applications and simulated examples, we demonstrate that it is not sufficient to solely monitor clinical failures. In this paper, we propose to jointly monitor clinical failures and predisposed risks of patients. This joint monitoring is not just necessary but also essential to avoid making erroneous inferences based on clinical failures when the predisposed risk distribution has changed. We also proposed a new charting procedure to monitor the risk distribution. The design of the joint monitoring scheme is described in detail by using a real data set.

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