12 A New Tool – Driver Diagrams A tool to help us understand the messiness of life!
13 What changes can we make? Primary DriversSystem components which will contribute to moving the primary outcomeSecondary DriversElements of the associated Primary Driver. They can be used to create projects or a change package that will affect the Primary Driver.
14 Stroke Driver Diagram Improve the outcome for people following stroke First hours bundleStart aspirinConfirmation of diagnosisRapid recognition tool e.g. ROSIERFirst day bundleSwallow screenAdmission to co-located bedsCT scanFirst 3 days bundlePhysiotherapy assessmentNutritional assessmentManual handling assessment36h continuous monitoringFirst 7 days bundleInformation sharing with patients/carersMDT goal setting meetingOT assessment commencedReduce the number of episodes of avoidable harmInterventions identified by the Global Trigger Tool analysis
15 Driver Diagram Exercise Establish stakeholder groupObjectivesDiscussion regarding concerns (group)Flipchart exercise (smaller groups)Sticky notes exercise (individual)Coffee!!Whilst this is taking place the notes are “themed”Stakeholders view themes (primary drivers)Group exercise to format driver diagram
20 How Will We Know We Are Improving How Will We Know We Are Improving? Understanding the System for Weight Loss with MeasuresHere is a theory about the drivers that impact my current weight loss campagin[BUILD1] Of course, every system is perfectly designed to achieve…[BUILD2] What would it take to achieve a NEW ME? Describe the drivers (alcohol drives both intake and outflow, the latter because it discourages exercise). Points to make:Secondary drivers have a clear impact on the outcomeSelection of secondary drivers to work on depends on where we start: if we’re already working out 5 days a week and fit, we’ll probably concentrate on intake; if we don’t drink, then we don’t need to consider that driver.Effective changes are idiosyncratic[BUILD3] Mention Donabedian’s categories, relate to the dietMeasures let us• Monitor progress in improving the system• Identify effective changes
21 Group WorkWorking in pairs, for an improvement aim arising from a national audit define the following:Primary driversSecondary driversPossible projectsAllow 10 minutes for this exercise
22 Guidance for testing a change concept A test of change should answer a specific question!A test of change requires a theory and a prediction!Test on a small scale and collect data over time.Build knowledge sequentially with multiple PDSAcycles for each change idea.Include a wide range of conditions in the test sequence.Don’t confuse a task with a test!29
23 The Model for Improvement Define the questionGather information and resources (observe)Form hypothesisGenerate new hypothesis and retestAnalyze and interpret dataPerform experiment and collect data
24 Why Test? Why not just implement then spread? Increase degree of beliefDocument expectationsBuild a common understandingEvaluate costs and side-effectsExplore theories and predictionsTest ideas under different conditionsLearn and adapt
25 Repeated Use of the PDSA Cycle Changes That Result in ImprovementModel for ImprovementWhat are we trying toaccomplish?How will we know that achange is an improvement?APWhat change can we make thatSDwill result in improvement?DATADSImplementation of ChangePAASPWide-Scale Tests of ChangeDHunches Theories IdeasAPFollow-up TestsSDVery Small Scale Test
26 The Sequence for Improvement Make part of routine operationsSpreading a change to other locationsTest under a variety of conditionsImplementing a changeActPlanStudyDoTesting a changeTheory and PredictionDeveloping a change
27 Group WorkWorking in pairs, devise a PDSA cycle to test an idea based upon a problem arising from a national audit.Note – your driver diagram exercise will have developed some ideas for testing!Allow 10 minutes for the exercise