1. Creating & communicating an improvement strategy Introducing driver diagrams

2. What is your aim ?

3. Driver Diagrams AIM – an improved system Primary driver 1 Primary driver 2 Secondary driver 1 Secondary driver 2 Secondary driver 3 Secondary driver 4 Secondary driver 5 CP1 CP2 CP3 CP4 CP5 CP6 CP7 AIMPRIMARY DRIVERS SECONDARY DRIVERS CHANGE PROJECTS

4. Avoid silver bullet thinking

8. Pedometer Gym work out 3 days Squash weekends No pub weekdays Take packed lunch Low fat meals Buy only 1 sandwich Water bottle for work bag Fruit for dessert Put away large wine glasses Put cycling days in diary Cycling kit out night before Get rid of Oyster card Take stairs 2 stone weight loss in 6/12 Generate Change Ideas

9. Pedometer Gym work out 3 days Squash weekends No pub weekdays Take packed lunch Low fat meals Buy only 1 sandwich Water bottle for work bag Fruit for dessert Put away large wine glasses Put cycling days in diary Cycling kit out night before Get rid of Oyster card Take stairs 2 stone weight loss in 6/12 Look for patterns

10. Pedometer Gym work out 3 days Squash weekends No pub weekdays Take packed lunch Low fat meals Buy only 1 sandwich Water bottle for work bag Fruit for dessert Put away large wine glasses Put cycling days in diary Cycling kit out night before Get rid of Oyster card Take stairs Be more active during the day Do sport Drink less alcohol Substitute lower calorie foods Eat less Marshall the mass of ideas 2 stone weight loss in 6/12

11. Driver Diagrams Weight loss example Pedometer Gym work out 3 days Squash weekends No pub weekdays Take packed lunch Low fat meals Buy only 1 sandwich Water bottle for work bag Fruit for dessert Put away the large glasses Put cycling days in diary Cycling kit out night before Get rid of Oyster card Be more active during the day Do sport Drink less alcohol Substitute lower calorie foods Eat less Reduce calories in Reduce calories in Increase calories out Increase calories out Take stairs 2 stone weight loss in 6/12

12. AIMPRIMARY DRIVERS SECONDARY DRIVERS CHANGE PROJECTS Reduce hypos in insulin treated patients Prescribing Self adjustment Monitoring Dealing with early hypo How much? By when? Choice of insulin Adjust for hot weather Adjust for time zone Adjust for exercise Adjust for food At every appointment By family / friends Recognition CP1 CP2 CP3 CP4 CP5 CP6 CP7 CP8 CP9 CP10 CP11 CP12 How much? By when? Taking action Example

13. AIM Improve access 2. Help marshal change ideas Waiting room info, list clinician interests/languages, web info, Rx access (Feel Better Faster), signpost more (WIC/HV/minor inj/Secs/DNs/A&E), Chronic disease training, care planning, review periods, get it right first time, test results processing, teamworking/multiskilling, results line hours, protocols for test results, widen skill mix, BP machine in watiting room, update rpt Rx, pharmacist planning, streamline processes, streamline recalls, education & reflection, up-to-date pt contact details, know what appt is for, pt registration management, Triage, Care planning / pathways, more TelC, emailC, clinical buddies/teams, test results, repeat Rx, forwarding tasks + results, check + update usual GP, results actioned by right person, advance appt booking, reserve list, ask pt who they want, rota in advance, notekeeping w plan + pt info, Consult skills, comp skills, speed reading/typing, forms + equipment, multi-skilling, longer appts, No emerg appts, Test results, Care planning, High risk processes, Referral chase-up, results continuity, streamline processes, streamline recalls, clear up alerts, handling of normal results, self-checkin, fast-track queue

14. AIMPRIMARY DRIVERS SECONDARY DRIVERS CHANGE PROJECTS Improve access

15. AIMPRIMARY DRIVERS SECONDARY DRIVERS CHANGE PROJECTS Improve access Doctors (capacity) Demand Dealing (efficiency) Appt system Supply of GP time Organisation of GP time Pt help-seeking Deflecting demand Creating our own workload Planning care Appt system project GP rota change project Community education Waiting room TV PILS & CDs & DVDs Feel better faster Student sick notes Reception signposting Test results Consulting skills Longer appts Guaranteed interpreters Dealing w failed referrals Chronic disease pathways Review periods More TelC’s Email appts Continuity

17. Software for driver diagrams – PowerPoint – Dia – Freemind – VUE – MindMeister – MindJet