Driver Diagrams: Improvement Theory

Jim Handyside

Improvision Healthcare Inc

1

Purpose

• To become familiar with driver diagrams.

• To recognize the input required for the development of improvement theory.

• Differentiate the driver diagram from other similar planning and improvement tools.

2

Why Theory? Effective change is not a “black box”.

Improvement

Aim

A new

process,

system,

culture… ?

3

A “simple” personal improvement

Improve my health and well being

Better mental health

Better physical health

4

A “simple” personal improvement

Better mental health

Better physical health

Burn more

Reduce Weight

Consume less

5

A “simple” personal improvement theory

Burn more

Reduce Weight

Consume less

Change Daily routine

Standing Desk

Walk to work

Start Exercise

Return to sport

Lunch time walks

Measure (app)

6

My improvement project

Burn more

Reduce Weight

Consume less

Change Daily routine

Start Exercise

Standing Desk

Walk to work

Return to sport

Lunch time walks

Measure (app)

7

A simplified quality improvement

Reduce falls resulting in

harm by 50%

Risk Identification

Multifactorial risk assessment

Multifactorial interventions

Communication of fall risk status

Education of staff, patient, and family/carer

10 secondary drivers

45 change ideas and concepts

Ref: Falls Prevention Driver Diagram and Change Package NHS

8

“Experience by itself teaches nothing… Without theory,

experience has no meaning.”

W. Edwards Deming(from: The New Economics)

9

Theory Definition

(Oxford English Dictionary)

A supposition or a system of ideas in intended to explain something…

An idea used to account for a situation or justify a course of action.

10

Two kinds of causal theory diagrams:

Fishbone:Team theories about what IS causing an effect.

Driver Diagram:Team theories about what changes WILL result in improvement.

Account forpresent situation

Justifyaction (change)

11

Anatomy of Driver Diagram

See article: What’s Your Theory

ImprovementAim

PrimaryDrivers

SecondaryDrivers

Direction of cause or influenceChange

Ideas

12

Change is an expression of theory

Thinking

Change ideas:

ProcessEliminate wasteKnowledge, skill

Behavior Technology

Etc.

(bundle)

Action

13

AIM

HOWHOW

HOW

HOW

HOW

HOW

build theory

14

AIM

WHYWHY

WHY

WHY

WHY

WHY

Rationale for change15

Careful with your logic…Is education a secondary driver?

Reduce falls resulting in

harm by 50%

Risk Identification

Multifactorial risk assessment

Multifactorial interventions

Communication of fall risk status

Education of staff, patient, and family/carer

Ref: Falls Prevention Driver Diagram and Change Package NHS

16

Work Breakdown Structure (type of tree diagram)Project Management

17

Work Breakdown Structure

Project Name

A: Planning Deliverables

A1: Charter & Other Planning Docs

A2: Driver Diagram

A3:Implementa-tion Plan*

B: PDSA Implementation

B1: Information Package

B2: Recruited Sites

B3: Prepared Sites

B4: Designed & Test PDSAs

B5: Implement PDSA(s)

B6: Analyzed Outcomes

C: New/Improved Process

C1: Lessons Learned

C2: New Standard Process

C3: Plan for Spread

C4: Implemented & Spread Process

QI Project schematicRef: Alison Paprica, PhD, PMP18

Your theory, driver diagram and PDSA

19

PDSA to develop/test change AND confirm or adjust theory

20

You need measurement to test theory

21

Improvement theory inputs

1. Evidence

2. Experience

3. Other’s improvement

4. Analysis of your current state

……

22

1. Compile inputs:• Evidence• Experience• Other’s improvement • Analysis of current situation

2. Sort, organize build primary and secondary drivers

Sticky note exercise

Or use a template document

DRAFT!

(it’s a draft until you know what worked or didn’t and why.)

Getting started:

23

@CFHI_FCASScfhi-fcass.ca |

Thank You!

Two articles:What’s Your Theory?

Demystifying Theory and Its Use In Improvement