1. Communication Summit 26th October 2016
Welcome

2. What’s in store…
This session will provide an opportunity to develop a draft driver diagram. This includes: Agreeing Aims for Improvement Measurement Introduction Plan, Do, Study, Act Cycle (PDSA) Driver diagrams – focus of our session
Welcome

4. All improvement requires change, but not all changes are an improvement
A vision – capable of stirring the heart of the community and able to serve as a constant
reference and anchor point as the change moves forward.
A story – to enable people to recognise where they have been and where they are going.
A set of actions – to take us to the next steps towards releasing the vision.
A clear framework for improvement.
A strategy to engage and empower the workforce - to provide the stimulation,
development and opportunity our staff need to fully release their deep commitment to public
service.
An understanding of how change will work locally (everywhere) – recognising
communities are different and creativity should be nurtured and released at a local level.
A guiding coalition – a team of key people to drive the change when the going gets tough,
and to sustain support.
Aim- Is there an agreed aim that is understood by everyone in the system?
Correct changes - Are we using our full knowledge to identify the right changes and priorities those that are likely to have the biggest impact on our aim?
Clear change method- Does everyone know and understand the method(s) we will use to improve?
Measurement- Can we measure and report progress on our improvement aim?
Capacity and capability - Are people and other resources deployed in the best way to enable improvement?
Spread plan- Have we set out our plans for innovating, testing, implementing and sharing new learning to spread the improvement everywhere it is needed?

5. Just a quick refresh- teach grandma to suck eggs

6. Model for Improvement Act on the plan - Testing
That’s where the Model for Improvement comes in. It hands the power back to front line and supports people to find processes that deliver
i.e. doing the right things right
Focus on the thinking if we don’t create a plan that people can understand they will Thinking

7. A good aim… Attributes of an aim: WHAT, HOW MUCH and BY WHEN
Specific
Timed
Aligned
Numeric
Attributes of an aim: WHAT, HOW MUCH and BY WHEN
We are going to focus on SPECIFIC and Aligned-
Clear sense of what we are trying to accomplish
it can be high level (large population/large system) or low level (focussed on small group/one department)
Clearly states objectives
Aligned – with the aims of the collaborative/programme and the strategic goals of the organisation.
What Deming meant by “aims create systems”

8. Why are you collecting data?
Start to think about what data there is –
Outcome- Voice of the customer or user. How is the system performing? What is the result
Process - Voice of the workings of the system. Are the parts/steps in the system performing as planned
Balancing- Looking at a system from different directions/dimensions. What happened to the system as we improved the outcome and process measures (e.g. unanticipated consequences, other factors influencing outcome)?
Improvement?

9.  Do  Study  Act  Plan  Do  Study  Act
“What will happen if we try something different?”
“What’s next? ”
Welcome
“Did it work?”
“Let’s try it!”

10. Why test changes?
To learn how to adapt the change to conditions in your setting
Increase the belief that the change will result in improvements in your setting
Minimise resistance when spreading the change throughout the organisation
If you roll out a fully formed plan and it doesn’t work it gets shelved.
Testing allows for tweaking and improvement so that good ideas aren’t abandoned before they’ve been given a real chance.
The more tests you do, the more evidence of you ability to adopt.
Adapt: taking preexisting knowledge but making it locally relevant
Minimise resistance – people buy in when you are able to offer them solutions and work arounds before implementation
Side effects – you will have balancing measures in place so that you are not at risk of missing the impact of your work on the bigger picture.
Evaluate the costs and “side-effects” of changes

11. Why a driver diagram?
Supports the team to explore all factors that will help achieve the aim
Helps identify measures
Provides an improvement route map
Communication tool
There are various mechanisms for mapping out an improvement plan – this is helpful because it is visual and interactive – it is also fluid – the outcome aim should not change but processes and change ideas may be adapted/altered as the learning journey progresses.
Developing a locally agreed driver diagram for your improvement priority will help you engage the people you need on board and provides a shared vision for the work
Explore all factors – people see where they and their ideas fit into the bigger picture
Clearly maps work that is relevant to your aim.
Handy comms tool – it is a handy shorthand for making sure people understand your aim. shows your whole strategy on one page

12. Driver Diagram for Quality Improvement in…
Theories about what drives this work for QI
Aim
Primary drivers
Secondary drivers
Tests of change
Secondary factors which will
influence delivery of the
primary drivers
The changes or
proposed
interventions that can be
tested out to achieve
the secondary drivers
A network
of factors
that drive the
outcome/aim
Aim statement:
general description
of desired
Improvement
(what, how much
by when)
Here’s a schematic view of a system – a ‘driver diagram’. On the left we depict the outcome.
As we move right we drill down into the network of causes that drive the outcome, from ‘primary’ to ‘secondary’ drivers.
On the right we depict the ideas for system changes that might ultimately impact the outcome.
This diagram represents our theory about how to modify the system to change the outcome.
Primary Drivers
Key system factors which will contribute to moving the outcome aim
Secondary Drivers
A number of elements of the associated primary
driver. They can be used to create projects or a
change package that will affect the primary drivers and
ultimately the outcome aim
and then….. your change ideas
The ideas you will take forward as tests with PDSA tests directly supporting delivery of the drivers

13. Driver diagram for a new healthier me!
Aim
Primary drivers
Secondary drivers
Tests of change
Reduce daily
intake
Low fat foods
CALORIES IN
Substitute low
Calorie meals
Plan meals in
advance
A NEW
HEALTHIER
ME!!
Reduce weight
by 1 stone
in 3 months
Limit alcohol
intake
Keep to shopping
list
Drink water not coke
CALORIES
OUT
Exercise regime
Gym 5 x per week
Increased activity
at work
Cycle to work
Use stairs not lift

14. Driver diagram for a new healthier me!
Aim
Primary drivers
Secondary drivers
Tests of change
Running calorie count
Ave. Cal/day
Limit daily intake
Track calories
CALORIES IN
Substitute low
calorie
Plan meals
Meals off plan/week
% of opportunities used
Daily calorie intake
A NEW
HEALTHIER
ME!!
Reduce weight
by 1 stone
in 3 months
Limit alcohol
intake
Keep to shopping
list
Avg. Drinks per week
Drink water not coke
CALORIES
OUT
Exercise regime
Non water drinks/week
Gym 5 x per week
Weight
BMI
Body Fat
Waist size
Fitness pal
Calories burned/day
Activity at work
Cycle to work
Use stairs not lift
A Family of Measures aid monitoring progress in improving system.
Improving reliability right to left results in outcome

15. Activity
Remember a primary driver- is a Key factor that deliver the aim
Each person (alone) takes a bunch of post it notes and thinks about the things that need to happened to enable us to reach our aim.
10 minutes
Table discussion- what points are similar on each table-
15 minutes
Take post it put on wall/ delegate from each table start to group together-
Those at the table start to think about what the themes where- Can we name them?- Access -

16. Reflections Have we agreed our aims? Do we have a few primary drivers?
Over lunch I will group the drivers- (name them with working titles)
After our afternoon session we will replicate this process to look at the secondary drivers
Q &A
thanks

17. Activity
Remember a Secondary Driver- is a number of activities that will influence delivery of the primary drivers
Replication of the AM session
Spit the group according to the theme/ topic of the primary drivers-
People can move to the most appropriate table.
Each in the group will look at the primary driver and think what things do we need to do to achieve this driver
Each person (alone) takes a bunch of post it notes and thinks about the things that need to happened to enable us to reach our aim.
10 minutes
Table discussion- what points are similar on each table- start to group these together the way we did this morning – start to name them.
On a flip chart start to write the drivers for this PD
30 minutes
Spokes person from each table to talk through the secondary drivers-
Each table feedback then puts the driver on the wall.
AC or SH to talk through what picture is forming.

18. What do we need to do to achieve the aim we have set?
Do we have the skill/ resource/ ability in the room?
If not who is missing?
Where do you start?
Think about the team?
Go back to the data that we skimmed over before let it guide you
Q&A