1. Practice Improvement – Making Quality Improvement Work for You
A series of Small Group Learning Sessions:
Session 3: What Changes Can We Make That Will Result in an Improvement?
Session Date
Presenters’ Name(s)

2. Faculty/Presenter Disclosure
Speaker’s Name: Speaker’s Name
Relationships with commercial interests:
Grants/Research Support: PharmaCorp ABC
Speakers Bureau/Honoraria: XYZ Biopharmaceuticals Ltd
Consulting Fees: MedX Group Inc.
Other: Employee of XYZ Hospital Group
Please fill out all applicable areas (highlighted in red). One slide per speaker.

3. Disclosure of Commercial Support
This program has received financial support from [organization name] in the form
of [describe support here – e.g. educational grant].
This program has received in-kind support from [organization name] in the form
of [describe the support here – e.g. logistical support].
Potential for conflict(s) of interest:
[Speaker/Faculty name] has received [payment/funding, etc.] from
[organization supporting this program AND/OR organization whose product(s) are
being discussed in this program].
[Supporting organization name] [developed/licenses/distributes/benefits from
the sale of, etc.] a product that will be discussed in this program: [enter generic
and brand name here].
Please fill out all applicable areas (highlighted in red).

4. Mitigating Potential Bias
[Explain how potential sources of bias identified in slides 1 and 2 have been
mitigated].
Refer to the College of Family Physicians of Canada’s “Quick Tips” document.
Please fill out all applicable areas (highlighted in red).
Please visit the following link for the CFPC’s “Quick Tips” document:

5. Agenda Welcome Review of Action Plan Brief content review (5 min)
Change Ideas (20 min)
Partner activity (10 min)
Break (10 min)
PDSA
Core concepts
Videos
Partner activity – PDSA (20 min)
Action Planning

6. Introductions: Peer Mentor and RST Coordinator
Please introduce yourselves and emphasize the working together/helping each other atmosphere, not just between Peer Mentor and RST but among each other (eg. Peer Mentor and audience)
Peer Mentor to provide example of case highlighting benefits to patients, practice and the physician experience. (ie your story about QI experience)

7. What is a SGLS?
Focus on application of knowledge and practical problem solving
Group of physicians and practice team members
Short &
Interactive
Session
Ongoing support
Action Plan
In-Practice visit with RST
Integrated Learning Package
Facilitators: Peer Mentors & Regional Support
Team Coordinators/Coaches
Small Group Learning Sessions (SGSL) are offered by the Practice Support Program (PSP) as a result of demand for short, accessible training sessions on priority content.
Small groups of physicians (and in some cases their teams) get together for short, interactive education sessions that are certified by the College of Family Physicians of Canada for group learning credits.
Peer Mentors guide participants through the content, encouraging questions and discussion throughout.
There is a focus on applying knowledge and lots of support for integrating session learnings and applying them in the practice.
Lots of options for ongoing support and learning
Sessions provide opportunity for both social and educational learning

8. Housekeeping www.gpscbc.ca/psp-learning/
Please put your cells on vibrate or turn them off. We appreciate that you may need to step out to take urgent calls. Please feel free to do so, but - as a courtesy to others - please keep your phones on vibrate.
Washrooms are here and there. We know emergencies sometimes come up so please feel free to leave the room if you need to take a call
We’ll be taking a 10 min coffee break at _____ and then there will be ______ when we finish at ______
Timing – We have two and half hours together today, and we’re going to work really hard to stick to this. We will be providing timelines for the activities and we ask for your help in keeping us all on track! We’ve tried to account for quite a lot of discussion and interaction time, so our hope is that we can achieve our timelines and get your questions answered. That being said, if we move on from a topic that you’d like to discuss further or get more information on, please make a note and let the RST know after the session; they can help make sure that you get what you need in an in practice visit.
We have a post session evaluation and ask that you fill it out carefully so that we can share it with the provincial office and try to integrate improvements to these sessions– in the true spirit of quality improvement!

9. Learning Objectives
Generate ideas for change collaboratively with your practice team.
Describe the function, value, and process of PDSA cycles
These are the learning objectives that we’ve committed to. You will leave the session ready to take these on, and know where and how to access support to do so.

10. Action Plan Report Out Share your Action Plan work.
Challenges, learnings.
30 minutes for this - can do table discussion, partner discussion in conjunction with group discussion. Depends on the size and composition of the group.
Options for discussion:
Ask someone from the audience to share their action plan and discuss what went well and what improvements could have been made?
Did what you learned in the second session support developing a viable action plan?
Turn and introduce yourself to your neighbor, and talk about the work they did in their Action Plan. You might discuss identifying opportunities for improvement in your practice or pain points identified by the team, what learnings from the last session that you integrated and why, how your office team responded to this work, and what challenges you encountered.
Prompt:
Was there anything from the last session that you did with us that might change your approach to your next QI project?

11. Review - Steps for QI project
Decide what needs to improve?
Build a team who knows about the process.
Clarify what the current process is.
Brainstorm ideas and test changes.
Implement sustainable changes.
Share learnings.
Hopefully this diagram looks familiar from prior sessions.
We are going to pick up where the prior session left off, and will focus on the green bubbles today. Before we get started, however, let’s do a quick warm up and review of our process.
I will start to outline the steps for a QI process – please just jump in and answer my questions…
The first step - Decide what needs to improve?
Here you are asking – what are you interested in? What is the problem that you want to address? What is important right now?
What format have we suggested putting this question into?
Prompt: A problem statement
Build a team who knows about the process. What are some useful questions to ask and try to answer in supporting building a team?
Prompt: “The Three Whos.” activity from the first session:
Who Needs To Be Engaged In This Inquiry?
Who knows? – about the situation/opportunity, or who has the information we need to solve it/realize it
Who cares? – that something is done about it
Who can? – do something about the solution
Some potential people who might be involved in your improvement team might include:
Eg. EMR vendor, PSP EMR support, RST/Peer Mentor, MOA, other physicians
Clarify what the current process is.
What are some approaches to this?
Prompt: Asking why! Using root cause analysis or other tools like driver diagrams to dig deep into the process and why it happens the way it does. Collecting data to quantify the current process is also a valuable activity to pursue at this point – it will set you up well for the next steps. We will talk about this more today.
Brainstorm ideas and test changes.
What changes could help improve the current process and address the opportunity/problem/interest?
This step is most effective as a brainstorm because people at different points of the process will have different perspectives and ideas – a collaborative discussion about change ideas can help find different ways to attack the issue. Testing changes requires collecting and using data so we can see if the changes are having the desired effect.
Implement sustainable changes.
After you’ve tested your ideas and found which is most effective, you can move to implementing this change in your practice. It’s important to take the time to understand which ideas are worth implementing, and which should be abandoned altogether – or first adopted.
Share learnings.
When you find something that works, it’s important to celebrate this and share your learnings with others – colleagues, clinics, etc. If all the members of your team are engaged in improvement and share your successes with their peers – you will all have more opportunities to learn from each other.
QI is an iterative process – you may move onto brainstorming ideas with your team and realize you still need more data, that you are missing a key person on your team, or even that you still have different ideas about what needs to improve. That’s okay. This is just part of the process and shows you are working hard.

12. Model of Improvement & PDSA
Aim Statements
Measures
Change ideas
Each PDSA cycle repeats the questions for a very specific, narrow question.
Think back to the video – there are several core questions that it’s important to ask when starting out and thinking about making improvements in your practice.
The model of improvement and PDSA cycles provide a structure through which to operationalize many of the steps for QI projects we will continue to discuss.
What are we trying to accomplish?
How will we know that a change is an improvement?
What change can we make that will result in improvement?
From this point, you start to run PDSA cycles, which repeat the questions for a very specific, narrow question.

13. What changes can we make that will result in improvement?
Model for Improvement
What are we trying to
accomplish?
_______________________________
How will we know that a
change is an improvement?
_______________________________________
What changes can we make that
will result in improvement?
Choose change ideas to test through a PDSA cycle.
In earlier sessions, we focused on the first two parts of the Model for Improvement. In this session we finish our exploration of the model, and move into talking about generating change ideas and using PDSA cycles for practice improvement.
It’s important to note that the process of thinking about and selecting change ideas should come after you have a solid understanding of what you are trying to accomplish, and how you will know that a change is an improvement. Some folks will naturally gravitate to thinking of solutions first- or may have even already started doing this. However – this will result in imposing your solution onto a problem you may not fully understand – or that your team may understand differently than you do.

14. Core Concepts – Change Ideas
Try challenging your “constraints”
Try new ideas
Try old ideas – context is everything!
Try many ideas from many different places
Try involving your practice team
….TRY!
Coming up with ideas that differ from how we regularly work can be difficult. It requires taking a step back from the day to day chaos and thinking about your work with a different lens. Improvement often involves doing things differently and thinking of creative solutions to old challenges.
It’s important to remember that not all changes lead to improvement. Indeed, we often we need a number of different ideas to achieve our aim.
It is also helpful to consider any specific requirements or constraints that will influence the changes you can make. Exploring these perceived constraints may also help you to think outside the box.
Don’t be afraid to try an idea that was not effective previously. In different conditions, it just might work. Or not! Even if the changes came from another organization or a best practice document, it doesn’t necessarily mean they will work well in this instance.
Ideas for change come from various sources, but should always involve input from those who will be working to implement and sustain the change – think about your practice team and who you work in your practice. They are a vital part of this process. One way to make sure your team is involved in this process is to complete the Integrated Learning Package with your team after the session. You can be compensated for your time in completing the package, which walks through this content and provides time and space to document and discuss.

15. Finding Change Ideas Adapting best practices Change concepts Mapping
Creativity of the team
There are some specific methods that can help generate new ideas for changes to test.
Adapting best practices:
Change concepts
Mapping
Creativity of the team
Note that the supplementary slides at the end of this presentation expand on
Peer Mentors can also include any specific preferred techniques here.

16. Change Concepts
General approaches found to be useful in developing specific ideas for change that result in improvement:
Eliminate Waste
Improve Workflow
Optimize Inventory
Change the Work Environment
Enhance the Producer/Customer Relationship
Manage Time
Manage Variation
Design Systems to Avoid Mistakes
Focus on the Product or Service
There are 72 general changes that successful organizations (health care and other businesses) have used to make successful and sustainable changes.
These are general concepts, many having to do with reducing waste and improving work flow.
Specific ideas can come from reviewing this list and then formulating ideas with more details.
Hand out paper copies of the list of change concepts.

17. Partner Activity
Work with your table to develop a list of change ideas related to your Action Plan
5 minutes each
I will tell you when to switch.
Work with a partner to determine a list of change ideas or ideas to explore that are related to your Action Plan work. Try to think of some from each category – what process could you map, what guidelines could you consult etc.

18. Once changes are identified…
Test on a small scale
Collect data over time
Build knowledge sequentially and include a wide range of conditions
Ideas should be tested using PDSA cycles before they are implemented.
Tests are simple and quick to start with and become more complex as they develop.
Tests become bigger as we become more confident that the change is causing an improvement.
Typically we need to test more than one change in order to meet the aim.
Optional Discussion:
Think about a change you’ve been involved with that hasn’t worked or hasn’t been sustained. Share a brief overview of the change and some potential reasons why it was not successful.

19. Table Discussion
Think about a change you’ve been involved with that hasn’t worked or hasn’t been sustained.
Share a brief overview of the change and some potential reasons why it was not successful.
Take 5 – 10 minutes for this. Practice examples preferred but can also be from your personal life if this resonates more.

20. Break
We will now take a ___ min break, and delve into PDSA cycles when we return.

21. Plan – Do- Act - Study A way to rest a change in your practice:
Plan – Understand the problem. Describe how you will test an improvement strategy
Do – Implement your plan – test your improvement/change strategy
Study – Measure whether the test worked. Can it be improved in any way?
Act – Review your test and decide what to do – adapt, adopt, or abandon

22. Now What? What did you hear? Video Link
This short clip from the Institute for Health Improvement helps to answer this question.
Now that you have some ideas for change, it’s time to move into testing them – and the PDSA cycle is a really effective and practical way to do so. We’ll talk about what you heard and thought was important after the video.
CLICK
After listening to the video, what did you think was important? Any surprises?
Prompts:
The goal here is to test your idea in a small way.
By using a series of testing cycles, you can learn what will be most effective in making improvements before you implement them on a full scale.
As you start to think through this process, consider involving others in PDSA cycles to try out the change before it is implemented.
This can really help to reduce barriers to change and help you achieve your aim statement.
Video Link

23. Why PDSA?
"Success comes through rapidly fixing our mistakes rather than getting things right the first time."
Tim Harford, Adapt: Why Success Always Starts With Failure
PDSA Your Way to Sustained Improvement!
Now that you have a sense of what a PDSA cycle is, will pause for a moment to ask the crucial question of – WHY. Why do we PDSA?
I’ll open this up to the floor – why do you think PDSA cycles are an integral part of practice and quality improvement? How do you see them supporting your QI projects in practice?
Prompts: PDSA cycles can show:
How well an idea will work
How the idea is best delivered
If it will work in all conditions
When it won’t work
How it will affect other parts of the system

24. PDSA Cycle Source: ihi.org
So we know what a PDSA cycle entails - several steps to structure the process of planning for and testing a change. We also know all sorts of reasons we’d want to use them. So we will now move into the HOW and talk about the steps involved.
PDSA cycles are deceptively simple - it is important to follow all the steps to provide the most value.
Going through each section before the test helps keep the tests small and ensures no steps are missed.
In a PDSA cycle, the “planning” stage is different from the overall planning for an improvement project. It is focused on the idea that will be tested and is very quick.
Be careful not to get hung up on planning, just try something – it may fail, and you can learn from that for your next PDSA cycle. Some folks would argue that if some of your tests are not failing, you aren’t thinking big enough or far enough outside of the box! I will stay out of that argument.
This is what the PDSA cycle should entail:
• Plan: deciding what you want to learn about your idea and how you can learn it. The team should predict what will happen. You may predict it won’t work and focus on learning why not.
• Do: doing the test and small measurement that will tell you whether your prediction was right.
• Study: comparing the prediction to the actual result and documenting what you learned from this cycle.
• Act: deciding what to do next. You may decide to do another test of the same idea with a different twist.
• After a few different cycles, you may have decided that a test worked and that you are ready to implement it. Or you might decide to completely abandon this idea and do some tests with a different idea.
Source: ihi.org

25. Now What? Aim Statement:
“The wait time for the Get Better Clinic will decrease from an average of 135 days to 60 days by the end of this year.”
Change Idea:
Modify clinic hours.
• For this example, one idea for change could be to modify the hours of the clinic.
• What would a PDSA cycle look like if you were to test this change?
Discussion question:
What are some other ideas you can think of for changes to test in this situation?

26. PDSA Cycle Act Plan Study Do Some promising improvements.
Consider adjusting the schedules
or having longer hours on the weekend.
Adjust the schedule of one physician
to offer evening appointments
one extra day/week.
Act
Plan
Study Do
Here is what a PDSA cycle might look like for one idea for change that could be tested.
Make additional appointments
available for clients
Monitor demand for additional
appointments.

27. Implementing PSDA Video Link
This last clip talks more about the PDSA in the context of implementation. After the video, we take some time in partners to craft a PDSA cycle that you might want to try in each of your practices.
During video, hand out PDSA worksheet.
Video Link

28. PDSA Practice Act Plan Do Study Carry out the plan. Record data.
Complete analysis.
Summarize new knowledge.
Do you agree with the prediction? What new questions have arisen? What is our updated theory? Under what conditions could the results be different?
Details of the plan (who, what, where, when, and how) including data collection.
What change are we seeking? What is our prediction end theory?
Adopt, adapt or abandon.
What actions are we going to take as a result of this cycle?
Are we ready to implement?
What other process might be affected by the change?
Act
Plan Do
Study
Let’s outline a PDSA cycle together. Does anyone have a change idea they’d like to test in a PDSA cycle?
You’ll try this in partners next.
Click the bullet to add notes into this chart; alternatively could use a white board or a flip chart.

29. Partner Activity
Work with your neighbour to craft a PDSA cycle related to your Action Plan.
Try picking a new or “out of the box” idea - goal here is to get used to the process!
10 minutes each.
We’ve handed out a PDSA worksheet provided by the BCPSQC and will now take some time to work through PDSA cycles that might be useful to your quality improvement projects in your practice.
Please take the next 20 minutes to work with a partner – we will ask you to switch half way through.

30. Repeated use of the PDSA Cycle
Increasing:
- complexity
- # of people
- different situations
PDSA cycles start small and then get more complex over time, until you have tested changes that you are confident will work.
When the team’s predictions start to be right all the time, it is time to move to more sophisticated tests – with more people and under different conditions.
This is a PDSA ramp that shows how testing progresses from an idea to a change that results in improvement over time.
Time

31. PDSA Reality
While PDSA cycles seem straightforward, using them in a project is not necessarily a linear event. There can be multiple PDSAs going on at the same time, each at different stages. The important thing is to keep track of the learning that comes from each cycle.
How long will it take?
Tests of change should occur rapidly. You can build momentum toward your overall aim by focusing your efforts on incremental changes in the short term.
To determine the timeline for your initial PDSA cycles, consider how long it will take to achieve your aim, then move 2 steps down this continuum. For example, if your aim will take 6 months to achieve, what can you do in 6 days to get started?

32. Test Under Different Conditions
Different employees
New employees
Different patient groups
Complex patients
Day shift vs. night shift
Hours of the day
Days of the week
An idea is ready to implement when it has been tested and the team knows it works under lots of different conditions.
What are some of the different conditions you could test in?
CLICK (for list of conditions)
There might be some uncertainly and concern about doing tests, specifically about the time it takes to do all of this. The time taken in testing helps ensure the project will be successful and the improvement will be sustained – which ultimately should result in a time savings.

33. Recap and Review What stood out for you today?
What do you want to remember about this session?
Take 5-10 minutes to discuss as a group or table (depending on size of group)
What stood out for you today? What do you want to remember about this session?
Prompts for key points:
Testing helps you learn about whether a change was effective
You may predict that the test will fail – this is good for learning too
Documenting PDSA cycles ensures that cycles are actually tests of change, not simply activities or tasks
Ensuring the necessary resources and supports are there to make sure the change can last over time will promote sustainability of your improvement.

34. Action Plan Intended to provoke thought and discussion with your team.
We’re going to talk briefly about the ongoing learning and supports offered.
We’ve handed out paper copies of the Action Plan. We hope you will be completing these with your office team, and we can compensate all of you for your time in working on this together (up to two hours). The Action Plan is a standard set of five questions that are core to the quality improvement process – you may recognize some of them from the model of improvement. You will learn more about this model as you progress through the QI SGLS sessions, and you may find that how you interpret the questions changes, or that you have more specific ways for the tools to help you answer the questions. This reflects your learning process and allows you to complete the Action Plan based on your current understanding and your comfort level with the concepts addressed.
You will start the AP today, work on it with your team back at the office, and then in a few weeks you will be ready to answer the final question, submit it and your sessional form.
Filling out the Action Plan is intended to provoke thought and discussion among your team about what you have learned, and your goals for practice improvement. There is no right or wrong here. The Plan may provoke questions and even be used to structure an in-practice visit with an RST or peer mentor. They will support you in working with your team to get everyone on the same page and get started.
Intended to provoke thought and discussion with your team.
5 questions core to the QI process.
The same for each SGLS.

35. Ongoing Learning and Support
Who to lean on and work with going forward:
Your colleagues
Your office team
Peer Mentor(s)
Regional Support Team Coordinators/Coaches
We are nearing the close of the session. I hope you have found this time useful and that you have some learnings to take away and begin to apply to your daily operations in your practice. I want to highlight that you have lots of resources to draw on as you begin – the group here today is a valuable resource for hashing out challenges and learning from each other’s successes, however big or small. If there is interest, we can facilitate sharing of contact information today so you can keep in touch and further support each other.
Your office team will be a key support in planning for change, and the Action Plan includes work with your team in order to start this conversation.
There are also a number of PSP resources available to you – the peer mentor team, including myself, and the Regional Support Coordinators, all of whom are available to work with you one-on-one in your practice to help integrate ideas that you learned today, complete your Action Plan, and work towards realizing improvements in your practice.

36. Next Steps
Action Plan – start today, due in 8 weeks (trigger for sessional)
Post Activity Participant Questionnaire (PARQ) – in 8 weeks (trigger for Mainpro+ credits)
Integrated Learning Package (2 hours) Optional
In-Practice RST or Peer Mentor visit Optional
External Resources:
UBC/BCCFP - “Shine a Light on Your Learning”: A Self-directed Assessment Tool (Independent, online, up to 24 Mainpro+ credits).
Our next steps are:
Completing the action plan (we will take a few minutes shortly to start this). Please submit your completed AP to your RST within 8 weeks in order to receive up to two hours sessional payment for your time in doing this work.
After these 8 weeks, you will be asked to complete the Post Activity Participant Questionnaire (PARQ), which hopes to identify the impact of participating in this session. Submitting the PARQ triggers the receipt of your Mainpro+ certificate.
You also have the opportunity to have an in-practice visit with an RST, who can help you and your team complete the action plan and/or the integrated learning package if you choose, as well as help address any challenges you are experiencing. Please connect directly with your RST to get schedule an in practice visit. One of the things the RSTs can do with you is the PSP Practice Assessment Tool, which may help you decide where you’d like to focus your attention for the Action Plan.
Finally, we’ve included a link to a tool developed by UBC CPD and the BC College of Family Physicians that is complimentary to the learnings today, and will allow you to get credits in a different category. This is a self-assessment tool which focuses on making improvements in your practice and can walk you through the process in more detail, providing ideas and support. This tool is something you can work through step by step and get up to 24 Mainpro+ assessment credits.
A fourth session in the series could be developed based on demand so please let us know if you would be interested in this, and what you might be looking for.

37. Get Started on Action Plan
10 minutes to start – Go!
We’ve handed out paper copies of the Action Plans so you can take a few minutes to reflect while the ideas are still fresh, and discuss with your table today.
You now have 10 minutes to start work on your action plan. We are here to support you - please flag us down if you’d like to talk.
As AP is being completed, hand out the evaluation form. Leave this slide up until the 10 minutes is complete.

38. Evaluation Please complete the Post Session Evaluation form
Your feedback informs improvements to this session and future SGLSs.
Thank you!
That’s it for learning today! We ask that everyone complete the post-session evaluation so that we can improve this session and make it more useful for your peers.
Thank you for your time, your attention, and your ideas. We hope the session has been of use, and look forward to working with you on planning and implementing improvements in your practice.

39. Supplementary Content
The following slides are supplementary content than can be used to enhance discussion and interactivity depending on the specific learner’s needs and the preferences of the deliverers.
These slides are suggested for insertion after slide 16

40. Change Concepts
General approaches found to be useful in developing specific ideas for change that result in improvement:
Eliminate Waste
Improve Workflow
Optimize Inventory
Change the Work Environment
Enhance the Producer/Customer Relationship
Manage Time
Manage Variation
Design Systems to Avoid Mistakes
Focus on the Product or Service
There are 72 general changes that successful organizations (health care and other businesses) have used to make successful and sustainable changes.
These are general concepts, many having to do with reducing waste and improving work flow.
Specific ideas can come from reviewing this list and then formulating ideas with more details.
Hand out paper copies of the list of change concepts.

41. Mapping A visual depiction of a process. Maps highlight:
Unnecessary delays
Unnecessary steps or transitions
Duplication of effort (waste)
Things that don't make sense
Hotspots, bottlenecks, or constraints
Mapping can help identify opportunities for improvement.
• Maps highlight certain things such as:
• Delays, overlap, and steps that don’t make sense.
• Bottlenecks and steps that might be in the wrong order.
• Examples of steps that could be done by a different person.
• Mapping also allows people to see different perspectives of how things work and can help you anticipate how changes may affect other parts of the system - this can be a great team activity.

42. Mapping example – Pre-visit process
Does the patient need to have any lab work or other diagnostics done before their next appointment?
Receptionist schedules follow-up appointment(s) for the patient before they leave the office
Medical assistant orders labs based on standing orders
Medical assistant schedules labs to be completed before the next appointment
Patient is at the office for their current visit
Use a visit planner checklist to arrange next appointment(s)
DURING THE CURRENT VISIT
Yes No
Consider a pre-visit phone call or to begin medication reconciliation, set the patient agenda and perform other preparations to ensure that the visit is thorough and efficient
Is the patient considered complex?
Medical assistant performs visit preparations:
Reviews notes from prior visit and confirms that documentation from interval care or hospitalizations has been obtained
Prints copies of lab results and other important results to discuss at visit
Use a visit prep checklist to identify gaps in care, such as immunizations or cancer screenings. If something needs to be scheduled before the upcoming visit, contact the patient to schedule the appointment
Yes
Send patients appointment reminders, either automatically or manually
BEFORE THE NEXT VISIT
Patient has pre-visit labs completed No
Medical assistant rooms patient and updates patient record based on information on pre-visit questionnaire, conducts medication reconciliation and sets visit agenda with patient
Hand off the patient to the physician, informing them of the purpose of the patient’s visit as well as any important information learned during rooming
Hold a pre-clinic care team huddle to prepare the team for the day ahead and anticipate
any patient needs
Receptionist hands out a pre-appointment questionnaire to each patient at check-in
Physician portion of visit begins. Pre-visit planning commences at the “current visit”
DURING THE NEXT VISIT
Terminal point
Process
Decision
Preparation
Document

43. Driver Diagrams A Driver Diagram illustrates several key elements:
The relationship between the overall aim of the project
The primary drivers (sometimes called “key drivers”) that contribute directly to achieving the aim,
The secondary drivers that are components of the primary drivers, and:
Specific change ideas to test for each secondary driver.
Dr. Don Goldmann from IHI

44. Driver Diagrams – Discussion
What is the causal pathway and how does it apply to improvement work?
What’s the difference between a primary driver and a secondary driver?
Why is it important to have a visual display of a system before embarking on improvement work? Do you think this would be useful to you and your team?
Driver diagrams are a popular QI tool and can be of great use to teams looking to understand processes they’re looking to improve.
Take 5 minutes to discuss driver diagrams. For larger groups consider having table discussions vs full group.
What is the causal pathway and how does it apply to improvement work?
What’s the difference between a primary driver and a secondary driver?
Why is it important to have a visual display of a system before embarking on improvement work? Do you think this would be useful to you and your team?
Optional Activity
​​​​
If time and engagement allows, take 10 minutes to come up with your own personal improvement project — getting to work on time or improving your running time, for example — and create a driver diagram with primary and secondary drivers. Identify some changes you could test. Report out if time allows.