1. Driver Diagrams

2. “Every system is perfectly designed to achieve the results it gets” - Improvement Axiom

3. Setting Aims Be impossible within the current framework of how our system functions Specific Measurable Ambitious (notice not attainable) Relevant Time bound

4. Conceptual Driver Diagram Outcome 1 ⁰ driver 2 ⁰ driver Change Concepts Specific Change Ideas Aim or Outcome 1 ⁰ driver 1 1 ⁰ driver 2 2 ⁰ driver 3 2 ⁰ driver 2 2 ⁰ driver 1 2 ⁰ driver 4 2 ⁰ driver 5 Concept 1 Concept 2 Concept 4 Concept 3 Concept 5 Concept 6 Ideas: 1 2 3 4 5 6 7 8 9. N

5. Where do specific change ideas come from? Front line team – if you could improve your day to day work in any way what would you do differently (no new resources)? The literature (Medical or Improvement) Go to the web – what have others done –www.koawatea.co.nzwww.koawatea.co.nz –www.google.comwww.google.com Logical positive thinking methods Use of formal creativity techniques

6. Counties Manukau Healthy & Well Days Admissions 20,000 Days Campaign Driver Diagram Length of stay Readmissions Complications Discharges Version 2 – 19 June 2013 Planned Unplanned Return to Business GP Engagement Experience of Care Access to Care Transfers of care Delirium Care Enhanced Recovery After Surgery (ERAS) Better Breathing – Community Rehabilitation Healthy Hearts - Community Rehabilitation Well Managed Pain Memory Team Gout Busters Mental Health Short Stay Healthy Skin Helping at Risk People SMART (Safer Medical Admission Review Team) Collaboratives Phase 1 Collaboratives Phase 2 Primary Drivers Secondary Drivers AIM Measures Hip Fracture Management Patient Safety Harm/ Infections St John Ambulance Service Very High Intensity Users (VHIU) Transitions of Care-Goal Discharge Date (GDD)/Weekend Discharge SMOOTH (Safer Medication Outcomes On Transfer To Home) Rapid Response & Supportive Discharge Implementing Changes Community Geriatric Service New Collaborative Key Cellulitis & Skin Infections Healthy Hearts Inpatient Care for People with Diabetes Enhanced Primary Mental Health Supporting Life After Stroke Environmental Cleaning Franklin Co-ordination Service ACE ( Acute Care for the Elderly) Medical Assessment Unit Saving Limbs, Saving Lives

7. Counties Manukau Healthy & Well Days Admissions 20,000 Days Campaign Driver Diagram Length of stay Readmissions Complications Discharges Version 2 – 19 June 2013 Planned Unplanned Return to Business GP Engagement Experience of Care Access to Care Transfers of care Healthy Hearts - Community Rehabilitation Well Managed Pain Memory Team Gout Busters Mental Health Short Stay Healthy Skin Helping at Risk People SMART (Safer Medical Admission Review Team) Collaboratives Phase 1 Collaboratives Phase 2 Primary Drivers Secondary Drivers AIM Measures Patient Safety Harm/ Infections Implementing Changes New Collaborative Key Inpatient Care for People with Diabetes Enhanced Primary Mental Health Supporting Life After Stroke Environmental Cleaning Franklin Co-ordination Service ACE ( Acute Care for the Elderly) Medical Assessment Unit Saving Limbs, Saving Lives

8. Break out Spend time creating a driver diagram (or refining your driver diagram) that represents your teams theory about what drivers will be important to focus on to achieve the outcome you are aiming for Use 1 or 2 of the 2 ⁰ drivers from the global driver diagram to serve as the outcome for your individual project (align these with your stated aim) From there, identify 1-3 primary drivers and their secondary drivers Begin building your theory