1. Driver Diagram Examples
Includes template and definitions

2. Driver Diagram Definitions:
A Driver Diagram is an improvement tool used to organize theories and ideas in an improvement effort. It displays visually, our theory about why things are the way they are and/or potential areas we can leverage to change the status quo. The driver diagram is often used to scope or size a project and to clarify the plan for reaching the aim.
Primary Drivers: major processes, operating rules, or structures that will contribute to moving towards the aim
Secondary Drivers: elements or portions of the primary drivers. The secondary drivers are system components necessary in order to impact primary drivers, and thus reach project aim.
Specific changes /Change concepts: Specific changes are concrete actionable ideas to take to testing. Change concepts are broad concepts (e.g. move steps in the process closer together) that are not yet specific enough to be actionable but which will be used to generate specific ideas for change.
Note: measures can be indicated on the DD as it becomes more mature.

3. Driver Diagram

4. Driver Diagram John W. Young, MBA RN
National Association of Public Hospitals and Health System

5. Ann Brown, Wave 23

6. Improving Colon Cancer Screening at Internal Medicine Faculty Practice
Specific Changes:
Primary Drivers:
Secondary Drivers:
Link colonoscopy database with EMR for automatic result reporting into the flowsheet
Generate bimonthly reports of colon cancer screening rates and actions taken by providers and work toward goal rate of 80%
Identify patients who should have colon cancer screening and have not received it
Aim
Preventive care EMR flowsheet (individual each visit)
Decrease
Waiting time between referral and colonoscopy
Waiting time for results of colonoscopy
Increase
Colon cancer screening rates
Direct colonoscopy referrals through EMR
Results of colon cancer screening in EMR
Whole panel performance reports
Create a referral form for Direct colonoscopy in the EMR
Create a benchmark for time from referral to colonoscopy schedule (access to test), and time from referral to Navigator completed all necessary steps (efficiency of program) and work towards benchmark goal
Increase access to colonoscopies
Use Direct colonoscopy Navigators (facilitated communication, preps, directions, scheduling)
Referral to Direct colonoscopy from inside the EMR
Facilitate delivery of evidence-based care in colon cancer screening
Communication/care coordination between GI and referring PCP (f/u interval, pathology findings)
Review current workflowof result communication in the EMR
Develop workflow that minimizes data entry by referring provider
Calie Santana, Wave 21
IHI

7. Improve Severe Sepsis Care and Reduce Sepsis Mortality
Primary Drivers:
Secondary Drivers:
Specific Changes:
Uniform Sepsis Screening/Sepsis Screening tool
Identify severe sepsis early in ED patients ??
Desired Outcomes:
Education/communication to frontline staff
Decrease
Mortality
Complications
Costs
LOS
Improve
Sepsis/Severe Sepsis Bundle Compliance
Early recognition of severe sepsis/septic shock
Recognizable, reliable language standards for sepsis care
Provide appropriate, reliable and timely care to patients with sepsis/severe sepsis using evidence-based therapies
Sepsis Algorithm and Standard Order Set
Bundle elements: Antibiotics within 180 mins and after blood cultures Serum lactate w/in 30 min Fluid challenge eligibility/delivery
Contingency team for 1st 24 hours of sepsis trigger
Coordination of treatment services
Organized team methodology for patient care transitions
Pharmacy
Create team process to support sepsis therapies
Caregiver communication
Lab
Josephine Melchione, Wave 21

8. Medication compliance in stroke patients by 50%
Primary Drivers
Secondary Drivers
Change Concepts
Specific Change Ideas
Knowledge of medications
Discussing medication benefits and side effects
Eliciting concerns and questions
Focus on the outcome to a customer
Listen to customers
Reach agreement on expectations
Coach customers to use a product/service
Optimize level of inspection
 Script to aid discussion
Shared decision making model
Document decision of patient/carer
SALT assessment of identify best means of communication
Patient/carer satisfaction and experience of medication discussions and usage
Effective communication
Communication aids for aphasic patients
Involve carers
Medication Delivery System
For those with cognitive impairment
For those with functional limitations
Patient choice
Use reminders
Use differentiation
Use constraints
Use affordances
Follow up compliance check(need to decide OPD, telephone call, home visit, questionnaire, etc)
Documentation of how medications will be taken and delivered
Coordination of care
Incorporate into weekly MDT meeting
Ensure medications dose, frequency, route and patient decisions stated on discharge letter to GP
Standardization
Desensitize
Improve predictions
Develop contingency plans
Manage uncertainty, not task
Match amount to need
 Document in case notes
Document in discharge letter to GP
Aim
Improve
Medication compliance in stroke patients by 50%
Asan Akpan, Wave 21

9. Driver Diagram for Reducing In-Patient Falls
Aim
Primary Drivers
Secondary Drivers
Specific Changes to Test
Reliable Assessment
Good/reliable tools for assessment
Staff awareness/education
Reduce Inpatient Falls on 4Cand 6WReduce falls to <3.5/1000 patient days and reduce moderate or higher harm from falls to <0.1/1000 patient days
Staff trained and know how to use assessment tools
Falls noticed board/story board
Process Measure
% Pts with falls risk assessment every 8 hrs.
Timely assessment
Care plans are easy to use
Reliable Care
Fallsafe Care Bundle
Care plans regularly updated
Use of pressure pads
Process Measure
% of patients with evidence of hourly rounding
Appropriate level of monitoring/supervision of patients
cctv or mirrors in corridors
Use of sitters for some patients
Outcome Measures
-Patient days between falls
-Patient days between a harmful fall
-The rate of falls per 1000 patient days
-The rate of harmful falls per 1000 patient days
-$ revenue loss avoided due to fall reduction
Patient and Family Centered Care
Willingness of patient and carers to cooperate
Physical strength/stability
Mental health
Process Measure: % Pts who can verbalize their role in fall prevention
Frailty
Slipper socks
Patient Condition
Patient understanding of their own abilities
New signs on doors easier to read
Adapted from Gavin Sells, NHS Scotland, Wave /2012
Used with permission.
Patient understanding of their own abilities

10. Example: Another way to organize change package: Driver Diagram
Driver Diagram: Improving Outcomes for High-Risk and Critically Ill Patients
Specific Changes:
Primary Drivers:
Secondary Drivers:
Rapid Response System
Identify & rescue worsening patients
See next page
Early Warning System
Provide appropriate, reliable and timely care to high-risk and critically ill patients using evidence-based therapies
Protocols and Standing Orders
Example:
Another way to
organize change
package:
Driver Diagram
Desired Outcomes:
Bundles
Decrease
Mortality
Complications
Costs
Improve
Satisfaction
Care planning
Create highly effective multi-disciplinary team
Reliable communication
Family involvement
Clarification of wishes
Integrate patient & family into care so they receive care they want
End of life care
Consistent care delivery
Flow
Develop an infrastructure that promotes quality care
Driver Diagram
IG: PP. 286,412,429
Leadership
Financial Stewardship