1. Your chance to apply the tool Ask team members to brainstorm issues under each category. All of the headings are interrelated so don’t worry too much about where you capture comments. The summary grid will allow you to agree and extract the key points.

2. The grid below can be used by your team to explore your collective understanding of your project area. Some example questions are given. System, context & environment What services currently exist? How do they interact to create a system? Who are the local stakeholders? Where are the bottlenecks? What might get in the way? Where is care below expectations ? What are the socio-economic factors affecting outcomes? Psychology, behaviour, beliefs What will different stakeholders want to achieve in this area? Who has power and influence and are they interested in this topic? What motivates patient, public and staff behaviour? How do people behave? What resistance or support for change is likely? Theory of Knowledge What national evidence exists? What do we think works, and why? What ideas for change exist locally and what are the theories behind them? What do you think is causing the local problems? What untested assumptions do you have about how / why things currently work? Why does this matter? Understanding Variation Do different groups (e.g. ethnic groups, diagnostic groups) have different needs? Are services provided or used differently by locality or groups? What do we know about trends in outcomes or processes over time? Do we understand why things are different? What data / measures do we have and what do they tell us?

3. System, context, environment What do you know about the system?

4. People, behaviours, beliefs What do we know about how people behave and why? What do different people want?

5. Variation and difference What data do we have? What patterns does it show? How do we explain them?

6. Theory of knowledge What assumptions or hypotheses do we have?

7. Summary Sheet Project area: _____________________ System, context, environmentPsychology: people, behaviour, beliefs Theory of KnowledgeUnderstanding Variation

8. Summary Sheet: actions Project area: _____________________ System, context, environmentPsychology: people, behaviour, beliefs Theory of KnowledgeUnderstanding Variation