This presenter has nothing to disclose. Driver Diagrams. Frank Federico, RPh. March 3, 2017

Transcription

1 This presenter has nothing to disclose. Driver Diagrams Frank Federico, RPh March 3, 2017

2 Framework for Clinical Excellence Patient Safety Psychological Safety Accountability Culture Leadership Teamwork & Communication Transparency Engagement of Patients & Family Negotiation Learning System Reliability Improvement & Measurement Continuous Learning IHI and Allan Frankel

3 Objectives Understand the principles behind using driver diagrams Explain the components of the driver diagram Build a driver diagram for your work

4 Aim What are we trying to accomplish? How much by when? Can be an outcome aim or a process aim e.g. reduce infections by 50% within three years e.g. reach at least 95% reliability of ventilator care bundles in 6 months

5 Theory of Change What do you have to do to achieve the aim? Example: Improve flow through the hospital by freeing up X number of beds by DATE.

6 Driver Diagrams A driver diagram depicts the relationship between the aim, the primary drivers that contribute directly to achieving the aim, and the secondary drivers that are necessary to achieve the primary drivers. A driver diagram represents the team members current theories of cause and effect in the system what changes will likely cause the desired effects.

7 Components of Driver Diagrams The Driver Diagram: tells us everything in the system that we need to work on to reach our aim Primary Drivers: tells us the BIG categories of work needed to reach our aim Secondary Drivers: the changes we need to make to complete the Primary Driver Change Package: what we actually have to do to make the changes work 7

8 What Changes Can We Make? Understanding the System for Weight Loss Outcome Primary Drivers Secondary Drivers Process Changes AIM: A New ME! drives drives Calories In Calories Out Every system is perfectly designed to achieve the results that it gets drives drives drives drives drives drives Limit daily intake Substitute low calorie foods Avoid alcohol Work out 5 days Walk to errands Track Calories Plan Meals See Drink H2O Not Soda change package Source: Richard Scoville, Improvement Advisor

9 WORKSTREAM 1 (conception to 1 year) Theory of what drivers infant mortality Aim 1⁰ 2⁰ Social Issues Poverty Housing Domestic Abuse & Violence Theory of what actions will reduce infant mortality Improved teamwork, communication and collaboration Improved uptake of benefits Increase rate of breastfed babies Quicker diagnoses of Neonatal Abstinence Syndrome Attachment Improved leadership & culture Reduce infant mortality Post-birth actions Health Parenting skills Improved family centred response Improved stability / permanence for LAC Improved identification Maternal smoking Increase referrals Detailed Aim: To reduce by 15% the rates of stillbirth & infant mortality by 2015 Pre-birth maternal health Maternal drinking Maternal misuse of drugs Maternal Obesity Maternal mental health Improved management of care Improved sharing of information Improved planning Identification & reasons for current resilience

10 Theory of what drivers prevent VTE Theory of what actions will prevent VTE Aim 1⁰ 2⁰ Detailed Aim: how much by when Risk assessment VTE Prevention Appropriate prophylaxis

11 Getting Started 1. Agree on the project aim (what will be improved, by how much, for whom, by when). 2. Brainstorm all of the system elements, or drivers, that team members feel are necessary to achieve the aim or are likely to affect it. Don t worry about whether drivers are primary or secondary at this point. 3. Logically group the drivers, and define high-level headers that summarize the groups. The headers will be the primary drivers. The grouped items will be the secondary drivers associated with each primary driver.4

12 Getting Started 4. Check the drivers for duplicates, clarity, missing elements, and team consensus. 5. You can now draw connecting arrows showing the cause-and-effect relationships (if secondary drivers have multiple arrows to more than one primary driver, then the grouping may need to be adjusted; most secondary drivers should align under one primary driver each).

13 Getting Started 6. You are now ready to define the interventions or strategies (the hows ) that you will use to have an impact on the various drivers. 7. You can also define project measures for tracking progress, to test and modify your theories for improvement, and to monitor for overall project effectiveness.

14 Can you develop Driver Diagrams for Everything Improvement Effort?

15 Develop Your Own Driver Diagram

16 Exercises Prioritize the areas you would like to work on. Select two or three (based on workload and resources). Suggest that one of the areas focus on a culture change Create a Driver Diagram for each of the areas. Generate a clear AIM statement and the mechanism to achieve your results. Design the Tests of Change (PDSA s) you will test in the coming week

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18 So Many Tools.. Framework: the foundational components necessary to provide safe and reliable healthcare Observations and focus groups: needed to understand the attitudes Diagnostics: needed to understand the system status and defects Measurement: How will you know if you are improving Model for Improvement: a method to engage individuals in improvement. Kaizen is about culture change Human Factors: understanding how people make mistakes and what we can do to address those failures

19 So Many Tools.. Maximally Adoptive Improvement: a way to address work overload and burn out Reliable Design: a method developed by IHI that increases the chances of successful improvement and adoption Underpinning all of the tools is Leadership and culture change.

20 What have we learned about tools? Tools Culture change Tools alone will not result in sustainable change Culture is changed by modeling the behaviors we expect from others

21 References IHI.org Langley, G. J., Moen, R. D., Nolan, K. M., Nolan, T. W., Norman, C. L., & Provost L. P. (2009). The improvement guide: A practical approach to enhancing organizational performance. San Francisco, CA: Jossey-Bass.

22 Take a moment to reflect on your own work. What will you incorporate from this session into your plans?

23 Framework for Clinical Excellence Patient Safety Psychological Safety Accountability Culture Leadership Teamwork & Communication Transparency Engagement of Patients & Family Negotiation Learning System Reliability Improvement & Measurement Continuous Learning IHI and Allan Frankel