Quality Improvement Zone

A simple visual display that outlines and logically connects:

• An improvement aim that quantifies what better will look like, for who and by when
• A small number of Primary drivers that focus on the key components of the system/main areas of influence that need to change to achieve the aim. These are often associated with process, infrastructure, norms (culture) and people
• Secondary drivers that break primary drivers down in to natural subsections or processes. They provide more detail on where interventions to positively influence the primary drivers are required
• Change ideas – These are the specific ideas that teams can test to see if they influence the secondary drivers and ultimately the aim

• To visually present a team’s theory of change for how an improvement goal might be achieved, aiding planning and team engagement
• To articulate what parts of a system, need to change in which way, ensuring everyone working on improving their system has a shared sense of why
• To help teams work collaboratively and focus on changes that will impact most on their system, while avoiding spending time and resources on changes that will have little effect
• To help identify outcome and process measures for improvement work so that teams can tell whether their efforts are leading to improvement

Driver diagram development works best as a group exercise.

Tips for Facilitation:

• Bring together the subject matter experts
• Ask the group to “Brainstorm” the following question and record their thoughts on post-it notes: “To achieve our aim the things we need to change are…….”
• Cluster the ideas to see if common themes emerge as primary drivers
• Expand these groups to identify subsections or processes that can be classed as secondary drivers
• Link the groups together into the Driver Diagram format
• Ask the group to suggest change ideas for each secondary driver
• Prioritise these according to which is likely to have the highest and/or quickest impact
• Sometimes it helps teams to develop their change theory by working backwards from their change ideas and asking, “what will this change about how the system is currently working?”
• Use outputs from process mapping, cause and effect analysis and other tools that aid system understanding to help develop the change theory.
• Refine the Driver diagram as changes are PDSA tested and measures tracked, using it as a focal point at improvement meetings