Driving the Driver to join the dots

Ward to board, clinic to clinical senate, and patients to pathways: Lining up improvement effort for patient safety.

Driver diagrams? Never heard of them? You are not alone, so read on!

Let’s take a look at how we normally work out how we get something we want. We’ll call this our goal, strategic aim or outcome. When we have a goal in mind we might write it on the left hand side of the page, and put a box round it. We’ll then list the things to the right of the box that we need to fix to get to the goal. And then we might connect them with a line or, more often, an arrow from the box on the left to the box on the right… are you with me so far?

driver-diagram-1This presentation tends to keep our focus on the goal – rather than the changes that are required to achieve the goal. The arrows tell us to focus on the goal and our bosses tell us to focus on the goal!

And the tasks that are needed to achieve the fix – where in the diagram are these represented? Well in many cases they are NOT represented at all!

The bosses don’t have the detailed knowledge to hand, so they (and the diagram or plan) stop at this point and the job of ‘detail’ is delegated to the next level – with the hope of a shared goal and a prayer that someone ‘in the know’ will fill in the gaps!

So if hopes and prayers fail, what other ways can we achieve our goal? Well for a start, it’s useful to recognise that it’s more often a series of small hard won improvements that deliver a goal. The kind that result from the changes that people at the ‘frontline’ or ‘sharp end’ of the business know about and can make. And this is the reason you might want to reach for a driver diagram!

driver-diagram-2A driver diagram links your goal (on the left) to the dependencies (to the right) rather than to a list of things to fix.

These dependencies (or primary drivers) link to their own dependencies (or secondary drivers) – even further to the right. And it is only then that you think about what needs fixing – the when and how comes even later!

This can feel quite back to front – and even uncomfortable to some people – as it suggests that the solution to achieving the goal doesn’t lie with a list of fixes sent down from the top table. Instead, it reveals the engine room for change to be the folks at the frontline!

Another great thing about this type of diagram is that it helps you add measurement to the mix – so you know from the start if some of the drivers are already fixed (working), getting fixed (being mended) or still needs fixing (broken).

The Driver Diagram is designed to keep the focus on the tasks that need to be accomplished to achieve the goal. But does it work for healthcare?

Healthcare is a complex business: a mix of science and craft; people and machinery; politics and humanity. To mobilise frontline staff we need to connect ward to board, clinic to clinical senate, and patients to pathways.

So here’s an idea – an Extended Driver Diagram… that connects all the dots from the frontline to the top table. Giving focus to each of the elements needed to achieve the goal, and making space for the change ideas that need to be generated, tested and, if successful, implemented: resisting our temptation to reach out and impose a solution grabbed hurriedly from our usual repertoire of ‘personal favourites’.

And as an added bonus this Extended Drive acknowledges both the importance of measurement for performance AND measurement for improvement (Solberg et al. 1997) – see my measurement Blog for details or listen to my Signuptosafety Campaign Webinar on measures using transfers of care/handovers as a worked through example.



If this makes a little more sense to you – then please use it. If it doesn’t you might just carry on with the way you have always done things, and get the same results!