Main title slide page Driver Diagrams linking ideas

Main title slide page Driver Diagrams – linking ideas to action Julie Connell – Improvement Leader Safer Care Team – Oxford Health HS FT

Main title slide page Members Learning about QI will: Be introduced to why we need a driver diagram Understand when to use a driver diagram Introduced to aims, primary drivers, secondary drivers and change ideas Introduced to the process of building driver diagrams Understand the benefits of a driver diagram Understand that measures can be generated from driver diagrams Registered charity no. 252892. Scottish charity no. SC 039245.

Main title slide page Registered charity no. 252892. Scottish charity no. SC 039245.

Registered charity no. 252892. Scottish charity no. SC 039245.

Why do we need an aim? Registered charity no. 252892. Scottish charity no. SC 039245.

AIM • Aims give meaning in our lives, they create a target to achieve and inspire and motivate us to achieve it. • What, how much, by when – so what? • Make your aims SMART Ø Specific Ø Measurable Ø Achievable Ø Realistic Ø Timely Registered charity no. 252892. Scottish charity no. SC 039245.

How do we know the change is an improvement ? Registered charity no. 252892. Scottish charity no. SC 039245.

We use measure to determine if a specific change actually leads to improvement Registered charity no. 252892. Scottish charity no. SC 039245.

What changes do we make ? Registered charity no. 252892. Scottish charity no. SC 039245.

Driver Diagram Template AIM PRIMARY DRIVERS Primary driver Ai m Primary driver Registered charity no. 252892. Scottish charity no. SC 039245. SECONDARY DRIVERS CHANGE IDEAS Secondary driver Change idea Secondary driver Change idea

AIM STATEMENT PRIMARY DRIVERS SECONDARY DRIVERS CHANGE IDEAS/TESTS Registered charity no. 252892. Scottish charity no. SC 039245.

AIM STATEMENT GOOD How much by when According to the consultant we hired we need to evaluate our clinic follow up, we need to improve the effectiveness and reliability of home visit assessments and reduce readmissions. The board agrees so we will work on these issues this year. UGLY Disengage staff x We aim to improve safety by reducing needless harm By April 2017 we will reduce the number of incidents of violence and aggression on Ward 10 by 50% Message from Director of Ops: ‘Our patient satisfaction scores are in the bottom 10% of NHS comparative database. We need to get the scores above the 50 th percentile by end of Q 1 2017’ We will reduce the number of falls on Ward 11 by 75% over the next year. Our first goal is 25% over the first 3 months BAD Vague x x Taken from: Quality Improvement in Healthcare: The Case for Change University of Bath Registered charity no. 252892. Scottish charity no. SC 039245.

You have decided you want to reduce/increase your weight Describe your aim 5 mins Registered charity no. 252892. Scottish charity no. SC 039245.

AIM STATEMENT PRIMARY DRIVERS SECONDARY DRIVERS CHANGE IDEAS/TESTS Registered charity no. 252892. Scottish charity no. SC 039245.

Primary Drivers • Referred to as primary drivers because they ‘drive’ the achievement of your main goal • Directly contribute towards achieving your aim - At the heart of the matter • Ask yourself: – If I made an improvement in this driver what would it achieve? (Would it move you closer to your aim? ) – If I did all these things (all primary drivers) could anything else stop me achieving my aim? If so, you may have missed another primary driver. Registered charity no. 252892. Scottish charity no. SC 039245.

Weight increase/reduction Add in the primary drivers Registered charity no. 252892. Scottish charity no. SC 039245.

AIM STATEMENT PRIMARY DRIVERS SECONDARY DRIVERS CHANGE IDEAS/TESTS Registered charity no. 252892. Scottish charity no. SC 039245.

SECONDARY DRIVERS • Elements within the related primary driver • Break down the primary driver into manageable components • Add secondary drivers to your diagram Registered charity no. 252892. Scottish charity no. SC 039245.

AIM STATEMENT PRIMARY DRIVERS SECONDARY DRIVERS CHANGE IDEAS/TESTS Registered charity no. 252892. Scottish charity no. SC 039245.

Step 5. Priorities for action • Once you have identified your drivers you can start to identify change ideas and tests of change • You need to decide priorities for action, interventions and change ideas • Where can you most influence your aim? Registered charity no. 252892. Scottish charity no. SC 039245.

6. Agree measures • You can then start to identify relevant, appropriate measures that fit each driver to show progress towards your overall aim • It may be difficult or take time to show progress in your overall aim. These measures will help demonstrate what progress is being made and can help others stay interested and motivated Registered charity no. 252892. Scottish charity no. SC 039245.

Registered charity no. 252892. Scottish charity no. SC 039245.

Fall Prevention Driver Diagram Registered charity no. 252892. Scottish charity no. SC 039245.

Registered charity no. 252892. Scottish charity no. SC 039245.

Registered charity no. 252892. Scottish charity no. SC 039245.

Registered charity no. 252892. Scottish charity no. SC 039245.

Registered charity no. 252892. Scottish charity no. SC 039245.

Registered charity no. 252892. Scottish charity no. SC 039245.

Registered charity no. 252892. Scottish charity no. SC 039245.

In summary: If you are feeling overwhelmed by the scale of what you want to achieve, driver diagrams can help you cut your aims down to a manageable size to enable you to identify elements to concentrate on now, and what can go on the ‘to do’ list for later The act of producing the diagram is a very important way of getting the team working together and committing to some common agreed goals and priorities Driver diagrams are a tool which assist teams in doing improvement work and help to communicate to others the aim and the rationale for selecting specific change ideas to achieve improvement Specifically a driver diagram: • • Assists teams in generating change ideas that lead to the root cause and will impact the aim Serves as a foundation/tool for developing measures and understanding where each is relevant Communicates to others the logic or design of the project Helps staff to understand how their work contributes to goals/aims Registered charity no. 252892. Scottish charity no. SC 039245.

NHS Scotland Quality Improvement Hub http: //www. qihub. scot. nhs. uk/knowle dge-centre/quality-improvementtools/driver-diagram. aspx The King’s Fund http: //www. kingsfund. org. uk/project s/pfcc/driver-diagrams Institute for Healthcare Improvement – video http: //www. ihi. org/education/ihiope nschool/resources/Pages/Activities/G oldmann. Driver. aspx Registered charity no. 252892. Scottish charity no. SC 039245.

D O Bright idea! ST UD Y AN PL AC T Registered charity no. 252892. Scottish charity no. SC 039245. g n i t a l u m cu c A D O AC T D O ST UD Y AN PL AC T d an n o i at rm o f in D O ST UD Y AN PL AC T ST UD Y AN PL Testing and refining ideas ge d le w o kn D O AC T D O ST UD Y AN PL AC T ST UD Y AN PL Developing improvement. Implementing new procedures & systems with PDSAs - sustaining change

Model for Improvement Registered charity no. 252892. Scottish charity no. SC 039245.

The patient safety collaborative has been a game changer for CFT in the way patient safety is understood from the Board to the ward. Our reporting culture has improved, staff are more engaged and empowered in making positive changes and patients are getting the benefits from safer care’ Phillip Confue: Chief Executive Cornwall Partnership NHS Foundation Trust The collaboration has raised the profile of safety improvement across the organisation and has helped us focus our attention on delivering reliable, safe processes and the spreading of best practice across the organisation and has been instrumental in encouraging collaboration with other mental health providers in delivering safe care. The method of improvement approach has driven the embedding of real change that has led to tangible improvements in the quality of care provided to people using our services. ’ Billy Hatifani: Director of Risk & Safety/ Deputy Do. N/ Emergency Planning Lead Being a part of this programme has allowed us to skill up our workforce so that using improvement methodology is becoming the way we do business. - our staff now ask how they can use improvement methodology to solve their harm problems’ Dr Helen Smith: Co Medical Director Devon Partnership NHS Trust Fettle ward was an early adopter of the methodology. They now make no changes without testing, especially with patient feedback. Their ward was rated "outstanding" by CQC.

The level of harm as a result of Absence without Leave (detained) incidents is sustained as zero on all wards, 2 gether aim of reducing the number of AWOLS which has been achieved and sustained, Oxford Trust wide there has been a 23% reduction in prone restraint incidents from 2014 -15 to 2015 -16. Seclusion incidents have reduced by 46% from 201415 -2015/16. Rapid tranquilisation incidents have reduced by 26% over the same period. An RCA is now completed for all rapid tranquilisation. The number and timeliness of the completion of RCAs has improved within adult mental health which will support prompt learning. Dorset Reduced the number of self harm incidents and sustained this, Oxford Patient Safety Walk Rounds by the Executive This programme has supported our staff to Team have resulted in actions to improve make widespread improvements including a patient safety concerns as identified by 51% reduction in falls, 30% reduction in AWOL, frontline staff. 94% of actions have been closed 95% medication reconciliation, DPT and sustained. 2 gether

• • • • What your organisation agrees to do By joining the South of England Mental Health Quality and Safety Improvement Collaborative, Chief Executives are committing to: Personally sponsor safety in their own organisation; Personally attend (as a minimum)1 learning set a year; Identifying a lead Executive in their organisation who will act as their organisation’s collaborative lead; The lead Executive attending the first day of all Learning Sets; Identify an appropriately senior Clinical Lead for safety who will attend; Learning Sets and become a member of the Clinical Faculty; Identify, via their lead Executive and program manager, workstream leads and work stream teams; Meeting the transport and accommodation costs of their staff who attended Learning Sets; Identify an internal program manager who will; Co-ordinate internal improvement initiatives with the Executive lead, Identify internal workstream leads, Support workstream leads, Attend all Learning Sets Facilitating the release of workstream leads to attend Learning Sets; Collaborate with other members of the Collaborative by sharing knowledge, skills and data (associated with work streams within the programme). Registered charity no. 252892. Scottish charity no. SC 039245. •

What you will receive Registered charity no. 252892. Scottish charity no. SC 039245.

Cont……. Registered charity no. 252892. Scottish charity no. SC 039245.

“Quality improvement begins with love and vision. Love of your patients. Love of your work. If you begin with technique, improvement won’t be achieved. ” A. Donabedian, M. D Registered charity no. 252892. Scottish charity no. SC 039245.

Main title slide page Co-brand logo here Thank you Heather. pritchard 1@nhs. net @IQMental. Health @Heatherp. NHS Registered charity no. 252892. Scottish charity no. SC 039245.