Improvement Theory Jim Handyside Improvision Healthcare Inc 1 - - PowerPoint PPT Presentation

Driver Diagrams: Improvement Theory

Jim Handyside Improvision Healthcare Inc

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Purpose

• To become familiar with driver diagrams.
• To recognize the input required for the

development of improvement theory.

• Differentiate the driver diagram from other

similar planning and improvement tools.

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Why Theory? Effective change is not a “black box”.

Improvement Aim A new process, system, culture…

?

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A “simple” personal improvement

Improve my health and well being Better mental health Better physical health

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A “simple” personal improvement

Better mental health Better physical health Burn more Reduce Weight Consume less

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A “simple” personal improvement theory

Burn more Reduce Weight Consume less Change Daily routine Standing Desk Walk to work Start Exercise Return to sport Lunch time walks Measure (app)

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My improvement project

Burn more Reduce Weight Consume less Change Daily routine Start Exercise Standing Desk Walk to work Return to sport Lunch time walks Measure (app)

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A simplified quality improvement

Reduce falls resulting in harm by 50% Risk Identification Multifactorial risk assessment Multifactorial interventions Communication of fall risk status Education of staff, patient, and family/carer 10 secondary drivers 45 change ideas and concepts

Ref: Falls Prevention Driver Diagram and Change Package NHS

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“Experience by itself teaches nothing… Without theory, experience has no meaning.”

• W. Edwards Deming

(from: The New Economics)

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Theory Definition

(Oxford English Dictionary) A supposition or a system of ideas in intended to explain something…

An idea used to account for a situation or justify a course of action.

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Two kinds of causal theory diagrams:

Fishbone: Team theories about what IS causing an effect. Driver Diagram: Team theories about what changes WILL result in improvement. Account for present situation Justify action (change)

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Anatomy of Driver Diagram

See article: What’s Your Theory Improvement Aim Primary Drivers Secondary Drivers Direction of cause or influence Change Ideas

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Change is an expression of theory

Thinking

Change ideas: Process Eliminate waste Knowledge, skill Behavior Technology Etc. (bundle)

Action

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AIM

HOW HOW HOW HOW HOW HOW

build theory

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AIM

WHY WHY WHY WHY WHY WHY

Rationale for change

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Careful with your logic… Is education a secondary driver?

Reduce falls resulting in harm by 50% Risk Identification Multifactorial risk assessment Multifactorial interventions Communication of fall risk status Education of staff, patient, and family/carer

Ref: Falls Prevention Driver Diagram and Change Package NHS

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Work Breakdown Structure (type of tree diagram) Project Management

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Work Breakdown Structure

Project Name A: Planning Deliverables A1: Charter & Other Planning Docs A2: Driver Diagram A3:Implementa- tion Plan* B: PDSA Implementation B1: Information Package B2: Recruited Sites B3: Prepared Sites B4: Designed & Test PDSAs B5: Implement PDSA(s) B6: Analyzed Outcomes C: New/Improved Process C1: Lessons Learned C2: New Standard Process C3: Plan for Spread C4: Implemented & Spread Process

QI Project schematic Ref: Alison Paprica, PhD, PMP

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Your theory, driver diagram and PDSA

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PDSA to develop/test change AND confirm or adjust theory

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You need measurement to test theory

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Improvement theory inputs

• 1. Evidence
• 2. Experience
• 3. Other’s improvement
• 4. Analysis of your current state

……

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• 1. Compile inputs:
• Evidence
• Experience
• Other’s improvement
• Analysis of current situation
• 2. Sort, organize build primary

and secondary drivers Sticky note exercise Or use a template document DRAFT! (it’s a draft until you know what worked or didn’t and why.)

Getting started:

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@CFHI_FCASS

cfhi-fcass.ca |

Thank You!

Two articles: What’s Your Theory? Demystifying Theory and Its Use In Improvement