Step 7a - What Influences The Outcome - Driver Diagrams
So what changes are we actually going to make? You will probably have a few ideas of your own already and some of these could have a high chance of success. However, we want to draw out all the potential ideas we can, because there might be ideas we hadn’t thought of ourselves or ideas from other people that may be just as good. Once we have many ideas, we can decide which ones we want to try first.
A tool which is very useful in exploring different ideas is a driver diagram. We work in very complex systems, with many factors influencing all parts of clinical practice. Identifying the main factors that influence your aim allows us to come up with different ideas to address them. Unfortunately, there is very rarely a ‘silver bullet’ idea that on its own solves everything and so using the driver diagram exercise to explore different change ideas is crucial to eventual success.
To construct a driver diagram you place your SMART aim, word for word, at the left hand side. You then branch factors that influence the aim to the right. Driver diagrams have 2 levels of branches:
Primary Drivers, which are the main general topics of influence
Secondary Drivers, which are the specifics within each general topic and themselves influence the primary drivers
Figure 7.1, Driver Diagram Example. This is from a real project conducted in an FY2's GP placement, which was successful. Recognise that there were multiple ideas for improvement tried (the 'change ideas'), and that these came from breaking down the things that influence the aim (outcome) to the level of the secondary drivers.
By the time you have secondary drivers, the influences should be broken down enough that you can think of ideas for improving practice (‘change ideas’) for some of them. As mentioned, the aim itself and the primary drivers are usually too large areas’ to directly impact, but secondary drivers can often be addressed more easily.
Like your SMART aim, driver diagrams often require revision as a project proceeds due to deeper knowledge of the problem being found as you work and it is not unusual to have updated versions.