Unlike some planning tools and methods that start at the top of an organization and filter down, key driver diagrams are an improvement strategy based on collective collaboration. For this quality alone, key driver diagrams are an effective strategy in the healthcare model for improvement.

Additionally, key driver diagrams allow for a visual representation of a team’s theory — an illustration of what “drivers” will be tested or worked on in the process of achieving aims.

Key driver diagrams are useful to outline a goal, or aim, plus the correlated, achievable steps that will have the biggest impact on achieving the aim. Take your idea from a specific aim to a fully outlined step-by-step process that can influence buy-in from stakeholders and team members alike.

The Elements of Key Driver Diagrams

As a tool for visually explaining complex problems, key driver diagrams are organized into 4 main parts: Aim, Primary Drivers, Secondary Drivers, and Ideas for Change. Let’s break them down:

  1. Aim. Start with an aim that’s measurable, specific, and achievable. Consider involving patients in the process of identifying aims that are meaningful to them. Also, look at relevant data to help identify any quality issues that must be addressed or could be improved.
  2. Primary Drivers. Identify key areas or topics you’ll need to work on in order to achieve the aim identified in step one. Each key topic identified here is called a primary driver. Primary drivers should outline each area you’ll need to influence in order to achieve the aim.
  3. Secondary Drivers. These factors influence your primary drivers, but are secondary in importance. Not all primary drivers will have secondary drivers, while some primary drivers will have a few secondary drivers.
  4. Interventions/Ideas for Change. Identify what your team should test in order to achieve the aim. All interventions/ideas for change should help to achieve the aim. These ideas may be ranked by impact and effort required. If a large group of change ideas is identified, prioritize the ideas that will have the largest impact and require ease of effort.

Key Driver Diagrams, Example Case Study

Source:
Subramanyam R, Mahmoud M, Buck D, et al. Infusion Medication Error Reduction by Two-Person Verification: A Quality Improvement Initiative. Pediatrics. 2016;138(6):e20154413, page e5

The Problem: Despite technological advances that improve patient safety, errors in intravenous medication infusion processes still occur. In this example, the Overall Project Aim was established in order to reduce these errors in the hospital setting.

The Solution: Implement a 2-person verification process for clinical staff, supported by visual reminders in the medical setting and a sign-off sheet for each person verifying the process. Key Drivers were established to illustrate the areas to be worked on. The supporting ideas for change were documented as Interventions and Changes.

The Result: As with many change implementations, staff was initially resistant to the change, which was eased by stakeholder buy-in. A successful implementation and long-term success satisfied stakeholders and the project team began to scale the process to additional locations.

Key Driver Diagrams: A Flexible System

Keep your driver diagram flexible and open to change. As your team grows to further understand the system you’re working to improve, you can make changes based on the team’s advancements. Also, remember that creating your project diagram is a collaborative process; as needed, involve other team members who may understand various facets of the system you’re working to improve. IHI has provided a template to help you set up your key driver diagram.