Driver Diagram Template: A Practical Guide for NHS Teams

Why this topic matters

NHS teams are continually pressed to deliver better care with finite resources. QI methodologies offer a structured way to achieve these improvements. Yet, many QI projects falter due to a lack of clear planning or an inability to connect specific changes to overarching aims. This is where the driver diagram excels.

A driver diagram provides a visual representation of how a chosen aim can be achieved by identifying the primary (key) drivers and secondary drivers, and linking these to specific change ideas. It helps teams:

• Clarify the 'why' and 'how': It makes explicit the theory of change behind the project.
• Engage stakeholders: A visual map is easier to understand and discuss, fostering shared understanding.
• Prioritise effort: By identifying key drivers, teams can focus on changes likely to have the biggest impact.
• Communicate effectively: It serves as a concise summary of the project's logic for review and presentation.
• Avoid 'solutionising': It encourages thinking about the underlying causes and drivers before jumping to specific solutions.

Practical explanation: What is a Driver Diagram?

A driver diagram is a visual planning tool, typically presented as a flowchart, used in quality improvement. It helps a team map out the causal links between their overarching aim, the factors that influence that aim (drivers), and the specific interventions they plan to test (change ideas).

It typically consists of three main columns, moving from right to left:

1. Global Aim

This is the ultimate goal of your QI project, usually expressed as a measurable statement that is specific, measurable, achievable, relevant, and time-bound (SMART). It defines what you want to achieve. For example, 'To reduce 30-day readmission rates for patients with heart failure by 20% by December 2024 at St Elsewhere's Hospital.'

2. Primary Drivers

These are the high-level leverage points or factors that, if influenced, will directly contribute to achieving your global aim. They are the 'big picture' categories of change. They are not specific actions, but areas where change needs to occur. For instance, for the heart failure readmission aim, primary drivers might be 'Improved discharge planning', 'Optimised post-discharge follow-up', and 'Enhanced patient education on self-management'.

3. Secondary Drivers

These are the specific factors or processes that, if improved, will directly impact the primary drivers. They break down the primary drivers into more actionable components. Continuing the example, 'Improved discharge planning' (primary driver) might have secondary drivers such as 'Timely medication reconciliation at discharge', 'Clear communication with primary care', and 'Availability of dedicated discharge coordinator'.

4. Change Ideas

These are the specific interventions, experiments, or initiatives you will implement and test, often using Plan-Do-Study-Act (PDSA) cycles, to influence the secondary drivers. These are the 'how-to's. For 'Timely medication reconciliation at discharge' (secondary driver), change ideas could be 'Implement a standardised electronic discharge checklist', 'Train pharmacists to complete all medication reconciliation before patient leaves ward', or 'Pilot a pre-discharge medication education session for patients and carers'.

Arrows are used to connect these elements, illustrating the theoretical causality: successful change ideas lead to improved secondary drivers, which in turn strengthen primary drivers, ultimately contributing to the global aim.

Common pitfalls

Building an effective driver diagram requires careful thought. Common pitfalls include:

• Confusing drivers with change ideas: A driver is a factor that needs to be influenced; a change idea is a specific action to influence that factor. This is the most common mistake.
• Not being clear or specific enough: Vague drivers or aims make it hard to identify meaningful change ideas.
• Too many drivers: Overloading the diagram can lead to a loss of focus. Aim for 3-5 primary drivers.
• Lack of logical flow: Ensure the causal links from change ideas up to the aim make sense and are evidence-informed where possible.
• Not involving the right people: A driver diagram should be co-created with the front-line staff and relevant stakeholders who understand the system. Doing it in isolation can lead to an inaccurate or unactionable diagram.
• Treating it as static: A driver diagram is a 'living document'. It should be reviewed and updated as you learn more through your QI cycles.

Step-by-step approach to building your Driver Diagram

1. Define your Global Aim

Start with a clear, measurable aim. What specific outcome do you want to achieve, for whom, by when, and by how much? Use SMART principles. Write it clearly on the far right of your diagram.

2. Brainstorm Primary Drivers

With your team, discuss: 'What are the major categories or high-level factors that, if improved, would directly lead to achieving our aim?' Think broadly about processes, systems, knowledge, or behaviours. Use sticky notes or a whiteboard for this stage. Aim for 3-5 key areas.

3. Identify Secondary Drivers

For each primary driver, ask: 'What specific, actionable factors or processes within this category need to change to strengthen this primary driver?' Dig deeper into the components that make up each primary driver. Again, use brainstorming and involve those who work directly in the area.

4. Generate Change Ideas

Now, for each secondary driver, brainstorm specific interventions or actions that you could test to improve it. These are your 'Plan-Do-Study-Act' (PDSA) cycle ideas. Consider what has worked elsewhere (benchmarking), what current evidence suggests, or what innovative ideas your team has. Remember, these should be small, testable changes.

5. Draw the Connections

Connect the change ideas to their respective secondary drivers, secondary drivers to primary drivers, and primary drivers to the global aim using arrows. This visualises your theory of change.

6. Review and Refine

Critically review your diagram. Does it make sense? Are the drivers distinct from change ideas? Is it comprehensive yet focused? Does it have stakeholder buy-in? Adjust as necessary. Seek feedback from colleagues or QI experts.

Example in clinical practice: Reducing Medication Errors on an Acute Medical Ward

Let's apply this to a common NHS challenge:

Global Aim: To reduce the number of medication errors reported on AMU Ward 3 by 50% within 12 months (April 2024-March 2025).

• Primary Driver 1: Improved Medication Prescribing Process

  • Secondary Driver: Enhanced prescribers' knowledge of common prescribing pitfalls.
    • Change Idea: Develop and deliver a mandatory ‘Safe Prescribing’ e-learning module for all new junior doctors.
    • Change Idea: Implement real-time prescribing audit with immediate feedback for individuals.
  • Secondary Driver: Standardised prescribing guidelines for high-risk medications.
    • Change Idea: Create ward-specific quick-reference guides for common high-risk medications.
    • Change Idea: Embed electronic prescribing alerts for dose limits or interactions.

• Primary Driver 2: Optimised Medication Administration Process

  • Secondary Driver: Improved 'right patient, right drug, right dose, right route, right time' checks.
    • Change Idea: Introduce a 'double-check for high-risk meds' policy with mandatory documentation.
    • Change Idea: Develop a nurse-led checklist for administration of complex drug regimes.
  • Secondary Driver: Reduced interruptions during medication rounds.
    • Change Idea: Implement a 'red apron' or 'no-interruption zone' policy during medication rounds.
    • Change Idea: Designate a non-medication-administering staff member to answer calls during drug rounds.

• Primary Driver 3: Enhanced Medication Reconciliation at Admission/Transfer/Discharge

  • Secondary Driver: Clear and documented medication history upon admission.
    • Change Idea: Implement a pharmacist-led admission medication reconciliation service for all admissions.
    • Change Idea: Develop a standardised 'best possible medication history' form.

This framework provides a clear roadmap. Each 'Change Idea' would then be tested through PDSA cycles, with data collected to measure its impact on the secondary and ultimately primary drivers, contributing to the global aim.

How Lazomis can help

Lazomis streamlines your QI journey, from initial planning to sustained improvement. Our platform includes:

• QI Project Setup: A structured framework for defining your aim, identifying stakeholders, and, crucially, documenting your driver diagram. Our intuitive interface allows you to build and visualise your driver diagram directly within the project plan, linking drivers to your specific change ideas and PDSA cycles.
• Templates Library: Access to an embedded, downloadable driver diagram template that you can adapt for your team's specific needs, alongside other essential QI tools.
• PDSA Management: Seamlessly link your change ideas from the driver diagram to individual PDSA cycles, helping you track testing, learning, and iterations. This ensures that every test is connected to a larger strategic goal.
• Collaboration Features: Facilitate real-time collaboration on your driver diagram with your multidisciplinary team, ensuring everyone is aligned with the project's theory of change.

By centralising your project documentation and providing tools like the driver diagram template, Lazomis helps translate your QI strategy into actionable steps and measurable progress.

Key takeaways

• A driver diagram graphically links your project's aim, primary drivers, secondary drivers, and change ideas.
• It provides a clear 'theory of change' for your quality improvement initiative.
• Effective driver diagrams are co-created with front-line staff and stakeholders.
• Common pitfalls include confusing drivers with change ideas and a lack of specificity.
• It is a dynamic document that should be reviewed and updated as you learn.
• This resource supports, but does not replace, clinical judgement. Local policy, formulary and specialist advice should be followed.