Lung Cancer Screening Improvement Collaborative
Mammography Positioning Improvement Collaborative
Prostate MR Image Quality Improvement Collaborative
Recommendations Follow-Up Improvement Collaborative

How to Use a Key Driver Diagram


The purpose of this article is to outline the different elements of the key driver diagram and provide guidance on how to utilize these elements.  Ultimately, key drivers will help you develop interventions - iterating on your existing processes or implementing new processes - thus enabling you to achieve your SMART goal.

What is a Key Driver Diagram?

The key driver diagram is composed of two components: key drivers and interventions.  Key drivers are like sub-goals.  They are the 4-6 things that must happen consistently or structures that should be in place to reach the SMART goal.  They are not specific tangible actions.  Interventions are the specific changes you need to make to achieve the key driver.  One intervention can address more than one key driver.  

The arrows in the diagram indicate the connections between key drivers and interventions they support.

Key Driver Diagram Example

Creating Effective Key Drivers

There should be a clear connection between the root causes identified from your current state analysis and the key drivers listed in the key driver diagram. When creating your key drivers, ask yourself, "Given the root causes of our problem, to meet our SMART goal, we need to find a way to do.........."

 Effective key drivers should:

  • Be clear, succinct and descriptive
  • Be positively framed
  • Have interventions that logically flow from them; key drivers "drive" good interventions
  • Address key elements that are essential for project success 
  • Allow for multiple, different types of interventions to be tested
  • Be universal across all project sites (interventions tend to be more site-specific)
  • Establish key structural programmatic elements
  • Incorporate intelligent redundancy

Generating Impactful Interventions

As a team, use the "How might we" activity to generate a list of interventions.  No editing during this activity.  Just get all ideas out on the table.  To do this, ask yourself, "How might we..." for each key driver.  There will be many different ways each key driver can be addressed.  As a team, review the generated list and add then add the specific items you would like to test as your interventions on the key driver diagram.  

Impactful interventions should:

  • Be clear enough that there is only one way in which the intervention can be accomplished
  • Address one or more key driver

Communicating Interventions and Measuring Progress

Communicating Intervention Testing Progress Symbols Legend

Reliability Level: Levels of reliability indicate how consistently the process will work as expected.  There are three levels of reliability.  

  • Level one (1) is the lowest level of reliability as it is dependent on individuals.  At this level you can expect the process to pee performed correctly about 90% of the time; it may require additional oversite to maintain.  
  • Level two (2) is the middle level of reliability as it is dependent on procedures.  At this level you can expect the process to be performed correctly 95% of the time.
  • Level three (3), systems, is the highest level of reliability as it is dependent on systems.  At this level you expect the process to be performed correctly 99.9% of the time; it may require investment in infrastructure.

Names:  Each intervention should be assigned to a team member to oversee the PDSA cycle and report back to the team key learnings and adjustments for the next cycle, if needed.

Maturity Bars: Maturity bars show the level of progress made in testing a specific intervention.  Maturity is measured by the number of PDSA cycles and degree of integration into the workflow.  If an initial PDSA cycle has not been conducted, then the progress bar will be blank.  Once the intervention is integrated and working well in operationally, the progress bar will be fully filled in.

Barrier and Abandoned Symbols: These symbols are used to communicate an issue with an intervention or abandonment of an intervention.  This allows the team to focus energy on active interventions and removal of barriers.  These visual cues also notify sponsor(s) as to where additional resources may be needed.


Larson, David (2022). Key Drivers. ImPower Video.

Garcia Tomkins, Kandice (2022). Reliability. ImPower Video.

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