Use of a Key Drivers Diagram in preparation for COVID-19 at an urban, academic anesthesiology department

Abstract

Background: The 2019 novel coronavirus pandemic has had a significant impact on anesthesiology practice globally. Its high infectivity and severity of onset has led to numerous examples of healthcare systems being overwhelmed, especially at its incipience. Drawing on experiences from previous pandemics, we anticipated that our Anesthesiology Department would be faced with unique challenges due to our proximity to airway maneuvers. We set out to intentionally strategize a quality improvement framework with which to guide our departmental response. Methods: We employed a Key Drivers Diagram (KDD) model to strategically account for the numerous novel quality improvement measures implemented simultaneously in response to the pandemic. Having identified areas of interest, measurable indices were identified, and dynamic progress assessed using run charts. These were (I) protect patients and staff, (II) keep up-to-date with evolving evidence, (III) maintain communication with department, (IV) keep staff engaged, and (V) align departmental goals with institutional aims. Results: Positive trends in staff engagement were identified across participation in educational activities such as guideline development, grand round attendance, and interdepartmental meetings. Conclusions: The KDD provided a valuable framework for managing parallel quality improvement processes. It enabled leadership to identify needs, measure adequacy of response and implement changes in a rapidly evolving environment.