29 August 2023

Reviewing, Reflecting, and Re-Focusing – We Updated our Aim and Driver Diagram

By Rebecca Lingard (Borough Lead Nurse City and Hackney) and Linnea Miklaucich (Improvement Advisor)

During a sunny afternoon in July, all the wards in City and Hackney came together for a “re-energising” workshop of the therapeutic engagement project. We had recognised that the work had started to slow down and wanted an opportunity to take stock and re-focus. We planned a four hour in-person workshop that aimed to review what we have done so far, reflect on the challenges as well as the successes, and connect with the purpose of the work and what is important for those involved. We wanted to also share the trust wide measurement plan and ensure we capture those expectations within the work.

Figure 1: Reviewing the Driver Diagram.

We started the session with an overview of the project so far and recognising all the hard work. We celebrated the success of the data collection, the service user involvement, and the established weekly meeting. We reflected that it has been difficult to bring the project to life on the wards and we discussed how the work could be more visible and alive.

Figure 2: Discussions in the room.

A New Direction – Updated Aim and Driver Diagram

A big section of the workshop was spent reviewing the aim and the driver diagram. The aim for our project had been focused on getting the observations to 100%. We discussed the aim, whether it felt meaningful and service user focused. With the trust wide measurement plan having the FFT (friends and family test) as an outcome measure, we further questioned whether our aim reflected the patient’s experience.

Everyone in the room was asked to spend a couple of minutes in silence thinking about what the aim should be. They were then asked to go into pairs and write an aim statement. Pairs then became groups of four (or five) and asked to combine the two aims into one. Lastly, the aims from the groups were put on the wall and participants voted on their favourite.

Figure 3: Writing an aim statement.

As we suspected beforehand, the aim statements the groups came up with were quite far from our original aim of getting observations to 100%. We didn’t have a winner from the voting, but instead combined two to get our new aim. Our new aim now focuses on improving the therapeutic environment and experience.

Figure 4: City and Hackney’s new project aim.


With the new aim in mind, we then used the nominal group technique to generate new change ideas.

Figure 5: Grouping change ideas together (affinity diagram).


We compared the new change ideas with what we had on our driver diagram. We identified some change ideas that had been on the driver diagram but no longer felt relevant and added the new ideas from the exercise.

Figure 6: City and Hackney’s updated Driver Diagram.

What’s next?

We ended the workshop with a summary and agreements for our next steps. Feedback from those attending was overwhelmingly positive, participants told us they feel more involved in the work, that the new aim feels more meaningful and motivating, and that they would like more workshops in the future.

Reviewing and updating our aim and driver diagram has reminded us that these are dynamic, an aim statement can change, driver diagrams can (and should) be updated as we learn through the course of a project. Ensuring everyone is included and listened to is crucial to keep momentum going. This was our first workshop of this kind, but it won’t be the last. The project has got some much-needed energy and we are excited to see what we will learn over the next few months.

Copyright © 2024 East London Foundation Trust. All rights reserved.

Subscribe to our newsletter

  • YesNo
  • 12345
    1 = poor | 5 = great
  • 12345
    1 = not useful at all | 5 = very useful


What are you looking for today?