To achieve true medical-surgical care transformation, improvement teams should create high-level aim statements that are consistent with the recommended design targets, as outlined in the Transforming Care at the Bedside framework. Specific aim statements must include targeted goals for each of the four improvement areas: safe and reliable care; vitality and teamwork; patient-centered care; and value-added care processes.
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 The first step in creating aims for transforming medical-surgical care requires a commitment by senior leaders and unit-level leaders. This commitment should be reflected in a clear, well-worded aim statement that sets an aggressive design target for change and answers the question, “What are we trying to accomplish?” It is crucial that the overall targets reflect numeric goals to transform each theme for medical-surgical care. For example, the aim for value-added care and increasing nurses’ time at the bedside could be stated as follows: “Within one year, 90 percent of the nurses’ time on the unit will be spent in value-added activities.”
Senior leaders should be integrally involved in setting aims for each of the four themes to ensure that the aims are aligned with the organization’s strategic goals. In addition to approving the aims, senior leaders also need to make a commitment to support the unit-based team in achieving those aims, including breaking down barriers and provided necessary resources.
Tips for Setting Aims
See the Improvement Methods section for more information and general tips on Forming the Team, Establishing Measures, Selecting Changes, Testing Changes, Implementing Changes, or Spreading Changes.
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The following aim statements reflect the overall aim of transforming medical-surgical care through improvement in each of the four improvement areas. Note that these aims are outcome-oriented, with specific numeric goals and time frames.
Safe and Reliable Care:
Care for moderately sick patients who are hospitalized is safe, reliable, effective, and equitable.
Example aim statements include:
- Reduce adverse events to five or less per 1,000 patient days in one year.
- Reduce raw mortality by 25 percent on the designated medical-surgical unit in one year.
- Achieve 95 percent compliance with all key clinical process measures (all-or-nothing measure) for the three top clinical conditions on the designated medical-surgical unit.
- Reduce harm from falls to one or less per 10,000 patient days.
Vitality and Teamwork:
A joyful and supportive environment that nurtures professional formation and career development; effective care teams continually strive for excellence.
Example aim statements include:
- Increase the percent of clinicians, staff members, and students who say, “I work within a supportive work environment that nurtures my professional formation and development,” to 95 percent in one year.
- Increase the percent of clinicians, staff members, and students who say, “I am part of an effective work team that continuously strives for excellence even when the conditions are less than optimal,” to 95 percent in one year.
- Reduce nursing voluntary turnover to 5 percent or less in two years.
Patient-Centered Care:
Truly patient-centered care on medical and surgical units honors the whole person and family, respects individual values and choices, and ensures continuity of care. Patients will say, "They give me exactly the help I want (and need) exactly when I want (and need) it.”
Example aim statements include:
- Increase the percent of patients discharged from the unit who designate “top box” agreement with willingness to recommend the hospital to family or friends to 95 percent by [Month, Year].
- Reduce readmissions within 30 days to 5 percent or less in one year.
Value-Added Care Processes:
All care processes are free of waste and promote continuous flow.
Example aim statements include:
- Increase nurses’ time involved in direct patient care activities to 70 percent in 15 months.
- Reduce cost per discharge for the high volume clinical conditions by 3 percent annually.
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