Science of Improvement: Setting Aims

Improvement requires setting aims. An organization will not improve without a clear and firm intention to do so. The aim should be time-specific and measurable; it should also define the specific population of patients that will be affected. Agreeing on the aim is crucial; so is allocating the people and resources necessary to accomplish the aim.

In 1999, the Institute of Medicine (IOM) in Washington, DC, USA, released To Err Is Human: Building a Safer Health System, a report that brought much public attention to the crisis of patient safety in the United States. In 2001, the IOM issued a second report, Crossing the Quality Chasm: A New Health System for the 21st Century, which outlines six overarching "Aims for Improvement" for health care:

  • Safe: Avoid injuries to patients from the care that is intended to help them.
  • Effective: Match care to science; avoid overuse of ineffective care and underuse of effective care.
  • Patient-Centered: Honor the individual and respect choice.
  • Timely: Reduce waiting for both patients and those who give care.
  • Efficient: Reduce waste.
  • Equitable: Close racial and ethnic gaps in health status.

Many organizations use the six IOM aims to help them develop their aims.


See also: Tips for Setting Aims.

 

Examples of Effective Aim Statements

For Patient Safety

  • Reduce adverse drug events (ADEs) in critical care by 75 percent within 1 year.
  • Improve medication reconciliation at transition points by 75 percent within 1 year.
  • Reduce high-hazard ADEs by 75 percent within 1 year. For example, reduction of 75 percent in one of the following:
    • Overdoses from benzodiazepines and narcotics
    • Percentage of patients with incidence of bleeding in patients being treated with anticoagulant medications
    • Percentage of patients on insulin with any blood sugar <50
  • Increase the number of surgical cases between cases with a surgical site infection by 50 percent within 1 year.
  • Achieve > 95 percent compliance with on-time prophylactic antibiotic administration within 1 year.

For Clinic Access

  • Reduce waiting time to see a urologist by 50 percent within 9 months.
  • Offer all patients same-day access to their primary care physician within 9 months.
  • Reduce waiting time to see a physician to less than 15 minutes within 9 months.

For Flow (all goals to be achieved within 9 months)

  • Transfer every patient from the Emergency Department to an inpatient bed within 1 hour of the decision to admit.
  • Transfer every patient from the Post-Anesthesia Care Unit (PACU) to an inpatient bed within 1 hour from the time patient is deemed ready to move from the PACU.
  • Transfer every patient from the Intensive Care Unit (ICU) to an inpatient bed within 4 hours from the time the patient is deemed ready to move from the ICU.
  • Transfer every patient from the inpatient facility to a long-term care facility within 24 hours after the patient is deemed ready to transfer.

For Critical Care

  • Reduce ICU mortality by 20 percent within 9 months.
  • Reduce incidence of ventilator-associated pneumonia by 25 percent.
  • Reduce average ventilator days by 2 to 4 days per discharge.
  • Reduce adverse drug events (ADEs) per ICU day by 75 percent (or absolute number of less than 0.10 ADE per ICU day).
  • Reduce incidence of oversedation or too lengthy sedation by 40 percent.
  • Reduce complications of ICU stay by 40 percent:

    • Development of deep vein thrombosis
    • Gastrointestinal bleeding from stress ulcers
    • Line infections
  • Reduce the average length of stay for Medical ICU patients by 50 percent within 9 months. 
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