Model for Improvement: What are we trying to accomplish?
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