Perfection-Level Goals and Promises to Patients Worksheet (Goals and Promises Worksheet)

Institute for Healthcare Improvement and the organizations of the Pursuing Perfection Program, funded in part by The Robert Wood Johnson Foundation
Cambridge, Massachusetts, USA


The Institute for Healthcare Improvement developed this worksheet for the organizations participating in the Pursuing Perfection initiative, funded in part by The Robert Wood Johnson Foundation. The worksheet guides teams on setting goals that make a difference to patients. The guidance is based on the six Institute of Medicine aims.

One of the first tasks for the organizations participating in the Pursuing Perfection initiative was to set goals that raise the bar in health care performance. We know from experience that breakthrough goals are achievable in specific topics, such as reducing symptoms for asthma patients or decreasing the number of patients who are harmed by medications.
In Pursuing Perfection, participants seek to exceed these performance levels in two ways: 1) they are stretching for perfect care, and 2) they are expanding the definition of quality to include the six Institute of Medicine aims: safety, effectiveness, efficiency, patient-centeredness, timeliness, and equity.
Goal setting is an ongoing process. Pursuing Perfection participants created initial goals and promises for their first two pilot projects. In order to make these goals bold, comprehensive, and meaningful to the people they serve, they looked at their goals "through the patient's eyes" and framed them as "promises" to patients.

  • Review the examples from participating organizations. Note which seem useful and why.
  • Using the worksheet, work with your project team to:
    • Establish a definition of perfection using the six Institute of Medicine aims;
    • Identify worthy targets for each aim;
    • Describe the measure that can be used to assess progress; and
    • Describe in lay terms what it would mean to patients to achieve these goals (the promises).
    • Be sure these are bold and far-reaching goals.
  • Work with the project teams to identify the path for reaching these goals. Use the concept of half-life to specify when new levels of performance will be reached and to design the changes. For example, if your goal is to eliminate harm from anticoagulants, and your rate is 2 percent, the "half-life" is the time it takes to drop the rate to 1 percent. Once that milestone is achieved, the "half-life" is the time it takes to drop to 0.5 percent.

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