Readiness Assessment & Developing Project Aims

Part 1: Introduction

Part 2: Key Characteristics of Readiness

Part 3: Assessing Organizational Culture for Change

Part 4: Tools to Support Readiness Assessment

Part 5: Developing and Writing Effective Aim Statement

Part 6: Tools to Support the Development of Aim Statements

Part 7: Related Resources

Part 5: Developing and Writing Effective Aim Statement

An aim statement is a written and measurable description of your organization’s desired improvement.  It targets a specific patient population and describes the amount of time needed to achieve the aim.  The purpose of an aim statement is to provide QI teams with clear, well defined goals.  It provides a sense of direction and allows your QI team to identify the steps that should be taken to meet the end goal.  Organizations are more likely to successfully improve quality when they establish effective aim statements.

Aim statement examples from Healthcare Communities:

1. Starlight Health Center (Word - 56KB) will redesign its care delivery model for our patients with diabetes. We will accomplish this through recognition that changes are required to improve care. We will also demonstrate a commitment to our patients’ health through addressing the six components of the Chronic Care Model and utilization of clinical best practices. We expect our process measures to show improvement within 3 months (by April 2006) and outcome measures to show improvement within six months (by August 2006). We will know we have achieved improvement by monitoring the following measures within our population of focus:

   • 70% with two HgbA1c three months apart annually
   • 70% with HgbA1c<7.0
   • 70% with documented self management goals
   • 70% with BP<130/80
   • 70% patients 40 years and older with an abnormal lipid profile have a current statin prescription
   • 90% have up to date pneumonia and influenza vaccines, and

2. Rural Health (Word - 56KB) will redesign the clinical practice to improve the care of our patients with depression by implementing the Care Model. We will increase the recognition rate of depression and implement an active follow-up program to enhance treatment. Our goals are to have current guidelines for care and referral consistently utilized by the practice. We will accomplish this by implementing the following measures:

• 70% of patients with the diagnosis of depression will have a PHQ score completed in their medical record.
• 70% of CSD patients with documented PHQ will be reassessed between 4-8 weeks of last new episode of PHQ.
• 40% of patients will have 50% improvement of PHQ score within 6 months.
• 70% of patients will have documented self-management goals set in the last 12 months

3. Pulaski Health Center  (Word - 20KB)To improve patient care and clinical outcomes for our patients living with diabetes.  We will accomplish this through implementation of the Care Model as part of our organization’s delivery system. This will be evidenced by:

• At least 90% of our patients receiving at least 2 HBAIC’s 3 months apart within one year
• An average HBA1C less than 7.0
• At least 70% of our patients will have documented self-management goals. 
• At least 75% of our patients 55 years and older will have current prescriptions for ACE inhibitors or ARB medications

In order to set successful aim statements, the Institute for Healthcare Improvement suggests that organizations state clear aims; include numerical goals; avoid aim drift; and refocus their aims when necessary.  Establishing an approach to develop aim statements may be difficult.  However, the Committee on the Quality of Health Care in America established by the Institute of Medicine (IOM) proposes six aims that your QI team can use to form aim statements specific to your organization.  These six aims propose that health care be STEEEP:

• Safe
• Timely
• Effective
• Efficient
• Equitable
• Patient-centered

If QI teams consider these overarching aims, they increase their chances of making improvements that will significantly impact patient care.  Your QI team may also consider using data-driven benchmarks to set target goals for their aims.  By doing this, QI teams set realistic performance goals for your organization.  As national benchmarks change over time, the QI team can refocus aims.

Once QI teams decide on an aim, they can begin to think about measures that will determine if a change in process actually leads to improvement.  Measurement also helps to assess performance and identify areas in the workflow in need of improvement.  Next, the team should brainstorm ways to alter workflow and other system processes for quality improvement.  Once your QI team selects a few worthy process change ideas, they should begin testing the changes on a small scale using the Plan-Do-Study-Act (PDSA) cycle. The Institute for Healthcare Improvement (IHI) describes steps of a successful PSDA Cycle:

Step 1: Plan

Plan the test or observation, including a plan for collecting data.

• State the objective of the test.
• Make predictions about what will happen and why.
• Develop a plan to test the change. (Who? What? When? Where? What data need to be collected?)

Step 2: Do

Try out the test on a small scale.

• Carry out the test.
• Document problems and unexpected observations.
• Begin analysis of the data.

Step 3: Study
Set aside time to analyze the data and study the results.

• Complete the analysis of the data.
• Compare the data to your predictions.
• Summarize and reflect on what was learned.

Step 4: Act

Refine the change, based on what was learned from the test.

• Determine what modifications should be made.
• Prepare a plan for the next test.

Results from the PDSA cycle will help the team identify process changes that should be implemented in the live environment.  Results will also help your QI team project costs and the potential impacts of the changes.