Use Well-Crafted Aim Statements To Achieve Clinical Quality Improvements

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Editor’s note: This mini lesson represents some of the content presented at Health Catalyst University’s Accelerated Practices (AP) Program. With the purpose of educating health professionals, the AP Program prepares healthcare teams to accelerate outcomes improvement. Faculty and guest experts of the program are recognized leaders in their respective fields of expertise. Below, Cherbon VanEtten, MBI, faculty member of Health Catalyst’s Accelerated Practices (AP) Program, shares insight about the need for organizations to use well-crafted aim statements to achieve their improvement goals—a topic she covers in her session on quality improvement tools.

aim statementsFor the professional, golf is a game of precision, strategy, and constant improvement with a clear aim to decrease the number of strokes.  There are multiple determinants in achieving that aim: driving, long irons, short irons, chipping, and putting. Course features (slope, water, sand, rough) require strategies that take advantage of them or take them out of play. Every professional has difficulty putting together a complete game. Once the putting game gets flowing, driving accuracy takes a break. A week of missed greens is followed by a week of missed fairways. Professional golfers constantly work to improve all parts of their game.

Although caring for patients is far more complex than golf, there is a lesson here for hospitals and health systems that want to make clinical quality improvements. In order to improve, you need a clear aim and you need to understand how what you do contributes to, or gets in the way of, achieving the aim.

Aim Statements Articulate the Problem

An effective aim statement begins with clearly articulating the problem being addressed so that, when resolved, will provide meaningful value to patients and the organization. I think of aim statements, and the time and resources required to address them, as two sides of the same coin. If the problem is significant enough, then the investment of the coin makes sense. Let’s face it, not all the challenges facing healthcare organizations, once addressed, represent the same worth.

To determine which issues could deliver substantial value, you need data, which most healthcare organizations have in abundance these days. But you also need a way to analyze that healthcare data to discover where the critical few problem areas are. The Key Process Analysis (KPA) application uses the “80/20 rule” to identify clinical areas with significant variation in care processes and high costs. The KPA combines clinical and financial data to highlight the best opportunities for improvement and cost reduction, and guides the development of applications to support improvement initiatives. However you get there, the important thing is to use your own data to understand where the greatest opportunities for improvement are, and then prioritize your investment of time and resources to address the critical few.

Taking Aim at Processes

Once you’ve identified and clearly defined the problem you are trying to solve it’s time to write your aim statement. In developing your aim statement, always remember the acronym SMART. You want it to be Specific, Measurable, Achievable, Relevant, and Time-bound. After selecting an aim, it’s time to diagnose the root cause of the problem. When you know that, you can begin to identify what alterations to make in the process in order to drive meaningful change, i.e., the sub-aim statements. These, too, should be written using the SMART method and they should represent the small changes that will collectively result in achieving the primary aim.

A simple example, and one most of us can relate to, is lowering cholesterol. Let’s say you’ve set a primary aim of lowering your cholesterol from 220 to 200 in three months. To get there, you identify several changes you believe will result in achieving the aim. They include losing weight, eliminating dairy, and exercising regularly. For each of these interventions, you would identify a corresponding sub-aim, i.e., lose four pounds in one month, eat five servings of vegetables four times a week for three months, and exercise 30 minutes per day, three times a week, for one month and increase to five times per week, thereafter.

Again, you will want to use the SMART criteria to create your sub-aim statements, focusing on the individual components or process changes that are tied to your goal statement.

Process Improvement Example

Here’s an example of how setting an aim statement and corresponding sub-aim statements worked to deliver clinical process improvement for mortality rates and sepsis in one of our health systems.

After analyzing patient data, the health system recognized that its 30-percent mortality rate for sepsis patients, especially those presenting through the emergency department (ED), was too high. Since 80 percent of its sepsis patients came through the ED, the health system decided to focus its improvement efforts there.

Digging deeper into the data, the health system realized that one particular hospital with mortality rates of 40 percent had very long wait times in the ED, and that the triage process was sporadic and chaotic. As a result, sepsis was often missed during triage in patients who came in with it, which meant critical labs and treatments were delayed.

From this data, the health system developed this aim statement: Decrease mortality rates of sepsis patients admitted through the ED at this hospital from 40 percent to 30 percent—and decrease variable direct costs by 5 percent – by September 30, 2015. This aim would not only bring this particular hospital in line with the rest of the health system, it would also address the most pressing issue around sepsis mortality rates. The lessons in this case could then be applied across all hospitals to drive additional improvements.

To get there, the health system developed two key sub-aim statements:

  1. Increase adherence to the ED early recognition triage protocol by 70 percent by July 31, 2015
  2. Increase by 10 percent the number of patients who were accurately diagnosed with sepsis within one hour in the ED by September 31, 2015

The organization went on to define several other sub-aim statements. For example, the health system determined that reducing the lactate turnaround time would help improve the triage process, which led them to review what process changes were required in both the ED and lab to speed the return of results.

Faster turnaround times by themselves won’t lower mortality rates; if that was the aim statement, it wouldn’t drive an improvement that patients care about. But faster returns of lab work helps clinicians in the ED identify patients with sepsis earlier, enabling them to create earlier interventions that do improve mortality rates. That is something patients care about. Quite a bit, as a matter of fact.

Winning the Quality Improvement Game

For professional golfers, reaching personal goals and winning championships doesn’t just happen. There are a lot of steps that must be taken, in the right way, to become successful.

The same goes for healthcare organizations that want to drive clinical quality improvements. Developing data-driven SMART aim statements that will be meaningful to patients, and developing detailed sub-aim statements that lay out the path for achieving the goals, are how to ensure your organization becomes a consistent winner.

Do you have any success stories around how having a well-defined problem made it easier to write an aim statement? Anything you’ve learned over the years that can help others use the process more effectively?


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