Step 3: Set an Aim

“Some is not a number; soon is not a time.”
– Don Berwick

 

The most critical part of the improvement journey is establishing the aim.

The purpose of an aim statement is to provide improvement teams with clear, well defined goals.  It provides a sense of direction and will allow your team to identify the steps that should be taken to meet the end goal.  Teams make better progress when their aim is very specific, unambiguous and focused.

An aim statement answers the first question in the Model for Improvement:

“What are we trying to accomplish?”

A strong aim statement operationalizes the problem identified in Step 1:  it is time specific, measurable, and defines a specific population.  As Don Berwick says “Some is not a number; soon is not a time.”  In other words your aim statement should address these points:

  • How good?
  • By when?
  • For whom (or what system)?

Example:  We will increase the proportion of all students who receive a flu vaccine from 50% to 80% by March 2018.

In crafting your aim statement you want to avoid a non-specific, albeit admirable aim such as “end world hunger.”  Here are some examples of less useful aim statements and their improved, actionable versions:

Less Useful Aim StatementsStronger, Actionable Aim Statements
Lose weightI will weigh 150 pounds or less by July 1st
Exercise moreI am going to run at least 2.5 miles per day by May 15th
Implement a registry to track students with depressionIncrease the proportion of students with depression who are entered into the registry from 0 to 50% by June 2016
Assess the efficiency of the check-in processIncrease the proportion of appointment check-ins in which all required information is collected at the time of check-in from 35% to 70% by June 2016
Improve the overall health and wellbeing of all studentsDecrease the proportion of students who have had a health issue negatively impact their academic performance within in the last 12 months from 45% to 35% by May 2017

The following tips for aim setting have been adapted from the Institute for Healthcare Improvement:

Make sure that the aim statement describes the system to be improved, and the population.  Some aim statements also contain information about key strategies and other guidance for the improvement project. But the aim should be succinct and not contain extraneous background information or side issues. It should be easy to understand exactly where we’re going and what we expect to accomplish.

Setting numerical goals clarifies the aim, helps to create tension for change, directs measurement, and focuses initial changes. For example, the aim “reduce wait times for walk-in services by 60%” is clearer than “reduce wait times”. Including a numerical goal not only clarifies the aim but also helps team members begin to think about what their measures of improvement will be, what initial changes they might make, and what level of support they will need.

A “stretch” goal is one to reach for within a certain time. Setting stretch goals such as “Reduce wait times for walk-in services by 60% within 12 months” communicates immediately and clearly that maintaining the status quo is not an option. Effective leaders make it clear that the goal cannot be met by tweaking the existing system. Once this is clear, people begin to look for ways to overcome barriers and achieve the stretch goals.

The team needs to be careful to avoid drifting away from the aim unconsciously or backing away from it deliberately. Repeating the aim helps to reinforce it.  Start each team meeting with an explicit statement of aim, for example, “Remember, we’re here to reduce wait time for walk-in services by 60% within 12 months,” and then review progress quantitatively over time.

If the team’s overall aim is at a system level, team members may find that focusing on an element of the wider system aim will help them achieve the desired system-level goal. For example a system level aim to screen 75% of students seeking services at the health center for depression using PHQ-9 within the next 6 months could be refocused to ” screen 75% of students seeking services in appointment based primary care visits at the health for depression using PHQ-9 within the next 6 months “. Note: refocusing the aim is not the same as aim drift (which usually isn’t a good tactic); refocusing is a conscious decision to work on a smaller part of the system (which often is a good tactic).

 

Improvement Journey Exercise #3

Write your Aim Statement.

Be sure to specify:

  • How good?
  • By when?
  • For whom (or what system)?

Document your Aim Statement using the Model for Improvement Worksheet