1. What are we trying to Accomplish? Establishing Aim Statements
January 30, 2017
Day 1
What are we trying to Accomplish? Establishing Aim Statements
Phyllis Virgil Christina Gunther-Murphy

2. Session Objectives
Describe the essential components of an effective aim statement
Distinguish between effective and ineffective aim statements
Apply these principles by crafting a draft project aim statement

3. Session Agenda Topic Time Why Care about Aims 10 minutes
Effective and Ineffective Aims
You make the Call
20 minutes
Craft and Coach

4. MFI: A Model for Learning and Change
Aim
Let’s start with the First Question
Langley, et al, The Improvement Guide, 2009
The Model for Improvement,* developed by Associates in Process Improvement, is a simple yet powerful tool for accelerating improvement. The model is not meant to replace change models that organizations may already be using, but rather to accelerate improvement. This model has been used very successfully by hundreds of health care organizations in many countries to improve many different health care processes and outcomes.
The model has two parts:
Three fundamental questions, which can be addressed in any order.
The Plan-Do-Study-Act (PDSA) cycle** to test changes in real work settings. The PDSA cycle guides the test of a change to determine if the change is an improvement.
Langley, et al, The Improvement Guide, 2009

5. Aim – is critical to your success!
You will sink or swim based on the clarity, and commitment to your aim...
Source: Phyllis Virgil, Strategic Quality Planning Retreat, 2008
Source: Phyllis M. Virgil

6. Why aims matter
Lose Weight
Be Healthy
CHRISTINA

7. Why aims matter
“Quiet at Night”
Sleep

8. Why aims matter Implicit 7 person meeting = 7 understandings
Understood
Implied
Unspoken
Embedded
Hidden
“We are trying for zero days for all patients”
“We are going to reduce it for elderly patients”
“We are going to reduce it by 10% by next week.”
“I know we have to get something done by end of fiscal year.”
“Why am I at this meeting? I think it has something to do with mammography?”
“We are trying to reduce it by 50%, because I think it’s at 10 days.”
“What about this indicator over here? It is a better measure.”
7 person meeting =
7 understandings
Adapted from Quality Improvement Fundamentals LLC

9. Why aims matter Explicit 7 person meeting = 1 shared vision
Open
Clear
Unambiguous
Precise
Plain
“We will reduce our Urinary Catheter Utilization Rate for inpatients from an average of .31 to .25 by the end of FY17 with the guidance of our Nursing Quality Council and our CNO.”
7 person meeting =
1 shared vision
Adapted from Quality Improvement Fundamentals LLC

10. Why aims matter Set internal expectations Set external expectations
Ensure the right SME’s
Solidify participation
Common rally point
Avoid “Scope Creep”
Set external expectations
Ensure the right Leaders
Solidify support
Common rally point
stop temptation for…

11. Why aims matter The essential components of a solid Aim
On setting goals
The essential components of a solid Aim
Population (For Whom?)
Goal (What, How Much?)
Time Expectation (By When?)
System or Process (Where?)
“We will reduce our Urinary Catheter Utilization Rate for inpatients from an average of .31 to .25 by the end of FY12 with the guidance of Linda Darling, CNO.”
… but what if I don’t have all this information at first?
Progress and Consensus trump perfection in improvement and “sharing is caring”
Source: William Peters, 2012
Quality Improvement Fundamentals LLC

12. Why aims matter

13. Why aims matter From… To…
Improve percent of patients reporting their room is always quiet at night
Be quieter
Make management happy
Get some new equipment
Aim: Improve patients reporting they got 6+ hours of sleep per night from 30% to 60% by March 31, 2017.
LAURA

14. Definition of Aim Noun: a purpose or intention; a desired outcome
the directing of an object (effort) at a target (destination)
Verb:
point or direct at a target (destination)
have the intention of achieving
Source: Google
So Aim requires a target, or destination and an intention of getting there... Like a journey, you get in the car to take a trip, what is the first thing you do... Ask where are we going... Must know where you are going in order to get there...
aim
ām/
verb
verb: aim; 3rd person present: aims; past tense: aimed; past participle: aimed; gerund or present participle: aiming
1. point or direct (a weapon or camera) at a target.
"aim the camcorder at some suitable object"
synonyms:point, direct, train, sight, line up "he aimed the rifle"
direct (an object or blow) at someone or something.
"she had aimed the bottle at his head"
synonyms:take aim at, fix on, zero in on, draw a bead on "she aimed at the target"
direct information or an action toward (a particular group).
"the TV campaign is aimed at the age group"
synonyms:target at, intend for, destine for, direct at, design for, tailor for, market to, pitch to/at "this system is aimed at the home entertainment market"
2. have the intention of achieving.
"new French cooking aims at producing clear, fresh flavors and light textures"
synonyms:work toward, be after, set one's sights on, try for, strive for, aspire to, endeavor to achieve; formalessay for
"undergraduates aiming for a degree"
intend, mean, have in mind/view;
plan, resolve, propose, design
"we aim to give you the best possible service"
noun
noun: aim; plural noun: aims
1. a purpose or intention; a desired outcome.
"our primary aim is to achieve financial discipline"
synonyms:objective, object, goal, end, target, design, desire, desired result, intention, intent, plan, purpose, object of the exercise; Moreambition, aspiration, wish, dream, hope, raison d'être
"our aim is to develop gymnasts to the top level“
2. the directing of a weapon or object at a target.
"his aim was perfect, and the guard's body collapsed backward
Source: Google

15. Importance of Aim
`A system is a network of interdependent components working together toward a common aim. Every system must have an aim. Without an aim that is clear to all there is no system. - W. Edwards Deming, Out of the Crisis Corollary 1: Every team must have an aim. Without an aim there is no team. Corollary 2: Determination without destination leads to disaster.
Source: Phyllis Virgil, Strategic Quality Planning Retreat, 2008
Original Slide Created 1998, Phyllis Virgil, Corollary 1 & 2 adapted from 2008 PMV materials on strategic quality planning
Key Point: A system is a network of interdependent components working together toward a common aim. Without a common aim among the components, you don’t have a system.
Source: Phyllis M. Virgil

16. Aim Statement Components
What? State the focus of your improvement effort.
How good? Declare a Numerical Goal for outcomes Ambitious but achievable.
By when? Specify the timeframe.
For whom? Name the customers or population of focus. Primary persons to receive benefit?
Where? Define the process or system you want to improve What is the scope? Boundaries? Starts/Stops?
Created by Bob Lloyd and Phyllis Virgil
Photo Credit:
What?
How Good?
By When?
For whom?
Where?
Source: Robert Lloyd and Phyllis Virgi
Photo Credit: Pixabayl

17. Aim Statement Analysis
By August 1, 2017 Good Samaritan Clinic will reduce Emergency Department visits related to pain for patients with heart failure by 50% , or reduce delays in communication with the physician office to 4 hours or less.
What 
(reduce ED visits related to pain)
For whom?
(patients with heart failure)
By how much? 
(reduce ED visits related to pain by 50%, or reduce delays in communication with the physician office to 4 hours).
By when?
(by August )
Where?
(Starting with our Good Samaritan Clinic)
Source: Jane Taylor, CHAMP Improvement Advisor for the VNA CHAMP Improvement Program,.
What do you think about this one -- pluses/minus – is it effective, why, why not, does it meet your
By August 1, 2017 Good Samaritan Clinic will reduce Emergency Department visits related to pain for patients with heart failure by 50% , or reduce delays in communication with the physician office to 4 hours or less.
Source: Jane Taylor, CHAMP Improvement Advisor for the VNA CHAMP Improvement Program.

18. Characteristics of an Effective Aim
As clear as a vision
As motivating as a mission
As concise as an elevator speech
As targeted as a bulls-eye
Source: Phyllis M. Virgil, Aim Statement Presentation, 2012
Source: Phyllis M. Virgil

19. Loser Aim Statements The Lone Ranger The From on High The Bamboozler
The Wildly Ambitious
The Lack Luster
List created by Phyllis Virgil
Photo
Photo Labeled for Reuse Creative Commons --
Lone Ranger – pet project one person, no one else cares about
From on High – close relative of Lone Ranger, often referred to as “they gave it to us”
Drifter --  lots of words, drifts off into many areas, unable to pin it down
Rambler – says many things, goes on and on and on, but says nothing
Bamboozler – sounds very impressive, lots of exciting words, while remaining unclear
Wildly Ambitious – world hunger plus, loads of energy but unrealistic
Last Luster – ho hum effect, fall asleep before finishing...
Source: Phyllis M. Virgil
Photo Credit: Pixabay

20. Loser Aim Statements
The Lone Ranger -- pet project of one person, no one else cares about
The From on High -- close relative of Lone Ranger, often cryptically referenced as coming from “above”, or “they told us...”
The Bamboozler -- sounds very impressive, lots of exciting words, while remaining unclear
The Wildly Ambitious -- world hunger plus, loads of energy, but totally unrealistic
The Lack Luster -- ho hum effect...
List created by Phyllis Virgil
Lone Ranger – pet project one person, no one else cares about
From on High – close relative of Lone Ranger, often referred to as “they gave it to us”
Drifter --  lots of words, drifts off into many areas, unable to pin it down
Rambler – says many things, goes on and on and on, but says nothing
Bamboozler – sounds very impressive, lots of exciting words, while remaining unclear
Wildly Ambitious – world hunger plus, loads of energy but unrealistic
Last Luster – ho hum effect, fall asleep before finishing...
Source: Phyllis Virgil

21. Winner Aim Statements What? How good? By when? For whom? Where?
Photo Credit:
Created by Bob Lloyd and Phyllis Virgil
What?
How Good?
By When?
For whom?
Where?
Photo Credit: Pixabay

22. Aim Statement Exercise: You Make the Call!
You Make the Call: Good, Bad, or Ugly? For song see: Song:

23. Table Exercise
Pick a table leader to facilitate your table’s discussion
Using the essentials of an effective aim statement review and discuss your assigned aim statement (10”)
Analyze and dissect your assigned aim statement, does it cover the essentials > what, how good, by when, for whom, where?
Identify what is and what is not effective about the aim statement. How could it be improved?
Rate the aim statement > Good? Bad? Ugly?
If you finish early, work on any extra credit aim (H or I)
Be ready to report out your teams analysis and rating (10”)
Table 1 = A Table 2 = B Table 3 = C Table 4 = D Table 5 = E Table 6 = F Table 7 = G X Credit = H X Credit = I
Adapted from: John Dowd, Consultant in Continual Improvement, and Jane Taylor, Improvement Advisor
Adapted from: John Dowd, Consultant in Continual Improvement, and Jane Taylor, Improvement Advisor

24. Good Bad Ugly Handout ASSIGNMENTS Table 1 Table 2 Table 3 Table 4
By December of 2017 we will reduce the incidence of pressure ulcers in the critical care unit by 50%.
Table 1
Our outpatient testing and therapy patient satisfaction scores are in the bottom 10% of the national comparative database we use. As directed by senior management, we need to get the score above the 50th percentile by the end of the 3rdQ of 2017.
Table 2
According to the consultant we hired to evaluate our home health services, we need to improve the effectiveness and reliability of home visit assessments and reduce rehospitalization rates. The board agrees, so we will work on these issues this year.
Table 3
Our most recent data reveal that on the average we only reconcile the medications of 35% of our discharged inpatients. We intend to increase this average to 50% by 10/1/16 and to 75% by 3/31/17
Table 4
We will reduce all types of hospital acquired infections.
Table 5
By Labor Day, our agency will implement SBAR communications in every interaction with a provider or office practice.  We will train 95% of our permanent staff, who will all be able to teach back SBAR and demonstrate when and how to use it.
Table 6
We aim to reduce harm and improve patient safety for all of our internal and external customers.
Table 7
By the time school starts in the fall, we want our nurses to be such concise communicators when interacting with a provider or office practice that the other person does not feel their time was wasted, was glad to receive the vital information, and is willing to act on the nurse’s concern. This means that we will have a provider communications rating of 100%. (Adapted from Jane Taylor, CHAMP Improvement Advisor for the VNA CHAMP Improvement Program,
Extra Credit
We will improve transitions home for all heart failure patients as measured by a reduction in unplanned 30- day all-cause readmission rates for heart failure patients (decreasing the rate from 25% to 15% or less in 18 months.) We will focus on patient and family caregiver’s understanding of medications and comprehension of signs and symptoms that require medical attention, timely follow-up in the heart failure clinic and coordination with community providers.

25. Aim Statement A – Table 1
By December of 2017 we will reduce the incidence of pressure ulcers in the critical care unit by 50%.
What?
How Good?
When?
For whom?
Where?
Photo Credit: Adapted from Andrew Taylor, Flickr
Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.

26. Aim Statement B – Table 2
Our outpatient testing and therapy patient satisfaction scores are in the bottom 10% of the national comparative database we use. As directed by senior management, we need to get the score above the 50th percentile by the end of the 3rd Q of 2017.
What?
How Good?
When?
For whom?
Where?

27. Aim Statement C – Table 3
According to the consultant we hired to evaluate our home health services, we need to improve the effectiveness and reliability of home visit assessments and reduce re-hospitalization rates. The board agrees, so we will work on these issues this year.
What?
How Good?
When?
For whom?
Where?

28. Aim Statement D – Table 4
Our most recent data reveal that on the average we only reconcile the medications of 35% of our discharged inpatients. We intend to increase this average to 50% by 10/1/13 and to 75% by 3/31/14.
What?
How Good?
When?
For whom?
Where?

29. Aim Statement E – Table 5
We will reduce all types of hospital acquired infections.
What?
How Good?
When?
For whom?
Where?

30. Aim Statement F – Table 6
By Labor Day, our agency will implement SBAR communications in every interaction with a provider or office practice.  We will train 95% of our permanent staff, who will all be able to teach back SBAR and demonstrate when and how to use it.
What?
How Good?
When?
For whom?
Where?

31. Aim Statement G – Table 7
We aim to reduce harm and improve patient safety for all of our internal and external customers.
What?
How Good?
When?
For whom?
Where?

32. Aim Statement H – Table 8
By the time school starts in the fall, we want our nurses to be such concise communicators when interacting with a provider or office practice that the other person does not feel their time was wasted, was glad to receive the vital information, and is willing to act on the nurse’s concern. This means that we will move from a provider communications rating of 100% for highly satisfied from our current 60% level by September 1st.
What?
How Good?
When?
For whom?
Where?
Adapted from Jane Taylor, CHAMP Improvement Advisor for the VNA CHAMP Improvement Program,
Adapted from Jane Taylor, CHAMP Improvement Advisor for the VNA CHAMP Improvement Program,

33. Aim Statement I – Table 9
We will improve transitions home for all heart failure patients as measured by a reduction in unplanned 30-day all-cause readmission rates for heart failure patients (decreasing the rate from 25% to 15% or less in 18 months.) We will focus on patient and family caregiver understands of medications and comprehension of signs and symptoms that require medical attention, timely follow-up in the heart failure clinic and coordination with community providers. What? How Good? When? For whom? Where?

34. In Summary, the Aim Statement
Answers and clarifies “What are we trying to accomplish? for the QI Project
Creates a shared language to communicate about the project
Facilitates conversations and understanding
Provides a basis for developing the rest of the project (measures and changes)
Photo Credit:
IHI, API, 2012
Photo Credit: Pixabay

35. Aim is crucial to your success!
You will sink or swim based on the clarity, and commitment to your aim...
Photo source: MS Office 2007
Source: Phyllis Virgil, Strategic Quality Planning Retreat, 2008
Photo source: MS Office 2007
Source: Phyllis M. Virgil

36. Aim Statement Essentials
What?
How good?
By when?
For whom?
Where?
Photo Credit:
Created by Bob Lloyd and Phyllis Virgil
What?
How Good?
By When?
For whom?
Where?
Photo Credit: Pixabay

37. Craft an Aim Statement
Craft a draft aim statement (or review and revise your current statement, base on your learning)
Remember this is your prediction, so don’t get attached
Use Aim Statement Handout as a resource and guide
You have 10 minutes to craft a draft
When you are done team up with a partner, go to the coaching exercise on the next slide
5 minutes sessions coach/client
You can an continue over lunch
Source: Jane Taylor, Improvement Advisor

38. Coach an Aim Statement
You will coach your “client” on how to review an aim statement
Form groups of two: 1 is client, 1 is coach
Interview your “client” about their project
Use the aim statement worksheet
Coach your client on their draft aim statement
Make sure they state: What, how much, by when, for whom, and where
5 minutes sessions coach/client, then switch roles
You can an continue over lunch
Source: Jane Taylor, Improvement Advisor
Source: Jane Taylor, Improvement Advisor.

39. Worksheet: Aim Statement
What? When? How Much? Where? For Whom? Why?
Team name:
Customer or Population: (for whom?)
Process or System Boundaries: (Where? Start/Stop?)
Aim Statement (what?):
(What’s the problem or opportunity?
Can also include Why is it important? What are we going to do about it?)
How good? ____________________________________
By when? _____________________________________

40. Assignment Post a draft aim statement on your storyboard by the end of the day.

41. Lunch