Take Aim to Create Meaningful Process Improvement

Remle Crowe

If you’ve ever had a quality improvement project spin its wheels and get nowhere – or put countless hours of effort and work into implementing an intervention just to have it make little or no impact – you may have fallen victim to a common (yet infrequently-recognized) pitfall in process improvement.

The culprit behind a quality improvement intervention that barely makes a ripple, much less the cannonball splash you’d hoped for, may actually be an inadequately developed aim statement. While it’s tempting to dive right in and make a big change, slowing down and spending extra time up front developing the right aim can be a huge step towards getting the big results.

Defining the Problem and Creating Your Aim

So what exactly is an aim statement? An aim statement is a clear, explicit summary of what your team hopes to achieve in a specific amount of time, including a concise description of what success will look like. An aim statement is also notably different from your project’s “problem statement,” which is a bigger-picture description of the overall issue your team is trying to solve and a great place to start. Failure to properly vet out either of these statements can result in a misalignment of efforts and an investment of time and resources on an intervention that does little to move the measure you’re interested in.

Crafting an effective aim statement sounds simple enough; in fact, many teams fly through this step, excited to get to the nuts and bolts of their plans for improvement. However, the reality is that many teams come to the table with a solution already in mind, and never take the time to dig deeper into what the true problem is and what the primary measure of success should be.

Asking ‘Why?’

In my role as a process improvement manager, I help teams ask the right questions to narrow in on effective problem statements – and translate them into actionable aim statements. This oftentimes means I play the role of the inquisitive toddler who just learned the word, “Why?” For example:

  • The proposed problem statement may be: “The floors at our shop are too slippery.”
  • Why is this a problem? “Well, it is dangerous.”
  • Why is this a problem? “Because people fall down and get hurt at work.”

Ah, now we’re getting somewhere. In reality, the better problem statement would be, “Too many people are falling down and getting hurt at work.” Digging deeper into the underlying problem, rather than beginning with a solution (let’s fix the slippery floors) opens up a wider range of possible interventions (stickier shoes? shorter walking distances? less to carry?) that will likely have different levels of effect on the outcome we truly care about (people not falling down and getting hurt).

Quality Improvement Aims for EMS

For quality improvement efforts in EMS where time and resources are often tightly constrained, this process can be especially useful in identifying the most important drivers and anticipating challenges to ensure that your efforts will garner real results. For example, a common aim statement for an EMS agency might be to “decrease on scene times.” By using the tools of process improvement, however, you can dig deeper, again asking yourself why this is important.

You will likely see that you are acting on the belief that decreased on scene times will result in faster transport to definitive care and decrease negative patient outcomes like mortality. However, recent research is suggesting that providing earlier interventions for some patients (as in the case of pediatric cardiac arrest) is associated with improved patient outcomes, which may mean staying on scene to perform the intervention right away, rather than rapidly loading the patient for transport and performing interventions while en route to the hospital.

This of course, would likely not decrease on scene times, but might actually decrease mortality rates. Suddenly you are seeing that the aim that matters is not to simply decrease on scene times, but to decrease overall mortality rates for a specific patient population. And for this aim, there may be a whole list of other possible actions that can drive the desired outcome, rather than limiting your interventions to those that shorten the on scene interval.

Getting S.M.A.R.T. About Your Project Aim

After we’ve identified the problem that matters, a project’s success hinges largely on the articulation of the aim statement. A common and effective tool for generating an aim statement is the S.M.A.R.T. criteria, a simple acronym that helps ensure teams are creating aims that will elicit real world results. An effective aim statement will be:

  • S (Specific): We want to ensure the aim is well-defined and of an appropriate scope.
  • M (Measureable): We want to be able to measure and monitor progress over time. How else will we know when a change is an improvement?
  • A (Attainable): We should be able to take action to overcome barriers to achieving results.
  • R (Relevant/Realistic): We want to ensure that goal is within our reach with our available resources and there’s no other significant project that will compete with the resources needed to achieve this goal.
  • T (Time-bound): We need to set a specific timeframe for accountability and target dates for action items.

Time Spent Up Front is Time Well Spent

Being disciplined and taking the extra time at the beginning of a project to get the aim right actually saves a team hours and hours of wasted effort and frustration down the line. Properly defining the aim of a quality improvement project helps ensure that all actions are geared at affecting what truly matters to the team and will make measurable differences towards the desired outcome.

Additionally, well-vetted problem and aim statements make it easier to build support within your organization and develop champions to your cause, making it simpler to communicate what your team is hoping to accomplish and reporting on your progress as you go.

The bottom line is that you don’t need a big budget or perfect data to get started with process improvement at your agency or organization. Asking the right questions, will help you define an aim that matters and set you up for real system-changing success.

If you are attending the 2019 ESO Wave Conference on March 21-22, I invite you to check out the Research and Quality track that will be covering many topics on process improvement. My presentation, “Taking Aim and Targeting the Right Problem for Quality Improvement” – will specifically address how to pick a problem and translate it into an S.M.A.R.T. aim statement suitable for a successful quality improvement project.

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