Too often, hospitals and health systems stop at developing broad clinical quality improvement statements that come up short of achieving their desired goals. What’s missing are clearly defined improvement objectives in the form of aim statements that take into account the effects on other areas of the organization: patient safety and satisfaction, physician engagement, and financial contribution. Aim statements help articulate the problems that add value for patients and the organization, but good data, and the analytics tools required to understand the data, are essential to illuminating high-value problem areas. Additionally, aim statements must stick to the SMART guidelines: Specific, Measureable, Achievable, Relevant, and Time-bound.

1. Use Well-Crafted Aim Statements To
Achieve Clinical Quality Improvements

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The Analogy of Golf
Golf is a game of precision, strategy,
and constant improvement with a clear
aim to decrease the number of strokes.
There are multiple factors in achieving
that aim: driving, long irons, short irons,
chipping, and putting.

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The Analogy of Golf
Course features such as slope, water,
sand, and rough, all come into play.
Strategies must adapt to each condition
as it is encountered.
Professional golfers constantly work to
improve every aspect of their game.

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The Analogy of Golf
Caring for patients is far more complex than golf, but
improving your process require the same diligence.
In order to improve you must understand how what you do
contributes to, or gets in the way of, achieving that aim.

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Aim Statements Articulate the Problem
An effective aim statement
begins with clearly articulating
the problem being addressed.
The end result should provide
meaningful value to patients
and the organization.
Aim statements, and the time
and resources required to
address them are two sides of
the same coin.

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Aim Statements Articulate the Problem
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

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Aim Statements Articulate the Problem
To identify the issues that would
deliver substantial value you must
analyze the healthcare data at hand.
The Key Process Analysis (KPA)
application uses the “80/20 rule” to
identify clinical areas with significant
variation in care processes and
high costs.

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Aim Statements Articulate the Problem
The KPA combines clinical and
financial data to highlight the best
opportunities for improvement
and cost reduction.
It’s crucial 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.

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Taking Aim at Processes
In developing your aim
statement, always remember
the acronym SMART.
After selecting an aim, it’s time
to diagnose the root cause of
the problem.
When you know the root cause
you can begin to identify what
process changes to make in
order to drive meaningful
change, the sub-aim statements.

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Taking Aim at Processes
Consider an example many of us
can relate to – lowering cholesterol
from 220 to 200 in three months.
To get there you identify several
changes you believe will result in
achieving the aim.
• Losing weight
• Eliminating dairy
• Regular exercise

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Taking Aim at Processes
For each of these interventions, you
would identify a corresponding sub-aim:
Lose four pounds in one month.
Eat five servings of vegetables four
times a week for three months.
Exercise 30 minutes per day, three
times a week, for one month.
Increase exercise to five times per
week after the first month.

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Process Improvement Example
Here’s an example of how setting
an aim and corresponding sub-
aim statements worked to deliver
clinical process improvement for
mortality rates and sepsis.
After analyzing patient data, a
health system recognized that its
30-percent mortality rate for
sepsis patients, especially those
presenting through the emergency
department (ED), was too high.

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Process Improvement Example
Since 80 percent of its sepsis
patients came through the ED, the
health system decided to focus its
improvement efforts there.
Studying the data, they realized
that one facility had a mortality
rate of 40 percent.
They determined this hospital had
very long wait times in the ED,
and that the triage process was
sporadic and chaotic.

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Process Improvement Example
As a result, sepsis was often
missed during triage in patients
who came in with it. As a result
critical labs and treatments were
delayed. From their conclusion
they developed this goal:
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
AIM STATEMENT

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Process Improvement Example
To get there, the health system
developed two key sub-aims:
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

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Process Improvement Example
The organization went on to define
several other sub-aim statements.
They discovered that reducing the
lactate turnaround time improved the
triage process, so they reviewed what
process changes for the ED and lab
would speed the return of results.

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Process Improvement Example
Faster turnaround times by themselves
won’t lower mortality rates. 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.

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Winning the Quality Improvement Game
Winning professionals plan,
practice and adjust their way to
success.
The same is true in healthcare.
Developing data-driven SMART
aim and sub-aim statements
lay out the path for achieving
your goals.

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More about this topic
A Key to Measurable Healthcare Quality Improvement: Use AIM Statements
Kathleen Merkley, Engagement Executive
Planning for Healthcare Improvement: A Goal Without a Plan Is Just a Wish
Dr. John Haughom, Senior Advisor
How to Improve Clinical Programs by Breaking the Cycle of Waste in Healthcare
Ann Tinker, Vice President for Customer Engagements
Introducing the Accelerated Practices (AP) Program: An Innovative Way to Help Health
Systems Accelerate and Sustain Outcomes Improvement
Dr. John Haughom, Senior Advisor
Bryan Oshiro, MD, Medical Director
Sherry Martin, Med
Link to original article for a more in-depth discussion.
Use Well-Crafted Aim Statements To Achieve Clinical Quality Improvements

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“This is a knowledge source for clinical and
operational leaders, as well as front-line
caregivers, who are involved in improving
processes, reducing harm, designing and
implementing new care delivery models, and
undertaking the difficult task of leading
meaningful change on behalf of the patients
they serve.”
– John Haughom, MD, Senior Advisor, Health Catalyst

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Cherbon VanEtten joined Health Catalyst in 2013 as the Director of Education with
responsibility for team member and client educational programs. Ms. VanEtten has 18
years of healthcare experience in information technology and healthcare analytics.
Prior to joining Health Catalyst, she worked for MultiCare Health System as a Senior
Project Manager Professional (PMP) where she led numerous enterprise wide
strategic initiatives – including the implementation of a healthcare data warehouse and
quality improvement programs. She developed tools and methodologies to calculate ROI and total
cost of ownership for IT investments – including EHR and EDW systems.
Ms. VanEtten was responsible for leading a multi-disciplinary clinical team in developing content for
computerized physician order entry (CPOE), physician note templates and interdisciplinary plans of
care. She earned her under graduate degree in Psychology from the University of Washington and
graduate degree in Biomedical Informatics from Oregon Health and Science University.
Other Clinical Quality Improvement Resources
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