The Common Sense Guide to Improving Palliative Care > 2.2 Identifying the Problem and Stating Your Aim

Sick To Death book cover This extract from the online edition of The Common Sense Guide to Improving Palliative Care is used with permission.

Identifying the Problem and Stating Your Aim

Most teams want to jump right in to identify issues and nominate fixes for the most prominent problems affecting their patients or clients. But this jump-start can lock you into misplaced priorities. It is usually better to have your group do some brainstorming and a little research to identify real problems (i.e., patterns of service delivery that create problems for patients and families) and to consider which to tackle first. You may have to collect some data—just a bit—to check your hunches. For instance, you might not think pain management is an issue for your organization, until you discover that it takes several hours to get medication from the pharmacy to the floor.

Once you think that you know what the problem is, check to be sure. At the same time, do not let indecision slow you down; rather, be committed to getting started . . . now! Our favorite mantra is, "What can you do by next Tuesday?"—a question that pushes you to get started with what is at hand. By next Tuesday, you can probably try out a pain scale for dementia patients, test an advance care planning checklist for nursing home residents and families, or put together a hospitality cart for families keeping vigil in the intensive care unit.

With the problem reasonably well identified, you will next develop an aim.

What Are We Trying to Accomplish? (Writing an Effective Aim)

This sounds like an easy task, doesn't it? Actually, writing an aim can become challenging, but a few pointers will get you there. First, write down what you want to accomplish. Keep it simple, as in the following examples:

General Statement:

Improve advance care planning for the patients in this particular hospital unit.


Provide better pain management for all of our cancer patients.

Once you have a general statement, you will need to convert it into a useful aim.

Elements of Effective Aims

  1. What will improve?
  2. When will it improve?
  3. How much will it improve?
  4. For whom will it improve?

Take a look at an aim statement that includes all of the four components.

Aim Statement: In 30 days, 90% of inpatient cancer patients on unit 4A will report pain levels lower than their own pain goal by the evening shift on their second hospital day.

This example features the four components needed to set a focused and clear aim. Anyone who reads this statement will be able to understand what you are trying to accomplish in your project, and the aim statement will keep your team focused and on track.

What will improve: Pain management should be brought within the patient's acceptable range within one day.

When: Within 30 days of project start.

How much: Increase from 30% at baseline to 90%.

For whom: Inpatient cancer patients on unit 4A.

Coming up with a useful aim is hard to do. You have to clarify your goals, think how you will measure them, and make it enough of stretch to be worth doing. Try not to use the QI model for tiny gains; teams actually stay enthused for the work more readily if the goal is obviously worthwhile and clearly an improvement. Be prepared to adjust your aim as you work through the other issues, such as establishing a team and developing a process, which we describe in this chapter.

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