Step 5c - Defining the Problem - SMART Aims
When answering ‘What are we trying to accomplish?’, we are in fact stating the raison d’etre of the project, the whole purpose of it existing. In this we need to create a statement that acts as your project’s aim. There are many benefits to having such a statement:
– Communicates clearly what you are trying to do – Having a clear direction towards a defined goal is important as everyone you need to work with in undertaking your project can then easily understand what you are trying to do. This helps in getting them onside, whether it’s co-operating with changes to practice, collecting data for you, etc.
– Keeps the project manageable – In step 2 we briefly mentioned scope and scale. Having a clearly defined aim also prevents these becoming too large i.e. ensuring the focus is on a single aspect of care, and starting with a small area (such as one ward, rather than a whole hospital). You may get others making suggestions for additional work as part of your project such as those with authority with their own ideas. If you have a clearly defined aim you can evaluate very quickly whether that is something that fits with your project or not. The phrase ‘inch wide, mile deep’ is sometimes used and is a good approach – pick a narrow focus, but drill down deep into the topic to really find what works and doesn’t, rather than trying to tackle many different things and ending up only being able to make superficial efforts.
– Helps with the rest of the MFI – Other concepts we will cover in the guide count on the fact that you have produced an aim statement. Therefore it is a vital component of the project.
The best way to produce an aim statement is to make it SMART. A SMART aim is a single sentence that has all of these components:
Specific – As we’ve mentioned above, keep the scope and scale manageable. Pick a single aspect of care and define clearly the clinical areas you are making the improvement in.
Measurable – Your aim must have some sort of numerical value you can measure, and this is vital when we come to using data as we’ll be plotting it on a chart. Simply saying ‘to improve X’ is not good enough, it should be something like ‘to increase X by Y%…’. The number is often a percentage (e.g. of patients receiving a particular aspect of care, of patients suffering a complication, etc.) but can also be a standard number (such as a count of the number of occurrences of something), ‘time since’ last occurrence or an average score (e.g. patient satisfaction score). There are many others that would be suitable, and the best measure depends on what you are looking to do in your individual project.
Achieveable – Is what you are trying to achieve possible at all, with our current understanding of the world? For example an aim to cure all patients with metastatic cancer is simply not currently possible.
Realistic – With it being achievable, is there a reasonable chance that with a strong effort within the realities of actual clinical practice, the aim can be met? It is theoretically possible for every FY2 to be able to learn to perform an appendicectomy solo, but very unrealistic that would ever happen.
Timely – Simply, what date do you think you can meet the number defined in ‘measurable’ by?
To quickly assess whether you have a good SMART aim you can apply this test – does it say: what, by how much and by when?
Examples which are SMART
- To reduce the average pain score of patients on admission to the orthopaedic ward from ED by 2 points (score out of 10), in 4 months
- 60% of asthmatic patients aged above 35yrs with COPD symptoms to have spirometry performed at GP practice by 31st October 2018
- 95% of patients on long-term NSAIDs to be prescribed a concurrent PPI in 4 months.
- To reduce the number of falls in patients aged over 65yrs on ward B2 by 50% by 5th December 2018
- 70% of cases of death not referred to the coroner, for the family to receive the medical certificate of cause of death within 24hrs, in 2 months
Examples which are not SMART
- To deliver a teaching session on breaking bad news to all FY1 doctors in 3 months [not measurable over time]
- We aim to ensure patients get daily bloods [not specific, no target, no time frame,]
- By 2017 we will have reduced the number of falls [not specific, no target]
- It is a priority of the trust to reduce the number of cardiac arrests by employing 10 more nurses [not specific, no target, not realistic, no time frame]
Target-setting and modifying your aim
A question you might have is how do you know what a realistic target measurement value, or time frame, is? To begin with in our projects, all we are able to do is make a reasonable estimation. When we have baseline data (step 6) this can inform what we think might be possible. However as you proceed with your project you might find your initial target is met incredibly easily, or that it’s far too ambitious. That’s OK – simply alter your aim as you see fit. It’s not unusual for a project to have SMART aim version 4!