Setting Goals

The Goal:

Develop and share specific aims for the hospital's participation in TCAB, and identify measurable, achievable, time-sensitive goals for each aim.

Why It's Important:
Transforming medical/surgical care requires commitment and support of both system and unit-level leaders in achieving unit-level aims. Many of the innovations and changes necessary to redesign care of medical/surgical units depend upon change throughout the system—including technology support, housekeeping, food service, pharmacy, etc.—that have the buy-in from other departments and integration of physicians.

How To Do It:
A key step in setting goals for the TCAB initiative on a unit is to align the work with the organization's overarching quality and safety agenda. Specific targeted goals should then be developed for each TCAB theme to address improvement in safety and reliability, patient-centered care, care team vitality and reduction of waste.

1. Articulate a clear aim statement for each of the four TCAB themes: patient-centered care; care team vitality; reduction of waste; safety and reliability.
Each aim statement should set an aggressive target for change and concisely answer the question, "What are we trying to accomplish?" To transform bedside care, a unit typically has several unit-based, multidisciplinary teams working on multiple aspects of the transformation at once, addressing more than one aim at a time. All of these teams should share a common understanding of the aims.

2. The aim statements should be outcome-oriented, with specific goals and time frames for each transformation category.
Sample aims for the four TCAB themes may include:

Safety and Reliability:
Care for moderately sick patients who are hospitalized is safe, reliable, effective and equitable.

  1. Reduce falls to one or less per 1,000 patient days within one year
  2. Adverse events are reduced to one (or less) per 1,000 patient days
  3. Codes on med/surge units are reduced to zero
  4. 95 percent compliance with all key clinical process measures (all or nothing measure) for a high volume clinical condition on the TCAB unit.

Patient-Centered Care:
Truly patient-centered care on units honors the whole person and family, respects individual values and choices, and ensures continuity of care. Patients will say, "They give me exactly the help I want (and need) exactly when I want (and need) it."

  1. Within one year, increase the percentage of patients discharged from the unit who designate "top box" agreement with willingness to recommend the hospital to family or friends to 95 percent.
  2. Readmissions within 30 days are reduced to five percent or less.

Care Team Vitality:
Within a joyful and supportive environment that nurtures professional formation and career development, effective care teams continually strive for excellence.

  1. Reduce unit turnover to an annualized rate of less than 5 percent within the next 18 months.

Reduction of Waste:
All care processes are free of waste and promote continuous flow.

  1. Within one year, 75 percent of the nurses' time will be spent in value-added activities.
  2. Cost per discharge for the high-volume clinical condition is reduced by three percent annually.