A moment of reflection can lead to a smarter improvement aim

Learning about the Model for Improvement (Langley et al., 1996) has changed my life, and I believe it has done the same for many people: It has given me a robust change method to work with; it allows me to fail safely and learn fast; and most importantly, it allows me to measure how the changes I make have made a difference.

The first question in the Model for Improvement concerns our aim and, as we need it to answer the second question (‘have we achieved our aim?’), it needs to be a SMART one.

Now I’m going to come onto SMART aims in just a moment – but first I want to invite you to pause a moment as I share some reflections. In all the years that I’ve been learning and teaching improvement methods, I have found that this first question ‘what are you trying to accomplish?’ stumps people more than you might expect it to.

I think there are reasons for this. First, we are often asked to make a change where the aim, usually presented to us by someone more senior, is to make the change – not to achieve a specific outcome. Second, the desired outcome, if it does indeed exist, is either – not spoken (assumed to be known and understood by us) or – not known (by us or the person delegating the change action). I believe another reason is that we fail to articulate the problem that we are trying to solve when we are starting out.

So, when I say ‘take a little time to reflect’ – I’m advising us all to give our problem some quality thought, do some simple diagnostics, and think about it from our end users’ perspective. A simple articulation of the system problem, with a little bit of background data (national and local) to put it into perspective, will set a firm foundation and then we can begin thinking about our aim.

So now back to your SMART aim -As with all methods, none are perfect – and SMART has its fair share of critiques, so feel free to pick another method that allows for similar reflection, and even drop me a note to say which is your preferred method and why)

As with all things ‘QI’ we aren’t surprised that this is also an iterative activity. One well known mantra for an improvement aim – is how much by when? Our articulation of the aim can only emerge as intelligence is gathered and, from humble beginnings, its SMARTness will be formed. Check out the example below – and browse our poster gallery to see if you can spot others who have shared their ‘workings out’ with their audience.