Establish General Aims

Establishing good goals is essential for maintaining focus and motivating the team.

Eventually your aims should be specific, measurable, and time defined and should specify the population or populations for whom you want to improve care. A "stretch" goal should be established that should be aggressive enough to mandate a change in the design of your current process in order to achieve it. Until you have reliable metrics and a baseline evaluation, however, team-supported general aims or goals can be important for galvanizing action and establishing clarity of purpose.

One important task is to define the scope of your efforts. Do you want to focus on just one ward or service? Critical care patients, ward patients, or both? Will you focus on medical patients, surgical patients, or both? Again, we encourage a broad view of the scope of your efforts as affecting all inpatients with hyperglycemia, but it may be reasonable to start small and then spread your improvement methods to other areas. On the other hand, even if the scope of your effort includes all patients in your hospital or system, the interventions you choose should be piloted on a small scale when possible. The bottom line is this: think BIG! Don't bite off more than you can chew initially, but serial testing and learning on a small scale can make even very large projects more manageable.

Examples of general aims

1. General aim 1: Substantially improve glycemic control of inpatients in critical care units.
2. General aim 2: Substantially improve glycemic control of all adult inpatients in non-critical care units.
3. General aim 3: Reduce the incidence of hypoglycemic events in non-critical care inpatients.
4. General aim 4: Increase the percentage of patients receiving evidence-based, rational insulin regimens.
                            _____ % on insulin infusions
                            _____ % with basal/bolus regimens
5. General aim 5: Improve the knowledge and education of patients and health care providers on diabetes and hyperglycemia management.

As your team develops, your challenge will be to define many of the terms in your general aim, which will entail developing defined metrics and more mature, specific, time-defined aims. For example, how will you define/summarize/report glycemic control in the critical care setting? How will you define and quantify hypoglycemic event incidence in your institution? How do you define an evidence-based protocol or insulin regimen? How will you know if a variation in hypoglycemic rates or glycemic control is a result of "noise" and random variability or whether it is a real and meaningful change? These and many other issues are addressed in later sections, so don't get nervous if you don't know the answers right now!

Download the General Aims Task Sheet