---
title: "Choosing What to Improve"
---

::: {.callout-note appearance="minimal"}
"What do we want to improve?"
:::

## Identifying Aims

Here are some places to look for ideas of what to work on:

-   **Evidence**, including research studies that demonstrate that certain changes lead to better results.
-   **Regulatory requirements** from federal, state, or local government.
-   **Standards of practice** from groups that promote good EMS care.
-   **Issues** you’ve seen in your own agency, possibly found through quality assurance activities, such as skills assessments and chart reviews.

:::: {.callout-tip collapse="true"}
## Example: Minimizing Lights & Siren Usage

::: clearfix
![Example: Using Evidence](images/example-evidence.jpg){.example}Nikolas noticed there's been a bunch of research studies highlighting how using red lights and siren means more ambulance crashes. He is using **Evidence** to identify a performance improvement aim.
:::
::::

## Prioritizing

You may have a whole pile of ideas to work on, but you'll need to prioritize. It gets messy to try improving too many things at once. Here are some filters you can use:

1.  **Impact:** Will it make a big difference?

2.  **Alignment with Organizational Priorities:** Is it important to your agency?

3.  **Feasibility:** Can you do it?

4.  **Community Readiness:** Will your community, including patients and partners, support it?

5.  **Cost:** Is it low cost? Does it lower your costs?

6.  **Demand:** Is there a high need for it?

7.  **Health Equity:** Will it make things better for people who have typically had worse outcomes?

8.  **Integration:** Can you easily incorporate it into your daily flow? Does it improve your connections with your partners?

9.  **Leadership Support:** Does leadership within the agency and higher up think it's important?

10. **Prevalence:** How widespread is the problem?

11. **Resources:** Do you have the people and equipment needed to do it?

12. **Minimal Risk:** Is the chance of failure or bad side-effects low?

13. **Urgency:** Does it need to be done right away?

14. **Guidelines:** Are there guidelines or standards of practice that address it?

15. **Measures:** Has someone created measures that you can use to track performance?

Compare potential aims using these filters, and start with an aim that scores high. After you've made some progress in that area, you can come back to the idea list and pick your next aim to begin work on.

:::: {.callout-tip collapse="true"}
## Example: Prioritizing Agency Financial Health

::: clearfix
![Example: Prioritization](images/example-prioritization.jpg){.example}Kelly is considering a few performance improvement ideas for her agency. One potential area is to improve the financial health of her agency. She fills out the [Prioritization Worksheet](worksheets/prioritization.qmd):
:::

**Potential Aim**: [Improving our agency's financial health]{#prioritizationaim contenteditable="false"}

```{=html}
<table id="prioritization">
  <thead>
    <tr>
      <th>Score</th>
      <th>Criteria</th>
    </tr>
  </thead>
  <tbody>
    <tr>
      <td><span contenteditable="false">3</span></td>
      <td><strong>Impact</strong></td>
    </tr>
    <tr>
      <td><span contenteditable="false">3</span></td>
      <td><strong>Alignment with Organizational Priorities</strong></td>
    </tr>
    <tr>
      <td><span contenteditable="false">2</span></td>
      <td><strong>Feasibility</strong></td>
    </tr>
    <tr>
      <td></td>
      <td><em>Since the aim scores favorably on the first three criteria above, she continues filling out the worksheet.</em></td>
    </tr>
    <tr>
      <td><span contenteditable="false">2</span></td>
      <td><strong>Community Readiness</strong></td>
    </tr>
    <tr>
      <td><span contenteditable="false">3</span></td>
      <td><strong>Cost</strong></td>
    </tr>
    <tr>
      <td><span contenteditable="false">2</span></td>
      <td><strong>Demand</strong></td>
    </tr>
    <tr>
      <td><span contenteditable="false">1</span></td>
      <td><strong>Health Equity</strong></td>
    </tr>
    <tr>
      <td><span contenteditable="false">2</span></td>
      <td><strong>Integration</strong></td>
    </tr>
    <tr>
      <td><span contenteditable="false">3</span></td>
      <td><strong>Leadership Support</strong></td>
    </tr>
    <tr>
      <td><span contenteditable="false">2</span></td>
      <td><strong>Prevalence</strong></td>
    </tr>
    <tr>
      <td><span contenteditable="false">2</span></td>
      <td><strong>Resources</strong></td>
    </tr>
    <tr>
      <td><span contenteditable="false">2</span></td>
      <td><strong>Minimal Risk</strong></td>
    </tr>
    <tr>
      <td><span contenteditable="false">2</span></td>
      <td><strong>Urgency</strong></td>
    </tr>
    <tr>
      <td><span contenteditable="false">1</span></td>
      <td><strong>Guidelines</strong></td>
    </tr>
    <tr>
      <td><span contenteditable="false">1</span></td>
      <td><strong>Measures</strong></td>
    </tr>
    <tr>
      <th><span contenteditable="false">31</span></th>
      <th><strong>Total Score</strong></th>
    </tr>
  </tbody>
</table>
```

She fills out the worksheet for a couple other performance improvement ideas, too. She decides to work on the one with the highest score first and save the others for later.
::::

::: callout-note
## Worksheet {.unnumbered .unlisted}

[Prioritization Worksheet](worksheets/prioritization.qmd)
:::
