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VALUE
IMPROVEMENT
LEADERS
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813 words + 2 activities | 1 hour (4 minutes to read email, 56 to write goals)
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PRINCIPLE
A well-written goal is necessary for a successful improvement project.
TOOL
SMART goals (guidance provided by the Value Summary tool).
APPLICATION
1. Define the metrics critical to your project.
2. Write SMART goals for your project with your coach and team.
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It’s not enough to get better. We need to get better faster. This imperative is the motivating force behind Value Improvement Leaders and our entire value improvement initiative. So here you are, a model citizen, doing your part, possibly for extra credit.
Thank you.
And now, before your back foot is even off the starting line, I’m going to badger you about how to write goal statements starting with this question:
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How Do You Know If Your Process Is Succeeding?
Sometimes it’s asked, “How do you know if your process is winning or losing?” because it implies that the score is kept. Not just a single score, but a handful of meaningful stats.
Young children on the baseball diamond want to know the score and other relevant stats. They aren’t satisfied with mere sense of things. Sure, there’s that kid in the outfield contemplating the dandelions and she may not care, but the rest of the team demands objective measures. Critical measures.
It seems self-evident: If it’s critical, measure it.
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When You Measure, Be SMART About It
Here are two example goals:
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Find ways to reduce falls.
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They’re goals, but not SMART. I’ve always felt that acronym was a bit condescending but my effort to change it to STARM goals didn’t catch fire. SMART stands for:
- Specific: Just how specific is based on your judgment. “Poor communication” and “inefficiency” are not specific. “Readmission rates for ileostomy patients,” is specific enough.
- Measurable: Include the latest mean or proportion of the measure. If you don’t have the number yet, that’s okay. Fill it in later, probably after Baseline Analysis. Don’t include editorial words such as “high rates” and “unacceptable conditions.”
- Attainable: Is this goal realistic? Setting unattainable goals are often not taken seriously. If they are, they are demoralizing. For instance, if you set a goal anywhere above 0% for SSIs, are you suggesting an occasional SSI is tolerable? On the other hand, we have seen 0% CLABSI rates.
- Relevant: State clearly why it’s a problem. This is another judgment call. Your Value Summary is targeting people familiar with your work; you needn’t explain why readmissions are bad or increasing access is important.
- Time-bound: State when you want the goal met.
We try again:
By June 30, 201_: Type 60 words per minute. Type with an error rate <= 3%.
Reduce falls to the 2010 national benchmark of _ per 1000 patient days by 12/31/201_.
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The Value Summary Makes SMART Goals Easy
The value summary app has a Mad-Libs style fill-in-the-blank, a forcing function designed with human factors in mind.
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To measure improvement you need the befores and afters of your critical measures. Notice the baseline number is part of your SMART goal statement: “from <number> <unit of measure>…”
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Also note the “Goal Type” in the top left corner. Choices here are
- Process: Measures of your various critical process inputs
- Outcome: Measures of your various critical process outputs
- Balance: Outcomes measures outside of your project focus but may suffer an undesired effect
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Even with this forcing function format, there are still ways to get a SMART goal wrong, typos notwithstanding.
- This template doesn’t force the R or A of our acronym. That’s up to you and your coach.
- Defining the desired solution. A solution and a goal are different. Solutions are means to your desired goals. We often hear something like, “install a new database by June 1, 20__.” And then the M is a one or a zero. No. What measurable do you expect to improve with a database?
(PS: If you already know the solution to your problem in this, the Project Definition phase, you’re shortchanging the methodology.)
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A Stress Avoiding Checklist for Defining SMART Goals
- Make use of your team and coach.
- Start with the right expectation; this work requires effort. This isn’t easy for everybody. Thinking through and writing a complete set of SMART goals is not box-checking busywork.
- If a measure is critical to your project and no one is currently collecting it, you’ll need to devise a data collection plan. Happens all the time. But when you can, choose measures already being collected even if that means selecting a surrogate.
- It’s reasonable to not have the baseline numbers at the moment you are defining your critical metrics. Let everyone on your team know: Goals can be revised and the numbers (baseline and goal) can come later.
- Strive for a mix of process, outcome, and balance measures.
For another take, check out: The SMART Way to Keep Your New Year's Resolutions
Next time: Voice of the Customer.
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ACTIVITIES
1. Define the metrics critical to your project.
2. Write SMART goals for your project with your coach and team.
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HEADS-UP
Looking for the videos, slides, and/or previous emails?
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