VALUE
IMPROVEMENT
LEADERS
TOPIC #4
808 words + 2 activities | 1 hour (4 minutes to read article, 56 to write goals)
OVERVIEW
PRINCIPLE
A well-written goal is an accelerator for value improvement work.

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.
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:
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 a score is being 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 a mere sense of things. Sure, there’re kids in the outfield contemplating the dandelions. They may not care, but the rest of the team demands objective measures. Critical measures. 

It seems self-evident: If it’s critical, measure it.
When You Measure, Be SMART About It

Here are two example goals:
  Type as fast as you can.

Find ways to reduce falls.

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, but here's some guidance: “Poor communication” and “inefficiency” are not specific enough. “Readmission rates for ileostomy patients,” is. 
  • 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? Unattainable goals are often not taken seriously. If leadership is serious about unattainable goals, they become a demoralizing force.
  • Relevant: This is another judgment call. Consider your audience. 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_.
The Value Summary Makes SMART Goals Easy

The value summary app has a fill-in-the-blank, a forcing function designed with human factors in mind.
To measure improvement you need the befores and afters of your critical measures. Notice the baseline number is built into your SMART goal statement: “from <number> <unit of measure> …”
Also note the “Goal Type” in the top left corner. Choices here are:

  • Process: Measures how well or how often the designed process was followed
  • Outcome: Measures of your various critical process outputs
  • Balance: Outcome measures outside of your project focus but may suffer an undesired effect if your project succeeds. An example: Will your work on LOS cause readmissions to increase? Maybe. Better measure both.
Even with our easy-to-use 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 statements like, “install a new database by June 1, 20__.” And then the M is a binary one or a zero. This is wrong. The database is a solution, not a goal. What measure 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.)
A Stress Avoiding Checklist for Defining SMART Goals

  • Make use of your team and coach. 
  • This work requires effort; set aside some time to work through it. 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 you're defining how to measure success. The actual numbers (baseline and goal) can come later. 
  • Strive for a mix of process, outcome, and balance measures. 
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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