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Making SMART goals smarter
Article in Physician Executive · August 2013
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Goal-setting
Making SMART Goals Smarter
By Les MacLeod. EdD. MPH. LFACHE
In this article... the organization in fulfilling its mission and realizing its
vision.
Study the differences between goals and objectives
Goals
and get some valuable insights on how to use SMART
Goals are the somewhat general ends toward which
goals in a health care organization.
much more specific sub-goals or objectives are directed.
This is where much of the confusion usually occurs. Goals
and objectives are very different concepts, whereas sub-
A critical role of leadership is goal setting.' As our goals and objectives are basically the same things.
health care system continues to evolve, physician execu- The popularized term, SMART goals, actually refers more
tives will be called upon to play increasingly proactive roles to sub-goals and objectives than it does to the much broader
in formulating appropriate goals for their respective health term, goals. In the outline that follows, the term objectives
care organizations (HCOs). is used because of its close association with Peter Drucker's
With what looks like a major perspective shift from well-known practice of management by objectives (MBO),^
provider-driven volume to consumer-driven value,^"-* and because of its more practical use as a basic management
physician leaders will be entrusted with the responsibility skill. Some of the commonly recognized distinctions between
of ensuring high standards of care throughout the extended goals and objectives include the following:
process of resource realignment. An HCO's mission, vision, goals and objectives are
How well they are able to formulate effective goals will inextricably related. They comprise the fundamental "what"
have, no doubt, a major influence on the future success of
their respective HCOs. In times of system turbulence, goal
initiation is usually a far better alternative than goal response.
It should be noted initially that, as popular as the con- Difference Between Goals & Objectives
cept of SMART goals has become in recent years, it is also
somewhat of a misnomer. The terms goals, sub-goals, and ^B Goals Objectives ^ |
objectives are often used interchangeably, which has often
been the source of unnecessary confusion, and as goal-set- Broad in scope Narrower in scope
ting theory continues to develop as a useful body of knowl- General Specific
edge, related application benefits can be markedly improved Intangible Tangible
when their differences are more clearly understood.
Together with an HCO's mission, vision, strategies Qualitative Quantitative
and tactics, goals and objectives serve as the foundation Abstract Concrete
elements for most major programmatic initiatives. End result Required steps
An organization's mission is basically its reason for
being. Its vision describes where it wants to be in the Hard to validate Easy to validate
future, and its values are a statement of the principles that Longer-term Shorter-term
form its moral foundation.' Collectively, they are the basis
for devising the supporting goals and objectives that assists
68 PEJ MARCH •APRIL/2012
of present and future organizational In order to reach a single goal, several enabling or supporting objectives usually
pursuits. Coupled with the "how" of have to be met. In health care settings, this involves the time and talents of trained
professionals who function more on a collégial basis than in the superior-subordinate
strategies and tactics, they form the
relationships.
blueprint for the allocation of scarce
economic resources.
Each element is important; how- challenging goals consistently out- a host of performance improvement
ever objectives are the principal means performed those who were given consultants.
through which they ultimately become vague, less challenging goals. Unfortunately, a successful goal
operationalized. The careful design and The Yale Goal Study surveyed setting process is not quite as simple
strategic use of operational objectives 1953 Yale graduates, asking how many as these examples might at first
are important leadership skills. of them had specific written goals for indicate. In the earlier development
their future. It was determined that of goal theory, the terms goals and
Goal theory three percent of them had such goals. objectives were not always clearly
SMART goals have become a A 20-year follow-up survey indicated distinguished and, as mentioned ear-
widely used management tool in that the three percent of students lier, they are still used synonymously,
many of today's HCOs. Part of this with specific written goals had accu- which often presents problems.
popularity stems from the develop- mulated more personal financial As for the results of the Yale
ment of goal-setting theory during wealth than the other 97 percent of and Harvard studies, it has become
the latter part of the last century, the class combined. increasingly clear that they ar¿
part of it from the increasingly com- The Harvard study followed more likely the products of urban
petitive need for greater intentional- the 1979 Business School graduates myth than of validated research.*
ity, and part of it, no doubt, stems and similarly found that only three Nonetheless, there now exists a sub-
from the often cited findings of the percent of the graduates had specific stantial body of research that sup-
1953 Yale Goal Study as well as the written financial goals, but ended up ports a strong positive relationship
1979 Harvard Written Goal Study. making 10 times as much income as between setting specific goals and
Earlier goal theory research did the other 97 percent of the gradu- achieving better outcomes.^
by Latham and Locke^ involved ating MBAs. The results of both the
extensive laboratory and field studies Yale and Harvard studies have been General vs. specific
that clearly indicated that partici- frequently referenced in management Goals tend to be somewhat
pants who were given specific. texts as well as in presentations by general, whereas objectives are much
[Link] 69
Motivational studies have demonstrated that rewards are
essential factors in bringing about desired behavior.
more specific. Goal statements are disagreements. Also implicit in the in terms of overall priorities. Lower
typically formulated at higher, more measurement criteria is the important priority objectives are pursued at the
strategic organizational levels, while concept of accountability. It is much expense of addressing the higher,
objectives are geared more toward more difficult to avoid accountability more important ones. The most
tangible, operational targets. when measurement criteria are clear straightforward way to ensure that
In order to reach a single goal, and not subject to interpretation. objectives are relevant is through
several enabling or supporting objec- prior validation of the relationship of
Achievable: If the established objec-
tives usually have to be met. In expected outcomes with the intended
tives are not reasonably achievable
health care settings, this involves the goals and then to list each objective
with respect to available time, talent
time and talents of trained profes- in writing in their order of priority.
and resources, frustration is sure to
sionals who function more on a col-
follow. It is up to the physician execu-
légial basis than in the superior-sub- Time bound: Some versions of SMART
tive to set objectives that are realistic.
ordinate relationships around which goals list "timely" as the attribute
This can be best accomplished through
the MBO and SMART goal processes represented by the letter T. In the out-
a process of negotiation and consensus.
were originally developed. line presented here, T indicates "time
Comparative benchmarks from other
The following SMARTER objec- bound" which is considered to be more
similar organizations can also be help-
tives criteria take this important dif- appropriate than "timely" in as much as
ful. The use of "reach" objectives, which
ference into account along with the timeliness is implied in the preceding
are a bit more ambitious, can be used as
substitution of the term objectives, "relevant" attribute (if an objective is
well, with the understanding that they
which more accurately reflects the truly relevant it is sine qua non, timely),
exceed normal expectations and will
operational level of focus. and "time bound," further makes
require exceptional levels of effort and
The first step in making SMART it clear that the objectives are to be
commitment.
goals SMARTER is to refer to them accomplished by an agreed-upon point
as SMARTER objectives. Subsequent Relevant: Few things are more frus- in time. As soon as possible is simply
steps include the following: trating to organizational leadership not an acceptable timeframe. Without
than to observe busy professionals a predetermined deadline, there is only
Specific: Making objectives specific is using up scarce resources without a a general notion about due dates, which
an essential first step. It brings a much clear direction. Too much time is spent in turn generates a less than rigorous
needed practical reality to distin- "doing the wrong things right" or pursuit of closure. Where there is only
guishing effort from results. Effort, "being in the thick of some very thin a loose expectation of closure, priori-
while indeed admirable, only amounts issues." It is natural for staff to focus tizations and associated time manage-
to a wheel spinning exercise if on those things that they find interest- ment requirements are more apt to lack
intended results do not follow. In the ing and enjoyable. Unfortunately those needed discipline.
process, valuable time and resources things might make only marginal con-
are wasted. Committing objectives tributions toward the more important,
overarching goals. This can easily occur Engaging: Adding engagement to
to writing in plain language leaves no
when goal relevance has not been made the SMARTER objectives criteria is
doubt about exactly what needs to be
explicit. There is rationalized justifica- particularly relevant for the physician
accomplished.
tion based mostly on the exertion of executive. Few things are more valu-
Measurable: There is a long-standing effort without sufficient validation that able to busy clinicians than their time.
saying in management circles that, what is being done is, in fact, relevant. Waste it once and second chances will
"You can't manage what you don't be much harder to come by. Merely
measure." Objectives should be quan- A similar problem occurs when laying out a pre-established objective
tified so that the degree of accom- there is an absence of prioritization. is not about to excite busy clinicians,
plishment can be accurately mea- When this occurs, efforts get focused nor will it promote a sense of partici-
sured. Specific measurement criteria on objectives that, although reason- pation. Change theorists would be
will eliminate the possibility of future ably relevant, are decidedly lower quick to point out that where there is
70 PEJ MARCH-APRIL/2012
no "ownership" of an objective, mean- unlikely to work very well with medi- References:
ingful stakeholder engagement will be cal colleagues. Instead, SMARTER
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While much of what is used in
an MBO process has been incor- Les MacLeod, EdD,
porated into the SMARTER objec- MPH, FACHE, is a profes-
sor of health management
tives approach, there are crucial
& policy at the University
differences that directly apply when of New Hampshire in
working with physicians. The MBO Durham, NH.
process was designed for a superior- macleod7@metrocastnet
subordinate relationship that is
72 PEJ MARCH'APRIL/2012
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