Health Services Advisory Group Podcasts
Health Services Advisory Group Podcasts
SMART (Specific, Measurable, Achievable, Realistic, Time-based) Goals
HSAG will describe what a SMART goal is and how to write one, and outline how to use these goals as part of the quality improvement process.
The speaker for this podcast is Christine Bailey, Quality Improvement Organization Executive Director, Health Services Advisory Group.
This material was prepared by Health Services Advisory Group (HSAG), a Hospital Quality Improvement Contractor (HQIC) under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services (HHS). Views expressed in this material do not necessarily reflect the official views or policy of CMS or HHS, and any reference to a specific product or entity herein does not constitute endorsement of that product or entity by CMS or HHS. Publication No. XS-HQIC-IP-03012023-01
The speaker is Christine Bailey, Quality Improvement Organization Executive Director, HSAG.
Speaker 1 (00:03):
Today's topic is on SMART goals. So, what are SMART goals? We talk about them being specific, measurable, attainable, relevant, and time-bound. So, we're going to unpack that a little bit, and you can think your goal, kind of like your project vision. So, it's really going to keep your team focused on where they're going, what that destination is for that project. It's going to set direction and purpose. So, what are we really trying to accomplish? It gives context to the goals. So, you know, when we look at that, each of those letters, S-M-A-R-T, and we unpack that more of what each, each of them mean. Then, it's going again to give that context to what your goal is. We don't want to say our goal is to increase hand hygiene. Our goal is to reduce fully catheter utilization.
Speaker 1 (01:06):
I mean that's just too loose. So, SMART goals really give us those details and context. Another very key thing is you should articulate that SMART goal frequently. Put it on the agenda for all your meetings. You know, if you meet in a specific location, always put your SMART goal maybe up on the board. It just will help keep you focused on what you're doing. Repeating that SMART goal frequently will help kind of solidify it in everybody's mind. So, we're going to take an example. And again, you know, the SMART goal is specific. So, what exactly are we trying to accomplish? Is it measurable? So, how am I going to measure that? And again, as we look at that, remember the data and remember what data elements you have available. When you start looking at it being measurable, always see who has the data, how we can best measure it.
Speaker 1 (02:18):
And, and we really want to try to avoid additional data collection. So, keep that in mind. Is it attainable and is it realistic for some hospitals having a hundred percent patient satisfaction? You know, we want that, yes, but is it truly realistic and attainable? Probably not. So again, when you set these goals, we want to make sure that, that it's realistic, otherwise, your team gets really discouraged and it's okay to have incremental goals. So, by a certain date, I want to improve my hand hygiene from 32% to 50%. Then, once you achieve that, you can expand it further. But again, those small wins, those incremental successes and goals are important and time-bound. So, sometimes we get really stuck in, you know, we want to improve hand hygiene, so 90%. Well, when? You know, we have to hold ourselves to a timeframe, and that's really important for project management, right?
Speaker 1 (03:37):
It's really important that you have those timeframes and you set those timeframes for people to accomplish things. You know, when we're doing our action plan, we really want to make sure that we're adhering to our timeline. So, we need to make sure our SMART goals are time-bound. So, you know, we are developing these SMART goals as part of plan. In the PDSA, you're going to carry out the experiment, in other words, and collect data and, and what are you expecting? The "do" is to carry out that plan of how you're going to reach that SMART goal. The study is looking at your results, what worked, what didn't, and then "act." Are changes needed? And, in a previous quality and safety presentation, we talked about adapt, adopt, or abandon when we talked about quick test to change and rapid cycle improvement.
Speaker 1 (04:42):
So, when, you know, you have your SMART goal, you're going to look at it and say, "okay, these are, this is my action plan. This is how I'm going to get from where I am to achieving my SMART goal." So, that's your step-by-step kind of instructions. And then, we're going to look and see if there was an impact. And remember, our processes are perfectly designed to yield the outputs that we see. So it, when you're measuring and you're looking at, "did we achieve our goal?," if the answer is no, then you have to change that process because without changing that process, you're not going to change your outcome. And then, I just want to talk a minute, you know, and give a couple more examples of SMART goals in our world. So, we want to increase hand hygiene. Our goal is going to be increase hand hygiene in our green zone units from 60 to 80% by January 1st, 2022.
Speaker 1 (05:52):
Again, we don't want to stop at the 80%, but, but if I make it too high, my team can lose focus and be discouraged. And our timeline is by January of 2022. So, another one, for example, is reducing fully catheter utilization. So, by first quarter 2022, there's my time-bound, the medical intensive care unit will reduce fully catheter utilization. So, very specific where and what as evidenced by, SUR or standardized utilization ratio less than one. So, again, I'm saying it's time-bound, we know where and when and we know what, what we're measuring. The last one could be, you know, with medication reconciliation, increase the number of initial admission medication reconciliations from 40 to 60% by second quarter 2021. So, when we're talking about experimenting, so these are our quick test of change, right?
Speaker 1 (07:10):
These are trying intervention, seeing if it meets the SMART goal and then adjusting. You'll do those quick tests to change. Target a specific unit or department, and then you can scale and spread. So again, these are our key takeaways. So, you know, we want to have that SMART goal to keep our team on track, to keep us from jumping down rabbit holes that scope creep. And it's so easy to do, especially as you start looking at root causes and you find other things that are wrong. And you know, again, some things have to be fixed before you can move forward with a project. Be careful that you're not taking on a project that's too big that you can't succeed. And maybe they need to be separate projects and, and maybe one needs to be done before the other. So again, keep really focused on that goal.
Speaker 1 (08:13):
Keep it on your meeting agenda. Repeat it. And, and just another little tip is we can so get caught in what I like to call "analysis paralysis" that we lose sight of what we're trying to do. And, and refocusing on that SMART goal sometimes will pull you out of that analysis paralysis. And then the SMART goal will assist you in writing a true goal, something meaningful. Don't forget about the parameters being time-bound, and specifically, where am I doing this, and how am I measuring it? So, make sure you have all those pieces. And then the goal serves as the foundation for your quality improvement models.