Developing and Using SMART Objectives

 

Introduction

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Many quality improvement (QI) projects start as simple ideas, and although objectives may have been set to achieve specific goals, the objectives are often vague. A successful QI project, regardless of how small or large, consists of well-defined goals and objectives. Goals are high-level statements of what an organization hopes to achieve (Terris, 2015). Objectives are created by breaking down goals; thus, objectives are more detailed and limited in scope than goals (Terris, 2015). Although goals and objectives are both essential in framing the work involved in the project, objectives provide a roadmap to the activities that need to occur.

Within the makings of a QI project, once the goal statement is complete (see the first QI Spotlight article: What are goal and aim statements and why are they important), defining SMART objectives will help move the idea into action. This transition from planning to action occurs because objectives provide the project with a direction so that a clear process improvement can be planned. The clearer the objectives, the more successful the project will be.

Gurleen Roberts, author
Gurleen Roberts

What are SMART objectives?

SMART is an acronym for:

  • Specific: focused, detailed, and defined so that the direction of the project is obvious and resources can be allocated appropriately. The language used needs to be clearly defined so that anyone reading the objective can understand exactly what the writer meant.
  • Measurable: quantifiable and/or descriptive values addressing issues such as quantity, quality, cost, satisfaction scores, and percentage of improvement (Terris, 2015). This part of the objective will allow everyone to know exactly what is intended to be measured and compared from baseline to post-implementation.
  • Achievable: feasible and within reach of current roles, responsibilities, and available resources. If you don’t have control of or influence on the suggested improvement, don’t waste your time because it will demotivate those involved in the project. Objectives should be challenging enough to inspire people, but not too challenging that they are out of reach (Zahorsky, 2014).
  • Relevant: related to the goal the project is trying to achieve, and linked to the organization’s mission (Terris, 2015). By directly linking the objective back to the goal statement, the project is strengthening its foundation for success. It’s important to make sure that the project aligns with the organization’s overall mission so that the impact from the project can potentially affect other parts of the organization, and resources and leadership support can be maximized.
  • Time-bound: specific time frame to create project boundaries and help keep the project on track (Centers for Disease Control and Prevention, 2011). This piece keeps the project focused and can range from a few days to a few months. Having a start and end date can also help the project move into the evaluation phase so that it’s not stuck in the planning and implementation phases.

Why use SMART objectives?

SMART objectives provide a plan. Writing a SMART objective on paper is the first step toward achieving that objective; this means that the team is on the same page and the project can now move forward. SMART objectives can also provide transparency for individuals outside of the project to understand the focus of the improvement. In addition, SMART objectives can direct future projects in order to reduce repetition and foster continuous quality improvement.

How do you write a SMART objective?

Keep it simple! The purpose of SMART objectives is to avoid writing vague objectives. Although each objective should consider all five components, it does not have to fit into one sentence. The SMART format helps others who are reading your objectives to know exactly what you are planning to do.

Here are some example objectives:

Not so SMART: We want to decrease patient wait times in our health department.
SMART: Over the next 30 days, we want to decrease patient wait times by 25% in our health department by allowing the front-desk clerk to check patient IDs and insurance cards immediately upon check-in.

Not so SMART: We want to increase the number of customer satisfaction surveys collected.
SMART: By allowing customer satisfaction surveys to be completed online and/or on a health department tablet before check-out, in addition to existing paper-based surveys, we hope to increase the number of surveys collected by 30% in the second quarter of fiscal year 2015. The health department clerks will remind and assist customers in completing this survey.

Here is a list of questions to assist in molding simple objectives into SMART ones. Keep in mind that not all of these questions have to be answered in your objective; they are simply listed to help guide your thought process.

Objective Transforming Questions
Specific What do you want to accomplish?
Who is going to help?
How do you plan to do this?
Measurable How will you know a change occurred?
Can these measurements be done?
Achievable Do you have the resources needed to succeed?
Who is going to help?
Is leadership approval needed?
Is the goal set too high or too low?
Are there any barriers?
Relevant Do you know the boundaries related to this objective?
Is this related to the goal we are trying to achieve?
Will the organization benefit from this?
Time-bound When do you plan to do this?
For how long?
When will you stop to evaluate?

What do you do with a SMART objective once it is developed?

Now that SMART objectives have been developed, they can be used to create activities for the project. Each objective commonly has between one and three activities.

For example, activities for previous SMART objectives are listed below:

SMART objective: Over the next 30 days, we want to decrease patient wait times by 25% in our health department by allowing the front-desk clerk to check patient IDs and insurance cards immediately upon check-in.

Activities: train the front-desk clerk on the new process, display signs to educate patients on the new process, ensure that the front-desk clerk has the tools needed to succeed in improving the new process, and so on.

SMART objective: By allowing customer satisfaction surveys to be completed online and/or on a health department tablet before check-out, in addition to existing paper-based surveys, we hope to increase the number of surveys collected by 30% in the second quarter of fiscal year 2015. The health department clerks will remind and assist customers in completing this survey.

Activities: create an online survey that can be accessible, ensure that the health department has a tablet for patients to use, ensure that the tablet is secure so it doesn’t get stolen, train clerks on the new process, ensure that the health department has wireless Internet access so the survey can be accessed through the tablet, and so on.

Examples of SMART objectives in action

Many QI projects using SMART objectives have been submitted to the PHQIX website. Although the submissions do not have a specific "SMART objectives" section, objectives can be found in the aim statement section of most submissions. Listed below are a variety of different types of SMART objectives used in various QI projects.

Electrifying the Adolescent Pregnancy Prevention Program Evaluation

SMART objective: Reduce the number of process steps by 50% by May 31, 2018.
  • This is a good SMART objective because it has a time frame and is simple, specific, and measurable.

SMART objective: Decrease the turnaround time to 6 months or fewer for 90% of first draft evaluation reports by December 31, 2016.

  • This SMART objective is achievable because it has a set goal for 6 months, and it guides the project to reduce the time to even fewer than 6 months, if possible.

Increasing Enrollment in the Early Intervention Program

SMART objective: Increase the percentage of completed mini-applications from 80% to 85% by July 1, 2013, and to 95% by January 1, 2014.
  • This is a great SMART objective because it has incremental mini-objectives within the larger objective. These mini-objectives help guide the project over a longer period so that momentum is continuous.

SMART objective: Decrease the staff time necessary at the Early Intervention Program and the Evergreen Health Insurance Program to monitor data exchange from 40 hours per month to 10 hours per month by April 1, 2014.

  • This SMART objective provides a great example of how to use a different type of measurement: the number of hours spent per month.

The Cleveland County QI Collaborative in Increased Community Engagement

This is another format for writing a SMART objective, with multiple objectives within the same time frame.

SMART objective: By March 2011, the Cleveland County Health Department will improve community engagement and health improvement planning processes, as evidenced by the following:
  • An increase in average score from 3.8 to 4.0 on the Meeting Effectiveness Survey
    • This SMART objective asks for a change in the average survey score (measurement) and specifies a survey tool to be used within the time frame listed above.
  • An improvement from 0% to 100% of a local strategic plan completed through the Step UP performance management web-based system
    • This is a unique way to write a SMART objective to create a strategic plan from scratch: going from 0% to 100% and using a specific system for the strategic planning process.

Women, Infants, and Children (WIC) Program Patient Flow Analysis

The following SMART objectives are all well-written examples of various ways to reduce wait time. They all list specific locations and criteria, have a time frame, and are measurable.

SMART objective: Ellis Shipp Clinic: By December 2013, WIC staff will decrease the waiting time for a nutritionist by 30%.
SMART objective: Rose Park Clinic: Reduce the average gross waiting time by 15% for WIC participants by December 1, 2013.
SMART objective: Salt Lake City Clinic: Reduce overall appointment time from 59 minutes to 50 minutes by December 31, 2013.
SMART objective: South Main Clinic: Food instrument appointments will decrease from 24.1 to 18 minutes.

References

Centers for Disease Control and Prevention. (2011). Public Health Information Network Communities of Practice: Develop SMART Objectives. Atlanta, GA. Retrieved from http://www.cdc.gov/phcommunities/resourcekit/evaluate/smart_objectives.html

Terris, D. D. (2015, September). Building a Toolkit for Success in Quality Improvement. Watkinsville, GA: SudOrd Consulting.

Zahorsky, D. (2014, December). The 5 steps to setting SMART business goals. About Money. Retrieved from http://sbinformation.about.com/od/businessmanagemen1/a/businessgoals.htm

 

 

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