I had the opportunity yesterday to share some ideas on lessons from the playing field that could assist in patient care at the Massachusetts Veteran Affair’s Medical Center. I truly could not have been more humbled by the attention and the enthusiasm he healthcare professionals showed towards the ideas presented. The lunchtime grand round session broke off into a brainstorming session about goal setting.
The general feeling expressed to me was that goals were valuable, the medical community encourages goals to be set, and the process had become unfulfilling and limited in its benefit to patients. In order to encourage evidence-based practice and to embrace technology, docs are encouraged to complete some sort of an app with/about their patients documenting goals for treatment and the upcoming months. Not a bad idea… but one that struggles due to the “Jekyll and Hyde Nature of Goal Setting” and the challenges of technology. Yet, all of the practitioners wanted goal setting to work well for their patients.
From sitting and listening, the nagging problem with “modern” approaches to goal setting came into focus. I witness this similar story play out in sports medicine settings on a regular basis. SMART goal setting is preached to and embraced by practitioners, yet its outcomes seem so… watered down. Rather than being a double shot of espresso to boost motivation and provide clarity, transparent decaf that does little to change the patient’s psychological status quo is being served.
Goals have dynamic power. They can…
- Enhance motivation
- Fine tune focus
- Enhance learning
- Nurture self-awareness
- Improve communication
- Minimize confusion
- Calm nerves
- Clarify direction
- Build confidence
They can… but are they?
When considering the use of goals in the industrial-medical complex (and elsewhere) the question I stumbled to was, “Who benefits from this goal setting process?” Tracking goals is valuable data for medical institutions. Setting goals is useful for practitioners charting a course of treatment. Goals could be valuable for the patient for all of the reasons listed above. Unfortunately it seems like the goal setting we have embraced benefits institutions far more than patients. Useful, but watered down decaf…
Is the process of goal setting that is adopted practitioner-centered or patient-centered? A check list of milestones to hit and charts to update seem well intentioned, but as a process are not patient-centered. Patient-centered is a cooperative, learning process between health care professional and patient. It is one where patient statements such as, “I don’t know how to _______” or “I don’t know signs of progress,” are connecting and educating points rather than answers that need to be quickly found. Patient-centered is allowing the individual to struggle for days (or even weeks) to articulate specific, positive, and controllable objectives. Patient-centered engages. Rather than being disempowering because medical records need to be updated now.
Healthcare professionals should value and set goals. It keeps them on track and allows for evidence-based practice. This is important practitioner-centered goal setting.
If the patient is to reap the numerous benefits of the goal setting process, simple questions such as, “What is one thing you would like to do more often this week?” or “What do you think would be a small sign of increased mobility be?” must be posed and dwelled upon. This is patient-centered goal setting.
In the hustle and bustle of life, goal setting can become an administrative task rather than a psycho-socially rewarding activity. This is not a call to abandon practitioner-centered goal setting, but rather encouragement to include patient-centered processes (the opposable mind in action – create an “and” rather than an “or”). Goal setting benefits a person in such dynamic ways… if its process is thoughtfully executed.