Abstract and Figures

There is general agreement that plans without well-formulated goals lack rationale, strategies lack relevance, actions lack direction, projects lack accountability, and organisations lack purpose (Mullins, 1999; Beardshaw and Palfreman, 1990; Bratton, et al, 2007). Moreover, goals need to be properly constructed to serve as credible and usable benchmarks by which the results can be monitored and evaluated via immediate outputs, intermediate outcomes over the short term or terminal impacts in the long term (Greenbank, 2001; Fitsimmons, 2008; Bipp and Kleingeld, 2011). Thus, it is a basic requirement of effective goal setting that objective statements are formulated using a clear and logical structure or framework. This article analyses examples of objective statements drawn from the literature and concludes that none of these can be truly described as SMART¹, posing the risk that organisations using them as guide will fail to attain their goals.
Content may be subject to copyright.
324 British Journal of Healthcare Management 2017 Vol 23 No 7
© 2017 MA Healthcare Ltd
Osahon Ogbeiwi
Why written objectives
need to be really SMART
Goal setting is a characteristic practice shared by
successful programmes and organisations across
every sector of human endeavour; and writing
clear and well-structured statements to express
objectives in a specic, measurable and achievable
format is the norm (Beardshaw and Palfreman
1990; Bratton et al 2007; Day and Tosey 2011).
Hence, it is best practice to use a conceptual
framework as a tool for setting goals to provide
a reliable and logical platform on which work can
be planned and assessed (Mullins,1999).
Generically, researchers dene a goal as the
desired end result of an action that is expected
to be achieved at some specied time in the
future, and toward which all eort and essential
resources are committed to achieving (Locke
and Latham, 2002; Locke and Latham, 2006;
Fitsimmons, 2008; Day and Tosey, 2011; Nanji
et al, 2013).
In this article, the term ‘objective’ is used to
refer to a sub-goal, one that expresses a desired
outcome: a short-term eect or change expected
to result from the outputs of activities performed
(Organisation for Economic, Co-operation and
Development (OECD), 2002).
In the hierarchy of goals illustrated in
Figure 1, the eects of the immediate output
of an intervention lead to the attainment of the
objective in the short term, which in turn over the
longer term contributes to achieving the broad
or overall aim, described by some organisations
as general goal and development, or a higher
order objective (OECD, 2002). Besides the levels,
Figure 1 also dierentiates outputs, objectives
and aims according to the diering time frames
for their attainment and goal attributes.
The literature suggests that it may take
3-12 months to achieve a short-term outcome
relating to an objective, and at least ve years to
accomplish a long-term impact relating to an aim.
A synthetic review by Ogbeiwi (2016) identied
seven thematic characteristics that distinguish an
Osahon Ogbeiwi
Doctoral researcher,
faculty of health studies,
University of Bradford
Email: o.j.i.ogbeiwi@
There is general agreement that plans without well-formulated goals lack rationale, strategies
lack relevance, actions lack direction, projects lack accountability, and organisations lack purpose
(Mullins, 1999; Beardshaw and Palfreman, 1990; Bratton, et al, 2007). Moreover, goals need tobe
properly constructed to serve as credible and usable benchmarks by which the results can be
monitored and evaluated via immediate outputs, intermediate outcomes over the short term or
terminal impacts in the long term (Greenbank, 2001; Fitsimmons, 2008; Bipp andKleingeld, 2011).
Thus, it is a basic requirement of effective goal setting that objective statements are formulated
using a clear and logical structure or framework. This article analyses examples of objective
statements drawn from the literature and concludes that none of these can be truly described as
SMART1, posing the risk that organisations using them as guide will fail toattain their goals.
Key Words: SMART1 objectives • Objective statements • Goal setting • OITT2
1 SMART = specic, measurable, attainable, realistic, time bound; 2 OITT = outcome, indicator, target level, time frame
326 British Journal of Healthcare Management 2017 Vol 23 No 7
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objective from other goal types, including:
Its stated object of outcome
Specic scope
Mid-level or intermediate hierarchy
Short-term time frame
Quantiable measurability
Signicance of eectiveness
Expression as a SMART (specic, measurable,
attainable, realistic and time-bound) goal.
Hence, while Figure 1 shows that an aim is
the broad statement of the expected terminal
achievement of an intervention, expressing
its long-term impact and overall purpose, an
objective is a specic statement of time-bound
interim accomplishment. The US Centers for
Disease Control and Prevention (CDC) denes
objectives as ‘annual milestones that the
program needs to achieve in order to accomplish
its goals by the end of a ve-year funding period’
(CDC, 2009).
SMART objective setting
Typically, writing objectives as SMART
statements is the gold standard for goal setting,
because it gives a clear direction for action
planning and implementation (CDC, 2008). The
SMART model was originally outlined by George
T. Doran in 1981 as the ve essential criteria that
the statement of every meaningful and eective
objective should full (Doran, 1981; CDC, 2008;
Day and Tosey, 2011). Many programmes and
organisations have since used the SMART
acronym as a reliable model to guide formulation
of objectives for dierent intervention levels
by simply asking the question: ‘Is the objective
Dierent divisions of the CDC have produced
tools such as checklists and templates for SMART
objective setting (CDC, 2008 , 2009; CDC
Communities for Public Health (CPH), 2017; CDC
Division for Heart Disease and Stroke Prevention
(DHDSP), 2017; CDC Division of TB Elimination
(DTBE), 2017). These checklists use the SMART
acronym as a base, and goal setters simply answer
questions related to each key word on how to
make the objective statement SMART.
To aid the construction of an objective
statement, the CDC DTBE (2007) provides a
tabulated template split into seven parts: verb,
metric, population, object, baseline measure,
goal measure and time frame. Two other CDC
divisions provide a template of incomplete
statement, with gaps to be lled with expected
components (Division of Sexually Transmitted
Disease Prevention (DSTDP), 2017; DHDSP,
2017). Thus, there are few tools that oer
structural guidance for writing objective
statements using a SMART goal framework or
templates against which goal setters can compare
their formulated goal statements to determine
whether they satisfy the SMART criteria.
Goal-setting frameworks
Goal-setting frameworks have been studied
extensively since the 1950s. The most popular of
these include:
Management by Objectives (Drucker, 1955;
Dahlsten et al, 2005; Bipp and Kleingeld,
Balanced Scorecard Approach (Kaplan and
Norton, 1996)
Goal Attainment Scale (Yip et al, 1998)
Total Quality Management and continuous
quality improvement (Ginsburg, 2001; Medlin
and Green, 2009).
0 months
end of activity
5 or
more years
Broad, subjective organisational
purpose or impact
Terminal-level effect of outcome
Long-term, end-term, higher order goal
Tasks carried out
Activities performed
Strategies executed
Specic, measurable result of action
First-level effect of process targets
Immediate-term goal
Specic, project-measurable and
timed outcome
Second-level effect of outputs
Mid- or short-term goal
Figure 1. Linear direction of the chain eects of
intervention goals
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increasing the chance of goal attainment (Locke
and Latham, 2002; Locke and Latham, 2006).
Thus, it can be assumed that a specic,
challenging, clearly written goal framework is an
indirect predictor of goal attainment. However,
like the SMART criteria, Locke and Latham’s
theoretical framework outlines only the goal
attributes that eective objectives should have to
enable the attainment of the desired goal eect
(Locke and Latham 2013); it does not specify
the goal contents that give the statements these
attributes. Therefore, there is still need for a
reliable and practical conceptual guide to aid goal
setters in writing objective statements with the
right components of a SMART goal framework.
Model framework
Writing SMART objectives
To be SMART and ensure goal clarity, according
to Doran’s original criteria, and to positively
inuence goal attainment according to Locke and
Latham’s (1990) theory, it is essential that every
meaningful objective statement should specify:
The positive change or improvement desired
The measurable indicator of the change
The challenging but attainable level of
the indicator
The realistic time frame of when the change
can be achieved (Doran 1981, Ogbeiwi 2016).
Therefore, SMART objective statements could
be constructed using a model framework that has
four components:
The outcome
Its indicator
Target level and
Time frame (OITT).
Figure 3 shows an example of an objective
statement constructed using the OITT
framework. To date, no empirical studies have
investigated or reported on the goal frameworks
used by goal setters for writing statements
of objectives, or assessed the extent to which
the objective statements formulated for their
development or intervention plans are SMART.
Purpose of review
No empirical goal-setting research has yet
been undertaken to investigate the constituent
components of goal frameworks used to write
Other models have included the RAID
(review, agree, implement, and demonstrate
and develop) model (Parker et al, 2003) and the
Productivity Measurement and Enhancement
System (Pritchard et al, 2008). Bovend’Eerdt
et al, (2009) reported the use of WHO
International Classication of Functioning,
Disability and Health (ICF) as a template for
goal setting, and Scobbie et al (2013) described
the G-AP (goal-setting and action planning)
framework. In the eld of engineering, Zhu et
al (2002) looked at the use of object/objective-
oriented maintenance management (OOMM) as
a goal-setting framework.
While most of these frameworks are hinged
on SMART goal setting, Day and Tosey (2011)
criticised the use of SMART criteria in the
education sector, recommending instead as
an alternative the use of the ‘well-formed
outcome’ framework for writing learning
objectives, based on Zimmerman’s (2007) eight
criteria for appropriate goals. According to
Zimmerman (2007), learning goals must satisfy
the conditions of goal specicity, temporal
proximity, hierarchical organisation, congruence
with self and others’ goals, degree of diculty,
self-generation, a level of conscious awareness,
and clarity about whether the goal is process or
performance related.
Day and Tosey’s (2011) well-formed outcomes
framework requires properly formulated
educational objectives to be written on a
POWER template, where POWER stands
for: positive outcome, own role, what task
(with dates), evidence of accomplishment and
relationships required.
Practically, besides the CDC and the Day
and Tosey templates, most frameworks simply
outline the process steps that goal setters
can follow in practice, rather than oering
lexical frameworks for writing SMART
objective statements. However, they are
largely underpinned by Locke and Latham’s
(1990) motivational theory of goal-setting and
task performance (Figure 2). This illustrates
how goals formulated with goal attributes
of specicity and diculty, under certain
mediating and moderating conditions, result
in improvement of task performance, in turn
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Goal commitment = goal condence (self-efcacy) + belief of goal importance
Feedback on progress toward goal
Task complexity
Situational constraints of resources
Conditions for goal effect
Set specic and
(e.g. performance
and learning goals)
Enhanced task
(e.g. productivity, cost
4 key moderators
4 mediators
Mechanisms of goal effect
Directing attention and action
Focusing effort on goal-relevant task
Persisting at task overtime
Motivating use and acquisition of required strategies/skills/knowledge
Attain desired
(e.g. satisfaction with
performance results
and rewards)
Figure 2. Locke and Latham’s goal-setting theory (adapted from Locke and Latham 2002; 2006)
a SMART objective statement. This review,
therefore, analyses the goal framework of SMART
objective statements found in the literature and
seeks to determine the extent to which they
satisfy the ve goal attributes of specicity,
measurability, attainability, realisability and time.
The review is designed to answer a core
question: Are SMART objective statements
really specic, measurable, attainable, realistic
and time bound? To answer the question,
the goal framework of sample SMART
objective statements is compared against the
OITT components (Figure 3) as a standard
analytical template.
This review presents a quantitative descriptive
analysis of published examples of SMART
objective statements obtained through a
purposeful search of the literature on SMART
goal setting. It involved online searches of
formal academic sources, such as the Health
Management Information Consortium and
Allied and Complementary Medicine databases,
Pubmed, Medline, PsychArticles, CINAHL, and
Google scholar, as well as using informal search
engines such as Google. The search phrases used
were ‘writing SMART objectives’ and ‘goal setting
and framework’, ‘goal-setting in healthcare’ and
‘monitoring and evaluation toolkits’. Goal-setting
framework articles were generated from these
databases, but only those that gave access to full
texts were printed for document review. Other
materials were obtained through snowballing
from the reference lists of accessed articles.
All materials were manually scanned for
objective statements given as ‘examples of
SMART objectives’ as the main selection
criterion. In line with the chosen denition
of an objective, any statements referred to as
‘SMART process objectives’ were excluded, while
‘SMART outcome objectives’ were included,
even though some of them still described tasks
as desired accomplishments.
The OITT framework was used as the standard
template for determining whether the goal
framework of each objective statement was truly
SMART or not. Accordingly, to be SMART each
objective statement had to be a single sentence
specifying a complete set of OITT components
(Figure 3).
To be an outcome, the specied
accomplishment needed to be an expected
short-term result or change that could be related
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to the activities of a project, intervention or
organisation (OECD, 2002, DSTDP, 2017) as
illustrated in Figure 1. To be an indicator, the
specied goal measure needed to be a direct
quantiable variable of the outcome. Usually
indicators are expressed in quantitative units
of number, percentage or proportion, average,
ratio, rates, etc. (DHDSP, 2017). To be a target,
the specied level or quantity needed to be an
amount of the indicator stated. Time frames had
to be specic dates, periods or time frequency.
Notably, no examples of SMART objectives
were found in any of academic goal-setting
articles reviewed. A total of 17 examples of
objective statements (Table 1) were collected
from Doran (1981) and four major healthcare
organisations, including the US CDC (11), Salford
Royal NHS Foundation Trust in the UK (3), the
World Health Organization (WHO) (1), and Save
the Children UK (1).
To comply with copyright, written permission
was obtained from Salford Royal NHS
Foundation Trust for the use its material in the
study. The 11 CDC objective statements were
published by ve divisions of the CDC: the CPH,
DHDSP, DSTDP, DTBE and Health Youths (CDC,
2009). The CDC are also the publisher of the
conference presentation by Carl Osaki (2008).
The structural contents of each of the 17
objective statements were analysed descriptively
and compared against the components of the
OITT framework to determine the degree to
which their structures or goal frameworks
were SMART. Each statement was assessed
by the number of OITT components specied
and the percentage completeness of the four
components. For each statements, completeness
was assigned as 0% (no components), 25% (one
component), 50% (two components), 75% (three
components) or 100% (four components).
In interpreting whether the structure or
framework of an objective statement is SMART
or not in this study, the following criteria were
applied according to Figure 3:
Specic: it states an outcome
Measurable: it states an indicator of the
Attainable: it states an achievable relevant
target level of the indicator
Realistic: the target level can be attained with
available resources in a particular time frame
Time bound: the desired time frame
is specied.
However, the realisability of the objective
statements in this study was not assessed
because the operational and resource contexts
were unknown (the objective statements being
published examples only).
The StatCalc epidemiologic calculator (part of
the Epi-Info software tools, version was
used for 2x2 contingency calculation of Chi-square
test values for dierences in the number of
individual components; statistical signicance was
determined by Mantel Haenszel test results and
two-tailed p-values of less than 0.05.
Contexts of objectives
Table 1 shows the 17 examples of objective
statements taken from 12 project contexts. All
are health related, except for the management
time bound
e.g. to improve the economic status
of the population in community X
e.g. poverty rate
e.g. reduce from 50% to 30%
e.g. by the end of
SMART objective statement:
To improve the economic status of the population in community X,
such that the poverty rate falls from 50% to 30% by end of one year
Figure 3. OITT framework of an objective statement
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Table 1. Published examples of the SMART1 objectives reviewed
Objective Work or care
Context Objective
1To develop and implement by 31 December, 198__, an inventory system that
will reduce inventory costs by $1 million (£781,000), with costs not to exceed
200 work hours and $15 000 (£11 700) (Doran, 1981)
Management Process
2By year two of the project, local education authority staff will have trained
75% of health education teachers in the school district on the selected
scientically based health curriculum (CDC2, 2009)
Youth health Process
3Reduce current operating costs by 5% in breast surgery by March 2012
(Salford Royal NHS Foundation Trust, 2011)
Hospital Process
4Increase the percentage of converted day cases in breast surgery from baseline
of 20% to 25% by November 2011 (Salford Royal NHS Foundation Trust, 2011)
Hospital Process
5By (month/year), increase the percentage from X% to Y% of providers in
county Z that fully adhere to the CDC sexually transmitted diseases treatment
guidelines for appropriate treatment of gonorrhoea (CDCDSTDP3, 2017)
Treatment Sexually
6Increase percentage of adult patients with non-resistant TB who completed
therapy (within 12 months) from 80% to 90% by 2006 (CDC DTBE4, 2017).
Case holding Tuberculosis Outcome
7By 29 June 2006, increase the number of training sessions given for heart
disease and stroke prevention programme partners on implementing and
evaluating system change from 10 to 14 (CDC DHDSP5, 2017)
Training Heart disease
and stroke
8By 15 February 2006, increase by four the number of community health
centres in (state) that have incorporated into the clinic system electronic
records with reminders of treatment protocols (CDC DHDSP5, 2017)
Heart disease
and stoke
9To achieve 80% immunisation coverage in the next ve years in district X
(Save the Children, 2003)
Immunisation Child health Outcome
10 By 31 December 2009, increase awareness of the signs and symptoms of stroke
and the importance of calling 911 among African American men in (state)
from 11% to 15% (CDC DHDSP5, 2017)
Heart disease
and stoke
11 The risk of diarrhoea is reduced by 50% in the target population in six months
(World Health Organization, 2016)
Prevention Diarrhoea Outcome
12 By the end of the school year, district health educators will have delivered
lessons on assertive communication skills to 90% of youth participants in the
middle school HIV-prevention curriculum (CDC2, 2009)
Youth health Process
13 Improve operating theatre productivity from 80% to 90% (Salford Royal NHS
Foundation Trust, 2011)
Hospital Process
14 From August 2008/09, establish recruitment initiatives at historically black
colleges and other minority institutions in conjunction with the training
initiatives of national partner organisations (CDC CPH6, 2017).
Training Minority
15 By 31 December 2008, develop an inventory of staff training and competency
needs (Osaki, 2008)
Training Human
16 By 31 July 2008, develop an information management plan that describes
how to identify, collect, store, analyse and correct environmental health data
(Osaki, 2008)
17 By 1 March 2008, begin a research project with the local university on the
impact of climate change on our community (Osaki, 2008)
Research Climate
1 SMART = specic, measurable, attainable, realistic and time-bound 2 CDC = Centers for Disease Control 3 DSTDP = Division of STD Prevention
4 DTBE = Division of Tuberculosis Elimination 5 DHDSP = Division for Heart Disease and Stroke Prevention 6 CPH = Communities for Public Health
British Journal of Healthcare Management 2017 Vol 23 No 7 331
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objective from Doran (1981) and Osaki’s (2008)
climate change research objective. The hospital
and heart disease/stroke projects each yielded
three objectives (17.6%); youth health two
(11.8%); and the remaining nine — STD, TB,
child health, diarrhoea, environmental health,
climate change, human resource management,
minority communities and management — one
each (5.9%). Similarly, the areas of work or care
for which the sample objectives were set varied,
covering 11 work settings.
According to Table 1, health education and
training have three objectives each, while breast
surgery and health information system are each
linked to two objectives. The remaining seven
work settings, with one objective each, range
across inventory system, STD treatment, TB case
holding, immunisation, diarrhoeal prevention,
surgical theatre management and research.
Type of objectives
To be considered an outcome objective the
desired change should be a short-term result
of a task, activity or strategy, rather than a
change of the level of task performance or
indicator. For example, No 10 (Table 1) is an
outcome objective because raising awareness of
stroke in a community is a short-term outcome
of project implementation. It does not state
accomplishment of particular awareness creation
activities as a goal.
No 1 is a process objective, because it seeks
to develop and implement an inventory system
with change in operation costs being the
indicator that measures the progress towards or
accomplishment of the inventory system.
Of the 17 statements, 13 (76.5%) are
process-oriented objectives that seek targeted
accomplishment of tasks or work, and four
(23.5%) are results or outcome oriented. Table 1
shows that the four work settings and contexts
where outcome objectives are formulated
are case-holding in TB, child immunisation,
stroke awareness health education and
diarrhoeal prevention.
Basic structure of objective statements
The majority, 11 (64.7%), originate from
CDC-related sources. Apart from the CDC DTBE
objective, all the CDC objectives are written
within a structure that includes the time frame,
task or outcome to be accomplished, and the
expected change in the measure from baseline
to target.
Objective No 5 (Table 1), relating to an STD
treatment goal, is typical of this template
for writing objective statements in CDC
programmes, which the CDC DHDSP (2017) set
out as:
‘By_____/_____/_____, [WHEN—Time
bound] [WHO/WHAT—Specic] from:
____ to: _____ [MEASURE (number,
rate, percentage of change and baseline)—
The ve examples from Salford Royal NHS
Foundation Trust, WHO and Save the Children
mostly share a similar sequence, stating the
desired accomplishment rst, and the measure
and time frame last.
Frequency of OITT components in
objective statements
Table 2 and Figure 4 show the distribution of the
four OITT components across the 17 objective
statements. The most frequent component is
the time frame, specied in 94% of statements.
The least frequent component is outcome,
specied in 18%. Figure 4 also shows that, while
59% of statements specify an indicator, 76%
specify a target. The Chi-square test values for
the observed dierences between the number
of statements with a specied outcome and the
number with each of the other components are:
Indicator (X2=5.92)
Target (X2=11.46)
Time frame (X2=19.57).
They are all statistically signicant on the
Mantel Haenszel test results (p< 0.05).
Completeness of the SMART goal
Table 2 and Figure 5 show the number of OITT
components in each objective statement, ranging
from one (25% completeness) being included
in four statements, two (50% completeness) in
one statement and three (75% completeness)
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Table 2. Analysis of the OITT1 SMART2 components in statements of objectives
Related task OITT1 components specied in objective statement No of OITT1
Outcome Indicator Target Time frame
1Develop and
implement an
inventory system
Unknown Inventory
Reduce by
$1 million
(£781 000),
with cost
not to
exceed 200
work hours
and $15 000
(£11 700)
375% No
2Local education
authority staff will
have trained health
education teachers
Unknown % health
75% By year two 375% No
3Reduce operating
Unknown Operating
5% March 2012 375% No
4Increase day cases
of breast surgery
Unknown % converted
day cases
from 20%
to 25%
375% No
5Unknown Unknown % providers
that fully
adhere to
from X%
By (month/
375% No
6Unknown Unknown % adult
patients with
TB who
90% 2006
(within 12
375% No
7Increase training
sessions given for
heart disease and
stroke prevention
Unknown Number
of training
from 10
29 June
375% No
community health
Unknown Number of
health centres
Four 15 February
375% No
9Unknown Unknown Immunisation
80 per cent Next 5
375% No
10 Unknown Increase
of signs and
Unknown from 11%
to 15%
375% No
11 Unknown Risk of
diarrhoea is
Unknown by 50% 6 months 375% No
12 District health
educators will have
delivered lessons
Unknown % youth
90% End of the
school year
375% No
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in 12 statements. The mean of 2.5 components
per statement represents an overall 61.8%
completeness of the framework of the 17
statements studied.
None of the 17 statements contain all four
OITT components, and therefore none is
SMART (Table 2). Figure 6 shows that the
most common combination of components is
indicator/target/time frame, which is present
in 59% of statements. Thus, no statement has
a structure with the required combination of
OITT components.
The objective statements analysed in this study
may represent the products of goal-setting
practice in multidisciplinary health contexts, but
the ndings may have wider application beyond
healthcare organisations. Clearly, the types of
objectives found in the literature suggest that
goal setting in healthcare may be oriented more
towards targeted accomplishment of tasks than
the achievement of specic levels of desired
results or outcomes of services.
However, the availability of different template
designs for formulating objective statements
indicates that there is no unied pattern for
writing objective statements across dierent
health organisations, even though the CDC
templates represent a commendable attempt to
standardise practice across dierent departments
or services within the same organisation. The
two template designs used clearly diverge:
while the CDC recommends using the time-
accomplishment target-measure pattern, the
statements of the other organisations refer
to accomplishment-measure-time.
Although using a particular template or
pattern may be helpful in writing goals, this
review indicates that it is a less useful tool for
determining whether the statement produced is
SMART, certainly not as important as the goal
13 Unknown Improve
Unknown from 80%
to 90%
Unknown 250% No
14 Establish
Unknown Unknown Unknown From
125% No
15 Develop an
Unknown Unknown Unknown 31
125% No
Develop an
management plan
Unknown Unknown Unknown 31 July
125% No
17 Begin a research
Unknown Unknown Unknown 1 March
125% No
Frequency of components 310 13 16
% components 18% 59% 76% 94%
Mean number of
2.5 61.8%
1 OITT = outcome, indicator, target level and time frame 2 SMART = specic, measurable, attainable, realistic, time bound
Time frame
3 (18%)
10 (59%)
13 (76%)
16 (94%)
Figure 4. Frequency of OITT components specied in
17 examples of SMART objective statements
334 British Journal of Healthcare Management 2017 Vol 23 No 7
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to include a time frame in every objective or use
acombination of indicator, target and time frame
than specify an outcome. Rather than being
objectives that state a specic outcome — along
with the dening components of indicator, target
and time frame — they are mostly statements of
measurable and time-bound indicators, but make
no mention of the intended short-term goal.
Thus, on the whole, the statements lack
clarity and specicity about the result to be
accomplished, of which the indicators, targets
and time frames should be relevant measures.
Therefore, none of the published examples of
SMART objectives really are SMART, since they
lack the complete goal framework comprising all
four OITT components needed to satisfy each of
the five SMART criteria.
It is noteworthy that most statements reviewed
are process oriented. Even the SMART example
published by Doran (1981) — the originator of
SMART criteria — states as the objective a task
performance, instead of an outcome. While some
statements may be acceptable as SMART process
targets, without a specic outcome, they do not
qualify as SMART objectives if assessed on the
OITT framework. Depending on the reliability
and external validity of the OITT as an objective-
setting tool, the inadequate frameworks in the
published examples, which span a range of
project settings, may suggest that there is a high
prevalence of non-SMART objective statements
in use in the health sector.
This observation primarily questions the
motives behind objective-setting practices in the
healthcare sector. Should goal setters set them to
show the expected changes in task performance
(Locke and Latham 2002), or the short-term
eect or outcome results they expect from the
outputs of implementing planned tasks (OECD
2002; Ogbeiwi 2016)? Should they state specific
changes in indicators that are solely statistical
measures of the changes towards a goal (OECD
2002), without specifying the goal itself? What
expected results should goal setters really specify
as outcomes in their objectives statements?
With the confusion surrounding the exact
definition of an objective (Ogbeiwi 2016),
it appears that the type of accomplishment
specified in an objective statement reflects the
content or the completeness of the components
required for the statement to possess SMART
goal attributes.
In terms of completeness, this analysis nds
that none of the examples of objective statements
sit within a goal framework that encompasses all
four OITT components. These examples have,
on average, a 62% completeness rate and, on
average, each health objective statement contains
three OITT components.
According to the frequency of components in
the statements, these examples suggest that goal
setters in health organisations may be more likely
Figure 5. Frequency of percentage completeness of OITT
components in objective statement
3 (Outcome/target/time frame)
3 (Indicator/target/time frame)
2 (Outcome/target)
1 (Time frame)
Figure 6. Frequency of combination of OITT components in
examples of SMART objective statements
10 (59%)
4 (24%)
Total = 17 objectives
Mean % completeness
= 61.8%
75% completeness,
12 statements
50% completeness,
1 statement
25% completeness,
4 statements
British Journal of Healthcare Management 2017 Vol 23 No 7 335
© 2017 MA Healthcare Ltd
goal setter’s organisational understanding of
what an objective is. Hence, organisations that
use the term objective as a generic term may
also assert that it can be both task (process) and
outcome oriented. They may therefore encourage
their projects to be formulated using objective
statements that show expected accomplishments
at dierent system levels of task, output,
outcome and impact (OECD, 2002; DHDSP,
2017, DSTDP, 2017).
The immediate implication of the ndings of
this analysis is that few projects, if evaluated
against this new template of the OITT framework,
have outcome-oriented objectives that are in
reality SMART. However, the current study may
have a weakness, in that it looked at only sample
objective statements and not objectives developed
in real project contexts. Nonetheless, it does
reveal the potential risk that projects relying on
the use of these examples as objective-setting
guides may lack the complete set of components
required to formulate a SMART goal framework,
including specic outcome, measurable
indicator, attainable target and realistic time
frame (Doran, 1981; Ogbeiwi, 2016).
According to Locke and Latham’s goal-setting
theory, clear, specific and challenging goals can
engender improved performance towards goal
attainment (Locke and Latham, 2006). So it is
reasonable to assume that projects designed with
an incomplete or defective goal framework are
less likely to attain their desired outcomes.
Consequently, the possibility that globally
many organisations are basing their planning
on non-SMART objectives should be a serious
concern to all stakeholders in the healthcare
sector, since it implies that many healthcare
projects with life-saving significance are likely
to be built on them. This is worrying because it
may mean that many health projects worldwide
are implementing health plans with no hope of
goal attainment.
There is, therefore, a need for projects to be
designed on a framework of objective statements,
such as the examples studied, to review the
extent to which their objectives really are
SMART. Hence, the above implications raise
more questions for further research in real-
eld situations. First, to what extent is the goal
framework of objective statements of real projects
actually SMART? Second, is it more likely that
projects planned on the basis of objectives with a
complete OITT goal framework will attain their
desired outcomes? These questions should lead
to further research to investigate the reliability,
validity and ecacy of using the OITT framework
as a standard tool for objective setting.
Writing SMART goals is fundamental to planning
eective results-oriented action. Even though
there are many goal-setting templates and
guides, it appears that none currently oers a
relevant and complete structural template to aid
the construction of written objective statements
that satisfy all the criteria for SMART goals.
The author proposes that writing objective
statements that encompass the four components
of the OITT goal framework as a conceptual
template might help goal setters to formulate
better objectives — SMART in goal attributes and
goal content.
The objectives analysed in this article may
have been drawn from just few examples and
skewed toward the goal-setting practice of the
CDC, but they provide a credible basis to invite
programmes and organisations worldwide to
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n There is no single, agreed template or standardised guidance for
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n Writing objective statements based on a template that encompasses
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andmeasurable aims
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... In addition, the application of SMART criteria in SCI/D rehabilitation is challenging because this framework requires clarity and specificity regarding the end result to be achieved. As mentioned earlier, progress in SCI/D tends to be uncertain, and therefore, goals are processoriented rather than SMART as defined (44). ...
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Introduction Goal setting (GS) is an important aspect of initial spinal cord injury/ disorder (SCI/D) rehabilitation. However, because expected outcomes are individual and often difficult to determine, GS is not straightforward. The aim of this study was to explore the health care professionals' (HCP's) experiences with and perspectives on the goal-setting process (GSP) during initial SCI/D rehabilitation. Method Five semi-structured focus groups (FG) (22 purposively sampled HCP, mostly in leadership positions, six different professions). The FG were transcribed verbatim. We analyzed the transcripts for qualitative content analysis following Braun and Clarke (2013). Results HCP described GS-influencing aspects at the macro, meso and micro levels. At the macro level, participants spoke about restrictions imposed by health insurers or difficulties in planning the post-inpatient setting. Regarding the meso level, HCP spoke of institutional structures and culture that facilitated the GSP. At the micro level, knowledge of the diagnosis, expected outcomes, and individual patient characteristics were mentioned as important to the rehabilitation process. It was important for HCP to be patient and empathetic, to endure negative emotions, to accept that patients need time to adjust to their new situation, and to ensure that they do not lose hope. Open communication and interprofessional collaboration helped overcome barriers in the GSP. Discussion This paper shows the complex relationship between external (e.g., health insurers), emotional, and communication aspects. It calls for a comprehensive approach to optimizing the GSP, so that patients' experiences can be fully considered as a basis to identify the most appropriate care pathway.
... There appears to be a lack of robust evidence to back up the use of the SMART acronym, which is mainly based on a practical approach. Ogbeiwi (2017) argued that a basic requirement of effective goal setting is that objectives are formulated using a clear and logical structure or framework. Each step in the action plan links to the next and it is important to consider the overall plan and ensure it flows logically (Canadian Nurses Association 2022). ...
... Goal setting is a practice shared by successful programs and organizations across every sector of human endeavor, and writing clear and well-structured statements to express objectives in a specific, measurable, achievable, relevant, and time-based (SMART) format. (Ogbeiwi, O., 2017). ...
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Preface and Acknowledgements This is the first text book that is prepared as a joint work between four Arab countries including Egypt, Jordan, Lebanon and Syria (in alphabetical order) which seeks to present and integrate relevant information related to the field of infant and young child feeding. It is prepared for individuals who wish to specialize in the field of lactation management for promoting, supporting and protecting breastfeeding and continued support of infant feeding in the first five years of life. It is intended for use by countries in different regions of the world with a focus of developing countries and countries where breastfeeding is mandatory for saving lives and achieving the Sustainable Development Goals. This book was prepared in three phases, the first phase was done between the main authors, in the second phase a team from Egypt and a team from Lebanon reviewed and edited the chapters, in the third phase the book was again reviewed and finalized by the main authors. It is divided into 22 chapters that cover the academic, clinical, nutritional and critical management procedures necessary for nutritionists, physicians, health providers to support mothers at different levels of care and in different chronological periods of child development from conception to five years of age and is centered around the needs of both the mother, the baby and the family and community at large for promoting, supporting and protecting breastfeeding. It is tailored to the needs of specialists globally, but especially for those from the developing countries. This book would not have been made possible without the bulk of authentic and growing literature updates and research work, from all over the world, that was accessed online. We are sincerely grateful to the Nutrition Unit in the Eastern Mediterranean Region (EMRO) for its support in the editing and finalization RI�the book to reach its current state. We sincerely appreciate the team in Lebanon led by Dr. Maha Hoteit and included: Lactation Specialist Rim El Hajj Sleiman; Ms. Carla Ibrahim, Holy Spirit University of Kaslik (USEK); Ms. Hala Mohsen, Lebanese University, and Ms. Nour Yazbeck, Lebanese University, who dedicated much time and effort in this work. We are also grateful to the team who assisted Dr. Azza Abul-Fadl from Egypt who included Professor Salah Ali Ismail Ali, Sohag University; Dr. Ahmed Alsaed Younes, Head of EPA and ESBMF; the team from Benha Univeristy including Professor AlRawhaa Abuamer and Dr. Ranya Abdelatty from Benha Faculty of Medicine, and the team from Alexandria University; Professor Nadia Farghaly, Faculty of Medicine, Dr. Ahlam Mahmoud and Dr. Eman Kaluibi, Faculty of Nursing and the team from MCFC including Dr. Shorouk Haithamy and Dr. Samaah Zohair and Organizational psychologist Ms. Iman Sarhan from Newcastle University. This has been an intense and invigorating experience especially with the feedback received from Syria by Dr. Mahmoud Bozo who participated in the activity despite the difficult circumstances in Syria. We are grateful to Dr. Moataz Saleh, Nutrition Specialist and Dr. Naglaa Arafa, Nutrition officer from UNICEF, Cairo office for their technical support. Indeed this work would not have been made possible without the coordinating efforts of Dr Ms. Nashwa Nasr from WHO-EMRO. We received support from the administrators, designers and information technologists and many other experts who supported this work and to whom we are also very grateful. Last but not least we owe this work to the spiritual support of mothers struggling to breastfeed their babies who have inspired us throughout this work and we hope our efforts will reach out to them and to all those who are encouraging, guiding and supporting them in their exceptionally unique motherhood experience. We commend and applaud the many scientists, research workers and authors of books in this field and are grateful to those who delivered libraries to our homes by the internet. We sincerely hope that this material as a publication or an e-book will be a match of their work and meet the needs of a large spectrum of readers, learners and scientists who wish to expand their knowledge in this field. We look forward to expanding this work and making it available in different languages and welcome those who can assist us to accomplish this
... Based on the latter, recent studies by the same author found that neither the frameworks of health objectives published as SMART by major international health organisations nor the frameworks of objectives in the project plans of a national leprosy organisation had the complete and right set of components to be SMART. 9,16 This suggests there is a dearth in the knowledge of the appropriate frameworks for setting SMART goals in health organisations globally. The extent to which existing goal-setting theories and frameworks are workable in the actual practice contexts of health organisations is therefore doubtable. ...
Introduction: Goal-setting in any practice context is vague unless the process is based on a framework that produces good goals. Popular goal-setting frameworks construct Specific, Measurable, Attainable, Realistic, and Time-bound (SMART) goal statements. Yet, research of how healthcare goals that are foundational to health plans are formulated is scanty. This case study explored the goal-setting practice of an organisation in Nigeria to discover the theoretical frameworks for setting the goals of their leprosy projects. Methods: The study triangulated individual semi-structured interviews of 10 leprosy managers with a review of their project plans and a participant observation of the organisation's annual planning event. A five-stage thematic analysis was used to serially identify, code, and integrate goal-setting themes from the data collected. Findings: This produced three final emergent themes: stakeholders, strategy, and goal statements, with 11 associated conceptual frameworks. All were further theoretically integrated into one general framework that illustrates the organisational goal-setting practice at the time of study. This revealed a practice with a four-staged linear centre-driven process that led to a top-down, problem-based goal formulation, and produced assigned project plans based on hierarchical non-SMART goal statements. Conclusion: Collaborative goal-setting process is proposed for Specific, Measurable, Attainable, Realistic, Timed, and Agreeable statements of project objectives and aims written with Change, Beneficiaries, Indicator, Target, Timeframe and Change, Beneficiaries, Location, and Timeframe models respectively.
Objective To evaluate the feasibility of a Social Cognitive Theory-based intervention on cognitive, affective, and behavioral outcomes in a college nutrition course. Design A pre-post quasi-experimental design. Setting Large metropolitan university. Participants College students (n = 138) aged 18–40 years. Interventions Students participated in weekly food challenges during a 15-week nutrition course to apply nutrition knowledge, develop self-efficacy and promote positive behavior change. Food challenges were implemented by a guided goal-setting strategy. Cooking videos, which modeled important nutrition-related skills, accompanied each challenge. Students independently selected 2-goal options to implement weekly and wrote a reflection about their experiences. Main Outcome Measures Cognitive outcomes (nutrition and cooking self-efficacy), affective outcome (cooking attitudes), and behavioral outcomes (fruit and vegetable consumption). Analysis Descriptive statistics and paired sample t tests. Results Analyses showed significant increases in cognitive outcomes (produce consumption self-efficacy [P = 0.004], cooking self-efficacy [P = 0.002], using fruit/vegetables and seasoning self-efficacy [P = 0.001]) and behavioral outcomes (fruit consumption [P < 0.001], and vegetable consumption [P < 0.001]). Conclusion and Implications This pilot study suggested a framework for behavioral change, grounded in constructs central to Social Cognitive Theory, that simplified the goal-setting process (by using guided goal setting) and used video technology to decrease the cost of implementation.
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The aim of the article is to present certain preliminary issues as regards the need for leadership in the team work. The analysis has been started with a discussion of what is meant by leadership, to a presentation of the specificity of effective leadership and a description of how leadership affects the team. The discussion ends with a summary and conclusion with respect to the need for leadership in team work. The problem has been considered within the cognitive category; hence, theoretical research methods have been used, such as: analysis, sytnhesis, inference and abstraction.
Academic promotion is desired by many faculty practicing at academic medical institutions, but the criteria for promotion often appear opaque to many physician faculty. In nearly all cases, evidence of scholarship is required regardless of academic track. Academic advancement can be stymied by unclear expectations, lack of protected time to engage in scholarly projects, insufficient evidence of dissemination, and limited guidance, mentorship and sponsorship. In addition to being important for promotion, scholarship is an essential aspect of academic medicine because it helps inform and advance the science. Pursuing academic excellence is an important goal for pediatric rehabilitation medicine faculty members because it helps advance the care of children with disabilities and the field itself. Pediatric rehabilitation medicine faculty in the clinician educator or clinician leader tracks are encouraged to understand the criteria for advancement, seek out mentorship, scholarize their career ikigai and identify opportunities to demonstrate academic excellence.
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Introduction: Most academic literature uses ‘goal’, ‘aim’, ‘objective’ and ‘target’ as synonymous terms, but development and healthcare sectors define them as distinct etymological entities with varied and confusing interpretations. This review sought to constructively harmonise and differentiate each definition using a thematic framework. Method: An inductive synthesis of definitions of the goal terms collected from 22 literature sources selected through a systematic internet search. Thirty-three specific definitions were reduced through serial category-building to single general definitions, and a set of theoretical themes generated as characteristic framework of each goal. Results: Seven conceptual themes evolved from the synthesis, including the object, scope, hierarchy, timeframe, measurability, significance and expression of each goal term. Two terms, ‘goal’ and ‘aim’ are thematically similar as broad objects of immeasurable terminal impact, with a long-term timeframe. They signify organisational success, expressed as general purpose statements. ‘Objective’ is differentiated as a specific object of measurable intermediate outcome, with short-term timeframe. It signifies intervention effectiveness, expressed as a SMART statement. ‘Target’ is simply a specific quantifiable level of an indicator. Conclusions: Goal, aim, objective and target are conceptually different. New frameworks for writing complete goal statements are proposed, including impact and timeframe; and outcome, indicator and timeframe frameworks for aim and objective respectively
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The authors summarize 35 years of empirical research on goal-setting theory. They describe the core findings of the theory, the mechanisms by which goals operate, moderators of goal effects, the relation of goals and satisfaction, and the role of goals as mediators of incentives. The external validity and practical significance of goal-setting theory are explained, and new directions in goal-setting research are discussed. The relationships of goal setting to other theories are described as are the theory’s limitations.
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Purpose – The purpose of this study was to investigate how individual perceptions by employees of a goal-setting program and personality traits influence job satisfaction and goal commitment. Design/methodology/approach – Using the German version of Locke and Latham's goal-setting questionnaire, 97 production employees judged the quality of the goal-setting program in their company with regard to content-related problems of goals (e.g. goal clarity), process in dyad (e.g. supervisor support), and setting-related aspects (e.g. rewards). Data were also collected on the participants' conscientiousness and neuroticism. Findings – The results showed that job satisfaction is predicted by content and setting-related aspects, whereas content-related aspects affected goal commitment. Conscientiousness explained variance in goal commitment independent of individual perceptions of the goal-setting program, whereas neuroticism affected job satisfaction indirectly via the perceptions of goal content. Practical implications – Performance management programs that incorporate goals belong to the most widely used management techniques worldwide. The study provides evidence on critical success factors from the view of staff members, which helps to design or optimize current goal-setting programs. Furthermore, the study implies practical consequences in terms of person-job fit based on personality traits. Originality/value – The study helps to build a more comprehensive picture of how content, process, and setting-related perceptions of a goal-setting program influence job satisfaction and goal commitment. In addition, it provides important insights into the processes through which individual differences affect work behavior.
Approaches maintenance management in a systematic way so as to achieve its business objectives. From a managerial point of view, this so-called object/objective-oriented maintenance management (OOMM) is an integral process of asset (equipment) management with behavior-based maintenance (BBM) as a major element. Within the OOMM concept, the objective-approach focuses on the managing of the maintenance processes so as to achieve the business objectives, and the object-approach emphasizes the object (asset or equipment) and the behavioral failures. Furthermore, combined together, the two approaches reflect the basic characteristics of the maintenance process. Also, both sides affect and influence each other, and are inseparable within OOMM. BBM addresses the monitoring and controlling of the technical and economic behavior of a piece of equipment in two ways.