OB by geoqureshi


Goal setting is a skill that is so often overlooked by home business owners.
Unfortunately, it is a vitally important skill when beginning your home business. If you
don't have goals then you really have no idea where your business is going. But that
isn't even the main reason you need goals. Goal setting is one of the most important
skills you can cultivate as a home business owner.

Make a list of long and short-term goals. Write the list down and make 12 copies. Then,
make a list of the things you need to be doing in your business in order to achieve these
goals. Be specific and be aggressive when setting your goals and determining what
action is required on your part in order to achieve these goals.

Now, address 12 envelopes to yourself and set these in your files just as bills to be paid
each month. Open these each month and measure how much you have achieved the last
month and where you see room for improvement. If you aren't making the progress you
should be, consider what should be changed in order to initiate the changes you need to

       Goal Setting Guidelines

       1. Your goal must be conceivable. You must be able to imagine, conceptualize
       and understand the goal or desired result. Top athletes practice visualizing step-
       by-step actual success in their sports competition. By visualizing your success in
       great detail, you are conditioning your mind and preparing yourself to achieve
       your desired success.

       2. Make your goal believable. Your goal should be consistent with your personal
       values system, and you must believe you can reach the goal. It is critically
       important that you believe in yourself. You must see yourself with the goal in

       3. Your goal must be achievable. You must have the mental and physical
       capacity to reach the goal. It would, however, be important for your goal to
       cause you to stretch beyond normal self-imposed limits. You will find a goal that
       causes you to stretch and grow will be the goal that gives you the most
       satisfaction. Don't be afraid to challenge yourself to go beyond old limits!

       4. Make your goal measurable. Deciding to do better than last year or to be
       happy gives you no standard by which you can measure progress. Be sure to
       relate your goal to quantity, percentage increases, dollar volume, time or
       distance. This will allow you to measure your progress.

       5. Your goal should be controllable. This means you must be able to achieve the
       goal yourself, or gain the willing cooperation of others to reach the goal. This
       emphasizes the importance of building team spirit. If you can have no control
       over the outcome of an event, it's not realistic to set a goal in this area. It would
       be like gambling in Las Vegas. Without a proven system that beats the odds, lack
       of control will lead to frustration - and cost you a lot of money!
6. be sure you have singleness of purpose. Make sure your goal is not in conflict
with other areas of your life. For instance, if you decide to travel extensively in
your business or work 80 to 90 hours per week, this will interfere with your
personal or family relationships. The travel and long hours could lead to poor
health or family discord. Some goals become mutually exclusive and create
conflict with other goals.

To be a competitive tri-athlete you must train for four to six or more hours daily.
That leaves little time from career and family. You must then decide what is
most important. Be sure to set priorities so you can focus on what is truly
important; not just urgent. Too often we spend our time putting out brush fires.
We handle daily crises instead of dealing with top-priority activities, which will
contribute to reaching the goal.

Personally Paying the Price

Why should you write down your goal? A written goal represents a real
commitment. Without a commitment, a goal is only a dream. A dream is
something we would like to have happen, but are unwilling to pay the price to
make it happen. Any worthwhile goal has its price! That price may be
confronting a personal fear or investing a certain amount of time and effort.
Whatever the goal is, if it's worthwhile, you can bet there will be a price for
achieving it.

One way to motivate yourself to pay the price is to create a reward for reaching
your goal. That reward can be a vacation or time off work, a nice dinner, a bottle
of wine or time spent with friends. If you select a reward, you can focus on the
reward rather than fear of failure in striving for the goal. If reaching the goal
requires performing some tedious or boring tasks, having a reward in mind will
give you something positive to focus on. Think about the fun just around the

Fear versus Reward Motivation

A few years ago I attended a National Speakers Association annual convention in
San Francisco. In addition to the many career-related activities, they offered a
10-kilometer run for NSA members. It was part of a total fitness program of
aerobics, jogging and calisthenics available to us. I signed up for the competitive
run, which went through the streets of San Francisco early on a Sunday
morning. Since I'd been both running and bicycling, I considered myself to be in
excellent physical shape. I really want to win at anything I do, and I'm quite a
determined competitor.

As the start of the race approached, I began to scope out the competition. As
each runner entered the starting area, I'd say to myself: "He's too heavy; he
can't be very fast," or "She looks like the woman who beat me in the Milwaukee
race." As I compared myself to others, I made judgments about who would be
the toughest competition during the race. I forgot that my former manager in
Oakland, California had said I should never compare myself to others. He said
that I would always end up with an inflated ego or be very discouraged!
The starting time quickly approached. I didn't know my way around the city. I'd
have to follow other people or be guided by the race committee. Because this was
the first event conducted by the race committee, there would probably be a few
glitches. I scanned the crowd once again for the fastest looking runner. My eyes
fixed on the most obvious leader. He was a young, broad-shouldered, muscular
man. Dressed in running clothes that gave him an experienced look, he also wore
a gray plastic inflatable helmet with huge horns. He looked like Mercury, the
fleet-footed runner.

We crowded to the starting line. I felt my heart pound. My nerves were keen; my
muscles twitched. The starter's gun went off, and 50 runners bolted down the
street, leaving the hotel behind. Just as I had imagined, Mercury Man sprinted to
the front of the pack. He was setting a blistering pace - for me, at least! I decided
to fall in behind him and let him set the pace for the event. Five or six of us
started to pull away from the rest of the runners.

It was clear that I was with the die-hard runners. I thought about my
motivations. Why was I in this race? Could I win? What would it mean to me if I
did? The answers came back quickly. This race was no different for me than
most events in my life. I really like to win; I really hate to lose! I was going to
tough it out, however tough the competition became. No matter what the cost.
My pride was at stake.

Middle-age or not, I would compete like a true athlete. I would give my absolute
best. I refused to quit despite the pain and shortness of breath. I said
affirmations over and over to block out thoughts of failure.

Fear and Failure

Some game plan. I didn't know the race route. I hadn't run for several weeks. I
was following a guy wearing inflatable horns. My heart was pounding so hard, I
thought it would come right out of my chest. My legs and lungs were burning. I
was pushing myself harder than I could remember. By now, Mercury Man had
reached the halfway point, and he was headed back to the finish line. Someone
was calling out times as we passed the 5 kilometer (3.1 mile) mark. I heard him
call "19.10," as I passed. That was about a minute and one-half faster than I had
ever run the same distance! No wonder I felt so tired and sore.

The fatigue began to take its toll. I began to think about the other runners. I was
in second place. Could I catch Mercury Man? Could I possibly hold my lead over
the other runners? I became paranoid. Footsteps. Footsteps. I kept hearing
footsteps. They sounded closer and closer. I just knew the other runners were
gaining on me.

Instead of focusing on the lead runner (about 100 yards ahead of me), I worried
about the runners behind me. I wanted to stay out in front, but I had already
taken myself beyond my limits of endurance. My legs were burning incessantly
now. My lungs begged me to slow down, but no, I had to keep pushing on.

The fear of being caught became an obsession. I couldn't put the other runners
out of my mind. I wanted to turn around to look at them, but I was afraid of
losing my footing and falling on the uneven Embarcadero. Could I hold this pace
and perhaps even challenge Mercury Man? Was he tiring, too? Would I be able
to catch him? What about the others? Would they work as a group to catch me,
then leave me behind as a fallen foe?

Footsteps. Footsteps. They sounded closer. I finally forced myself to change my
pace enough to glance backwards over my shoulder. I was at least 100 yards
ahead of the pursuit group. Could I hold this pace?

As I turned to face forward again, Mercury Man had disappeared! He had made
a turn following the unmarked route. I ran straight ahead, fearful that he had
simply sprinted beyond my sight.

I continued to run, by now numb to the pain. I was determined to finish this race
at the best pace of my life. But, after about five more minutes, I knew that I was
lost! I spent the next 30 minutes trying to find my way back to the hotel. My own
course took me to areas of San Francisco that are not on the tour maps. Now I
was afraid of being mugged, or worse.

I was either too stubborn or too afraid to ask local residents for help. When I
finally did build up the courage to ask, I was sent in two different directions.
Now I was tired, angry, frustrated, embarrassed and lost!

About an hour after the start of the race, I found the hotel. My aching legs
carried me up the red-carpeted stairs. I re-joined the group of runners as they
gulped down refreshments. Several people asked me what had happened. They
said, "Bruce, you were so far ahead of us, we thought we'd never catch you!
What happened?" In total embarrassment, I admitted that I'd become lost. I told
a few people that 10 kilometers wasn't enough challenge, so I thought I'd run a
few extra.

That event provided a great learning experience: I had let fear destroy my
singleness of purpose. I had taken my eyes off the goal and worried about other
people behind me. Have you ever done the same? Have you worried so much
about your performance that you performed poorly? Have you let fear prevent
you from trying a new job, a difficult sale or some new experience? I really
wanted to win that race but not enough to learn the race course and commit it to
memory. I wanted to win, but my fear of losing held me back.

How do these goal-setting guidelines relate to your goal and your performance?
What does success mean to you? To some people, success means a great deal of
money or financial independence. To others, it means recognition for a job well
done. To others still, success may mean freedom from worry or strife. What does
success mean to you?

Bettie B. Young’s offers additional suggestions when selecting and striving
towards personal and corporate goals:

1.Select a goal for the right reason. Choose a goal that makes you happy, not
because it makes your boss or your spouse happy. Be sure that reaching your
goal will help satisfy your needs.
       2. Keep a copy of your goal plan in sight and refer to it often. This will help you
       concentrate on results, rather than on activities. It will also provide a constant
       reminder and help motivate you to the goal.

       3. while approaching the completion of a major goal, begin formulating another
       important goal. Goals are like foundation-building blocks. Each goal provides
       the strength and direction necessary to help you attain the next highest goal.
       Every time you attain a goal you gain personal pride and self esteem. This
       increased confidence and more positive attitude will enable you to more eagerly
       approach your next challenge or opportunity.

       How do you see unexpected road blocks on the path to each of your goals? Do
       you perceive each road block as a problem? Do you see it as an opportunity to
       test your skills and to learn? My running experience taught me I must learn
       from each setback. It's usually easier to quit than it is to go on. By forcing
       yourself to persist until you reach your goal, you build greater character.

       By building your character and adding in persistence, tenacity and
       determination, you can reach any worthwhile goal. Go for it!

Goal Setting
Importance of Goals
An important step in health information technology (HIT) strategic planning is to establish
specific, measurable goals that are communicated to all. Specific goals play an important
part of many of the aspects of planning, selecting, implementing, and realizing benefits of

HIT Goals . . .
Writing Goals

Writing effective goals is not easy. Many organizations recognize the importance of SMART
goals. The acronym has taken on many meanings to fit specific organizations’ needs.
   Specific. Goals should identify who, what, where, when, and why. They should be well
   defined and clear to anyone that has a basic knowledge of the workings of your
   organization. Some also suggest that the goals not only need to be Significant enough to
   make the investment in achieving the goal but Stretching for the organization to push
   itself to continuously strive for improvement.
   Measurable. “If you can’t measure it, you can’t Manage it” is a well-known business
   mantra. Goals should answer the questions how much and how many, so you can
   determine when a goal has been accomplished. To be measurable, goals must contain
   specific Metrics, be Meaningful, and Motivational.
   Attainable and Agreed upon. Although the most common citations of SMART goals
   refer to the need to develop attitudes, abilities, skills, and financial capacity to reach the
   goals being set; gaining consensus on Acceptable goals and commitment to Achieving
   the goals is critical as well. Goals need to be Action-oriented if they are going to guide
   your organization to success.
   Realistic, Relevant, Reasonable, Rewarding, and Result-oriented. Goals must reflect the
   availability of resources, knowledge, and time so they can be achieved. Set the bar high
   enough to be meaningful in light of the investment made to Reach the results.
   Timely and Tangible/Trackable. Allow enough time for staff to acquire and learn to use
   HIT in support of achieving goals, but too much time so as to suggest that the goal is not
   important or meaningful for your organization. Specific metrics enable the goal to be
   tangible and for your organization to track its accomplishment. If a goal is achieved
   within the timeframe established, celebrate it. If not accomplished, carry out an analysis
   of why it has not been achieved.

Template for Writing and Tracking Goals

Your health care delivery organization may be concerned about writing SMART goals
because you do not have baseline data, or because you fear results will be difficult to
achieve. These issues are actually a part of the problem—not a reason for inaction. The
adage “you can’t manage what you can’t measure” is true in health care organizations and
reflects one of the main reasons for pay-for-performance. If baseline data are not available
to your managers, now is the time to start collecting data for the most important functions.
Even for difficult measure, you can estimate baseline data or paint scenarios. Cultivating a
culture of quality measurement, reporting, and improvement is often more important than
implementing the HIT. Engaging your end users in setting expectations, providing the
commitment and support to achieving the expectations, and then measuring, reporting, and
celebrating success is essential.
Use the template below to help write your goal statements. Start out with a general
statement, such as the example in the column Objective. As you dissect the goal to
determine how HIT can help you achieve it, you will be describing the intended action.
Identify the sources of data and which application within the HIT will enable you to make
improvements. Define the metrics so you have a clear understanding what data to collect.
Record your current baseline data. Then set your goal by summarizing the improvement
you think can be made within a realistic timeframe using the new HIT or EHR application.
You might also want to record the rationale for setting the goal and any obstacles to
achieving it that you see. An obstacle may be that the pharmacy you work with is not yet up
on e-prescribing so you may not be able to fully achieve your goal until they adopt the
technology. Finally, use a table like the one below to record results periodically until the
target date for achieving your goal is reached. If you wait until the targeted time, you will
not know whether you are on course to meet the goal and you will not be able to implement
corrective action to meet your deadline. While the deadlines are self-imposed, timeliness is a
key motivator. In the example in the template below, the goal to “eliminate ADE…” may
sound impossible, but the organization that set this goal expected to achieve it, and got very
close within the first six months of implementing an e-prescribing system.
In some cases, the goal may be set for you by regulation or contract, such as in the second
example. Describing the rationale/obstacles may help you communicate the importance of
the goal and find ways to overcome the obstacles. Record the results regularly.

Template with Samples for Writing Goals
Objective Intended     Source of Application Metrics Baseline Goal                Rationale/    Results
          Action       Data                                                       Obstacles
Prevent    Check for Drug          e-Rx         # ADE      53 ADE      Eliminat Patient         98%    
over- or   single,   knowledg                   due to     due    to   e    ADE safety          within 6
under-     daily,    e base                     over- or   over- or    due    to initiatives    months
dosing     cumulativ                            under-     under-      over- or
adverse    e                                    dosing     dosing      under-
drug       overdosin                            per        per year    dosing
events     g                                    year                   within 1
(ADE)                                                                  year of
Reduce # Notify MD     MD calls Login           #          50% of Reduce          The     Joint Month     1
of       on login to   to nurses Screen         charts     charts # charts        Commission check
unsigned sign VO       who enter                wo/VO             w/VO            requirement <10%
verbal                 into CPOE                signed            unsigne
                                                                                                Month     2
orders                                          within            d within
(VO)                                            24 hrs            24 hrs to       Physician
                                                                  <5% at          adoption of
                                                                  any time        CPOE must
                                                                  using an        be required
                                                                  alert at
                                                                  MD login

Resources for Goals
Identifying all the goals for a given HIT project may take some time. To help structure your
goals, consider the major functions your organization performs. The following table lists
many of these functions in hospitals, clinics, and health information exchanges (HIE).
Knowing how the clinic captures information gives you a better understanding how it is
shared through HIE and suports the continuum of care. Add to or delete as your functional
descriptions vary. Focus on the functions that need HIT support.
HIT Related Functions
Hospital Functions                        Clinic Functions                             HIE Functions
Patient identification, record location   Pre-visit      patient       registration,   Patient   identification,
(MPI), admission/discharge/transfer,      appointment       scheduling,     patient    record location
patient access, utilization review,       identification/ registration, insurance
insurance verification                    verification, chart preparation
                                          Health        maintenance/preventative
                                          services reminders, chronic care
                                          registry alerts and call-back lists
Automated self-history by patient or      Automated self-history by patient or         Personal health records
caregiver/personal health record          caregiver/personal     health   record
information retrieval, pre-admission      information retrieval, standing orders
testing                                   for advance diagnostic studies
Consent management                        Consent management
Nurse staffing, triage, bed control,      Manage workflow and wait times
Nursing assessment and clinical           Patient intake (reason for visit, vital
pathways                                  signs)
History and physical examination,         Validate patient history,       physical     Data collection
diagnostic studies review, previous       examination,     diagnostic      studies
admission      review,      referring     review,    previous    visits    review,
physician information review              referring physician and          patient-
                                          supplied information review
Problem list management                   Problem list management
Medication reconciliation                 Medication reconciliation
Care planning, clinical decision          Care planning, clinical decision             Data mining
making, clinical practice guidelines,     making, clinical practice guidelines,
documentation at the point of care        documentation at the point of care,
                                          level of service (E&M) coding
Provider order entry for: nursing         Provider order entry: internal office        Data transmission
services, medications, procedures,        tasking, diagnostic studies, surgery,
therapies,    diagnostic   studies,       referrals, admissions; prescription
consultations                             writing
Diagnostic    studies    operations:
anatomical pathology, blood bank,
lab, microbiology, radiology and
other imaging (picture archiving and
communication system [PACS])
Diagnostic studies results retrieval      Diagnostic studies results retrieval
and management                            and management
Medication administration
Operating room management
Patient monitoring and care charting
Medical devices information capture       Medical devices information capture
and display                               and display
Care coordination/scheduling across       Care coordination/scheduling across
sites of care: triage, ED, ICU,           sites of care: hospital admission, long
surgery, recovery, step down,             term care/home care, referrals to
specialty areas, long term care,          specialists
behavioral health care, home care,
assisted living, migrant care
Care communication, continuity of         Care communication, continuity of            Release of information,
Hospital Functions                     Clinic Functions                          HIE Functions
care, discharge instructions, health   care, medication instructions, health     health education
education                              education
Charge capture/coding                  Charge capture                            Purchasing,     pay-for-
Quality measurement, reporting, and    Quality measurement, reporting, and       Quality    improvement,
improvement;    revenue       cycle    improvement;     revenue       cycle      public health reporting,
management, general accounting;        management, productivity, general         population health, bio-
supply chain management; human         accounting; supplies management;          surveillance
resources                              human resources
                                       Patient follow up; prescription refills
Health information management and      Health information management and
document archiving; release of         document     archiving;    release of
information; privacy and security,     information; privacy and security,
including data breach notification     including data breach notification

Setting Goals
The process of setting goals helps individuals understand the capabilities of HIT and builds
interest. Once written, the goals form the basis for a performance-based request for
proposal (RFP). The RFP is written to ensure that the application has all the functions
needed to achieve the goals. In the example of verbal orders, the hospital would seek a
verbal order alert at the time a physician logs in.
During the selection process, evaluate whether products truly can help achieve your goals.
Ask your references or those you visit about how well the HIT has accomplished the
outcomes that interest you. If a product is generally supportive of your goals but lacks one
function, you can identify that function in the contract as something that must be addressed
by a certain date.
Once you start the implementation process, your goals serve as the starting point for
training and testing scenarios. For example, exactly how the computerized physician order
entry (CPOE) will help reduce over- and under-dosing can be explained during training
and testing. As a drug is entered into the CPOE system, it can be checked against previous
orders to ensure that the drug or like drug has not already been ordered. Clinical decision
support built into the CPOE that compares a drug entered with a drug knowledge base and
other characteristics of the patient can recommend whether the dose is too much or too
Once implemented, the CPOE can generate reports on the number of times a potential
adverse drug event was avoided, and the quality committee or risk manager can track the
number of times actual adverse drug events occurred.

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