Blog

How to get SMART with your plan of care

Nearly every successful business is driven by clearly set and articulated goals. Whether you run a Fortune 500 business, small business or are just starting out, it’s important to know that your success often relies on your ability to achieve your own defined goals. What’s the secret to effective goal setting and hitting those goals? Getting SMART.

Luckily, SMART goal setting isn’t difficult, and even better, the framework of SMART can be implemented in nearly every aspect of a physical therapy business. From goal setting, to project management, to – you guessed it – effective care plans.  I started to realize this after I recently read an article devoted to SMART project management and think it is a great tool to consider using as your guide to great documentation.

What does SMART stand for anyways?

Let’s first start out defining SMART.

  • Specific: The goal should target a specific area of improvement or answer a specific need.
  • Measurable: The goal must be quantifiable, or at least allow for measurable progress.
  • Attainable: The goal should be realistic, based on available resources and existing constraints.
  • Relevant: The goal should align with other business objectives to be considered worthwhile.
  • Time-bound: The goal must have a deadline or defined end.

The objective with setting SMART goals across your organization is that every aspect of a project goal must adhere to these five criteria in order to be effective. It’s also important to understand when to formulate SMART goals. Often times, early isn’t always better since it’s not feasible that you have every aspect of your business, project or goal figured out. As it pertains to a care plan, creating SMART goals prior to the initial visit won’t do you much good. In that situation, it’d be highly likely that you’d be back to the drawing board before long – plus you would be setting yourself up to fail.

Now, let’s look at how the SMART criteria can be factored into creating a SMART plan of care…

SPECIFIC

It is obvious that using “decreased pain and improved strength” as a goal is not specific and not tied to function, but that phrase is written thousands of times every day. Think outside the box on how you can make this goal more specific. What does the patient need?

MEASURABLE

Lack of specificity is often paired with lack of measurability. If a test has poor validity it isn’t worth including in your documentation.  My favorite example is Passive Intervertebral Mobility Testing (PIVMs), often used in manual therapy. We know that inter-rater and test-retest validity of PIVMs is non-existent, so why bother? If I were a chart reviewer and I saw documentation of PIVMs, I would go right past that nonsense and look for something that is measurable and relates to the patient’s function.

Here is a re-creation of a typical conversation that I heard from one of my staff more than once while doing a discharge interview:

  • Therapist Dave: “So, Joe, are you doing better?”
  • Patient Joe: “Yes, I sure am!”
  • Therapist Dave: “How much better do you think you are?
  • Patient Joe: “Gosh, I don’t know.”
  • Therapist Dave: “Would you say that you are 70-80% better?”
  • Patient Joe: “Uh, sure, I guess. Yea, I am about 70-80% better.”

Then Therapist Dave would write something in the chart like “Patient reports he is 70-80% better.” Huh? What does that even mean?

Download this free tip sheet to learn more on how to create a SMART plan of care.

Download Now

ATTAINABLE

Are the goals you are describing even achievable, given the patient’s condition? How do you know?

RELEVANT

Does your documentation describe a functional problem and why it is important for the well-being of the patient? Does it tell a story about how fixing the problem will improve patient independence, avoid surgery, hospitalizations, and other expensive costs?  Is it concise?

Make it concise and do everyone a favor … forget the fluff! If a detail is not important, leave it out (does the reader really need to know that the patient is “pleasant”?). The quality and usefulness of your documentation is often inversely related to the length of the report.

TIME-BOUND

Seems obvious, but is there an end to this plan of care in sight? How long is it going to take, and what is the patient’s function going to look like at the end?

A Road Map

A well-organized plan of care and good documentation is like a great road map. It not only informs you when you are on course, and when course corrections need to be made, it also informs everyone involved in the patient’s case: the referring physician, the insurance auditor, and, most importantly, the patient.

Your plan of care should be shared with the patient and reviewed with the patient routinely. It can be used as an educational tool, a source of motivation for your patient, and a powerful tool for establishing medical necessity and demonstrating the value of your services. Poorly done, and it serves little purpose other than keeping chart auditors employed.

A well written evaluation, plan of care, daily notes, progress reports, and other written communication will help you deliver even better care.  Look at your documentation objectively using the SMART goal setting framework. It will make your great care even greater.

Leave a Reply

Your email address will not be published. Required fields are marked *