In this article I will be looking at one of the commonest and often the biggest mistake both clinicians and patients make when goal setting. And that is, trying to control the outcome or result.

During my career as a clinician, I’d often hear people say that their goal was to be pain free. As most would know, this is a very vague goal and does not fit the standard SMART formula at all. Furthermore, it’s an outcome and has no clear guideline as to the actions the patient will take to achieve their goal.

Other patients would be very specific in the goal they wanted to achieve. An example might be: 

“I want to back playing basketball with my team in 3 months time.”

This goal fits the criteria of being specific, measurable, acceptable, realistic and time-bound. But I am going to challenge your thinking here. Is this a goal or is it a RESULT?

How much of this SMART goal is within their control?

Goals Versus Results

In the scenario above, there is likely to be many aspects of the rehab process that is out of the control of the patient. Most noteworthy, is being picked to play with the team in 3 months time. Team selection is under the control of the coach, not the patient.

The only effective goal is one that is under the control of the person setting it. In the above scenario, what is under the control of the patient?

The answer is their attitude, thinking, and behaviour.

Examples include:

• Commitment to the rehab process – behaviour
• Commitment to getting the professional help they need to succeed – behaviour
• Daily decisions on whether to do the rehab program – thinking
• The effort they decide to put into their exercises – attitude
• Their self-talk. Is it self-sabotaging or self-supportive? – thinking
• The money they choose to commit to getting the help they need – thinking and behaviour
• The environment they put themselves into. Is it supportive or destructive? – behaviour
• The people they choose to surround themselves with. Are they helpful or hindering? – behaviour
• Their attitude towards the situation they find themselves in – attitude

If the above patient were to reword their goal, with a result that they know is realistic, then it might look something like this:

“My goal is to commit a minimum of one hour/day in doing the rehab program I’ve been given. To do this, I will see my health professional weekly for guidance and support. The effort I put into my program will be 100% and I will surround myself with people that will help me achieve the result I want.”

This goal is totally under their control. If they stick to it they will achieve the result of putting them-self in the best position to be picked to play with the team in 3-months time. Whether they get picked or not, is still up to the coach.

Rethinking Clinician’s Goals

Let’s take an example from the clinician’s perspective. Their goal might be to have their non-compliant patient commit to the rehab program that’s been created for them.

Is this goal under their control? NO. It isn’t. Again, it’s a result. 

The clinician cannot force the patient to do the exercises. There are too many decisions and influences that are out of the control of the clinician.

If I re-word their goal it might look something like this:

“I will give 100% of my attention to this patient every time he/she sees me and commit to listening with full attention. Understanding their perspective is something I will commit to doing every time I see them. Together we will create a treatment plan that is collaborative and engaging, even if it’s not my original plan. I will find out what they need from me to succeed and commit to doing it.”

This is a goal that is totally under the control of the clinician. As a result, it will build trust and put their patient in the best position to do the rehab program. Whether that eventuates in them taking action or not is a choice for the patient.

If they don’t take action then the clinician has still achieved their goal. The reality is that you can’t force exercise onto anyone.

If the clinician’s goal is to get patients to commit to rehab programs, it would be easy to get disheartened, frustrated and give up. Especially when the patient looks as if they’re not interested in taking any action.

When the clinician’s goal is specifically related to what is under their control, they can effectively and frequently review their performance. Likewise they can consider how they might improve or do things differently. Now they are in a constant state of learning. 

Hopefully the patient will commit to the rehab program.

Changing Staff Behaviour

The same principles apply to business owners who want to change staff behaviour. If they focus on results that are ultimately out of their control, then frustration sets in. 

By the employer focusing on improving their own behaviour, thinking and attitudes then there is a reasonable chance that the behaviour of others will adapt and change to.

What you cannot control is the result of this behaviour, thinking and attitude. But by following your behavioural goals, you are more likely to get to your objectives.

Goals you can control, objectives you cannot.

Next time you find yourself frustrated by lack of compliance, ask yourself: 

“Is my goal with respect to this staff member/patient, under my control?”

If any part of your goal is under the control of behaviours, attitudes or thinking by the other person then it is a result. 

Consider changing your goal. Trying to control the outcome often leads to frustration or at worse, burn-out.

For many this concept will be a paradigm shift. But if you are prepared to make it then you may prevent yourself from getting frustrated or burnt out. Certainly you will also put yourself in the best position to learn, adapt and constantly improve.

A Daily Track Helps You Monitor Your Work

When you have goals that are specifically related to your thinking, attitude and behaviour you can review your performance at the end of each day.

How did you go with respect to giving 100% attention to your patient?

Was listening with full attention a priority or were you thinking of the next question as the patient answered your question?

Even though you could sense resistance did you push for your treatment plan?

Are you clear on what your patient needs from you to help them succeed?

Did you commit to seeing things from your patient’s perspective or were you pushing your own perspective?

By setting personal goals that are in your control, you are in a position to review and improve on a daily basis. 

This goes for your patients as well. By helping them set goals related to actions they can take you can set them up for success. They too can do a daily review of their performance. They will be able to see where they are struggling and what their strengths are.

This knowledge is valuable information. You can collaborate on how to overcome the struggles they have. You can also applaud their successes.

I believe the SMART goal formula is great as long as it focuses on what is under the control of the person setting it. Goals that are results driven can lead to frustration and are best avoided. Or at best recognising what is under or out of control of the goal setter.

To learn more about motivational tools through effective communication download my eBook:

“Improving Patient Motivation In Physiotherapy”

I wrote this eBook in response to the most common question I get asked and that is “How do I motivate my patients?”

If you would like to fine-tune your communication skills when working with resistant patients, you might consider working with a coach or mentor.

Or perhaps your staff would benefit from training in this area.

Contact us, and find out more about what we can offer you.

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