More on Goal Setting
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Loading ...I started typing this out as a response to Brad’s comment on the last post about goal setting, and it grew into its own post.
Brad,
I agree that flexibility with goal setting is important; I find that this comes naturally when you add timeframes. If my goal is to train twice a week for a month, I naturally have to re-evaluate it at month’s end (or perhaps sooner, if I can’t meet the weekly requirement). It’s important to note that a lot of research out there has goal SETTING as the important thing–as they say, shoot for the stars and you might land on the moon. We don’t have to do everything we set out to do, but it gives us much-needed direction. It’s OK to change direction to continue working towards what makes the most sense for you.
A lot of issues that the article you linked gets at have to do with the nature of the goals set. For one, they’re entirely outcome-based. Profit. Market share. These are goals that depend on somebody else, namely the consumer, to meet. They’re also goals that are handed down from on high–so you’re setting goals that may or may not be realistically achieveable, are not entirely under the control of your employees…and then expecting magic. It’s no wonder indeed that it leads to problems.
I’m a really big fan of focusing on process. The example of Southwest, who worked to cut down their turnaround time to 10 minutes–that’s something entirely in their control, something their employees can manage with enough practice and improvement (assuming 10 minutes is not a wholly unrealistic number), is a good process goal. They didn’t say “let’s double our profits by reducing turnaround”–that doesn’t necessarily follow, but because they focused on the process they still made good things happen.
There’s a saying, “that which is measured, improves.” It doesn’t say it improves organically, just that it improves, and I think that’s the trap a lot of the corporate goal-setting falls into (and incidentally is why I’m very, very leery of incentive-based restructuring of the American healthcare system). We need to be very careful of what we choose to place stock in measuring (this same warning applies to stat-keeping as well).
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I don't get the jump you make from corporate goal setting to incentive based restructuring of healthcare.
Right now many providers set goals around productivity (patients / hour) or "up-coding" for expensive procedures. Why not change the rules to incent behavior that aligns better with value to the patient?
I'm concerned for the incentives because they necessarily narrow focus. Incentives aligned with better "value" to the patient might mean reducing costs, or it might mean rewarding doctors for applying a particular heuristic given a set of symptoms, etc.
The risk it all runs, in my mind, is a reduction of the "art" of medical practice. The article talks about how mandated goals can reduce creativity. With any set of incentives you have, a large number of doctors will treat to those incentives to the exclusion of other, likely valuable factors. It certainly can be well-intentioned, and I'm sure there's some progress to be had with improving the current incentive structure…but I remain unconvinced that it's the optimal solution. Improving a fundamentally flawed structure doesn't change the facts that there are flaws, and I don't know that it's really possible to account for and incentive-lace ALL there is that goes into being a good doctor and providing the best possible care to a patient (while, of course, balancing this with the need to not spend frivolously).
Of course, the entire overhaul appears to be shaping up as a big compromise, so "optimal" likely doesn't fall into the realm of "doable."
You're part of the industry and probably have a better view than I; what's your take? We can shift to e-mail if you prefer.
I think 99% of the "reform" going on right now is a bunch of hooey, and I'm of the opinion that we have got to change the reimbursement schema if we are ever going to control costs. Look, I hear what you are saying about reducing the art of medicine, but at the end of the day, someone has to pay someone else money for something. You have to have some rules, and whatever rules you come up with will dictate how the system works (and how the unscrupulous will try to game it). The rules right now pay almost exclusively on a service basis regardless of medical outcome. The result is a ton of unneeded services (docs do more to get paid more) & wide variation in clinical outcomes among doctors and organizations (with no negative ramifications for the poor performers). No system is perfect, and gamers will also game the system. But I remain convinced that there are better ways to incent people to perform job well done and not just a job done. And I think you can do it in such a way that does not overly sacrifice the "art" of practice.
Have you read the recent New Yorker article by Gawande?
What it comes down to is that there are always trade-offs between systems and innovation. It's a line you always have to draw and be cognizant of.
Like in ultimate – I sometimes feel that set plays and offenses stifle the creativity of the players that act within them. But you need some sort of structure, right?
Yeah, I hear you. I do agree that we need some structure, and there certainly are better ways than what we've got currently.
We'll see what emerges by the time I'm entering the practice proper–part of me wishes I'd been born 5-10 years earlier so I could be more involved in the reform going on now, but part of me recognizes there'll still be plenty to be done 5 years from now, too.
I've had the Gawande article on tap for a while; I'll read it today. Thanks!
Another thought you may want to ponder on in goal setting is finding a way to integrate checkpoints and intensity increases into the exercise program.
For example, I had a (cruel) lifting coach back in high school (pre-ultimate days), who had all of his kids lifting several hours a day, 3 days a week, with an fourth day of cardio (typically MWF lifting, Sat track workouts). His main lifts were power clean, deadlift, squat and bench, and his goals (standard for everyone) were 1.5x body weight max clean, 2.5x body weight max deadlift, etc. Each lifting period you'd do 3 sets of x reps of these lifts, and on the friday you'd boost your final set by 10 lbs (or whatever the appropriate increment was). If you could finish the set you'd use that weight as your baseline for the next week. Obviously you couldn't do all 3 sets at that weight come monday, but by friday you were usually pretty close to being able to move up again.
Obviously this program isn't ideal for ultimate training, and reflects a bit of the old school get-big-or-die-trying mentality, but the act of incorporating automatic progress checks and weight increases was very useful for a lot of his very successful kids (read: not me). I've experimented with it a bit doing plyos (i.e. on friday add in 1 more set of every sprint/drill, and if you can complete the increased workout it's time to change up your program, or add a weight jacket, or whatever), and it seems to work reasonably well.
Concerns about the self-selecting nature of your coach's success aside (it worked well for the people who could do well, and not for those who didn't), that's a great point.
Testing and re-testing is really valuable for any fitness program; it's something I've been considering as I've been giving thought to the team's pre-season training and what we might want to do this year. It's important to note that this doesn't just apply to things like lifting either–track times, but also more subjective things like throwing. I haven't figured out all of the ways you might consistently test ultimate skills, but it's a fun thought exercise to work through (throwing to a target? consistency in a particular drill? etc etc).