Disclaimer: Use of this tool is not mandated by CMS for regulatory compliance nor

does its completion ensure regulatory compliance.

Goal Setting Worksheet

Directions: Goal setting is important for any measurement related to performance improvement. This

worksheet is intended to help QAPI teams establish appropriate goals for individual measures and also for

performance improvement projects. Goals should be clearly stated and describe what the organization

or team intends to accomplish. Use this worksheet to establish a goal by following the SMART formula

outlined below. Note that setting a goal does not involve describing what steps will be taken to achieve

the goal.

Where will it take place?

MEASURABLE

Describe how you will know if the goal is reached:

What is the measure you will use?

What is the current data figure (i.e., count, percent, rate) for that measure?

What do you want to increase/decrease that number to?

Disclaimer: Use of this tool is not mandated by CMS for regulatory compliance nor

does its completion ensure regulatory compliance.

ATTAINABLE

Defend the rationale for setting the goal measure above:

Briefly describe how the goal will address the business problem stated above.

TIME-BOUND

Define the timeline for achieving the goal:

What is the target date for achieving this goal?

Write a goal statement, based on the SMART elements above. The goal should be descriptive, yet concise

enough that it can be easily communicated and remembered.

[Example: Increase the number of long-term residents with a vaccination against both influenza and

pneumococcal disease documented in their medical record from 61 percent to 90 percent by