Clear objectives in NHS

Michael West

Staff in the NHS are often overwhelmed by tasks and unclear about their priorities resulting in stress, inefficiency and poor quality care.  Vision and mission statements about high quality and compassionate care provide a directional star for staff in NHS organisations. But creating cultures that are truly focused on high quality care requires that these are translated into clear, aligned and challenging objectives at all levels in the organisation. This will radically transform the effectiveness and efficiency of our health care organisations.

Research and objectives

An axiomatic discovery from research in organisations over the last 60 years is that when people have clear objectives at work, they are motivated to work harder and smarter and to develop new and improved ways of working. All need clear objectives, ultimately derived from the organisation’s vision, mission and strategy. The Board should have its own five or six clear objectives (many do not). So should each Directorate and Department; so should every team in the organisation and so should every individual (via their appraisal/PDR process). These objectives should be aligned across the organisation so that efforts are collectively focused on achieving the same outcomes – high quality, safe, compassionate care; high quality patient experience; efficiency and innovation.

What do good objectives look like?

They must be limited in number (five or six maximum); specific – specific objectives are far more motivating and helpful than ‘do your best’ vague goals; and challenging. Research shows that there is a linear relationship between how challenging a person’s goals are and their subsequent performance, except when the goals are clearly unattainable. So we need to agree challenging goals in our PDR conversations with staff. The SMART acronym, useful thought it is, misses out this critical element of good objectives, probably because it is uncomfortable to try to agree challenging objectives. 

One of the implications is that we should not expect people to achieve all their objectives and certainly not censure them for not achieving them. Otherwise they will simply resist setting challenging objectives next time round. We have to celebrate and recognise progress towards goal achievement rather than simply attainment. That requires a change in leadership mind sets.


And we have to establish measures to assess progress towards achievement of goals so that we can feed back this information to staff. If we want people to learn, adjust their efforts, identify and overcome obstacles in their work, and improve performance we have to give feedback constantly on performance. And leaders must support staff to help them achieve their objectives by removing obstacles and building skills.

And every team in every NHS organisation should have as one of its five or six objectives, improving the effectiveness with which the team is working with other teams to deliver care (or whatever the task focus is). Because inter-team working is as important to NHS success as intra-team working.

Having clear objectives orients efforts away from irrelevant activities, activates relevant knowledge and skills, and lead to increases in the efforts and persistence of staff. Such objective setting also increases staff interest in their work, promotes success and therefore satisfaction, and ensures that the efforts of staff are being directed towards a sensible number of strategically important objectives across the entire organisation.


If this simple guidance was implemented across a Trust, the effects on Trust performance would be simply enormous. And we must ensure that is not just the ‘what’ but the ‘how’ of delivering care that is motivated by objective setting. Caring, compassionate, safe and high quality care is what staff want to deliver and patients need. We must build that in to objective setting and staff development across the organisation.

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