Where do you want to be in five years? How fast do you want to run your next 10k? What promotion do you want to earn? We all set goals, in both our personal and professional lives. Our parents, coaches, and bosses all tell us that we must set goals if we want to reach our full potential.
Goal-setting is also important in health care. For example, studies have shown it can improve communication and understanding among care providers working in an Intensive Care Unit. Setting goals may even shorten the duration of the patient’s stay.
Last Friday I started another week of ICU clinical service in Saskatoon. I took over the care of someone who, during my first bedside visit, seemed just like any other patient that I’ve looked after during my career. But this patient clarified for me the true value of setting meaningful goals with our patients and their families.
It’s my usual practice to create a list of daily goals for each patient as we complete our morning rounds. Every morning we meet at the bedside of each patient. Often the patient’s family joins us too. Each team member presents his or her assessment, then together we create a plan for the day, to address the identified problems. By the end of the group discussion, we have a list of daily goals for the next 24-hour time frame on the whiteboard next to each patient’s bed. These goals solidify and help communicate the plan, making sure we all know what each team member needs to contribute that day.
On Saturday morning I came in to the ICU and started rounds. When I entered Mrs. C’s room, her daughter jumped up with excitement and said, “Look at what Mom wrote for you!” She showed me a piece of paper on a clipboard, with two goals written in somewhat shaky writing.
“Heal this broken body. Cut grass.” Those are two Big Hairy Audacious Goals. They are emotionally compelling, strategic, and require time, effort, and commitment from the team. Now we knew what she wanted to achieve. Now we could relate to who she was before she became “my patient.” Now she was a real person, with a real life. Now I, along with all the nurses, respiratory therapists, and physiotherapists, all knew what she wanted to do, where she really wanted to be.
Mrs. C gave me permission to take this photo and share her story. When she heard me set her 24-hour medical goals, she decided to do something much more meaningful: tell me what she really wanted to achieve.
At this point in her stay she had been in our ICU for three weeks.Before she was admitted to our hospital, Mrs. C lived fairly independently in her own home, supported by her loving kids and grandkids. Her greatest joy was cutting her grass. She wanted to recover enough to get back to her farm and tend to her land.
The following Monday one of Mrs. C’s sons returned to our hospital from a brief visit home. He had stopped by his mother’s farm to take photos of the grass she longed to cut. In my head I had imagined a small lawn. But what his photo revealed was Mrs. C loved to jump on her riding tractor mower to tend to a huge farmyard full of grass!
The daily goals I set with my team focus on the medical management: a negative fluid balance, a specific level of wakefulness, followup with a pathology report, moving to the next step on the ICU mobility protocol.
These goals are important. They provide direction for the ICU nurses and therapists. But they aren’t inspirational or motivational. They are simply small steps that must be taken to get us to what really matters: the goals set by our patients.
Photo credit for lawn image: AdamKR