How do you want your practice to look in the next five or 10 years? Most likely, your “vision” includes high-quality patient care, satisfied patients, productive employees and financial success — all laudable pursuits. But how is your practice going to achieve that vision? The answer lies in setting goals.

If your vision is the “far look” into the future, goals are the “near look.” Once you have determined where you want to go (vision), you need to map out the steps (goals) that will take you in that direction. [For information on developing a vision for your practice, see “Beginning With a Vision,” FPM, March 1999.]

The goal-setting process involves these stages:

1. Assemble the right people. If your staff is small, you may be able to include everyone in the goal-development process. If your practice is large, ask for volunteers to serve on a goal-development work group. In either setting, a group of five to 10 people is ideal and should be chaired by yourself (or another practice leader), with assistance from your office manager.

Make sure the group is representative of your practice, including clinical and nonclinical staff and individuals with various levels of enthusiasm for the goal-setting process. (Often times, critical individuals will buy into the goals more readily if they have been part of the development. In addition, their comments can lead to a better product.)

2. Review your vision. When your group meets to draft the practice's goals, have a written copy of your vision in front of you. For example, a practice's vision might read, “Quality Care Family Practice (QCFP) is committed to providing timely, sensitive, state-of-the-art medical care for its patients; providing a highly professional, friendly work environment for staff; and maintaining a profitable business.” Invite comments and discussion so each person feels he or she understands the vision and believes in it.

3. Brainstorm. As a group, begin to toss out ideas for goals and have one person record those ideas on a flip chart. At this stage, group members can ask for clarification but shouldn't criticize or veto one another's ideas.

If your vision has multiple components, you may want to divide the group into several smaller groups, with representation of medical and non-clinical staff, then divide the vision statement among the small groups. For example, using the sample vision statement shown above, group one would brainstorm goals for “Quality Care Family Practice (QCFP) is committed to providing timely, sensitive, state-of-the-art medical care for its patients”; group two would brainstorm goals for “QCFP is committed to providing a highly professional, friendly work environment for staff”; and group three would brainstorm goals for “QCFP is committed to maintaining a profitable business.”

Once you've listed your ideas, review and discuss them. Can any be lumped together? Do they fall into various categories? Think big picture, not details, at this point.

4. Draft your goals. The best goals are those that are specific, achievable, relevant and measurable. As the small groups draft their goals, they should consider whether the goals meet these criteria. For example, group one might ask, “How will we know our practice is providing timely, sensitive, state-of-the-art medical care? How can we measure it?” The answer to this question should produce measurable performance goals, such as these:

• Patients will wait 10 minutes or less in the reception area before seeing the nurse/physician in the exam room.

• Staff members will treat every patient like “a guest in their home.”

• Staff members will choose and improve upon one Health Plan Employer Data and Information Set (HEDIS) clinical quality indicator each quarter (e.g., foot exams for patients with type 2 diabetes).

After the small groups have drafted their goals, they should present them to the larger group. Individuals can then ask for clarification or suggest revisions, helping everyone gain a common understanding and buy-in of the goals.

5. Prioritize your goals. Once the goals are written down and accepted by the group as a whole, it's time to prioritize them. What goals are most important? Do any goals need to be achieved first in order to achieve the others? Which goals can be achieved easily? Which will be more difficult?

One way for a group to rank its goals is the use of multivoting. For example, if a group had 14 goals, each member would get seven votes (half the total number of goals) and would assign a 7 to his or her top priority, a 6 to the next priority, and so on.

After each member has voted, the goal with the most votes is the practice's top priority and the area to focus on first.

Editor's note: For more details on how to conduct a goal-setting retreat, see the “Vision and Goal Setting” module on the AAFP's Quality Clearinghouse at www.aafp.org/quality.