MMHA 6475 Week 3 SMART Objectives Worksheet Example

From One Goal to Seven Measurable Objectives: A SMART Objectives Worksheet for Tamarack Hospital at Home

Student Name

Walden University

MMHA 6475: Program Planning, Implementation, and Evaluation

Instructor Name

Month Day, Year

From One Goal to Seven Measurable Objectives: A SMART Objectives Worksheet for Tamarack Hospital at Home

Goal

Goal: eligible adult medical patients at Tamarack Health's flagship campus can receive acute care at home safely, freeing inpatient capacity during the months of greatest demand.

The goal states a direction. The objectives below turn it into results that can be checked. Each is written to the SMART pattern: specific, measurable, achievable, relevant and time-bound. Each is also tied to one dimension of RE-AIM, so that the seven together speak to every letter of the framework rather than to outcomes alone (Glasgow et al., 1999). Targets are round numbers marked illustrative; Tamarack's actual targets would be set after the baseline data described in the Week 2 case are pulled.

Objectives Grid

Table 1 lists the seven objectives with their RE-AIM dimension, the record that would verify each, the role that owns the record and the date by which it is judged. Month numbers count from the first patient enrolled.

Table 1

SMART Objectives With RE-AIM Dimension, Verification and Owner

Notes on the Reach Objectives

Reach is split into two objectives because offering and accepting are different problems. If staff offer the program to few eligible patients, the fix is in the emergency department workflow; if patients decline, the fix is in how the program is explained or in what it asks of families. A single combined objective would hide which problem exists. The 60% offer target leaves room for clinical judgment, since some eligible patients will have reasons not to be offered home care that the screening criteria do not capture. The acceptance target is set lower because studies of home hospital programs report that many eligible patients prefer to stay in the hospital, often because of concerns about burdening family members.

Notes on Adoption and Implementation

Adoption is measured by hospitalist groups rather than individual physicians because groups set referral habits and share call schedules. A program used by only one group is fragile: if that group's leader leaves, referrals may stop. The implementation objective focuses on the twice-daily nurse visit because it is the program's most frequent core activity and the one most likely to slip when staff are stretched. Visit timestamps in the electronic health record make the objective verifiable without extra data collection. Other core components, such as daily video rounds and medication delivery, will be monitored in the Week 8 fidelity plan, but one implementation objective at this stage keeps the grid readable.

Notes on Effectiveness and Maintenance

The escalation objective measures how often patients at home need to return to the hospital during their episode. Some escalation is expected and appropriate, since a safe program will bring patients back when they worsen. The 8% ceiling is illustrative and should be set after reviewing published programs and Tamarack's eligibility criteria. The readmission objective is framed as non-inferiority to matched inpatients rather than as a specific rate, because the right comparison is with the care the patient would otherwise have received. Randomized evidence suggests home hospital care can reduce readmissions (Levine et al., 2020), but the pilot's objective is set conservatively so that it tests safety first.

The maintenance objective concerns money because programs funded only by launch grants or strategic funds often end when that funding does. Moving recurring costs into the operating budget by month 18 is a clear test of whether leadership regards the program as part of the system's capacity rather than as an experiment.

Dependency Note

The objectives depend on one another. Objective 6 cannot be judged until enough episodes have occurred, which depends on objectives 1 to 3. Objective 7 depends on the effectiveness objectives, because leadership will not fund a program that is unsafe, and on the Week 7 break-even analysis, which will show whether the program's volume can cover its costs. Objective 4 depends on staffing decisions made in the launch plan. If objective 3 fails, with only one hospitalist group referring, volume may be too low to judge effectiveness within twelve months, and the timeline for objectives 5 and 6 should be extended rather than the program judged on too few cases. No objective measures boarding hours directly. That is deliberate: boarding is a system outcome influenced by many factors, and it is evaluated separately in the Week 9 design rather than set as a target the program alone could be blamed for missing. The objectives will be revisited after the logic diagram in Week 4, since drawing the arrows sometimes reveals an activity that no objective watches. Any change will be recorded so the final proposal can show how the objectives evolved and why. Logic models are most useful when they and the objectives are built together and revised together (W. K. Kellogg Foundation, 2004).

References

Glasgow, R. E., Vogt, T. M., & Boles, S. M. (1999). Evaluating the public health impact of health promotion interventions: The RE-AIM framework. American Journal of Public Health, 89(9), 1322-1327. https://doi.org/10.2105/AJPH.89.9.1322

Levine, D. M., Ouchi, K., Blanchfield, B., Saenz, A., Burke, K., Paz, M., Diamond, K., Pu, C. T., & Schnipper, J. L. (2020). Hospital-level care at home for acutely ill adults: A randomized controlled trial. Annals of Internal Medicine, 172(2), 77-85. https://doi.org/10.7326/M19-0600

W. K. Kellogg Foundation. (2004). Logic model development guide. W. K. Kellogg Foundation.