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

does its completion ensure regulatory compliance.

QAPI Goal Setting Worksheet


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.

[Example: We will 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 December 31, 2017.]

1. Describe the business problem to be solved (Use the SMART formula below to develop a goal)


Describe the goal in terms of 3 ‘W’ questions:

· What do we want to accomplish?

· Who will be involved/affected (what staff, what residents, others)?

· Where will it take place?


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?


Defend the rationale for setting the goal measure above:

· Did you base the measure or figure you want to attain on a particular best practice/average score/ benchmark?

· Is the goal measure set too low that it is not challenging enough?

· Does the goal measure require a stretch without being too unreasonable?


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


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. Use the example at the beginning for a reference on statement format and information.

Goal Statement:

Tip: It’s a good idea to post the written goal somewhere visible and regularly communicate the goal during meetings in order to stay focused and remind caregivers that everyone is working toward the same aim.

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