Goals and goal-setting are inseparable from the practice of medicine. Whether you’re an emergency department physician with the goal of saving the life of the patient that was just wheeled in, or whether you’re a CMO looking to stop HAIs in your facility, goals give you something to aim for and work toward. But as the CMO and the ED physician will both attest, a goal isn’t achievable without a system to support it. Doctors who are setting goals for themselves or their practices need to adopt the same mindset. By all means, start by setting a goal. Maybe it’s to master a new skill, implement a new technology, or actually use your vacation days. Just know that your goal is only as achievable as your system is strong. In his recent bestseller Atomic Habits, James Clear elucidates this important distinction brilliantly. “You do not rise to the level of your goals,” Clear writes. “You fall to the level of your systems.” Start by setting better goals If you want to achieve your goals, Clear explains, you need to elevate the quality of your goals. The key to success is making our goals a part of who we are. Clear writes that we should “build identity-based habits. With this approach, we start by focusing on who we wish to become.” What does this mean? Let’s take a look at a practical example. Let’s say you’re trying to kick your social media addiction. A family member texts you an Instagram link. You could either say to them, sorry, I’m trying to quit social media. Or, you could say to them, sorry, but I don’t use social media. The latter feels much stronger than the former, right? Clear explains the distinction is because the latter is rooted in identity, whereas the former is rooted in what one does, or in this case, doesn’t do. Let’s apply this approach to some professional goals you might create for yourself. Instead of saying, I want to spend less time on my EHRs, say, I want to be the kind of doctor who is efficient with EHRs. Or, instead of saying, I want to master the Mako robotic arm, you could say, I want to be the surgeon other surgeons in my hospital turn to for advice on Mako. By making goals a part of your identity, Clear explains that you’re more likely to work toward them, and more importantly, you’re more likely to build the systems you need to achieve them. Next, create better systems “Goals are good for setting a direction, but systems are best for making progress,” Clear writes. But what, precisely, comprises a sound system? According to Clear, it’s habits. What are the small everyday actions you can carry out that will accumulate, moving you closer to your goals? For the doctor looking to beat their social media addiction, maybe it’s scheduling a block of time for scrolling. For the surgeon looking to master Mako, maybe it’s shadowing a more experienced surgeon during one procedure monthly. Precision enhances the quality of your system. What does that mean, precisely? Let’s use the following example. Say you are a doctor looking to master a new EHR system. The new system will launch in exactly one month. You have struggled with every technological upgrade to date. You could resign yourself to suffering through hours of training that will do you little good when you’re one-on-one with the new technological monster. Or you could devote 5 minutes daily to playing around with the new system, getting a feel for it independently. By devoting 5 daily minutes of practice, you’ve refined your system by making it more specific. You could even take this a step further by using what Clear calls the Habit Stack. This method involves pairing something you already do (an old habit) with the new habit you’re trying to instill (mastery of the new EHR). Let’s say every day after your morning rounds, you sit down for 10 minutes to have a coffee in the cafeteria. The old habit is drinking coffee. You would stack onto it, practicing the new EHR for 5 minutes. Therefore, when I sit down for coffee, I practice the new EHR for 5 minutes on my tablet or laptop. Those 5-minute intervals accumulate into a new habit, and a whole mountain of frustration saved. This behavioral choice represents a key shift in your mentality. You are choosing to be process-oriented (focusing on the practice) over outcome-oriented (focusing on the end goal). Clear explains: “The purpose of setting goals is to win the game. The purpose of building systems is to continue playing the game. True long-term thinking is goal-less thinking. It’s not about any single accomplishment. It is about the cycle of endless refinement and continuous improvement. Ultimately, it is your commitment to the process that will determine your progress.” TL;DR Mastering new skills or achieving new goals as a doctor involves making a shift from being outcome-oriented to being process-oriented. James Clear provides steps on how to do this in his new book, Atomic Habits. Create identity-based goals: I.E., I don’t use social media rather than I’m trying to quit social media. Create processes for your goals: I.E., I’ll spend 5 minutes daily practicing on the new EHR for a month prior to the rollout. Enhance the precision of your process: I.E.: I’ll do my 5 minutes of practice daily during my 10-minute coffee break after morning rounds. Source
