Creating SMART Goals

All users of PKB are encouraged at the outset of implementation to consider how to evaluate and measure the impact of using a patient controlled health record with patients and in clinical services. The implementation of PKB directly contributes to clinical transformation strategies and digital health strategies in a healthcare organisation. Our experience tells us that in order to achieve clinical transformation and the adoption of PKB in a team, it is important to identify at the outset, what the clinical team/service intends to achieve and how they are going to track the progress towards these targets when use of PKB is initiated and routinely used.

PKB recommends that each team sets out a clear set of objectives and articulated outcomes and outputs. All teams should work with their team members, service and organisation to create and agree on these objectives, goals and desired outputs to help achieve measurable outcomes that can demonstrate the benefits of using PKB. PKB recommends evaluation that includes the use of SMART goal methodology to articulate objectives, goals, outcomes and desired outputs within an agreed timeframe.

To help you create SMART goals

  1. A template of smart goal writing, documenting the agreed outcomes

  2. Examples SMART goals

  3. How to review and track SMART Goals at review meetings and set new goals

  4. A template to help you pull together a use case/case study

Evidence generating

Gathering evidence at the beginning of the project is key, as this provides the metrics to check again at the end of the project. To see if the team has achieved what they set out too.

Evidence gathering can be done in these ways;

  • Patient-reported outcomes

  • Clinical outcomes - hard facts (patient's living longer)

  • System efficiency (save money / make staffs job easier)

  • Real-world evidence = implementable product

  • Research = thought leadership on PHR

  • Evaluation = clinician, organisational and patient outcomes

Following the team’s demonstration of PKB, the team can take the opportunity to map current pathways and look at new digital pathways incorporating PKB. Set SMART goals with a full understanding of the key functionalities they can use with patients, secure messaging, dynamic care plans and data sharing.

What are SMART goals?

SMART goals are used to help guide goal setting. SMART is an acronym that stands for Specific, Measurable, Achievable, Realistic, and Timely. Therefore, a SMART goal incorporates all of these criteria to help focus your efforts and increase the chances of achieving your goal.

Using SMART goal methodology allows you to clearly define the goals using these five attributes. PKB recommends that each team creates goals to help them achieve measurable benefits.

SMART goals are:

  • Specific (simple, sensible, significant)

  • Measurable (meaningful, measurable outcomes)

  • Achievable (agreed, achievable for your resource and skills)

  • Relevant (reasonable, realistic and resourced, results-based)

  • Time based (time-bound, clear end date for the goal to be achieved)

Examples SMART goals

Rheumatology team

Reduce the number of patients not attending appointments (DNA) of the rheumatology team by Sept 2023 (12 months post team go live) from (current DNA rate) to ( %) by sending all appointment letters and appointment details into PKB instead of by post. Current DNA rates are (%). 12 months post go live, the team compared DNA rates of patients with and without a PKB record. It is a local NHS priority to reduce DNAs to save money.


Reduce the number of patients not attending appointments by 10% over the next 12 months by sending appointment details into PKB records.


Reduce the number of patients not attending appointments by 10% over the next 12 months by sending appointment details into PKB records.


Appointment integration is going live in 2 weeks, teams are currently recording DNA rates for baseline. PKB Devs can provide a list of registered patients so Trust can compare their DNA rates vs unregistered patients.


It is a local NHS priority to reduce DNAs - saves money.


Monitor after 12 months.

Lung Defence Team


  • The three clinical nurse specialists, reduction number of telephone calls on the helpline and follow up calls with patients, by delivering care through PKB, with the use of the secure messaging functionality, give patients a care plan to tract symptoms related to the condition and pre-call consultation to be sent to patients about how they are feeling to help focus any calls.


  • Measure number of telephone contacts lead nurses are fielding (need to baseline) and also compared to messaging

  • Reduction in face to face follow-ups by Measure new to follow-up ratio every 6 months, currently 1:20; number of remote care plans created and follow-up; number of remote follow-ups done via messaging


All three clinical nurse specialists to be trained on PKB, create care plans and consultation content. Pre and post live comms to the patient regarding new service and what’s included, make the whole department aware of patient pathway changes, nurses to track each week number of phone calls versus PKB messages


  • Better self-management of patients with Lung disease by the amount of symptoms tracked

  • Better patient experience by satisfaction survey

  • Freeing up nurses time without numerous lengthy phone calls


  • Team go live, two months, review at three months post go live and redo phone call metrics at six months and embedded PKB in service by 6 month post go live

Reviewing SMART Goals

It's important for the team to review the S.M.A.R.T goals defined at the beginning of the project regularly and in a formalised way every three months. PKB advise that the team book these sessions in advance with the PKB Success Project Manager and the Org Level Clinical engagement lead present.

Further Smart Goal Examples