Stretch goals have enduring appeal, but are the right organisations using them?

BACKGROUND: The healthcare industry faces significant challenges and opportunities that demand lofty aspirations and novel approaches. Pursuing seemingly impossible goals, popularly known as 'stretch goals', can be a way to instigate dramatic change and innovation, but such extreme goals also come with substantial risks. After briefly reporting the results of a national survey we conducted to provide examples of how stretch goals are used in healthcare, we review and translate prior research on the effects of stretch goals on organisations and their members. FINDINGS: The survey results indicate that stretch goals are used regularly in healthcare and a wide range of other industries. Roughly half of respondents indicated that their current employer had used a stretch goal in the past 12 months. Healthcare stretch goals were focused on reductions in errors, wait times, and no-show rates, and increases in workload, patient satisfaction, clinical research participation, and vaccination uptake. Our review of prior research suggests that stretch goals can instigate both positive and negative psychological, emotional, and behavioural reactions. Although existing scholarly evidence suggests that stretch goals will have problematic effects on learning and performance for the majority of organisations that use them, stretch goals actually can have beneficial effects under some specific circumstances that we outline. CONCLUSION: Stretch goals are risky yet regularly used in healthcare and many other industries. They can be valuable, but only when an organisation has both strong recent performance and available slack resources to devote to goal pursuit. Under other conditions, stretch goals tend to be demotivating and destructive. We explain the paradoxical nature of stretch goals, whereby the organisations least likely to benefit from them are most likely to adopt them, and offer guidance on how healthcare leaders can tailor their goal setting practices to conditions most likely to lead to successful outcomes.

Reactions to decisions with uncertain consequences: reliance on perceived fairness versus predicted outcomes depends on knowledge.

Many decisions made by authorities pose uncertain consequences for the individuals affected by them, yet people must determine the extent to which they will support the change. Integrating the social justice and behavioral decision theory literatures, the article argues that individuals determine their support for proposed initiatives by assessing how knowledgeable they feel and using 2 main sources of information more or less heavily: their prediction of how the outcome of the initiative is likely to affect them or the perceived fairness of the decision maker. Three studies (2 experiments, 1 longitudinal field survey) assessing support for proposed public policies reveal that when individuals feel very knowledgeable they rely more on their prediction of how the outcome will affect them, whereas when they feel less knowledgeable they rely more on an overall impression of procedural fairness. The theoretical account and findings shed interdisciplinary insights into how people use process and outcome cues in reacting to decisions under uncertainty and ambiguity.

Between ignorance and truth: Partition dependence and learning in judgment under uncertainty.

In 3 studies, participants viewed sequences of multiattribute objects (e.g., colored shapes) appearing with varying frequencies and judged the likelihood of the attributes of those objects. Judged probabilities reflected a compromise between (a) the frequency with which each attribute appeared and (b) the ignorance prior probability cued by the number of distinct values that the focal attribute could take on. Thus, judged probabilities were partition dependent, varying with the number of events into which the state space was subjectively divided. This bias was diminished among participants more confident in what they learned, was strong and insensitive to level of confidence when ignorance priors were especially salient, and required ignorance priors to be salient only when probabilities were elicited (not during encoding).