The front page article on the Press for Friday 7th November 2014 says “Patients ‘forgotten’ in wait for surgery”.
It goes on to say that research published in the NZ medical journal suggests that:
“One in three people requiring elective surgery are being turned away from waiting lists to meet Government targets.”
It should be no surprise to any of us that if a numeric target is imposed on a system then the process performers will do what they can to achieve it, even when their actions are detrimental to the actual purpose of the system. The controlling influence of the targets will be even greater if contingent financial implications are involved (carrots or sticks).
If we viewed a league table of (say) hospitals and wait times, what would this tell us? Would it tell us which:
- has the best current method as judged against the purpose of the system; or
- is best at managing the system against the numeric targets?
…and what about quality?
This NZ research is not an isolated or even new incident. John Seddon has been following, and challenging the fallout from target setters for many years, across the whole range of UK public sector services. Many of his findings are comedy and yet scary at the same time.
Any target-setter should have no surprise by the resultant behaviours of process performers and their managers, such as to:
- Avoid, or pass on difficult work;
- Attempt to restrict work in the process, by:
- making it hard to get into the process; or
- throwing them back out (‘they didn’t do it correctly’); or
- inventing new ‘outside the target’ queues earlier in the process
- Applying the ‘completed’ stamp as soon as possible, and often before the customer has reached the end from their point of view;
- Earn easy points, by doing things anyway when not strictly necessary…because it will count towards the target
The target-setter has created a ‘survival game’ of ‘how can we make the target’ which replaces ‘serve customer’.
So what to do? How about adding on layers of compliance reporting and inspections to police the process, to spot them doing ‘naughty things’ to meet target and punish bad behaviour…that should work, shouldn’t it?
Thus the battle lines are drawn, with the customer suffering in the cross fire.
Of note, the Press article goes on to explain that the Government target of 6 months is soon to be reduced to 5 and then 4….because, obviously, adding more pressure on them will motivate them to improve!???
What about if we replace numeric targets with capability measures (which measure the capability of the process against the purpose of the system)….and then used these measures to help us improve.
We can laugh (or cry) at the public sector comedy…but let’s not forget what we do with targets in our own organisations.