The trouble with targets

1136281264582304The 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.

‘Management by results’…how does that work?!

cause_effect__1_1_5312The CEO of the company I work for recently shared a tweet with us summing up an insight she gained at a recent engagement she attended, which read as follows:

“Nick Farr-Jones dinner guest at conference key message focus on process not the scoreboard and you will get result.”

I like this tweet – the words, whilst short, are incredibly important for anyone wanting to make improvements. I thought it useful to dig into this a bit.

Dr W. Edwards Deming was very clear on this point! He set out the practise of ‘Management by results’ (e.g. focusing on a scoreboard of outcomes) as one of the diseases of a ‘modern organisation’ and, instead, proposed that we should spend our time and focus on understanding and improving the processes that produce the results i.e. the results are the outcome of something, and you can look at the outcome till you are blue in the face…but this won’t make it change!

“The outcome of management by results is more trouble, not less….Certainly we need good results, but management by results is not the way to get good results….It is important to work on the causes of the results – i.e. on the system. Costs are not causes: costs come from causes.” (Deming, The New Economics)

Professor John Seddon (think ‘Deming on steroids’ for Service organisations 🙂 ) takes this message on further. He notes that the measures used in most organisations are ‘lagging’ or ‘rear-view’ measures – they tell you what you did.

Seddon has a very clear view on measurement but at this time I want to simply put forward his thinking regarding the difference between operational and financial measures. He says that we should use:

  • Operational measures (such as demand for a service, and a processes capability to deliver against its purpose) to manage; and
  • Financial measures (revenues, costs) to keep the score.

We know that one affects the other but we can never know exactly how and it is waste to divert time and effort to try to do so.

Bringing this back to Nick Farr-Jones and Rugby: A rugby coach uses process measures to manage (e.g. passes complete, line-outs won, tackles made…) and the result quite literally as the score!

So Nick Farr-Jones, Deming and Seddon quite clearly agree with each other. If you work on the capability of a system/ value stream/ process to deliver against its purpose (as from the customer’s point of view) then the results will come.

Finally, you may be thinking ‘ah yes, this is where the balanced scorecard comes in’…there’s a post in there! Watch this space.