Quality Management

Thoughts on Targets in Healthcare:

Introduction

Target setting has taken on a momentum of its own in recent years without always a lot of thought and reflection as to whether it is ‘a good thing’ and if it is being applied appropriately.

I am just jotting down a few ideas without doing a full review of the subject. This follows a day’s course at the RSM on targets.

Reasons for setting targets

• As a management tool to focus the energies of an organisation on certain key areas.
• As a political agent to present a case to the electorate as to the virtue of a particular programme.
• As a reward mechanism to differentiate between various managers.

Problems with targets

• Can distort priorities in an organisation.
• Can be used to manipulate data so as to present a wished for result which does not stand up to scrutiny.
• Can be divisive in an organisation setting groups against one another.

How are targets set?

• Benchmarking – the best that others can do.
• Forward projection – draw a graph and extrapolate
• Political expediency
• Easily achieved – tick – well done
• Impossible to achieve – opportunity for change!!

Why are targets not reached?

• Unachievable – not enough resources
• Projections should be curves not straight lines
• Limits of systems to change

Why do extra resources not produce the expected effects?

• The ‘Super Tanker Momentum Effect’ – large organisations have great difficulty in changing direction.
• Stop / Start policies – today it’s this target the next a new one.
• Entrenched positions – we have always done it this way – bloody mindedness.
• Up-welling of suppressed demand, unmet needs, new technology.
• Projective curves do not fit with economic textbooks.

What the Gurus say.

Machiavelli – The Discourses

Although owing to the envy inherent in men’s nature it has always been no less dangerous to discover new ways and methods than to set off in search of new seas and unknown lands

Deming – Out of Crisis

Eliminate slogans, exhortations and targets for the workforce

Definition

Target – ‘targe’ – a shield (old French)
(possibly: to hide behind?)

Summary

Fashions come and go in medicine as in all enterprises. There is suddenly a need for hundreds of targets in the NHS, which to those trying to apply them is totally overwhelming.

There seems little to indicate that they are a good way of motivating the workforce and improving the quality of care to the patients. They are easily manipulated and circumvented causing distortions in a highly complex and chaotic system. If one were to imagine the NHS as one of those bean-bags, the hippies of the 60s sat on, then pushing in one area merely makes the bag bulge out somewhere else. I suppose that as long as the bag holds there is no problem but if it bursts then those bits of polystyrene shoot everywhere.