Once again, the public sector, seem to have tied themselves in knots with more measures that are clearly driving the wrong behaviour. Cut through the variously spun political messages and you get down to the core issue that tick box targets don’t add value to an organisation.
Unfortunately in this case, it’s people’s lives that are being used as the gaming pieces of this argument.
The Chairman of the College of Emergency Medicine, Dr John Heyworth is on record saying that he has nurses in tears and Senior Consultants threatened with disciplinary action over this target.
In his words “This is an outrageous misuse of the standard” is a perfect summation of all that is wrong with target driven behaviour.
The staff placed under immense pressure to meet these targets find themselves bending the rules to massage the figures. When you are producing “Widgets” this can be put down to sharp practice, but when it’s people and their care it’s criminal.
Now these targets were all conceived with good intentions in mind. They were always meant to be about improved service, reduced cost, greater efficiency and improved patient care. However they were looked at far too simplistically. An holistic systems thinking approach to patient care in the UK would have produced a very different look to the NHS. I’m sure that targets would still have been the outcome, but maybe these targets would all be complementary to each other.
The pressure to dispatch people from A&E within 4 hours has knock on effects throughout the whole of the NHS. You may show improvement in this one area, but what does that improvement cost the rest of the organisation?
If by rushing people through one department you end up with people who are inadequately assessed, then the whole treatment regime they may be heading for could be incorrect. This will cause increased cost, resource drain, inefficiency, not to mention the fact that this sick human being is not being cared for. Isn’t this the core job of the NHS, care?
Of course the worst case scenario is people dying. There we have different knock on effects. Reputation damage (Look at Stafford NHS trust), public trust shattered, increased checking by inspection bodies, lack of staff motivation and engagement, all leading to organisational paralysis.
It is not just the NHS that is plagued by these methods of performance analysis. The whole of the public sector is beset by targets that drive the wrong behaviour. The frightening aspect is that the pressure to achieve, backed up by a Command & Control approach from the top to ensure they achieve forces people to shelve their principles and better judgement and cheat.
Who would have thought that a tick in the wrong box could cost a life, but it could. If you were able to confront that member of staff with that reality, how do you think they would feel?
When will our public bodies listen to the constant stream of advice from people like John Seddon and apply a “Systems Thinking” approach to our public services.
We’re quite literally dying for it to happen.
Matthew Scott, Dip. Management, Cert. MCE.
The views expressed in this article are solely those of the author and do not necessarily represent the views of the IBC.