Key performance indicators (KPI), targets by another word, seem to be here to stay.

In the commercial world, they may be self imposed: budgets, forecasts, sales targets, the expectations of the city. In services for the public good, the government creates the targets. For example in health, there are 698 targets that align with Standards For Better Health[1], and another 166 that don’t[2]. In addition to these, we have QOF, activity reporting for enhanced services, and many more.

The big question is: do they improve performance or reduce it[3-4]? Let’s explore?

Targets that get in the way

Simply reporting on all these targets appears to take 25-40% of all NHS management time. How much of your time to you personally spend reporting to Department of Health or their proxies, PCT, and SHA?

But is this all a bad thing?

Targets have decimated waiting times. The 4 hour wait in A&E; the 18 week wait for commencement of treatment; the 8 minute ambulance target; the improvement in patient care has been absolutely outstanding.

Targets enable us to do what the best do; to model how the best achieve what they achieve, whilst understanding which bits are worth copying and which bits we should leave out. Targets define minimum standards, the minimum acceptable level of service, and make sure that all patients received at least that.

Targets are, in essence, the basis of regulation, and are here to stay.

Characteristics of a successful organisation

Organisations which don’t hit targets generally fail in many areas. Sure, you can have perverse incentives, targets that you achieve, but that don’t do anyone any good. The old chestnut is “the patient died but the operation was a success”. Occasionally highly visible perverse incentives overshadow many excellent and outstanding results.
The truth is, that organisations that are capable of hitting targets, are generally also capable of achieving exemplary results in every area.

Would it be wonderful if . . .?

Wouldn’t it be great to hit targets without really trying? If your only effort was to make decisions, to steer the organisation, and the results took care of themselves? Wouldn’t it be great if the reporting was simplified, to the point where it looked after itself?
In my GP practice, we tried using our relatively low cost admin staff to populate a dashboard, so that we could make decisions. The results surprised us.

Only fairly senior staff were able to run the reports needed to populate the dashboard. Our data analyst was occupied at least half time running reports and transferring data, just to populate the dashboard. It meant that when the dashboard was presented, she hadn’t had the time or space to prepare recommendations. And we lost an important member of staff, who had plenty of other duties.
This situation was unsustainable.

We identified an automated extract tool which are listed not just the performance against target, but also the remedial actions that we would need to take, to hit that target. In our case it took this a stage further, recommending priorities. Because it ran locally, it was able to list the individual patients needing care. There are other tools that run automated extracts[5], and to make the decision making process straightforward, and they apply in different environments. [6]

Getting results

Bringing in an external like me to identify where you could use automation and identify existing tools, could release potential within your own staff delegate and empower. I won’t stay long: the point is to transfer knowledge, and let you and your staff run the show.
If you feel the directors are leading, dragging everyone else kicking and screaming into the future – then you need to get everyone pulling in same direction.

Citations

1. DH, Standards for Better Health, D. Health, Editor. 2006. p. 29pp.

2. Blunden, F., Frances Blunden on the burden of NHS bureaucracy, in Health Service Journal. 2009, HSJ.co.uk.

3. Dryburgh, A., Don't you believe it . . . forecasting works, in Management Today. 2010: London. p. 16.

4. MacBride-Stewart, S.P., R. Elton, and T. Walley, Do quality incentives change prescribing patterns in primary care? An observational study in Scotland. Fam Pract, 2008. 25(1): p. 27-32.

5. NHS IC. General Practice Extraction Service - benefits for patients. 2009; Available from: www.ic.nhs.uk/gpes.

6. DH, Improving quality in primary care, in World Class Commissioning, DH, Editor. 2009, Crown.