In the run up to the election the King’s Fund have written a series of articles to assist the voter to evaluate the state of the NHS. One of these is entitled, Have targets improved NHS performance? The article hedges a lot and describes the pros and cons as they see it. They list the targets that have been hit or otherwise and they conclude like this:
In summary, enforced targets do appear to have been successful in improving aspects of NHS performance, particularly in relation to waiting times, but there is some evidence of unintended consequences – for example, distortion of priorities or neglect of other non-targeted activities. However, it is important to recognise that such unintended consequences may not be the inevitable result of targets in themselves, but rather of the particular way in which those targets were designed and enforced.
Regular readers will know that I disagree with any use of targets. They are arbitrary and they skew behaviour to hit the target rather than delivering high quality care.
To say that unintended consequences may not be the result of targets but the way they are implemented is to miss the point that the setting targets necessarily constrains the methods used to improve. Worse, the methods excluded are precisely the ones that could far exceed the targets while completely avoiding the malodorous consequences and save money to boot. The use of Lean Service techniques along with Systems Thinking will get you further, faster and with a lot less hassle and effort.
The improvement seen from setting a target is like the progress seen when you bang your shoulder against a door that opens towards you. You might make several dents in the door and it may even bend slightly in the desired direction if you really give it some welly. But much more effective is to step back, turn the handle and step through the door. You achieve your aim of getting to the other side of the door faster, without bruising your shoulder and with no damage to the door.
There is no doubt many aspect of the NHS have improved, but that is in spite of the target regime and not because of it.