Cheating – no other way to stay within target

Polly Toynbee writes on The Guardian Comment Is Free website that she has been contacted by Carol, who tells of cheating waiting lists at an NHS Foundation trust.

They have a target; they are bound to cheat. That is what people do.

Carol told Polly that,

She was told to cancel operations for anyone who was already waiting over 18 weeks, and instead to fill that theatre time with people closest to breaching the 18-week limit. “I was told to call people who had already gone over the 18 weeks and pretend there was no longer theatre time for their operation, and not give them a new date.”

What amazes me is that people are so ingenious. What could happen if that creativity was turned to improving the system of treating patients? Well you could make a mockery of the 18 week target for a start. And give better care to boot.

Carol also reports that,

The worst was when she was told to call a mother of three young children to offer her a short-notice slot for Christmas Eve, knowing she would refuse and so could be knocked off the list for refusing.

At least Carol had a conscience, since she quit over what they made her do. But the saddest, most frustrating part of the article is this:

She protested first to her line manager, then to the one above and finally to the one above that. “I said I wanted these instructions in writing before I would lie to patients. Of course they said it could never be written down. But the manager in charge of operating theatres said other hospitals were all doing it, so we had to too. There’s no other way to stay within target.”

That final part is worth repeating:

“There’s no other way to stay within target.”

That’s what makes me mad. There is another way (to paraphrase Deming).

All the effort, time and creativity that is going into making phone calls to mothers, lying to patients, fiddling the figures, messing with the types of operations could be going into making things better. That trust, and others around the country would have shorter waiting times and no need of a target if they simply:

1) Did what the patient needed,

2) When they needed it,

3) With no waste, errors or delay

All the monitoring, expediting, lying, cheating and fiddling would melt into the air, and they would have a nice clean, simple system for treating the public that would smash the targets they are currently desperately trying to meet by any means necessary.

Best,

Rob

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