Thursday, 17 November 2011

Killer targets II

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  1. Having read the Conservative pre-election policy document "Outcomes not Targets" very carefully when it was first published, I get a sense of deja vu. That's not meant to imply anything about you, just to say that politically there were plans. However, in practice, the targets could not be dropped.

    I know from talking to managers at my local hospital how perverse the targets can be. However, having been on a waiting list - in discomfort and with some fear - I can also attest to how popular targets are with patients. There has to be a middle way.

    Here's a suggestion, well, two. First, achievement (or not) of targets should be informative. The problem is all too often that it is the providers problem without a recognition that perhaps that are other issues (lack of investment, demographics, affect of neighbouring providers etc). DH should attempt to help providers to achieve the targets, rather than assuming it is solely the provider's responsibility.

    Second, patient choice. One of the most unsettling thing about being on a list is not knowing *when* you'll be treated. If you are given an absolute date - and guaranteed as much as possible that you will be treated on that date - then the uncertainty goes. I would argue that with an absolute guarantee of a date many patients will not mind if the date is more than 18 weeks away. And Dare I also suggest that if electives were carried out at *weekends* patients would be happier to have an appointment more than 18 weeks away if it meant that they didn't have to lose a day's work.

    Get patients to choose: guarantee within 18 weeks, but at a date the hospital chooses; or your date, as long as it is more than 18 weeks away.

    Spreading the treatments over a longer period will help hospital managers schedule treatments.

  2. There's another huge problem in the way, and that is the capability of the system and people in the system to take on board operational management principles, whether they are badged Vanguard method, Lean, Six Sigma or whatever.

    Experiments are required. And that means learning. And that means failures from which to learn. And the current macho, Theory X paradigm is that failure is not an option.

    Leadership is required, not merely management.

    Bruce Gray.