Talk Health and Care

Measuring success

Measuring success can come in many format, for many different areas. Measuring the success of the individual staff member is fundamentally different from measuring the success of a Trust, or what goal it can meet.

On a Trust level, the concepts of meeting targets, specific times etc often forces a Trust into a bureaucratic spiral where the medical system is manipulated and gamed simply to be able to provide stats that look good, and whilst such practices are frowned upon, it's because the Trusts don't have sufficient funding to legitimately meet those targets.

An example of gaming the system to meet targets might be a Trust giving a patient an initial earlier timeslot for an appointment, reporting the earlier timeslot, and then cancelling it and replacing it with a realistic timeslot. The target reporting hasn't achieved anything.

The more targets that are demanded, the greater the burden on the system. Monitoring systems need to be created, roles for auditing and reporting the figures emerge and an entire system can exclusively be based around reporting targets. This in turn consumes internal resources that causes a system to significantly degrade as each department tries not to let another department know what is actually going on.

The UK government shouldn't be concerned with metrics or measurements. An apt analogy in software development is that if the developers spend 2 hours every day in a meeting reporting the progress of their software development, that's 2 hours not spent actually developing the product (in some cases, panic-stricken organisations will try to schedule many meetings in sequence when a deadline for a piece of software nears, basically asking 'is it done yet?' which greatly stalls development).

The UK government needs to move to a completely abstract idea entirely. Software development moves fastest when problems are identified; knowing what problems exist and why allows people to respond to them and develop solutions. The UK government shouldn't be measuring success (you can't learn anything from success), it should be trying to record problems. In-fact, it should ask Trusts to report the problems they encounter.

By switching a mindset from trying to meet targeted statistics via hoopjumping to a process where analysis of intrinsic problems are discovered, it allows both the Trusts and the UK government to become aware of problems and thus start developing solutions to those problems.

Instead of saying 'get 10 patient appointments done in X time', ask 'What stopped you from getting 10 patient appointments in X time?'. It could be late transport, it could be a lack of doctors, it could be patients cancelled, it could be booking system doesn't work (which then follows 'how do we fix such things?'). Focus on the problems, and the solutions will come by themselves.

edited on Nov 1, 2018 by Adam DHSC

Adam DHSC 2 months ago

Thanks Joshua for your insights.

How do you think this would impact on the workforce?


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Joshua Flynn 2 months ago

Hi Adam,

The impact on the workforce would be twofold:

Firstly, a movement away from metrics frees up those particular resources to do other, more important administrative tasks (the end goal is real world results rather than numbers that can be easily distorted on a spreadsheet), and avoids encouraging departments simply trying to hit targets (a similar effect can be seen in education with students being trained to take specific tests with rote memorisation rather than the learning of general skills).

Secondly, by trying to document issues, or problems, it changes the mindset. Rather than 'can we meet this weeks target figures?', the question becomes akin to 'what problems can we find?'. In the process of actively seeking out actual problems, is the first step to the development of solutions.

It's a bit like how the additional armour placement on a Spitfire was conceived in WWII. Additional armour had weight, so could only be used sparingly. Spitfires came back with bullet holes in areas on the plane, and it was suggested what little armour they had be placed in those parts, as they contained holes. But it was correctly pointed out that those were the parts that could take bullet holes and survive, and thus the armour should be placed elsewhere, which led to a drastic increase in survival rates.

Similarly, current target metrics measures and rewards what works, but we're not concerned with what works, we should be identifying what doesn't work. In doing so, we will learn where to place the proverbial armour. Identifying problems, will in turn, allow the application of solutions, and if all parts of the workforce join in, common themes of common issues should be identifiable and new solutions easily rolled out.

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