All targets are flawed, some are useful - comment on article by Alan Meekings, Steve Briaolt and Andy Neely

ALL TARGETS ARE FLAWED, SOME ARE USEFUL

 

I would like to commend the recent article by Alan Meekings, Steve Briault and Andy Neely in Measuring Business Excellence (Meekings et al, 2011) which aims to bring together different viewpoints on target setting and provides a number of valuable insights.

 

However by characterising the debate as two different viewpoints which it calls 'red' and 'blue', it does ignore those of us who have consistently offered a more balanced viewpoint.

 

My view of target-setting can be encapsulated in the phrase 'all performance targets are flawed, some are useful' (Moullin, 2009a), deliberately echoing the quality guru W. Edwards Deming who said 'all models are flawed, some are useful' 

 

Several authors talk about the perverse effects of targets, but in fact they are not perverse at all. They are predictable consequences of a top-down performance management culture that encourages staff to prioritise an inevitably flawed target over service to the public.

 

It is wrong, however, to dismiss targets out of hand. That they have the potential to make people accountable and achieve change is evident from the perceived urgency for governments to commit to emissions targets to address climate change. So while targets are flawed, they can be useful.

 

This debate can be illustrated by looking at the targets for acute hospitals in the National Health Service in England. That these targets are flawed is evident from the fact that St Edwards Hospital - a fictitious hospital from the BBC programme 'Yes, Minister' with 550 administrative and non-clinical staff but no nurses, no doctors and no patients - would outperform all other hospitals on 9 of the 10 performance targets for acute hospitals (Moullin, 2003).

 

However, although it is not fashionable to be sympathetic to politicians, in 1997 the new Labour government under Tony Blair found that 175,000 people in England - about 1 in 280 of its population - had been waiting more than nine months for admission to hospital.

Ministers were prepared to invest in the NHS, but were aware that simply providing more resources would not by itself change the way people work - and the system definitely needed changing. Moreover, there was a perverse incentive in the system, as the length of the waiting list was a prime determinant of the demand for private health care.

 

It is clear that performance targets were instrumental in cutting this figure to 223 people by March 2004 - a reduction of 99.9% - when you consider that waiting times in both Wales and Northern Ireland, which chose not to use targets, stayed high throughout this period (Moullin, 2010).  Clearly, reducing waiting times is only one aspect of the service required by patients and there is evidence of perverse incentives (Moullin, 2009b) but there is evidence that this is a key driver of both patient outcomes and patient satisfaction.

 

However, targets alone would not have achieved this change. Without investment or change in the process we would have had what Deming calls 'goals without methods' which he claimed are always counter-productive.

 

Avoiding numerical targets without some idea of how they can be achieved is one of the excellent recommendations in Meekings et al's article. Others include a systems thinking approach and charting performance to show variation, cyclicality and seasonality.

 

However in my view the most important aspect of using targets is to ensure a culture of improvement and innovation rather than a top-down blame culture.

 

Because all targets are flawed, then staff and others will always be able to get round them. Whenever there is a blame culture or staff are rewarded for meeting targets at the expense of their professionalism or providing a quality service to their customers, then targets will always be counterproductive.

 

 

 

 

Moullin, M. (2003) Until there's a broader range of indicators for star-ratings system we need to say "No, Mr Milburn" rather than "Yes, Minister", Health Service Journal, 6 March

 

Moullin, M. (2009a) What's the score? Feature Article, Public Finance, 21 May Chartered Institute of Public Finance and Accountancy, London

 

Moullin, M (2009b) Using the Public Sector Scorecard to measure and improve healthcare services (PDF 1.7MB). Nursing Management, September 2009, Vol. 16, No.5, pp.26-31

 

Moullin, M. (2010) Careful targets can help to achieve goals. Local Government Chronicle, 11 February 2010.