Targets, damn targets. Why leading by top-down targets is wrong

This is relevant to leadership and customer issues, so I’ll post this in both blogs.

From BBC News today comes another example of how people cheat when they have to work in a target-based performance management system – even with the best intentions and even the most senior people (what, you only expect call centre agents to cheat their targets? Target-based systems distort everything and most people’s behaviour).

Again, this one is from the National Health Service, and follows on from sporadic stories of ambulances having to wait outside hospitals with patients in the back (because the Accident and Emergency ‘waiting time limit’ for patients, imposed by central government, is measured from when they come in through the door, and the hospital would have broken its limit and been penalised if the patients waited inside the hospital for treatment, so they were kept in ambulances).

This isn’t evidence of pernicious people. It’s brilliant, dedicated people pushed into ludicrous behaviour by top-down target-setting. Top-down targets distort. Check out any of the lean service analysts and consultants to see how flawed the whole thing is. Anyway, here’s the latest example of what bad targets do to good people – and the terrible damage it does to the reputation of a much-loved institution:

FROM THE BBC

Patient waiting lists ‘manipulated’
Last Updated: Saturday, 07 April 2007, 12:28 GMT

A senior cancer specialist has admitted giving patients unnecessary treatments to manipulate hospital waiting lists.

Chris Hamilton, consultant clinical oncologist at Hull’s Princess Royal Hospital, told the BBC the problem was a government requirement that all treatment began within 31 days of diagnosis.

He says it means some low-risk patients are being treated before more urgent cases.

Mr Hamilton told the BBC he had given some prostate cancer patients hormone therapy to move them down the waiting list.

He said: “You’re caught in a bind. Either you give them unnecessary treatment with hormones and reclassify them or you put them to the front of the queue where they shouldn’t really be.”

He added that he knew other hospitals were carrying out a similar practice and he had informed national cancer director Mike Richards.

The Prostate Cancer Charity condemned Mr Hamilton’s claims saying it was “deeply unethical” to give patients treatment they did not need.

Dr Chris Hiley, head of policy and research, said: “It would be totally unacceptable if hormone treatment were being prescribed for men with prostate cancer simply in order to meet treatment target times – when it is not required to treat their cancer.

“It has nothing to do with patient centred care or good medicine.

“When men are diagnosed with prostate cancer, they need personal support and timely treatment. Providing the wrong treatment to meet NHS targets shows no regard for what patients need – the right treatment given at the right time with care and respect.”

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