BMJ  2003;327:680 (20 September), doi:10.1136/bmj.327.7416.680

Letter

Target centred medicine

Targets can seriously damage your health...

The first 150 words of the full text of this article appear below.

EDITOR—Concerns about waiting lists and targets in the NHS are not new. They have been central to the experience and perception of our health care since its inception.1 Nevertheless, Bogle's comments about the lengths to which some hospitals appear to go to meet targets should be taken seriously.2 That targets and personal incentives influence managerial practices is not in doubt.

We observe that patients may be admitted to a medical ward for a few hours to wait for results of investigations. Such admissions certainly help throughput in accident and emergency departments. But they also increase paperwork and add to nursing workloads. It is perhaps ironic that such admissions may reduce average lengths of stay, another management benchmark.

Recent evidence has supported the view that a focus on particular targets may make clinical services worse. Harrad estimated that to meet waiting time targets for new patients, 25 patients with . . . [Full text of this article]

Kevin K Y Yoong, research fellow

Kingston Hospital, Kingston upon Thames KT2 7QB kevin.yoong@kingston hospital.nhs.uk

Tim Heymann, honorary senior lecturer

Business School, Imperial College, London SW7 2AZ


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