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Harms of target driven health care

BMJ 2008; 337 doi: (Published 17 July 2008) Cite this as: BMJ 2008;337:a885

This article has a correction. Please see:

  1. Nigel Rawlinson, consultant in emergency medicine
  1. 1Bristol Royal Infirmary, Bristol BS2 8HW
  1. Nigel.Rawlinson{at}

    I went to listen to a senior member from the Department of Health explain the new “dogma” of target driven health care to our hospital’s consultant group. This was in 2005, as we were coming to terms with the fact of targets and with their use to drive healthcare performance. After her slick presentation I asked how the government was going to measure the harm that these targets would do to patient care. I remember being amazed at the skill with which that question was not answered.

    From 2003 to 2006 I was associate clinical director of the emergency department at the Bristol Royal Infirmary. I soon realised that targets were here to stay, and led the unit to accept this and work with them. The phrase “I treat patients, not targets” was consigned to the past. We had to engage with the targets that had been set, and use them to attract the resources we needed to treat patients faster. We had a philosophy in the department that was forward thinking, aiming to find solutions rather than identify problems. The trust recognised this and supported us, and we met the 98% …

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