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The idea that pursuing a target must cause deteriorating performance
in areas
where there are no targets seems logical when resources are finite. And it
sometimes seems to be what happens.
But--and it is a big but--there is a hidden assumption in the logic
that is rarely
made explicit as it critically undermines the argument. The assumption is
that
the services in the department or hospital are currently being delivered
at the
maximal possible efficiency. If we don't believe most hospitals are
operating at this peak manner, then it should be possible for good
managers or
doctors to improve the performance of some services with no tradeoffs.
And that is what good management (from managers or from medics)
achieves.
Only bad management delivers targets not by improving but by trading off
the
measured for the unmeasured.
Assuming Gwyn Bevan's statistics are impeccable then one could
reasonably assume that setting targets improves the targetted services.
However, in particular when resources are finite, concentrating on
services x,y and z may well lead to neglect of services a,b and c. So, if
the research on targets neglects the potential impact on non-targetted
services,then it cannot be regarded as definitive. The role of "unintended
consequences" must never be forgotten.
Re: Targets - good or bad
The idea that pursuing a target must cause deteriorating performance
in areas
where there are no targets seems logical when resources are finite. And it
sometimes seems to be what happens.
But--and it is a big but--there is a hidden assumption in the logic
that is rarely
made explicit as it critically undermines the argument. The assumption is
that
the services in the department or hospital are currently being delivered
at the
maximal possible efficiency. If we don't believe most hospitals are
operating at this peak manner, then it should be possible for good
managers or
doctors to improve the performance of some services with no tradeoffs.
And that is what good management (from managers or from medics)
achieves.
Only bad management delivers targets not by improving but by trading off
the
measured for the unmeasured.
Competing interests:
None declared
Competing interests: No competing interests