Once again another hospital finds itself in the news because of its target driven culture. This time it is Colchester General Hospital and follows an inspection by the Care Quality Commission which found inaccuracies in recorded cancer waiting time data at the hospital. The manipulation of data to give the impression that targets were being met may well have put patient’s lives at risk.
According to a Unison spokesman the employees at the hospital have been told to ’keep quiet, to shut up, to not say anything about the directions that they’ve been given by senior managers to make sure that the hospital meets its target by massaging the data.’
The Care Quality Commission said that staff told inspectors they were “pressured or bullied” to change data relating to patients and their treatment to make it seem people were being treated in line with national guidelines.
Of course there has been an out-pouring of surprise at the results and the great and good are appalled that an organisation would do such a thing but what is surprising is that anyone is surprised by this and what is appalling is that the culture of target driven ‘improvement’ continues.
All targets, however well-intentioned will skew the focus of an organisation. Setting cancer waiting time targets spells out to the whole organisation, management, staff and patients that this is where the hospital will put its effort. Achieving the target will always come ahead of achieving the intended objective.
The only way to resolve cancer waiting times is to understand the demand, understand the flow of patients and understand the hospitals ability to service these needs. Addressing the system will make the improvements not focussing on the target.
The shame of this is that there are parts of the NHS that understand this and have made great inroads into improving quality and reducing cost.
What I find appalling however is that there is now a clamour for heads to roll. Somebody must be found responsible, the more senior the better and will lose their job. I accept that the regime has not served the patients but, as John Seddon, Managing Director of Vanguard, always points out, it is not the people it is the system.
Cutting a few rotten leaves off will not save the tree. Only by cutting out the culture of target setting and replacing it with a clear commitment to patient care will deliver real service improvement.
I’ll be surprised when this happens.
Thoughts from a Guerrilla Worker 