Targets and Public Services: a case of incorrect thinking Jake Chapman Demos Associate
The case for targets � Within the public sector targets have shifted attention from the inputs (budgets) to the outputs � Targets have forced the collection of performance data � Targets provide clear guidance on priorities and what is expected � Improved accountability for both Ministers and operations staff
What has occurred? � Very large numbers of targets - areas not covered by a target are neglected � Professionals and front line staff complain - particularly about time wasted filling in forms � Not meeting a target regarded as failure - so managers manipulate data or system � Significant number of negative unintended consequences
School Grades � Secondary schools are ranked according to the number of students obtaining GCSE grades A,B and C � One immediate consequence of this was that teachers focussed most of their attention on students they expected to score C or D � Very good and very weak students received significantly less attention
Doctor appointments � Doctor’s surgeries have been given a target that 80% of patients should be seen within 24 hours � In our local rural surgery this has caused mayhem and reduced the availability of doctors � because people try to organise their visits to the surgery well in advance to coincide with other trips into the village
Hospital co-operation � Hospitals in a locality used to share resources, particularly A&E � One of the hospitals has a zero star rating due to excessive trolley waits � One of the other hospitals has a borderline 2 star rating and has withdrawn from the sharing arrangement � which has reduced the performance of A&E in the locality
Reporting crime � Police have targets to meet on solved crimes � Wallet stolen between leaving taxi and being on train at Paddington station � Serious difficulty having anyone accept the report of the crime - Paddington Green, Taunton, Transport Police � Conversely domestic rows are eagerly accepted � as two ‘solved’ cases of assault
Breast Cancer treatment � Target that all suspected cases are seen by a specialist within 14 days � Works well for women with standard symptoms detected in mass screening � Caused loss of service for women with non- standard symptoms - not easily detected � these women have a greater need to see specialist, but now have to wait a lot longer
Performance Management � Based upon scientific management � which is explicitly based upon regarding organisations as machines � Language used exposes the way of thinking � But large organisations are not machines � and professional staff are not ‘cogs’ � Where the theoretical assumptions do not match reality then can expect distortion, unexpected consequences and failure
A systems view � Adopting a more holistic or systemic view of organisations � metaphor of a complex adaptive system � Key difference is in degree of predictability and control possible � and in recognition of importance of different perspectives and context � Leads to prediction of many of the negative effects of targets
Modes of failure � A target will become the purpose of the organisation - not serving clients � Targets cause managers to focus on operations rather than overall activity � Data associated with the target will be distorted by ‘gaming’ and ‘cheating’ � Significant sources of variation will be ignored � Qualitative aspects of service ignored � Generates high overhead of ‘failure demand’
A Public Value view � Public services are fundamentally different from commercial services � As recipients of public services we are � consumers of the service � citizens concerned with spending taxes � interested in issues of equity and fairness � as concerned about trust, being treated with dignity and sustainability as with value for money
The delivery trap � Public services cannot be ‘delivered’ � because we are each directly involved in the processes of our own health, education etc � We are co-producers of the outcomes of public services � talking about health and education as if they can be delivered like pizzas undermines and undervalues citizen’s own responsibilities � to the detriment of the whole enterprise
Conclusions � The use of targets emerges from a particular view of public services and organisations � a view that is demonstrably inadequate � and leads to a large number of negative consequences associated with targets � There are more productive approaches based upon systems theory and public value � adopting these requires a radical change in the way that we think about public services
Thank you for your attention
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