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Ethos Issue 3, Oct 2007
Public Services at the Crossroads
Edited by : Richard Brooks
Contributors : Richard Brooks, Kay Withers, Miguel Castro Coelho, Tim Gosling,
Guy Lodge, Sophie Moullin, Nick Pearce, and Ben Rogers
Published by : Institute for Public Policy Research, UK: 24 September 2007
MISSING THE TARGETS IN PERFORMANCE MANAGEMENT
In the last decade, much public service reform has focused on adopting “top-down”, market-derived performance management mechanisms such as targets, incentives, regulation and intervention. In the UK, this “target-oriented” approach appears to have led to a number of unintended behaviours (outlined in Table 1). The drive to define the quality and efficiency of public services through performance targets may also have been at the expense of establishing useful norms and long-term outcomes for citizen behaviour in relation to public services—in terms of constructive feedback and dialogue, for example.
TABLE 1. PERFORMANCE, TARGETS AND THEIR POTENTIALLY PERVERSE SIDE EFFECTS
(Source: Public Services at the Crossroads, p36)
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| THE PROBLEM |
EXAMPLE |
| Tunnel vision: Concentrating on what is included in the performance indicator to the exclusion of other important considerations |
Attempting to meet the high-profile target for five A-C grade General Cerificate of Secondary Education (GCSE) passes has incentivised schools to focus on those on the C/D margin. Evidence suggests that very low-achieving pupils have, as a result, not shared in educational gains.
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| Measure fixation: Focusing only on measured outcomes—hitting the target but missing the point |
The target to see a general practitioner (GP) within two working days led to some practices refusing to book more than two days in advance. 30% of patients surveyed in 2005 reported that their general practice did not allow them to make an appointment three or more days in advance. |
| Gaming: Getting round the system by altering behaviour to obtain strategic advantage |
In order to meet targets for total time at Accident and Emergency (A&E), gaming behaviour included requiring patients to wait in ambulance queues until the hospital was confident that they could be seen in under four hours, and the performance of cancelling scheduled operations and drafting in extra staff over the period was measured. |
Data misrepresentation:
A spectrum of behaviours from “creative accounting” to fraud |
Auditors found evidence that 12 National Health Service (NHS) Trusts had adjusted their waiting lists ‘inappropriately’ for the two hospital waiting time targets. In 2004/5, officially 96% of patients at A&E were seen in under four hours, but the survey-reported level was only 77%. |
| Myopia: Concentrating on short-term issues and ignoring long-term risks |
Waiting-time targets for new ophthalmology outpatient appointments had been achieved by cancellation and delay of follow-up appointments, on which there were no targets. At least 25 patients had lost their vision over two years as a result. |
| Sub-optimisation: The pursuit of narrow objectives, at the expense of strategic coordination and goals |
Managers in the NHS were ladened with performance targets and required to ensure financial viability amongst the projects in their portfolios. When managers discovered that Primary Care Trusts were accorded low priority in the NHS balance sheet (and could therefore be deprioritised without affecting their bottomline), the proportion of Trusts left to “significantly underachieve” in financial performance rose from 3% in 2001 to 30% in 2005. |
| Convergence: Also known as “threshold effects”, where targets do not provide incentives for those performing above the target level |
Waiting times in A&E departments have converged just below the four-hour target. |
| Ossification: A disinclination to experiment with new and innovative methods |
A poorly designed pupil assessment regime in English schools has led to shallow, narrow teaching in pursuit of gains in test results. In tight target regimes, budgets for research and development necessary for innovation have been cut to focus resources on essential work to meet targets. |
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