Targets on suspended…targets to return…new targets…targets to be revised – all sound like phrases to instil a mixture of music to the ears and a sense of dread to any manager in the NHS. How often does it seem we go through the same cyclical change to internal and external targets that assess how well we deliver our services and quality of care?
Yet how scientific is it? The usual practice is to review data from the previous year, work with our stakeholders on what the national, regional and local priorities might be, have internal discussions, then come up with a new set of targets. Often, these represent a trim round the edges of what came before, with some further stretching of improvements already made. It sounds like a reasonable process but too often we forget to go back to the basic principles of how targets should be set.
All targets should stem from the organisation’s strategic objectives. If your plans, goals and metrics don’t stem from these, then you should ask yourself what you are trying to achieve with your targets. Part of target setting is to ensure you are gathering evidence that your strategic objectives are being met; if your targets are being missed, it should help you understand where your plans and controls are not working.
At GGI, we often use a process improvement methodology to understand processes currently in place and to review whether waste can be removed, whether it be in structures, systems or processes (suppliers, inputs, process, outputs and customers – SIPOC). A similar method can also be used for target setting, sometimes known as an impacts and outcomes toolkit.
This 10-step process ensures the organisation truly focuses on its objectives but also then measures every measurable element in achieving each objective. The steps are:
1. Identify your objectives
2. Identify your activities
3. Analyse your inputs
4. Identify your outputs
5. Identify your outcomes and impacts
6. Link the elements
7. Create a list of potential indicators
8. Map these against known indicators
9. Prioritise your indicators
10. Choose which indicators to feature on your dashboard
By following this process each year, not only will you ensure the goals are specific to your strategic objectives, but it also helps takes into account any changes to service provision.
Of course, just knowing what you can measure is not enough. As highlighted earlier, we often apply targets that are just better than the previous year, or have been asked of us by regulators.
Recent BMJ research showed that the UK is worse in patient outcomes than many other OECD countries in areas such as mortality, breast cancer, stroke and inpatient suicide. So even if you have one of the best mortality rates in England, you may still be quite far behind your international peers.
This shows that, rather than just rating your services against national targets and how you performed in previous years, you should look to international standards to stretch your organisation further. The Health Care Quality Indicators (HCQI) is one place to look.
Apples with pears
Once you have completed your indicators, it’s important to ensure you are comparing like for like. You don’t want to find yourself in a situation where your data is telling you that your organisation is great or terrible at something, only to discover that this is due to the inclusion or exclusion of certain datasets in your numerator. If you feel there is a real need to measure slightly differently to others, you should ensure this is made clear, along with your reasons for doing so.
If an appropriate process for target setting is followed, with good benchmarking in place, boards can gain confidence that what they are measuring is key in assessing whether strategic objectives are being met and therefore can be used to test the controls and assurances being received.
Questions for boards
Do our targets compare internationally? Where do we benchmark against international standards?
- Are we measuring the right things to achieve our strategic objectives?
- What is our process for target setting?
- Are our targets the same as others? If not, what are the differences and why?
If you have questions or comments about this briefing, we’d love to hear from you. Please contact us by calling on 07732 681120 or emailing firstname.lastname@example.org