A Target Driven Culture Is Killing Us

Target for rapid fire pistol at 25 meter shoot...

Mid Staffordshire NHS Trust and the Metropolitan Police Southwark Sapphire Unit. The Francis report and the even more recent Independent Police Complaints Commission report investigated these two scandals and have exposed the serious and even life-threatening consequences of a blind devotion to targets.

Both of the reports highlighted the pressure to meet targets as a key reason for losing sight of patient care and proper policing. As a result many people died and many rapes went unreported and uninvestigated.

In order to meet detection targets, the Metropolitan Police Southwark Sapphire Unit, a specialist sex crimes unit, pursued an explicit policy to encourage victims to retract statements, according to an Independent Police Complaints Commission report. It led to a detective from Southwark, dismissing allegations of rape against Jean Say who went on to murder his two young children, Regina (8) and Rolls (10). A report into this incident and the activities of the wider Met sex crimes unit has investigated a period during which you could “never advise women with any kind of surety that justice would be done” according to Debbie Marshall of Eaves. The report has described it as “wholly inappropriate” and “deeply disturbing”.

At the Mid Staffordshire NHS Trust, the Francis report concluded “that patients were routinely neglected by a Trust that was preoccupied with cost cutting, targets and processes and which lost sight of its fundamental responsibility to provide safe care.” The toxic, target driven culture at Mid Staffordshire has led to the needless deaths of hundreds of patients and the extreme distress of many more. Reports of people lying in soiled sheets for days, drinking water out of vases to stay hydrated and going without food have led to a public outcry.

A target-based approach to improvement has infiltrated our attitudes to such an extent that there are targets for everything, from recycling to education, that are pored over endlessly. Journalists devote countless column inches to analysing which targets are missed or met. Politicians use them as a club to beat their opposition. Targets are used by pundits, politicians and the public alike as benchmarks to judge the performance of not only the government but also individual schools, hospitals or recycling programmes.

Targets have failed to generate improvements and played an active part in the serious and shocking incidents in Southwark and Mid Staffordshire. The pressure over targets has become so pernicious that there doesn’t seem to be a way to rehabilitate them. Not only are the consequences of “hitting the targets but missing the point,” as the IPCC put it, potentially lethal but they are no longer useful as a performance indicator because the statistics are so frequently manipulated to hit targets. In Scotland for example, NHS waiting lists are manipulated to show improved waiting times but the patients are still waiting. Targets have become an end in themselves rather than a tool for improvement.

It must be time now for a serious rethink about how we measure success and the emphasis on targets before the next person dies.

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