Targets drive behaviours – not all of them good

An article in The Independent (http://www.independent.co.uk/life-style/health-and-families/health-news/healthcare-experts-accuse-nhs-of-fiddling-figures-to-meet-performance-targets-10193482.html) highlights again the iniquitous culture of targets in the UK’s National Health Service.

The headline talks about ‘experts accusing the NHS of fiddling figures’. These experts happen to be the very people who make a living out of crunching numbers to feed the beast of data collection and analysis.

It would be far more fruitful if, instead of ‘accusing’ anyone, these super-rational men and women had some insight into human behaviour to understand why people in organisations act as they do in the environment of fear and loathing created by successive governments in a desperate attempt to manage the system and to ensure that limited resources are used wisely.

To a certain extent, the NHS has itself to blame for allowing the current situation to arise. People have known for years that the gap between demand and funding was going to grow, requiring new thinking around how to provide for the health needs of the UK without bankrupting the country. The NHS did not respond to the challenge.

Instead, it was left to hubristic politicians to ‘Save the NHS’ and impose on it disciplines that Josef Stalin would have recognised and been completely at home with. The NHS now has a 5-year plan! It also has Gulags where those who under-perform and who fail to hit the centrally-dictated performance targets become the ‘disappeared’ – their lives and careers destroyed by the unforgiving and relentless dictatorship of the centre.

In order to survive, like anyone who has lived under a dictatorship, people adapt their behaviours. We should not be surprised that people ‘game’ the system. It gives back to us humans some power and autonomy and avoids the prospect of the Gulag.

Rather than accuse people of fiddling, the so-called experts, the commissars of data, would do much better to gain an understanding of human nature and create a system which, surely, has to be human at its core and has to be designed around people rather than data.

Data’s important but people are more important.

Until we design a health service around people, the ghost of Josef Stalin will continue to haunt the corridors of power, smiling at the irony that his legacy has surfaced in a capitalist country. Those ordered to deliver for the State will either perish in the Gulag or survive through craft and ingenuity. Positive values such as honesty will be squeezed out by survival instincts – that’s what happens in dictatorships. The system will evolve so that positive values become the exception rather than the norm. We await our Solzhenitsyn…

The views expressed are personal to the author.

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