Friday, 19 March 2010

Taking Aim at Targets

Constantly Furious has posted yet another example of targets going horribly wrong and generally ruining things for the people they are meant to help. Like I have, he has reached the conclusion that targets are not a magic way of improving public services; they are a lazy way. They are a way that it adopted by people who are incompetent managers. Managers who are managing people who are far, far more intelligent and able than them.

But no - a commenter has found a counterexample! Andrew from South London points to the 4 hour A&E target for hospitals - a good thing that patients love and doctors hate.

No, Andrew.


My comment in reply to Andrew's reads as follows.
Sorry Andrew, the 4 hour A&E target is not a good thing.

It is not a good thing when you take your child in the evening to A&E with suspected post-operative complications, and wait for 3 hours 30 minutes to be seen because people have to be seen in strict order because meeting the 4 hour target is more important than being assessed on clinical need.

It is not a good thing when, 20 minutes into the consultation with the doctor, the charge nurse walks in and informs the doctor that this child must leave A&E, now. No discussion, he must leave, and all trace of him must be gone within 10 minutes.

It is not a good thing when your child is therefore admitted to the ward and spends the night there waiting for someone to confirm that he can go home, because the ward doctors don't know the test results and the A&E doctor is not there.

It is not a good thing when you have to drive the two hour round trip back home to get overnight stuff for your wife; two hours, because they closed the A&E unit 10 minutes from your home because it was "more efficient" to have a single unit for the whole county. Such a single unit being, naturally, more able to meet the 4 hour target.

So no, the 4 hour target is not a good thing. And the doctors are right to hate it. Why? Because they are skilled. They know what they are doing. They went into medicine for a reason. And their skilled assessment of the best clinical approach to a patient is being overruled by a man with a clipboard and a stopwatch.

If you want to know how I know this, it's simple. I was there.

1 comment:

  1. I took a friend to hospital with acute appendicitis.
    He was seen within 20 minutes then put on a trolley and told he would be OK. A doctor would see him again shortly.
    Waited about 2 hours without anyone coming. A nurse said that a doctor couldn't come as they were very busy with a knifed teenager.
    FFS I thought. What kind of place is this!
    Waited another hour. Watched a very stressed big built nurse telling the local loonies to sit down or get out as they were very busy that night and had no time for their nonsense. He also turfed the drunks out. Told them all to clear off. I asked him why were so busy and he said everyone was working on these two knifed kids and I would have to be patient.
    As I sat next to a woman a doctor came over and called her away to tell her her son had died.

    I will never complain about waiting again.
    They do know what they are doing.
    They saw my 3 month, very high temperature child at once while telling a bloke with a badly gashed head to sit still and he wouldn't die if he pressed the paper towels harder.

    4 hours. It feels like ten anyway. As long as you've been quickly assessed then let them get on with it.