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Hospital Targets Damaging Efficiency (What Businesses Can Learn)

Businesses that set targets in place to achieve a specific goal can easily lose sight of their overall objectives. Sooner or later, they can lose sight of why the targets even exist to begin with.

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Even if you don't work in a hospital, chances are you can relate to these scenarios.

Positive patient experiences are becoming a strategic business imperative for many hospitals. Hospital reimbursements are increasingly tied to patient satisfaction and HCAHPS scores, which is why many healthcare providers are setting targets to meet targets. Ironically, this increased focus on customer satisfaction might be impacting customer satisfaction negatively.

The Negative Effect of Setting Targets

Hospitals are businesses, but they are unique businesses. The bond between a caregiver and a patient is extremely close, and the experience of being a "customer" at a hospital is a negative one by its very nature. Not only is the customer not always right - they don't want to be customers at all. They are vulnerable, afraid, stressed and may be on the receiving end of devastating news from staff. Setting tasks to meet customer expectations and hit a specific target when it comes to patient experiences can impact already-stressed staff members in several ways:

1. It Creates Tunnel Vision

When targets are set, the hospital invariably starts focusing on the many variables within a performance indicator, turning a blind eye to everything outside of it. There was an incident where an A&E nurse was assigned the role of greeting patients. Their only role was to greet and log the arrival of patients in order to meet waiting time targets. The target was met, but the A&E was short a nurse, which impacted the patient experience more negatively than a slightly longer waiting time would have.

2. Short-term Goals, Long-Term Impact

Local authorities decided to keep the cost of care homes down by keeping bed occupancy levels as high as possible. This meant that there was a long waiting list of patients who ended up spending long periods of time in hospitals because there simply wasn't a care home bed to transition to. This costs the government more money in the long term because hospital care is considerably more expensive than that of a care home. In another incident, authorities limited the money spent on training doctors to hit their budgetary goals, which led to a year-long shortage of doctors.

3. Gaming The System

When targets are tied to bonuses and reimbursement, there's a much better chance that staff will manipulate the numbers to make things look rosier than they are. Many hospitals implemented "Finished Consultant Episodes" to measure their productivity. When a patient "finished" their consultation, it was a sign of productivity. But the program never really defined what "finishing" looked like. For example, if a consultant couldn't immediately determine what was wrong with a patient, they would quickly bounce them to another and mark the episode as finished. Not only does this approach not benefit patients, but it may even exasperate and create problems because efficiency targets that are met or exceeded (if only on paper) will inevitably increase every year.

How Hospitals (And Businesses) Can Get It Right

Even if you don't work in a hospital, chances are you can relate to these scenarios. Businesses that set targets in place to achieve a specific goal can easily lose sight of their overall objectives and become bogged down by a million checkboxes that need to be ticked and goal posts that should be met. Sooner or later, they can lose sight of why the targets even exist to begin with, damaging efficiency.

High-performing hospitals (and businesses) keep people focused on the big picture through the use of good, visible processes and cultural alignment. Instead of weaving (sometimes conflicting) initiatives into day-to-day work, adding pressure and anxiety to employees, it's important to focus on the end goal. What would a typical patient experience be like in a hospital that was focused on meeting a patient's needs instead of a target? Targets tend to treat every patient and situation as the same, leaving very little room for deviation - even when it's necessary.

Processes, in any business, can help employees gain a better understanding of what they are actually meant to do in any given scenario. Employees should focus on fixing what is broken, executing required tasks to the best of their abilities, and supporting new initiatives and innovation. Instead of setting a target to improve patient satisfaction, make satisfaction part of your ethos and guiding principles. Make sure everyone knows what they need to do to ensure that patients have a great experience.

Hitting a target is just a momentary change. If you have a messy garage, you could set a goal to clean it and achieve your target. But if you keep up the pack-rat habit that led to the mess, to begin with, you'll have a messy garage again in no time because you are addressing a symptom and not the cause. Don't be tempted to think that the results are the only thing that needs changing in your business. You need to change the systems and processes that lead to those results. Instead of honing in on a single accomplishment, your processes and systems should drive continuous improvement in line with your goals.

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What Makes For a Good Process?

A list of tasks that employees already know they should be doing isn't a process. Processes are just a means to an end result, and they should be continually improved over time. Here's what makes for a great process:

  • Simplicity: Unnecessary complexity makes processes difficult and cumbersome to follow. This not only increases the likelihood your staff will forget steps in the execution, but it'll make it even harder to inspect and control your process.

  • Adaptability: Good processes should account for sudden inputs and changes. There should be contingency plans for unexpected events. Your team should still be empowered to think on their feet and drive activity through the process, even when a curveball is thrown at them.

  • Documentation and Discovery: Your process should be documented. Any process that isn't documented and easy to find becomes dependent and influenced by the communication style of the person who is telling the next what to do. This can drive bad behaviour and misunderstandings.

  • Manageability: Good processes can be managed and controlled - which also means they can be improved. Companies should have insight into processes so that they can evaluate them over time.

  • Communicability: What is the point of a good process if no one can find it or knows what it is? Good processes are communicated to the people who execute them, people who receive the outputs and who provide the inputs. Expectations should be understood from the beginning.

Switching from a target mindset to an outcome-based mindset isn't always easy, but it's the best way to achieve your goals. As long as you are continually driving improvements in your processes and systems and focus on the results you would like to see (not just the numbers on a scorecard), you can deliver a better product or service to your customers (or patients).


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