Measurement Madness: Recognizing and Avoiding the Pitfalls of Performance Measurement

Chapter 6Target Turmoil

Saturday evenings in the accident and emergency (A&E) departmentⁱ in UK hospitals are notoriously busy. The waiting rooms are filled with amateur sports men and women with sprained or broken limbs; with the walking wounded who have injured themselves attempting home improvements; with revellers too drunk to be left safely on their own; and with small children having swallowed something they shouldn't have. After long tedious hours of waiting, tiredness and weariness soon set in. This used to be so bad that it was a commonly held belief that a broken limb would heal whilst waiting to be fixed, or that the drunk would have had long enough to sober up.

Shortly after winning the 1997 election, the New Labour government set out to reform the National Health Service (NHS) in England.ⁱⁱ To ensure consistent standards throughout the country, the government introduced national targets that would become enforceable across the whole sector. The most notorious target of all was that imposed on A&E departments to improve waiting times. The target was set at four hours and covered the period of time from a patient's arrival in A&E to the completion of treatment or admission into an inpatient ward. This target was designed to address citizens' growing dissatisfaction with the length of the waiting time in NHS hospitals. At the turn of the millennium, an interim target of 90% compliance with the A&E target was set, with the intention of reaching 100% by March 2003. However, ...