Let the system be itself
I was helping to run a workshop for NHS staff to assist them in preparing to meet the 18 week target set by the government. The target requires that the time between a GP referral and treatment be less than 18 weeks. The fact that targets are rubbish is not something that I am going to go into today. The fact remains that the NHS has to try to meet this target by hook or by crook.
During the latter part of the workshop an attendee raised a very interesting question.
"Is there any best practise to tell us how to monitor patients? When should we intervene to ensure that a patient does not breech the 18 weeks."
They went on further to explain that for example, if a patient has not been seen by a consultant for 6 weeks since the referral, should they bump them up the queue to ensure that patient won't breech the 18 weeks.
The problem with this thinking is that it is only thinking of the target and how to hit it. It is not thinking of the current system and its capability to hit the target. In fact I would advocate forgetting about the target in order to hit it.
In order to do what the attendee was asking about, they would have to add in a whole layer of monitoring and expediting mechanisms. This would take resource away from the patient and their journey through the system.
My answer was that, at present there will wide variation in the end-to-end time from referral to treatment and that many patients will breech. You need to understand that, but as long as the system is stable, you must not act upon it. The way to proceed is to understand the variation in end-to-end times, ensure it is stable, then work on the system to improve it. Look at the end-to-end process to improve the work on the ground until the system is predictably capable of hitting the 18 week target.
If you tamper, you will only increase the variation. Everytime you intervene to expedite a patient you displace other patients and the variation increases. You are worsening the system, not improving it.
The attendee replied that that was all very well, but that they would get "killed" if there were target breeches after the deadline.
Ho hum for the real world. Does government or the Department of Health realise what it is making the NHS staff do in order to meet their targets? If they did, I would hope they would stop setting them.
During the latter part of the workshop an attendee raised a very interesting question.
"Is there any best practise to tell us how to monitor patients? When should we intervene to ensure that a patient does not breech the 18 weeks."
They went on further to explain that for example, if a patient has not been seen by a consultant for 6 weeks since the referral, should they bump them up the queue to ensure that patient won't breech the 18 weeks.
The problem with this thinking is that it is only thinking of the target and how to hit it. It is not thinking of the current system and its capability to hit the target. In fact I would advocate forgetting about the target in order to hit it.
In order to do what the attendee was asking about, they would have to add in a whole layer of monitoring and expediting mechanisms. This would take resource away from the patient and their journey through the system.
My answer was that, at present there will wide variation in the end-to-end time from referral to treatment and that many patients will breech. You need to understand that, but as long as the system is stable, you must not act upon it. The way to proceed is to understand the variation in end-to-end times, ensure it is stable, then work on the system to improve it. Look at the end-to-end process to improve the work on the ground until the system is predictably capable of hitting the 18 week target.
If you tamper, you will only increase the variation. Everytime you intervene to expedite a patient you displace other patients and the variation increases. You are worsening the system, not improving it.
The attendee replied that that was all very well, but that they would get "killed" if there were target breeches after the deadline.
Ho hum for the real world. Does government or the Department of Health realise what it is making the NHS staff do in order to meet their targets? If they did, I would hope they would stop setting them.
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