Learning organisation or measuring organisation?

The Sunday Times’ article yesterday about the failings of the NHS performance management system was disturbing: Labour hid ugly truth about National Health Service.

Any organisation that gives higher priority to performance measures, rather than to its core business, needs to ask some harsh questions. In this instance it will be the country asking the questions – not only of the NHS but also of the government.

Since the days of Florence Nightingale we have understood the need for basic hygiene in order to prevent infection. It seems that performance measures were able to wipe away 250 years of performance improvement by not following the most basic of health procedures.

So when results like this are achieved from a performance measurement system that we can only presume was meant well, where does the blame lie?

It would be both true and too easy to say the blame lies with the leadership. Fish rot from the head down, and those in positions of leadership must shoulder the greatest share of the responsibility. But when a trained nurse does not pay attention to basics such as washing hands, or disinfecting areas where patients are cared for, there is either a massive culture problem, or a problem with basic training. My money would be on the issues of culture, many of which have been well documented.

However, those who devised and rolled out the targets must be feeling uncomfortable now the results of their performance management exercise have been revelealed:

“Most targets and standards appear to be defined in professional, organisational and political terms, not in patients’ experience of care.”

Maybe that’s easy to say with hindsight, but for the rest of us it is a chilling reminder that performance measures must be appropriate, tested, and constantly reviewed to ensure the organisation is achieving the results it needs. And not dysfunctional results it doesn’t want.

Performance measures are a way to understand and learn what works and what doesn’t. We all make mistakes, and performance measures are not easy to get right. But what is unforgiveable is to let such a bad situation go on so long. Performance measures should be a tool for the learning organisation, not a control mechanism for the measuring organisation.