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Home » Book reviews » Studying reveals the impact of incentives

Studying reveals the impact of incentives

March 20, 2019 By Howard Clark Leave a Comment

One of the most important capabilities for any organisations to have, is to be able to study their services from the customer’s point of view. Most organisations lack this capability, and this means that the vast majority of their change activity makes services worse for the customer and increases costs. So the incentive you think has improved things has made things worse and you have no visibility. And a RAG status of GREEN is almost certainly RED and your RED is probably RED too. Faster is slower if it made your service worse or you have to fix it again later. I once studied a service where the nine previous projects, deemed GREEN on the RAG had all made services worse!

About these videos

This compilation on targets and other incentives and the second film from a sales environment was recorded between 2010 and 2013 when I was working as a consultant for Vanguard Consulting. All of the staff and managers had the opportunity to study and learn together to understand their service from the customer’s point of view. When they removed the targets, changed the design of the service and introduced better measures the results were staggering. This lesson is that the majority of performance is down to the design of the system. Focusing upon people misses the point. Changing the system gives you better results.

Becoming aware and making visible

Many managers are often unaware of the dysfunction, cost and poor quality driven into services through the use of incentives. One of the core tasks for us (as interventionists) is to help leaders and staff see and understand. If you are a leader, manager, business analyst, technology designer, services improvement consultant it is important to gain basic grounding in the theory and the thinking surrounding targets (e.g. theories of control, incentives, human motivation, variation, variety attenuation, unintended consequences) and the different perspectives. And we should at least know how to study the services that we help bring into being to understand what the actual impacts of the designs are. If they are found to be harmful then they should be removed or improved. And if as leaders we can’t influence or remove, we have a duty to protect the service, staff and service users from any predictable adverse effects.


This is an example from a sales call centre.

Here are a selection of the impact of targets. It isn’t exhaustive.

NHS Targets are Crazy nurses warn (Independent, 24th January 2003)

Targets can seriously damage your health (British Medical Journal, 18th September 2003)

Election deportation targets put lives at risk (IRR news, 11th April 2005)

Indicators, targets and the decline of education? (Teaching Expertise, February 2008)

‘Creative’ solutions to knife crime thwarted by government targets (Children & Young people now, 28th May 2008)

Targets aimed at speeding up English planning decisions have led councils to reject more developments (BBC, 17th December 2008)

Hospital turns away ambulances…to meet Government targets (Sutton and Croyden Guardian, 17th December 2008)

NHS targets ‘harm hip patients’ (BBC, 24th December 2008)

Hospitals ‘dump’ patients in wards to hit target (The Telegraph, 23rd December 2009)

Culture of targets prevents nurses from tending to patients (21st March 2009)

Hospital uploads paper referrals to hit Choose and Book targets (Pulse, 25th March 2009)

Patients with suspected cancer forced to wait so NHS targets can be hit (The Telegraph, 7th June 2009)

Planning measures ‘perverse incentives’ (LGC, 3rd July 2009)

Patients moved from A & E units before they were properly assessed to hit a Government target to treat them within four hours (The Telegraph, 14th July 2009)

‘A&E targets put patients at risk’ (Telegraph & Argus, 14th July 2009)

Parking enforcement officers face “humiliation” if they fail to meet their targets for issuing parking fines (BBC, 25th July 2009)

Hospital chairman quits over dangerous targets (The Telegraph, 25th July 2009)

‘Prisoner chess’ is a result of government targets (The Independent, 21st October 2009)

NHS staff ‘fiddle waiting time figures’ survey claims (The Telegraph, 21st November 2009)

Call for 999 ambulance response targets rethink (BBC, 17th December 2009)

Police still burdened by Government targets, says former chief constable Tim Brain (The Telegraph, 7th January 2010)

‘Two-tier’ ambulance trust accused of prioritising town dwellers over rural patients to meet targets (The Telegraph, 10th February 2010)

Hospital ‘bent the rules’ on four-hour A&E target: report (The Telegraph, 4th March 2010)

The Ambulance service is being paid bonuses for not taking patients to hospital in a bid to help the NHS hit controversial targets (The Telegraph, 27th March 2010)

Manipulation of the examinations system is being fuelled by a target-driven culture (The Telegraph, 9th December 2011)

Forces were routinely manipulating crime statistics to meet targets (BBC, 29th November 2013)

NHS hospitals appear to be “gaming” the system to meet performance targets (The Independent, 22nd April 2015)

Two police workers who made fake 999 calls to meet performance targets have been sacked (BBC, 17th August 2016)

Desperate 999 call handlers attempted suicide amid an “endemic culture of bullying” at a scandal-hit ambulance service intent on hitting targets (The Telegraph, 13th February 2013)

Doctors ‘being pressurised into manipulating patient records to meet A&E targets’ (The Independent, 27th January 2018)

Amber Rudd admits deportation targets are used by Home Office after denying it (The Independent 26th April 2018)

Natural-birth targets ‘put lives of mothers at risk (The Times, 28th September 2018)

Police had ‘perverse’ target to limit number of drink-drive busts (The Age, January 15th 2019)

Secret CPS target may have led to rape cases being dropped (The Guardian, 13th November 2019)

NSW Police set quota for 241,000 personal searches and strip searches in 12 months documents reveal (ABC news, 13th February 2020)

Filed Under: Evidence, Media, Other, Videos Tagged With: Effectiveness, effectiveness exchange, efficiency, efficiency exchange, targets, the Vanguard Method

About Howard Clark

Howard Clark has 20 years experience of services effectiveness, operations management and consulting in the public, private and HEI sectors. He has spent 12 years consulting as an external and internal consultant including 5 years with Vanguard Consulting.

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