We are all for ‘high performance’

Health manager, ’Laurence Nightingale’ takes a look at ‘high-performance’ in a health sector context.

‘High Performance’ is a term with which we are all familiar. A quick survey of your bathroom cabinet or dressing table will doubtless reveal a palette of ‘high-performance’ skincare products with ‘patented technologies’ infused with obscure but all-powerful herbs. Whether these products have the capacity to make you indistinguishable in age from your daughter is questionable. But whether it’s skincare products, diesel, or masonry paint, marketing moguls know that adding ‘high performance’ to your tag-line is a winner with consumers.

In recent years health services in a number of jurisdictions have adopted this concept and made its achievement an ambition of government policy documents. Indeed our own Health Strategy ‘Quality & Fairness’ (2001) placed significant emphasis on it as one of its major goals. A high performing health system is not one which claims to turn back time; however its outcomes – longevity, better quality, increased value – are not a million miles from the claims of product lines from all corners of the retail world. And it’s something the public can get behind. Who among us wouldn’t want to be treated in a ‘high performing’ hospital?

Since Quality and Fairness, there has been significant effort expended in the pursuit of this ambition across the public health services. Time was that a hospital was to be considered high performing if it were only a few million adrift at year-end and could get the local T.D.’s nephew bumped up the waiting list for his in-grown toenail. Nowadays, hospital CEOs and General Managers and their counterparts in non-acute facilities are subject to a dizzying level of scrutiny, with every internal process unpicked, every decision evaluated and every result compared.

The series frequently airs the conflict between shadowy political advisers and police chiefs around the interpretation of crime data and their respective self-serving approaches

The last edition of Health Manager carried an article on Compstat – the Special Delivery Unit’s successor to Health Stat and the latest strategy engineered to drive us towards higher performance. At its most basic, a straightforward ‘traffic light’ categorisation is used to score individual business unit results against the various targets set for it corporately. These targets may be’ off-the-shelf’ best practice measures, absolute targets or arbitrarily set based on previous trends or peer averages. Much criticism has been levelled at previous attempts to instil a target driven approach to service delivery. This was fuelled in part by the simplicity of the methodology applied or – to borrow from another beauty product – the lack of ‘the science bit’.

Viewers of HBO’s police drama ‘The Wire’ may recognise the term ‘Compstat’ as it has been used in the past by the New York Police Department as a means of mapping, reporting and subsequently managing crime statistics. The series frequently airs the conflict between shadowy political advisers and police chiefs around the interpretation of crime data and their respective self-serving approaches. Whilst it may be a stretch to think RTE’s The Clinic will feature any explicit reference to this, it is not beyond the realms of possibility for results to be spun out of control.

Despite the rhetoric and self-congratulatory bouquet throwing, there is a general sense of ‘old wine in new bottles’ about Compstat. Much of the data has been in the public domain for years and already forms part of existing performance monitoring systems and data suites.

Whether it’s a rehash or a revolution, any initiative which compels managers to be on top of their trends and be intimately acquainted with the finer detail of their processes must, in the current financial climate, be supported. In recent years however, there has been good progress made in developing more of an empirical basis for the design and setting of targets for our hospital and community services. It remains to be seen whether this level of scrutiny works to support and enable the system as it purports to or whether it becomes yet another expensive stick to beat a resource-starved system with.

The ‘hot-housing’ of talent in high-performance training centres is now a pre-requisite for would-be Olympians and future Sports-Stars.  Taking this kind of approach to the identification and nurturing of future health service leaders and managers would be both a complement to and support for the target-driven, results focussed ethos which characterises the management of the Irish health service.