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ACCA Strategic Professional · Strategic Business Leader · Enabling success: performance excellence

Aldermoor Hospital Trust is told to cut patient waiting times. Clinicians start treating the easiest cases first, leaving complex patients waiting longer, while the headline average waiting time improves. Which is the most appropriate response by the board?

The board should supplement the average with measures of distribution, clinical outcomes and priority, and review incentives. The average alone invites cherry-picking of easy cases. A broader measure set keeps accountability while reducing dysfunctional behaviour, whereas raising the target or abolishing targets does not solve the design flaw.

  1. ARetain the average as the sole measure but raise the target
  2. BSupplement the average with measures of distribution, clinical outcomes and patient priority, and review incentives accordinglyCorrect
  3. CAbolish waiting-time targets because they cause dysfunctional behaviour
  4. DTransfer responsibility for the target to the finance department

Explanation

The behaviour is cherry-picking caused by a single average metric. A balanced set of measures, including worst-case waits and outcomes, reduces gaming while keeping accountability. Raising the target worsens pressure, abolishing targets removes accountability, and moving ownership to finance does not change the incentive.

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