Patrick Keady

How to make performance management a little more interesting







My phone rang late one afternoon in early February.  It was a withheld number and that meant one of two things – that the caller was an NHS client or from an agency.     


This call was from an NHS Trust. 


They wondered if I might be interested in helping them achieve what hadn’t achieved so far – that “investigators” open all reported incidents within 48 hours, and that they close all incidents within 20 working days.


While their performance was at stuck at 68%, they really needed to be at 100%. There were financial reasons for this – because opening incidents in two days and closing them in 20 working days were two of the 80 key performance indicators set by the “Commissioners”.


Achieving all 80 KPIs would lead to the Trust receiving full payment.  Achieving less than 80 KPIs would mean that the Trust would receive less than full payment.


Needless to say, not achieving the 80 KPIs was not the right answer – because of cumulative financial effects of the ‘Nicholson Challenge’, cash releasing efficiency schemes (CRES) and quality innovation productivity and prevention (QIPP).


At 68%, the Trusts approach clearly had room for improvement. They had put in lots of energy, although something seemed to be missing.


Far too much effort was being wasted on trying to rationalise why the Trust could not achieve 100%. They were missing the potential ‘value added’ from speeding up the incident investigation processes, learning lessons and closing them – so that clinical staff would have more free time to care for patients.


In hindsight I had the easy role. My objective was to achieve 100%. It was that simple.


100% is measurable and I knew it was achievable.


It helped that I am a ‘towards’ person and not interested in trying to find reasons why things cannot be improved.


There was the implicit requirement that investigations were suitable and sufficient so that the Trust was well placed to learn lessons. This was also necessary in the event that the complaints and claims departments were to get involved at a later date.


However, while investigating and closing incidents was on the ‘radar’ for some ‘investigators’, other ‘investigators’ were not so keen on radar.


On my first day I looked at a selection of incidents that were reported on the Datix incident reporting module. I introduced a number of approaches to push the Trust to 100%.


Although the approach that had most impact was the ‘name and thank‘ report – this went to every investigators every Monday morning.  Copies were emailed to Directors, Managers and Consultants and they nicknamed it the ‘name and shame‘ report.  But they soon convinced themselves of the strengths of the weekly report.


I ensured that the investigations were quality checked and worked directly with those investigators who needed to improve.  Some needed training on root cause analysis, others on Datix, some needed to be nudged to have a ‘deputy investigator’ to cover for them when they were on leave and so on.


So how did we do? In just over one month, performance went up from 68% to 100%. Mission accomplished!

The Trust dropped the ‘name and shame‘ phrase from their vocabularies.


Investigators reacted positively to the weekly ‘name and thank‘ reports.


And some of their more creative colleagues renamed the weekly reports, the ‘thanky panky‘ reports !


Have you thought about how ‘thanky panky‘ reports could help you, your patients and your organisation ?


And if you think that I might be able to help, then please do get in touch here.


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© Copyright 2013 Better Outcomes Ltd.  Feel free to print, download and save this article for your non-commercial use.

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