The solution is simple...

@NathanConstable who writes a rather good blog published a recent blog post entitled "The Theory of Assumed Incompetence" in which he describes the consequences of "an executive culture where financial consideration [take] precedence over all else and meeting targets became the raison d’être". As he points out, we have all been observing the responses to the Francis report into the Mid Staffordshire Hospital circumstances which led to many avoidable deaths.

This is a subject that I have blogged on lots before as well. (Most recently here.) In Nathan's blog he outlines a simple course of action when it comes to finding improvements in delivering services:

• Use the data.
• Probe more deeply.
• Ask more questions.
• Don’t stop UNTIL you have identified a problem AND it’s causes.
• Don’t demand “improvement” until the causes are fully understood.
• THEN target the messages and improvement to the people or areas where it is needed

I commend that method to you. It is the essence of root cause analysis and there are many good tools to help people to do this. In my practice, I observe many instances of what I call 'solushing' - the rush to solutions without a detailed analysis of the causes and a creative exploration of all the possible ways to tackle those causes.

But perhaps people will answer me this conundrum:

If Francis has correctly identified that one of the main causes of the problems at Mid Staffs was an over concentration on targets to the detriment of a focus on what was in the patients' and public's best interest... how will large scale outsourcing in the NHS (or indeed in the criminal justice system) make things better? How will (for example) payment by results not lead to exactly the same cultural problems that Francis is recommending a move away from?! 

If you out outsource, you install contract culture. And in contract culture, how do you hold contractors to account? Through an elaborate system of performance management and (wait for it) targets! 

It is behoving upon the advocates of 'market solutions' to explain (with evidential support) how outsourcing will not lead to an even greater obsession with short term targets that what we saw in Mid Staffordshire hopsital.

PS if you are into 'Assumed Incompetence' you will be also interested in 'Assumed Competence' too.... see my other blog post here.