Risk-based performance

This week I have had a number of discussions with clients and other experts about the best way to use indicator information. 

One of the points that consistently comes up for discussion, and appears to be accepted wisdom is that if indicators are RED, some action must be taken; even if it is only providing some commentary as to why it is red. On the other hand, if an indicator is green, the general consensus is that no action is required. However we believe failing to analyse green indicators is a huge missed opportunity for organisations.

Naturally, when reviewing indicators, the eye is drawn to the red ones and instinctively we know we should take action to correct the underlying problem that causes the red. Red indicators should prompt the following questions: “What is the root cause of this indicator turning red?” and “How do we correct the problem?” 

However what about green indicators? Why not just accept they are within our desired tolerances and move on? Whilst this is the approach taken by many, we believe a more proactive approach will add more value. Just as we analyse reds to understand their root cause, so should we analyse greens. Green indicators should prompt the following questions: “What is the root cause of this indicator turning green?” and “How do we repeat/replicate and build on this example of excellence?”

When we implement Risk-based performance, Balanced Scorecard or dashboard projects, we consistently advise and encourage our clients to look at both the green and red indicators with equal priority.

Often when indicators are introduced to an organisation they can bring with them a new fear – the fear of getting ‘beaten up over my red indicators’. This is not healthy or productive. This fear should be countered with a celebration of success around green indicators. Understanding, repeating and building on these local examples of excellence should be a priority. It is at least as important as analysing the root cause analysis of reds because it adds significant value.

An NHS Trust client recently demonstrated the value of understanding green indicators. One of the indicators they used related to patients attending follow-up appointments. 

When this indicator was implemented across the trust’s various sites it seem to be consistently red at all sites, which triggered a number of individual activities to understand the root cause at each site. 

However when we introduced an automated dashboard solution, we were able to comparing like indicators from all sites. We found that all the sites were consistently red for the attendance indicator except one. This one very small site was consistently green for the indicator and had been for more than 12 months. 

With some simple analysis (and a quick couple of phone calls) this example of local excellence was quickly understood. The main driver that led to 95% plus attendance was simple – in addition to the normal reminder letters, a reminder phone call was made a few days before the appointment. 

This step in the process was unique to the one successful site. It was rapidly replicated across the whole NHS Trust and within two months average attendance for follow-up consultations increased from 20–30% to 90% plus, delivering a significant reduction in wasted time, misallocated resources and costs. Most importantly there was also a major increase in the quality of service and patient health.

This is an example where focusing on the red indicators did not solve the issue because all the leading indicators showed that the NHS Trust was following the standard process correctly. It was only by finding the green indicator, and focusing on this local example of excellence, that the problem was overcome, the standard process was enhanced and performance increased dramatically.      

So when you next sit down to review a set of indicators, take time to ask yourself: “What is the root cause of this indicator turning red?” and “How do we correct the problem?” but don’t forget to also ask “What is the root cause of this indicator turning green?” and “How do we repeat/replicate and build on this example of excellence?”