In resetting targets for health, the challenge is to identify and articulate the underlying map, writes Paul Duignan
Will health targets end up on target? Imagine that you are talking to an Air Force chief in a war somewhere. You have the job of working out whether the targets they have selected for bombing are a good set of targets or not. You would have one obvious question. “Where is the map showing your proposed targets in relationship to where industrial production is concentrated, where key transport hubs are situated and where enemy forces are massing?”
It’s a bit like this with health targets. The government has recently decided to drop National’s health targets and to work up a new set. Stakeholder responses have varied. For instance, the Royal New Zealand College of General Practitioners wants “broader measures”. Auckland University’s Professor Alistair Woodward has warned that if broader measures are “spread too thin” they might not make enough of an impact.
What these comments reflect is that setting targets involves trade-offs. You want your targets as high (broad) as possible, but if they get too high they may not be controllable by the parties you want them to encourage. You also want to have a set of targets that covers all of your key priority areas, but this may mean a reduction in activity focused on specific targets.
Just as in the military analogy above, if you want a coherent stakeholder discussion about such trade-offs, you really need to hold that discussion against the underlying “map” of what you are wanting to achieve. But the traditional way that governments in New Zealand, and internationally, have presented information on their strategies does not provide this. There is not a concise tool for quickly overviewing the underlying “map” for target setting and other kinds of strategic work.
When you are dealing with large sectors such as health, governments have traditionally found it hard to both quickly and fully communicate their underlying strategy. Of course, they usually have glossy high-level overviews of their strategy, but you need something more detailed than that for coherent target setting. But the pursuit of that detail can lead to overkill. I was once facilitating a presentation by a director general of health where they told health providers that they needed to read seven different documents to work out what the then government’s health strategy was. In a world where our attention spans are shrinking, the days have long past when you could expect people to read that many documents to get an overview of government strategy.
For stakeholders to work out the trade-offs regarding suggested targets, they need to have in their minds a mental map of the strategy that the targets relate to. The problem with the traditional “seven documents” approach is that each of the stakeholders involved in the discussion ends up having to build their own summary mental model of the underlying strategy inside their own heads. But, as I know from being involved in many such target setting discussions, there is no way of being certain that stakeholders have the same mental model regarding the underlying strategy. Because of this, target setting exercises often become confused and frustrating for all concerned.
The solution to this is simple and lies in recent developments in strategic planning I, and others, have been involved in. This is where the underlying map or model of strategy is represented not just within very high level summaries plus long planning documents. In this new approach, it is also represented in a specific type of visual strategy model. Such models set out boxes with high-level outcomes and all of the important lower-level steps needed to get to them.
Such a concise visual model of the underlying strategic “map” at both the high and more detailed level can be used directly as a tool for quicker target setting. Proposed targets are put directly onto the visual strategy model. Stakeholders can then immediately “see” on the visual model in front of them the level at which the targets are being set and how comprehensive the set of proposed targets is. This approach mimics exactly how you would approach critiquing a set of bombing targets as I talked about at the start.
In one sense, this is just another argument for increased government transparency. In a visually orientated age, all governments need to be adopting approaches that make it easier and much faster for stakeholders and the public to “see” what they are trying to do.
It will be interesting to see if this government, interested as it is in innovation, will start adopting this sort of approach to target setting in health and other areas. It would also be good to see if the new approach could save some of the media column space generated around these exercises. A part of the discussion that arises in such exercises can just be people talking at cross-purposes. This is because stakeholders do not have a common map of the underlying government strategy to work directly from when they are trying to provide input into target setting.