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Target driven system?
8th Nov 2006
Roger Matthews discusses the merits, or lack of them, in the UDA system. Publicly funded dentistry in the UK has been target driven since at least 1960, and arguably before that. The introduction of TAGI and TANI (Target Annual Gross and Net Income) ruled dentists’ lives long before the UDA (Unit of Dental Activity) was born. There are many problems with targets. W Edwards Deming, the great guru of quality management, argued that ‘97% of what matters cannot be measured’, and he was a statistician! Unfortunately in modern life, management seems to focus 97% on what is measurable – so we spend most of our time on things that don’t matter. If I asked you to describe the things that make a dental practice great, you would probably say things like: enthusiasm, caring, teamwork, patient-centred, none of which are easily measured. So does that mean measurable targets are all wrong? Well, I’d say yes and no. In a successful enterprise, I think targets can be helpful and encouraging to get the best out of the whole team. But they need, in my view, to fulfil five critical objectives: • Do they reflect what is fundamentally important to your practice? And do they reward the accomplishment of that? Our role is to optimise oral health and I’m not clear that any of the measures I mentioned at the outset do that • Do they indicate what you should be doing? In the current situation, hitting the UDA figures seems to be the main, if not at times the only, priority. But then you have to ask, is that really what I want to have to do? • Do they tell you how to do it? Here there seems to be a sad lack of communication, shared purpose and education. A mass of regulatory mumbo-jumbo does not, in my view, constitute practical guidance – nor does the varying interpretation seen across the country. • Do they give effective feedback? Even the data supplied to dentists seems to be out of date, and the opportunity to compare performance with others, let alone to get encouragement, is very limited. The threat of clawback every six months is hardly an inspiration. • Finally, what’s in it for you? Every target system needs to respect and appropriately reward all participants: they should actually want to win. I see no sign of that either – hit the target and you may get a further one, fail and you are on a slippery downward slope. So, based on this assessment, which is the sort of analysis I would expect in any mature business environment, I’d have to say that UDAs score about 0.5 out of 5. Not much better than the system we had for the previous 40-odd years!
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