Care by Design understands the fundamentals of organisational development, service management and leadership for the 21st century public sector organisation and communities.

Tools described on this website involve taking performance measures of a process. These tools are unlikely to be of any use to you if you have not made sure that you are using the appropriate measure for your particular situation. Even worse, if you have chosen an inappropriate measure you are in danger of being led astray and fooled into making the wrong decision. So, what are the right things to measure?

If you have not already been there, it would be useful for you to first visit our pages on:

  • Clarifying True Purpose and Value,
  • Identifying and Measuring True Demand, and
  • Identifying and Measuring Capacity and True Capability.

The importance of measuring the right things is discussed there.

Take Value, for instance. What is important to the patient? What measure do you think they would use to decide how well you are satisfying their needs? If you compare the answer to this question with the performance measure you are actually using, you may find that they are not the same. Why? What effect is this likely to have?

Do you measure activity in the process, e.g. "the number of patients treated per month"? Will this kind of measure really tell you how well a process is performing?

A true performance measure is one that tells you how well the process is achieving its purpose. If the purpose is to meet demand and also treat patients "right first time", a true performance measure must reflect this. The "number of patients treated per month" does not necessarily have to be concerned with "right first time".

Unfortunately, organisations often measure activity (i.e. looking busy) rather than purpose. Activity measures are easier to achieve! Some other examples of activity versus purpose measures would be:

Activity Measure

Purpose Measure

Number of site visits per week

Number of successful / completed visits per week

Number of telephone calls taken per day

Number of queries/problems resolved per day

Number of training courses delivered

Number of people successfully applying the new skills

Here's another way that organisations fool themselves into wrong thinking :

A department carrying out a routine job is given a target of getting jobs completed in three hours or less. In Month 1, 60% of the jobs were completed within the target. In Month 2, only 50% were completed within the target. Things have obviously got worse.

Have they?

Here are the Histograms of the job completion time data for Months 1 and 2:


Published 1st January 1970