Unintended consequences of meeting health targets

The Government’s health targets had unintended consequences for one senior doctor at a large DHB recently.  Doing what was right clinically, she took a few extra minutes to reassure an anxious young patient she was preparing for surgery and to correct another surgical patient’s erroneous information about what was going to happen.  Satisfied that proper attention had been given to the patients they were about to operate on, the theatre team then worked quickly and efficiently to complete their list.  It was something of a surprise therefore when a charge nurse asked which of them had turned up late.  None of them had, they explained.  It turns out that the patient management computer system had recorded the list as starting late, and then subsequently recorded all of the operations that followed as also starting late.  As our senior doctor noted – the list did not in fact start late; it started at the clinically appropriate time once the patients involved had been attended to properly.  Unfortunately, there was no category for that in the computer…