Review of targets and indicators for health and social care in Scotland

Designing a more effective system

58. So far, the targets and indicators used in Scotland have been associated with significant improvements in performance. We could make the system more effective, however. Albert Einstein is credited with saying: 'we cannot expect to solve all our problems if we use the same thinking we used when we created them." We need to overhaul the system using the principles outlined in previous sections. Focussing on indicators as a means of determining progress of the system towards an outcome and coproduction of the methods by which indicators will improve by those who deliver the service, those who are accountable for its delivery and those who use the service all seem necessary if we are to achieve the best possible result.

59. We will not achieve a system which staff or recipients of the service feel committed to if one individual decides what should be measured. Accordingly, it would be most appropriate if, for each set of indicators, working groups were to agree what the actions most likely to improve progress were. These working groups could involve Health Boards, IJBs, Local Authorities and the Third and Independent Sector organisations. Important to the improvement process is the collaborative sharing of information as to what works in producing progress.

60. The assurance that explicit processes are in place, agreed by staff, managers and people who access the services, to deliver continuous improvement in indicators would resolve many of the issues of the current system.

61. The experience of programmes such as the early years collaborative has shown how collaboration across organisational boundaries can transform outcomes in a complex system. We should use that experience to achieve progress in delivery of a better society. To emphasise the fact that improvement is achieved when joint working is effective, the indicators have been grouped according to a life course or topic based approach.