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What will 2013 be known for? What will be the one defining moment which when we look back will fix the year in our memories. Perhaps a glorious summer of sport or the royal birth, perhaps the harsh winter or the endless baking hot days of summer, or perhaps 2013 will be known as the year in which successive reports and scandals bounced the public gaze back and forth between the NHS and the BBC. Professor Sir Bruce Keogh’s report into the NHS, and fourteen trusts in particular, has yet again fixed the idea of an organisation in crisis firmly into our minds. And whilst our own individual view on the NHS is coloured by personal experience very few could now refute the argument that some parts of the NHS simply failed to deliver. But where was the failure; was it in meeting up to expectations of quality care, in providing the best care possible for patients or in providing a cost-effective efficient service? Professor Sir Bruce Keogh sheds some light on the question in his introduction to the report. Tellingly in one paragraph he says: “Our NHS is the only healthcare system in the world with a definition of quality enshrined in legislation. It is simple. An organisation delivering high quality care will be offering care that is clinically effective, safe and delivering as positive an experience as possible for patients. These are not unreasonable expectations. The NHS should be good in all three. Being good in one or two is simply not good enough.” So how did the ideal of quality care fail? In truth every trust and every failure is different but two themes seem to run through this latest report and those which preceded it; firstly a disconnect between management and healthcare professionals and secondly the idea that targets should come before care. And these themes are not unique to the NHS. Far too often we see leaders gaily embarking on projects without any connection with employees and far too often we see the desire to provide high quality customer care quashed in process and procedure and the need to meet targets. This disconnect can often be laid firmly at the door of those who believe that goals and targets are interchangeable and in the process any pretence towards value simply disappears. Let’s give you a wholly fictitious scenario. PPI may have been conceived as a means of adding extra value to customer services and helping customers in their hour of greatest need. Bank executives may therefore have gone out of their way to encourage its take up and to help to keep the product in the minds of employees, targets were set. In that one action of setting targets pressure was put on employees, adding value went out the windows and mis-selling took its place. Or look at waiting times in the NHS. Targets were designed to improve the speed of care but in some cases they directly lead to a fall in quality standards. For organisations which want to provide exceptional levels of customer care, it is important that goals are not confused with targets and that company values are embraced by all. This means taking steps to align the culture with the values and to actively engage employees. Why does engagement matter? Well Professor Sir Bruce Keogh’s report said that “From talking to people in the 70 focus groups we conducted as part of the review, it was clear that staff did not feel as engaged as they wanted or needed to be: yet academic research shows that the disposition of the staff has a direct influence on mortality rates.” Employee engagement outside the NHS may not have such a drastic consequence but disengaged employees will affect profitability, staff turnover and sickness rates, wastage, company reputation and a host of other measures. There is nothing wrong in setting goals, there is even nothing wrong in setting targets but the outcome will only be a success when those goals and targets are draw up with the company values in mind and employees are actively engaged in stepping up to live those values every day.