Outcomes vs Outputs

There is a view that a process is defined that which changes an input into an output.  The consequence of this approach is that the output becomes the focus.  Great efforts are made to measure outputs, to use these as the basis of improvement targets and then expend even greater efforts to meet said targets.  Completely forgetting, on the way, why we implemented the process in the first place.

I’m certainly not saying that it’s wrong to consider or measure outputs – rather that it’s foolhardy to see them as the objective.  When documenting processes it’s important (probably vital, in fact) to clearly define the objective of each, both as a process in isolation and within the overall context.  Without the latter, the local objectives and, consequently, the immediate and measurable process outputs, become the primary driver.  Targets are set and people’s livelihoods depend on meeting them.  For example:

  • Health services are set targets to treat patients within a specific timescale mean speed takes precedent over the effectiveness of the treatment.
  • Contracts are placed on the need to meet budgetary targets rather than the need for whatever is being contracted.
  • Business managers maximise short-term profit targets at the expense of longer term company viability.
  • The safety of personnel performing plant inspection work is made paramount to meet this year’s safety targets – but at the expense of the longer term safety of the plant.  [I’m not saying safety shouldn’t be paramount but it has to be considered within the overall context.]

Perhaps some of the more extreme examples to illustrate the point but look at the more local processes in your own organisations – do you have processes that are measured by how much paper they generate.

It’s necessary to periodically step back from the focus on individual process outputs and, instead, look at what are the desirable outcomes.  Are patients being made well (or even surviving their treatment)?  Are the contracts delivering the necessary services to the end users?  Is the business sustainable (in the broadest sense)?  Is the plant being kept safe and operating efficiently?

Some outcomes can be measured and it is tempting to set targets to drive and monitor improvement – the caveat is that it is easy to slip back into measuring outputs, just on a grander scale.  Many outcomes, however, are difficult to measure, at least, measure objectively; many will be subjective – which is something anathema to many “quality experts”.  It goes against one of the eight quality management principles now enshrined in ISO9000: Factual approach to decision making.  If it can’t be enumerated (i.e measured and assigned an unequivocal numerical value) it is of no use.  Unfortunately, that risks consigning quality management to the realms of bean-counting.  In another section, I’ve written about the difficulty just coming to an agreed definition of “quality”.  One widespread use of the term is in “quality of life”; almost everyone will have a view and their own measurement.  I doubt we will ever find a universally agreed way to measure it – yet does that make it invalid?  It could be argued that everything we do affects this unmeasurable outcome – that this is the ultimate objective of all enterprise and business (albeit some focus on the quality of life for a specific group at the expense of others).
In our rush to measure success, lets not be sidetracked by the details; rather, step back and take a look at the bigger picture.

(Posted as a blog 11th March 2013)