TY - JOUR T1 - Performing or not performing: what's in a target? JF - Future Hospital Journal JO - Future Hosp J SP - 167 LP - 172 DO - 10.7861/futurehosp.4-3-167 VL - 4 IS - 3 AU - Julie Eatock AU - Matthew Cooke AU - Terry P Young Y1 - 2017/10/01 UR - http://www.rcpjournals.org/content/4/3/167.abstract N2 - This paper analyses how providers have coped with the 4-hour target over the past 7 years. To do this, we used publicly available data from NHS Digital to track how long patients remain in accident and emergency (A&E) departments and their ‘attendance disposal method’. Using this tool, we compared two A&E departments with similar arrival patterns and age profiles and that perform equally well against the target in a specific year. However, these hospitals exhibit very different underlying behaviour. Over 7 years, both exhibit a general increase in length of stay, increasing number of patients being admitted in the 20 minutes preceding the 4-hour target, and rising numbers of patients that breach the target. Despite the two hospitals having similar input profiles there is a 12 percentage point difference in the number of patients who leave the A&E department in the last 20 minutes. This operational information is not visible simply by monitoring the single existing metric. We conclude that the 4-hour target in isolation is an inadequate measure and we reflect on the difference between selecting measures for policy-level review, and for operational management. A link to download the graphs for each A&E in England is available. ER -