Monitoring and metrics are important but taken to excess are best wasteful or at worst detrimental to the goals they aspire to achieve. This key is about achieving balance. Strategies must be deployed to ensure targets are met with minimum monitoring.

It cannot be stressed enough that it is difficult to develop plans and strategies that optimise monitoring.

Level 1

Targets and workloads are aggressively monitored. Progress and targets are posted at various locations of the practice, are reported at every meeting and staff check and work daily to meet those targets. There is no recognition that excessive monitoring is wasteful. The belief will be that if it is not being monitored the target will not be met.

• Stop daily monitoring.
• Provide training, or promoting the idea that monitoring can be wasteful and that the role of the team is different to the role of a target or role.
• Nominate specific staff to monitor specific goals and targets, reducing duplication.
• Float the idea that teams can find targets/ goals can be met with the minimum of monitoring.

Level 2

At level 2 staff understand that monitoring can be wasteful. However, this is not enough as there is a fear that targets will be missed if monitoring activities stop. Until this is addressed then monitoring will continue and will not be engineered out of the practice processes.

• Promote the idea that monitoring is not too stopped just optimised.
• List the goals and targets that need to be met.
• Systematically design and build strategies that meet goals/ targets listed. Use Improvement Events to help build consensus for changes.
• Use objective fulfillment sheets to state the goal/ target, the strategy/ system used and where, when & who will monitor the progress.

Level 3

• The implementation of strategies/ systems have been implemented for 50% of the goals/ targets.
• Encourage SGA’s to look at smaller undocumented monitoring.
• Look at inventory for wasteful monitoring in conjunction with Key 4.
• Build into systems alarms that indicate disruptions in targets being met. e.g Staff sickness

Level 4

As systems come into place to alerting if there are issues with meeting a target or goal the length of time between checks can be increased. At level 4 there is a high level of trust in the systems/ strategies employed. Staff are more relaxed that targets can be met.

• Employ Quick Changeover Systems to deal with disruptions in the systems/ strategies to meet goals.
• SGAs are systematically looking for improvements to reduce monitoring.
• Use cues for events, eg. bell noise for new emails. Rather than checking emails repeatedly.
• Practice wide goals or strategies are being checked at least 4 times longer that previously.
• Fill the time spent monitoring with other tasks. At level 4 the monitoring levels can free so much time that employees may fear for their jobs. Encourage them to find work elsewhere or give them additional tasks. These could be identified in Improvement events or SGAs

Level 5

At level 5 monitoring at the practice accounts for less than 2% of all admin time. Given the various targets that are enforced, outside of a practices control means monitoring can not be completely eliminated. Strategies and Quick Changeover Systems are all in place.