Targets, claim their defenders, are simple, they provide focus, and they work. Yes, they do. Unfortunately, these are also their fatal flaws. The simplicity is a delusion. As Russ Ackoff put it: ‘The only problems that have simple solutions are simple problems. The only managers with simple problems are those with simple minds. Problems that arise in organisations are almost always the product of interactions of parts, never the action of a simple part.’

To focus on the individual parts and ignore the whole always makes things function worse at a system-wide level. Thus, to meet financial and waiting-time targets, Maidstone drove up bed occupancy rates. But that compromised cleaning. At the system-wide level, the cost was making the hospital more dangerous to patients than staying at home.

And if enough pressure is applied, people will meet targets - even if they destroy the organisation in doing so. As quality guru W Edwards Deming put it: ‘What do “targets” accomplish? Nothing. Wrong: their accomplishment is negative.’

These are systemic faults, which is why such regimes can’t be refined by setting ‘better’ or fewer targets. Deming added: ‘Management by numerical goal is an attempt to manage without knowledge of what to do’. This is what makes it so attractive to bad managers. Unfortunately, in absolving them from the effort of thought, it is also junk management