Interestingly Prime minstrel Blair recently showed an understanding of systems thinking (specifically how targets can result in worse performance, when targets result in distortion of the system rather than improvement). In the targets in health care case the easy “politics of the warm fuzzy feeling” would be to declare victory in setting targets. In that case PM Blair realized that while the data might look better the actual results might not necessarily be better (when the system is distorted or the data is distorted).
Measures are a proxy for the actual situation and far too often people forget the proxy nature of data in process improvement.
I would agree the target of a .7% of GDP as a aid goal is an activity/input measure. It is like measuring the amount of dollars spent on polio vaccination. Often (though to a lesser extent today than 10 years ago) the amount of money being spent is used as the measure of how much is being done (instead of a measure of outcomes). The best measure for the polio example, is the reduction, or elimination of polio in the population. The amount of money being spent is a measure that tells you something; but an outcome/result measure of polio within the population, is what should be used to measure success. At the same time, without the commitment of funds by the government to the vaccination program (and, in fact, research and development before that) the resulting reduction in polio would not have been achieved.
I would say most measurements used in any Six Sigma effort would be process measures. The problem in many efforts is not in having process measures, it is in the failure to use outcome measures.
The millennium development goal measurements should be the focus of success or failure. Two interesting things about those goals. First they actually have outcome goals; that is much better than most efforts that don’t even bother to have them (often they have what they believe are outcome measures but they are in fact not they are either process or activity/input measures). Second consultants will often say you need to set achievable goals and use as unrealistic a goal of “eliminate hunger worldwide” as the prototypical example of a bad goal. The first millennium goal – “Eradicate extreme poverty and hunger.” I don’t quite understand their measure for this goal though as is listed as “1) Reduce by half the proportion of people living on less than a dollar a day
2) Reduce by half the proportion of people who suffer from hunger”
It seems “Eradicate extreme poverty and hunger might be the long term goal, or vision, and reducing by half by 2015 is the real goal now.
However the millennium goals really should have operationally defined measurements specified. For example “Ensure that all boys and girls complete a full course of primary schooling” – there is no discussion of how that will actually be measured (although it may be listed somewhere since I only looked quickly).
This millennium project is obviously a huge project. The summary goals (those listed on the web site at highest level), while fine, will need to be supplemented with lots of outcome measures for the populations that together make up the entire population covered by the goals. At the very least the success at the level of countries will vary greatly (and likely even within countries that will be true).
If we take as a given the Declaration which each country has done, I believe, then the goals are set. The declaration obviously states that each country is not just responsible for achieving these results within their country but (specifically the industrialized countries) also to take significant action to help all the countries achieve these results. I think it would be a wonderful step forward, if countries that actually make progress are rewarded with additional resources. It seems to me without additional resources, in many countries there is no chance for success (and in fact I think it is pretty obvious that we will not succeed in actually meeting the goals). We can make significant progress but even just that is probably unlikely.
I agree it would be greatly beneficial if the method to reach those goals included a measurement system that provided good outcome and process measures (not just activity measures like spend so many billion dollars). And those measures were used to help determine what was working well and what was not. And then resources were focused where they had been effectively used and where they were not changes were made. The PDSA method should be used to test out potential good ideas on a small scale and then measure the success and invest in things that work and don’t invest in cases when results are bad. The failure to focus on results, and basing development efforts on all sorts of ill conceived considerations, is a large part of the reason many of the problems are as bad as they are now.
I think there is hope for progress in the attempts to improve the situation for people worldwide. However, it will not be easy. A great first step would be to hold accountable those leading the effort (the United Nations, individual countries [most especially the security council, etc.). If we could even get to the point where the progress was visible and failures were an embarrassment to those in power, then we will increase the odds of success. But I doubt failing to reach the outcome measures will be seen as a problem that must be addressed and fixed, instead of explained away.
While it violates some of the “quality management” principles I would like to see teams of nations formed to meet these goals – within the teams. Then we could measure the success of those teams in reaching the goals within the team. I think there are 2 huge problems with succeeding at these goals. First they are very challenging due to the huge scope of the problems. Second no-one is accountable and it is easier to obfuscate and explain away failure than to make real efforts to try and succeed. My concept is that with a team setup, if certain teams were achieving much better results, I believe there would be pressure to perform placed on the other teams. I know this is not going to happen but I think it would improve the odds of success. This could also be done in the existing system if the governments really take responsibility to succeed but I don’t see that as likely.
One reason I have an interest in the millennium goals has roots in my childhood. My father, Bill Hunter, was a professor (of statistics and engineering), worked on appropriate technology (see a great example of success in this area) and co-author of Statistics for Experimenters which is one of the classic text used by Six Sigma practicioners (the first edition was published in 1978 and second edition was published this year). As a child I lived in Singapore and Nigeria for a year as he was a professor in those countries. Singapore has pretty successfully improved, as measured by the millennium goals while Nigeria has not. Traveling during those years, and later, I was able to glimpse some of the conditions in many countries.
I do not think the success of a country is pre-determined. If a country is committed they can make substantial progress – some countries might need more resource help from others. But the commitment of the leadership of a country and of the people themselves is the most important factor. Economic success (which is required for many of the goals to be met) must be achieved, it has often required hard work and investment. That requires forgoing consumption of at least a part of the GDP growth to grow an economy. This is true even if you get large external resource additions, like the Marshall Plan, and if the people have very limited economic resources.
Trickle up is my favorite charity and an organization that is very effective at providing resources that allow people to make better lives for themselves. Trickle Up is focusing on 14 countries. I think some group of charities, foundations and countries could provide the same focus toward the Millennium Goals.