Quality Supply of Medical Services

P4P: Be careful what you measure

Simon Caulkin, management editor of The Guardian, has a great article titled “The rule is simple: be careful what you measure.”  The article discusses the fact that measuring performance leads to better performance on the dimensions measured, but can often lead to significantly worse performance on the unmeasured dimensions.  For instance,

What happens when bad measures drive out good is strikingly described in an article in the current Economic Journal. Investigating the effects of competition in the NHS, Carol Propper and her colleagues made an extraordinary discovery. Under competition, hospitals improved their patient waiting times. At the same time, the death-rate following emergency heart-attack admissions substantially increased. Why? As targets, waiting times were and are measured (and what gets measured gets managed, right?). Emergency heart-attack deaths were not tracked and therefore not managed. Even though no one would argue that the trade-off – shorter waiting times but more deaths – was anything but a travesty of NHS purpose, that’s what the choice of measure produced.

Hat tip to DB’s Medical Rants for this one.

The Retired Doc’s Thoughts has an interesting post as well.