Article

You Can’t Manage What You Don’t Measure

By Collection: Blog
Measuring Success
This editorial was originally published in the July/August 2022 issue of Journal of Healthcare Management, one of ACHE’s leading journals. Members receive access to the digital edition of JHM as part of their benefits. Not a member? Join in July for half off.

There is an adage in management that asserts “You can’t manage what you don’t measure.” By and large, it is hard to argue with that sentiment. Good metrics that accurately reflect the phenomenon of interest and are actionable can be very useful for organization leaders.

Nevertheless, that metrics mantra has some darker corollaries that need to be kept in mind. Let us consider three of them.

  • Corollary 1: People will manage to their metrics—and maybe little else. If there is a single metric that drives a unit’s performance evaluation or revenue generation, it will be the focal point of the people who work there. In addition, they will frequently ignore other activities that might make a unit more effective or efficient. Work-arounds that compromise quality but keep things on schedule are a classic example. The truly good systems have multiple metrics that reflect multiple aspects of the processes and outcomes that lead to success for all.
  • Corollary 2: We will manage to the metrics that are readily available, regardless of their true representation of our strategy. The classic joke that illustrates this point is one about looking for your car keys under the lamppost at night because that’s where the light is. It is occasionally difficult, if not impossible, to collect data points or metrics that would be desirable for management purposes. It turns out that the tendency to replace strategy with metrics—a practice called surrogation—is quite pervasive. The most common case of surrogation involves consumer satisfaction metrics. This is especially true in sectors where the customer lacks the education and experience to make comprehensive assessment, such as healthcare. In fact, patients fall back on surrogate metrics such as organizational reputation as they try to evaluate the service they received.
  • Corollary 3: Metrics will be gamed. When metrics are tied to incentives or compensation, they will invariably be gamed for advantage over time. In health insurance, we see this in the form of upcoding procedures. In the delivery space, gainsharing occurs in referring patients to other services that providers benefit from financially.

Metrics have their downsides, but they are not going away. Fortunately, the Journal of Healthcare Management receives many fine manuscripts that identify the metrics that matter and help managers factor them into operational strategies. We publish the best of those manuscripts in JHM, and this issue is no exception.

In This Issue

Jonathan B. Perlin, MD, PhD, FACMI, is the newly appointed president and CEO of The Joint Commission, which wields one of the most influential metrics that health systems pursue: accreditation. Dr. Perlin assumed his current role in March after leading clinical operations in the for-profit and federal healthcare sectors. In our opening interview, he shares his views on the future of healthcare and accreditation and identifies the points of “discontinuity” within our healthcare system.

Our yearlong series of various perspectives on the future workforce continues with the thoughts of Brenda Battle, RN, senior vice president for community health transformation and chief diversity, equity and inclusion officer at University of Chicago Medicine. “When our workforce doesn’t represent the people we serve, it fails the organization on several levels,” Ms. Battle maintains. She outlines UChicago Medicine’s successful efforts to increase its diversity, reflect its community, and ultimately provide better care.

(Note: Brenda also participated in a webinar with ACHE last year, “The Role of Hospitals and Health Systems in Gun Violence Prevention.” You can view the free recording for ACHE Qualified Education credit hours.)

Every year, JHM features student-developed papers that have been recognized at the American College of Healthcare Executives (ACHE) Congress on Healthcare Leadership. The first-place winner in the graduate division of the 2022 ACHE Richard J. Stull Essay Competition in Healthcare Management is Allison J. Weidman of the University of Minnesota School of Public Health. She also tackles workforce issues. It’s an employees’ market, and healthcare employers must adapt, she warns.

The first-place winner in the undergraduate division is Warren A. Poquiz of Texas State University’s School of Health Administration. He offers a primer on blockchain technology. Best known in the financial sector, blockchain’s underlying data-tracking structures can have many applications in healthcare. For example, the ability to track changes in health records over time presents the potential for valuable new research and management tools.

This issue’s peer-reviewed article section begins with a piece by Erin E. Sullivan, PhD, Amber L. Stephenson, PhD, and Aaron R. Hoffman, DO. Employing sound qualitative research methods to cover a complex topic, they look at how clinicians transition into administrative leadership roles and identify ways to facilitate their transition.

Jennifer O. Strahan, DSc, FACHE, Larry R. Hearld, PhD, Nathan W. Carroll, PhD, John McWhorter, DSc, and Jeff M. Szychowski, PhD, investigate whether hospitals realize significant operational and financial gains when applying the Baldrige Excellence Framework to their organizations.      

Dawn Wawersik, RN, CHSE, CNE-cl, and Janice Palaganas, PhD, APRN, ANEF, FNAP, FAAN, look at how to create a psychologically safe space for error reporting. In the pursuit of useful metrics, error reporting and tracking are among the greatest challenges for health administrators.

I hope that you enjoy this issue of JHM and find it relevant to your needs. One of our most important metrics is feedback from our readership. With suggestions for editorial or research topics, please reach out to me at ewford@uab.edu.