Law & Governance
What Gets Measured, Gets Done
The use of performance indicators can be a powerful driver of an organization's decisions and activities, particularly when coupled with consistently applied consequences. Given that the saying "What gets measured, gets done" is often true, it is imperative that both the actual choice of indicators and the process of how indicators are selected be carried out in a thoughtful, comprehensive and evidence-based manner.
A second issue that must be incorporated into a good suite of financial indicators concerns sustainability and long-term investment. Short-term thinking in training, information systems, technology adoption and leadership development can be inadvertently encouraged through rigorously enforced financial performance indicators at the expense of broader system goals.
A third key element in selecting effective indicators is to be mindful of the law of "unintended consequences." Because indicators can be powerful motivators and drivers of behaviours, poor choices not only can be ineffective but can create the opposite effect to what is desired.
The process undertaken by the Ontario Hospital Report Research Collaborative (HRRC) panel is a particularly interesting one. It sought to ensure, firstly, that a broad range of measures was identified and, secondly, that the potential measures were evaluated for effectiveness both by data analyses and by an expert panel of researchers and practitioners.
The common pitfalls in choosing indicators - namely, that the list is too narrow with important measures not considered, or that indicators may actually not be useful (or may even be harmful) in guiding behaviour - have been largely negated through the breadth and magnitude of the methodology used by the HRRC. Performance indicators are critical elements in improving accountability for outcomes. They provide important information for decision-making and can be powerful motivators if linked with incentives. Choosing the right indicators is fundamental.
The process undertaken by the HRRC is a unique marriage of research (through extensive data and evidence) with practical management experience. It should result in a set of indicators that will be effective and useful for hospitals, particularly when aligned with other system indicators such as health outcomes, sustainability and integration with primary care.
About the Author(s)
Ida Goodreau is the president and chief executive officer of Vancouver Coastal Health Authority, Vancouver, British Columbia.
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