Metrics guide our focus and our expectations. Choosing the right metrics, however, can be a complex task.

Consider the following two examples of efforts to make sweeping changes based upon the way performance is measured.

Medicare is no longer paying for treatment that is necessary to remedy an injury resulting from a medical mistake. The requirement that hospitals “report on 42 quality measures” is stimulating some changes in day-to-day practices. For example, The New York Times reports that hospitals are implementing simple, yet effective practices such as the use of “time out” towels over trays of surgical tools to ensure none are left behind. Opponents raise the concern that expectations do not allow for factors that are out of the control of the hospital, but the changes seem to be here to stay.

Similarly, the educational sector possesses its own example of a radical approach to pay-for-performance. According to The New York Times, the mayor and chancellor of Washington are proposing a new system that will turn the tenure based system on its head. Under the proposal, the typical tenure based pay system will remain in place, but teachers will also have the choice of undergoing a skills evaluation and giving “up tenure protection — for the first year of the new contract.” Those individuals then have the potential to earn a higher salary, based upon their performance.

It will take time before we see the full impact of these initiatives, but they do illustrate the complexity that lies behind the choice of metrics. For both of these examples, the chosen metrics seem to be forcing a paradigm shift. For example, The New York Times reports on potential savings for the medical system and that “The real money, many health economists believe, may come from reorienting the payment system to encourage prevention and chronic disease management and to discourage unnecessary procedures.”

These are just two examples of how metrics are a part of an extraordinary effort to ensure the definition of performance is synonymous with quality.

References:

“Merit and the D.C. School System.” The New York Times [www.nytimes.com]. October 2, 2008.

Sack, Kevin. “Medicare Won’t Pay For Medical Errors.” The New York Times [www.nytimes.com]. September 30, 2008.