Goodhart's Law in Healthcare: How Mortality Metrics Endanger Patients

Metrics are becoming false proxies for what we really care about. This trend creates a bad incentive system in many industries. It leads to harmful, unintended consequences. False metrics let people and teams game the system. They manipulate the numbers to create a desired image. They do not address the issues that the metrics are supposed to measure.

A striking example of this is in hospital care, where the stakes are life and death. Hospitals are evaluated on various metrics, especially their mortality rate. This metric shows how many people die after treatment at a facility. It is aimed at measuring the quality of care. But it created bad incentives.

Consider a scenario where a critically ill patient is admitted to a hospital. If the staff thinks the patient will likely die, they may take drastic measures to protect their mortality rate. This could mean refusing further treatment. Or, it could mean forcing the patient's family to transfer them to another facility. This decision often comes after the hospital has made the most money from its services.

By pushing out patients on the brink of death, these hospitals gain two benefits. They maximize their profit and lower their mortality rate. From a management perspective, this appears to be a win-win situation. The hospital maintains a prestigious status with an apparently low mortality rate. This also boosts its financial performance.

However, this practice reveals a fundamental flaw in how we approach metrics. We've tracked the numbers so much that we've lost sight of the strategy. More importantly, we've ignored the human impact of our actions. Implementation of metrics matters a lot. If your strategy isn't aligned with what your customers need, the consequences can be dire.

The hospital example shows a broader issue. False metrics incentivize methods misaligned with the original intentions behind the metric. Instead of improving patient care and outcomes, the focus shifts to manipulating statistics. This can happen in any industry that prioritizes metrics over real progress.

Metrics can help measure performance and guide improvement. But, we must be careful how they are used and interpreted. It's crucial to regularly reassess our metrics. We should ensure they truly reflect our goals and values. Otherwise, they become false proxies that encourage harmful behavior. We must align our metrics with our true goals. We can only then create systems that serve the people they're meant to help.