Blog | Thursday, June 7, 2018

The tyranny of metrics, a book review


From the Amazon web site:
How the obsession with quantifying human performance threatens our schools, medical care, businesses, and government
Today, organizations of all kinds are ruled by the belief that the path to success is quantifying human performance, publicizing the results, and dividing up the rewards based on the numbers. But in our zeal to instill the evaluation process with scientific rigor, we've gone from measuring performance to fixating on measuring itself. The result is a tyranny of metrics that threatens the quality of our lives and most important institutions. In this timely and powerful book, Jerry Muller uncovers the damage our obsession with metrics is causing–and shows how we can begin to fix the problem.
Filled with examples from education, medicine, business and finance, government, the police and military, and philanthropy and foreign aid, this brief and accessible book explains why the seemingly irresistible pressure to quantify performance distorts and distracts, whether by encouraging “gaming the stats” or “teaching to the test.” That's because what can and does get measured is not always worth measuring, may not be what we really want to know, and may draw effort away from the things we care about. Along the way, we learn why paying for measured performance doesn't work, why surgical scorecards may increase deaths, and much more. But metrics can be good when used as a complement to—rather than a replacement for—judgment based on personal experience, and Muller also gives examples of when metrics have been beneficial.
Complete with a checklist of when and how to use metrics, The Tyranny of Metrics is an essential corrective to a rarely questioned trend that increasingly affects us all.

Jerry Muller, a PhD in history, first recognized the metrics problem as a department chair. As he struggled with the many forms the administration wanted, he began to read and learn about the problem. In this book, he gives a wonderful historical perspective on metrics and “accountability”. He uses examples from higher education, K-12 education, medicine, policing and business.

Repeatedly he gives examples of the problems of gaming the stats. The act of reporting and rewarding a statistic almost makes that statistic irrelevant. The metric focuses attention towards that being measured, and diminishes focus on other issues.

We have written about this often. We are seeing this now. I recently participated in two sessions concerning the Medicare Access and CHIP Reauthorization Act of 2015. These sessions focused mostly on how to “pass the test.”

The metric designers believe that they are improving quality, yet no studies suggest that even performance improves. Each study that shows the problems induces the same retort; we are early in the development process for performance measures, we just need better measures.

Dr. Muller also writes about the costs of these measures. In medicine, most practices spend considerable money just to report these measures.

Measures can harm patients. Rather than focus on a patient's major concerns, we can become preoccupied with successfully adding to our report card.

While most readers already understand the problem, Muller provides great examples and insights into the discussion. Hospital administrators, legislators, insurance executives and governmental rule makers should all read this book. Sadly, they will continue to believe in metrics despite the rational arguments against most metrics.

Metrics can help us examine our own successes and failures. Muller gives some great examples of the positive metrics that we develop for ourselves. He distinguishes such metrics from the “accountability” metrics.

I highly recommend this book. It will take around three to four hours to read but it may induce even more anger over metrics.

db is the nickname for Robert M. Centor, MD, MACP. db stands both for Dr. Bob and da boss. He is an academic general internist at the University of Alabama School of Medicine, and the former Regional Dean for the Huntsville Regional Medical Campus of UASOM. He still makes inpatient rounds regularly at the Birmingham VA and Huntsville Hospital. His current titles are Professor-Emeritus and Chair-Emeritus of the ACP Board of Regents. This post originally appeared at his blog, db's Medical Rants.