The Weekly Reflektion 28/2023

‘What gets measured gets done’ is an expression that is often used in Management books as a key to achieve objectives. Key Performance indicators (KPIs) are often set up and at the monthly meetings the indicators are reviewed often with the traffic light approach just to make sure everyone knows the ongoing status. ‘Green’ we can relax, ‘Amber’ we need to watch out and ‘Red’ we need to do something to get back on track. The KPIs sometimes dominate the management attention so hopefully the KPIs represent what is important for the company. When the KPIs do not represent what is actually important then the management may not focus on the right things.

Do your KPIs lead to the tail wagging the dog?

Looking after the elderly is becoming a major challenge insociety as people are living longer and can live with more serious disabilities than before. Advances in medical science cure or keep serious illnesses at bay, and medical technology is continually developing for replacement of worn and diseased parts. The quantity of life is relatively easy to measure however what about the quality of life?

Atul Gawande is a doctor living and working in the United States. His family is originally from India. Gawande is the author of ‘Being Mortal’ and his insights into care for the elderly are well worth reading. As a surgeon Gawande’s views on treating people were based on modern medicine triumphing over the dangers of disease and injury and making people well again. The patient comes to the doctor and the doctor fixes the patient. As his father aged, Gawande started to recognise the inescapable realities of aging and death and that sometimes what medicine can do often runs counter to what medicineshould do. Through his own experiences, his study of elderly care in practice and review of research on the subject he experienced a radical change how he regarded patients and patient care. He recognised the failure of doctors to discuss uncomfortable issues and the false hopes created through faith in the medical treatments. He saw the focus on safety for the elderly over their well-being. He noted the drive for efficiency that leads to less choice for the people on what they can wear, what they can eat and when they have their meals. The elderly people were no longer people, they had become objects in a system that was keeping them alive, and for what? Yet research showed that elderly care that was focussed on the people and their fears, concerns, hopes and desires often resulted in a significant reduction in the cost of medical treatment. A win-win situation one would think. Not according to the KPIs that were used.

Typical KPIs associated with elderly care were accidents e.g.,slips, trips and falls; efficiency of care e.g., how many elderly people a carer could look after, and hygiene and cleanliness. The ideal situation for satisfying the KPIs was people sitting still, meals at designated times, washing and dressing when the carers were available. There were no KPIs for happiness, dignity, and quality of life. There were in fact no KPIs for the things that actually mattered for the people in care.

Sometimes the KPIs used in organisations become like the ‘tail wagging the dog’. What is important for the organisation is being controlled by something that is much less important. This can distract attention from what really matters.