Gaming the KPIs?

Berenson and Kaye have criticised US plans for performance measurement of doctors.  It leads to gaming the system.  When somebody measures your performance you will ignore most of the things you don’t get credit for and manipulate the indicators that do bring you credit.  Read their arguments and readers’ comments here: Grading a Physician’s Value — The Misapplication of Performance Measurement.  Paying GPs to meet unhelpful, bureaucratic targets hasn’t worked in the UK; it’s just skewed everything differently.

However, UK pathologists have become keen to have Key Performance Indicators (KPI) to show the “quality” of the labs’ work and for UKAS to assess under ISO 15189.  You can read about it on p15 of the October 2013 edition of the ACB News.


Will the users ever care to see the UKAS assessment?  Will it tell them anything they didn’t know already from the service they received?

But the real purpose of such measures is revealed by Fred Reed: disguising unemployment through the creation of non-jobs,

“We see that the market for merchandise and the labor market move in parallel: pretend jobs and phony demand. We have what looks like high endemic unemployment among people who were in the work force. Among these are highly intelligent folk who now can´t get work managing a McDonald´s. They are overqualified, they are told.

“Where is it heading, is what I want to know. In principle the manufacture of anything can probably be automated. So, I claim—watch—can a lot of routine administration. Do we accept a growing level of idleness, putting more and more people on welfare, unemployment comp, disability, and so on? Or keep them working in makework jobs? While many actually useful jobs cannot be automated— Toyota mechanic, dentist, reporter—enough can be to change the shape of society.

“Do we gradually become an almost total welfare state, not for reasons of ideology but because people have to eat and there in nothing for many of them to do? Do we end up just issuing people goods that spew from phenomenally fertile factories?

“Beats hell out of me.”

Fred Reed

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