"What happens when bad measures drive out good is strikingly described in an article in the current Economic Journal. Investigating the effects of competition in the NHS, Carol Propper and her colleagues made an extraordinary discovery. Under competition, hospitals improved their patient waiting times. At the same time, the death-rate following emergency heart-attack admissions substantially increased. Why? As targets, waiting times were and are measured (and what gets measured gets managed, right?). Emergency heart-attack deaths were not tracked and therefore not managed. Even though no one would argue that the trade-off - shorter waiting times but more deaths - was anything but a travesty of NHS purpose, that's what the choice of measure produced.
As the paper observes: 'It seems unlikely that hospitals deliberately set out to decrease survival rates. What is more likely is that in response to competitive pressures on costs, hospitals cut services that affected [heart-attack] mortality rates, which were unobserved, in order to increase other activities which buyers could better observe.'
In other words, what gets measured, matters. Measures set up incentives that drive people's behaviour. And woe to the organisation when that behaviour is at odds with its purpose. Imagine the cost to NHS morale (one of Deming's unknown and unknowable figures) of the knowledge that managing to the measure resulted in more deaths - the grotesque opposite of its aims. Hospitals are the extreme example of a general case. As such, they allow us a definitive rephrasing of our least favourite management mantra. What gets measured gets managed - so be sure you have the right measures, because the wrong ones kill."This thinking is based upon this article in the Economic Journal, whose abstract makes the situation rather clear:
In other words targets are a complete waste of time, not only do they increase the bureaucratic burden but they result in the lowering of standards in anything that is not directly linked to a measured target. The government's answer to this has been to produce more and more targets, but you cannot measure everything, so anything without a target attached is still left to rot, while the system becomes more and more innefficient as the bean counters and bureaucracy proliferates exponentially. Targets need to be decimated.