For content related to management
I precipitated a recent online discussion about healthcare’s obsession with measurement (quality metrics is the current buzz phrase) when I quoted two aphorisms that highlight some problems with metrics and targets:
Goodhart's Law: "When a measure becomes a target, it ceases to be a good measure,"
Campbell's Law: "The more a metric is used, the more likely it is to "corrupt the process it is intended to monitor."
One comment rubbed me the wrong way because it implied that measurement reduces harm:
The problem with bureaucracy is reluctance to respond to change. Its motto is 'Ready, aim, aim, aim, aim …' It just can't pull the trigger!
The bottleneck is always the top of the bottle.
- Peter Drucker
Imagine that you want a boat. You tell someone to build or buy you a boat, and tell them to send you a bill. What would you get? A kayak? A windsurfer? A boat for waterskiing? A sailboat. A party boat? A cruise ship? A submarine? A battleship or destroyer? You probably would not get what you want. Very likely you would end up with something expensive - that you cannot use.
Before you build or buy a boat, you need a defined goal and a process:
"The art of progress is to preserve order amid change and to preserve change amid order. "
(Alfred North Whitehead)
Our job – though many of us actually see it more as a calling than a job – is to care for patients.
A professional colleague and I were discussing (bemoaning) how hard it is to do quality primary care. She asked why I bothered to keep pushing for change in the face of so much institutional resistance and evidence that it was pointless. I told her, what we put up with is what we end up with.
In return, I asked her why she didn't push back and demand change if she is so unhappy about the way things are?
Her response: "Well, I watch you, and I can see that it is pointless."
I found a snippet in my Evernote file, sadly without anything citing a source. I have adapted it to fit my experience with Clinical Quality Improvement activities. I suspect it is broadly applicable…