Photo credit: Ian Thompson, CC BY-SA 2.0
“It is a well-known axiom that what is not measured can’t be managed” (Kaplan and Porter in the opening of their 2011 Harvard Business Review article “How to solve the cost crisis in health care”). This is well-known all right, and false, not to mention downright silly.
Who ever successfully measured culture, leadership, even the potential for a truly new product? Can none of these thus be managed? Did Kaplan and Porter measure the effectiveness of their own recommendations? Indeed, who has even tried to measure the performance of measurement itself, aside from assuming that it is marvelous? And how about measuring the performance of management? (Don’t tell me that increase in share price does this for the CEO. See “The tricky task of measuring managers.”) I guess, therefore, measurement and management can’t be managed.
Guess what? They can. We just have to understand that many of the things that matter most in organizations (and in life) cannot be measured, yet they have to be managed, whether personally or organizationally. Certainly we have to measure what we can; we just cannot allow ourselves to be mesmerized by measurement―which we so often are.
In this article, Kaplan and Porter (2011) provide a list of seven steps “to estimate the total costs of treating...patient populations”:
1. Select the medical condition [specifying the possible “complications and comorbidities"]
2. Define the care delivery value chain…which charts the principal activities
3. Develop process maps for each activity
4. Obtain time estimates for each process
5. Estimate the cost of supplying patient care resources
6. Estimate the capacity of each resource and calculate the capacity cost rate
7. Calculate the total cost of patient care
Don’t look for:
8. Include the costs of doing all this.
But you can get a sense of it by reading the authors’ example of a knee replacement, for which 77 activities are listed.1 Multiply this by elbows, hips, brains, hearts and minds, etc., factor in the frequency of improvements in these activities, which may come one at a time, and you have to wonder if analysts will soon outnumber clinicians in health care.
But the direct costs of their efforts are not the only costs. How about the costs of the distractions to the clinicians―for example, by having to record so much data―plus the costs of the political battles that ensue over who is measuring what, how, where, when, and for whom. Analysts see measurements as objective; contrast this with the political blood spilled over determining them.
Imagine if analysts put themselves through the same scrutiny as some do everyone else. In other words, imagine if they analyzed themselves. Maybe then, instead, we would get more of the following:
Years ago, the British retailer Marks and Spencer decided it was spending too much money controlling the movement of stock in its stores. So instead of a clerk filling out an order form to replenish a shelf, which was handed to another clerk behind a counter, who went to fetch the items, etc., the company got rid of the whole procedure and simply let the clerks go in the back and scoop up what they needed. The company was able to function with thousands fewer clerks and 26 million fewer cards and papers.
Now that’s truly efficient, and a vote of faith in the honesty of the clerks. Health care administrators take note: treated with respect, left to figure out many things for themselves, health care professionals can prove to be at least as trustworthy as store clerks.
© Henry Mintzberg 2016. Excerpted from my new book Managing the Myths of Health Care (forthcoming in 2017).
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1 Not to mention that “Outcomes for any medical condition or patient population should be measured along multiple dimensions, including survival, ability to function, duration of care, discomfort and complications, and the sustainability of recovery” (p. 5).