There is an old saying in measurement, often credited to economist Charles Goodhart: when a measure becomes a target, it ceases to be a good measure. In plain English, once people are judged or rewarded by a number, they find ways to improve the number, sometimes without improving what the number was meant to represent.
Healthcare and senior living are full of such numbers: census, response times, documentation completion, readmissions, falls, satisfaction scores and many more. Understanding this pattern helps leaders choose and use metrics more wisely.
Distortion rarely comes from bad intentions. Most people respond reasonably to the incentives in front of them. Here are some hypothetical examples.
A facility sets a goal for call-light response time. Staff begin to enter a room, silence the light and leave to fetch something, so the clock stops without the need being met.
A team is measured on documentation completion. Staff click through entries quickly to finish them, so the record is complete but not very accurate.
A target to reduce reported incidents leads people to stop reporting them, and the numbers look better while risk grows.
A phone team is judged on call length, so calls get cut short even when callers need more time.
An admissions team measured only on tours scheduled books tours with people unlikely to move in.
In each case, the metric improves and the real outcome stays the same or gets worse.
The number improves suddenly and sharply with no clear operational change.
Other related measures worsen at the same time.
Staff describe workarounds that seem to serve the number.
People are afraid of what the number will say about them.
Data quality questions appear, such as many entries made at the last minute or in bulk.
A metric is usually a stand-in for something harder to see. Keep asking what you actually want. If the goal is that residents' needs are met promptly, response time is only part of the picture. Add measures like resident feedback or time to resolution.
Pairing measures creates balance. If you track response time, also track quality or resident satisfaction. If you track volume, pair it with outcomes. When one is pushed at the expense of another, the pair reveals it.
Metrics used for improvement invite honesty, while those tied to punishment invite hiding. Where possible, use numbers to start conversations and solve problems before using them in performance reviews.
Reward people for reporting errors, near misses and bad news. If bringing up a problem is punished, you will stop hearing about problems.
Sample records to check whether the data matches reality. For example, compare documentation with direct observation or compare call logs to actual callbacks. Knowing audits occur discourages shortcuts.
A number hovering just below a threshold can be suspicious. Look at the whole distribution and at changes over time.
Targets lose meaning as behavior adapts. Review your metrics regularly and change them when they stop reflecting reality.
Write down how each measure is calculated, including what counts and what does not. Changes in definition should be documented, or trends become meaningless.
What decision does this help us make?
How could someone improve the number without improving care?
What would we see in other data if that happened?
Who might be afraid of this number, and why?
What is the companion measure that keeps this one honest?
Numbers matter, but culture matters more. Staff who trust leadership, understand the purpose of a measure and feel safe speaking up are far less likely to distort data than those who feel pressured.
UnityCare IT helps organizations collect and present data accurately, including audit trails that show how numbers were produced. Better data pipelines help, but the real work is deciding what you want to measure and why. We are happy to help with the first and encourage you to take the second seriously.
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