What's Measured Is Not Necessarily What Matters: A Cautionary Story from Public Health

A systematic review of the introduction and use of outcome-based performance management systems for public health organizations found differences between their use as a management system (which requires rigorous definition and measurement to allow comparison across organizational units) versus for improvement (which may require more flexibility). What is included in performance measurement/management systems is influenced by ease of measurement, data quality, ability of organization to control outcomes, ability to measure success in terms of doing things (rather than preventing things) and what is already happening. To the extent that most providers wish to do a good job, the availability of good data to enable benchmarking and improvement is an important step forward. However, to the extent that the health of a population is dependent on multiple factors, many beyond the mandate of the health system, too extensive a reliance on performance measurement may risk unintended consequences of marginalizing critical activities.