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Don’t Let Metrics Undermine Your Purpose
Utah’s Chief Medical Quality Officer Bob Pendleton describes a strategic challenge faced by many industries, including health care. We are at risk for prioritizing achievement of metrics over our purpose. He challenges us to think beyond metrics to what patients actually need from us: patient-centered, outcome-focused, affordable care.
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uccess has a way of bringing its own set of troubles with it. As an institution, we are hitting it out of the park. But it’s easy to be enamored by the benchmarks and lose sight of what those benchmarks are designed to help us achieve: never-ending movement toward our higher purpose of delivering world class care for our patients.

This process of losing sight of our purpose is what Michael Harris and Bill Tayler call surrogation. Surrogation describes a psychological phenomenon that occurs when the measures we use to determine success start to overtake our true purpose. It happens because our purpose, delivering world class care, is intangible. The only way to make sense of it is with measures that are more concrete. Often, these measures are failed proxies—things that get close to measuring what we are trying to achieve, but ultimately are only stand-ins. The measures are imperfect.

Surrogation describes a psychological phenomenon that occurs when the measures we use to determine success start to overtake our true purpose.

Surrogation has become my favorite word to represent how our best-measured intentions can sometimes undermine our purpose. One of the challenges I have for us is to look deep into how clear we are about our purpose. If we are clear on our purpose, these benchmarks play a different role and meaning.

Journal Club: "Are you falling into the surrogation trap?"

In Harris and Tayler's HBR article, "Don't Let Metrics Undermine Your Business," the authors examine Wells Fargo as a case study of metrics gone wrong.

Consider discussing this topic with your team. Read the article and ask these three questions:

  1. Are the people who implement the strategy/improvement/change at the table helping to formulate it?
  2. Are you using multiple metrics?
  3. How closely linked are your metrics and incentives?

Evolution from benchmarks to a higher purpose

We began our benchmark journey about 10 years ago and we’ve excelled. Our care has become patient-centered, with a steady climb into a place of stability. Our quality has earned us national recognition, scoring in Vizient’s top 10, now ten years in a row. And our efforts at clinical redesign are showing valuable returns, saving $15 million last year alone.

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U of U Health's 10 year journey by the numbers.

Given all these successes, you might ask: why am I worked up over whether or not we have lost sight of our purpose? I don’t want us to confuse rankings with our true calling as care providers. In addition to being an organization focused on results, codified in our value equation and Vizient benchmarks and Press Ganey percentile, we must continually commit to our shared purpose. It is a purpose that transcends graphs and spreadsheets; it is about nurturing a culture that drives us toward our human potential of people caring for other people.

Through this lens, things like Vizient benchmarks and data scorecards are put back in their place, not as the results of our efforts, but as tools for achieving our true purpose.

The way I think about benchmarks is that rather than chasing merit badges, we instead ask: What are the benchmarks that enable learning behaviors in our organization that will help us get better? As we do this, I think you’ll find that our benchmark measures are both effective and, at the same time, wholly incomplete. 

You’ve heard my story about my sister, Candi, who at 47 survived breast cancer. You’ve also heard about my wife when she needed orthopaedic surgery. When I talk to my family members about everything I’ve just discussed, they say, “Those benchmarks are my basic expectations, not a bonus. I assume that you’re going to show me respect, keep me safe, and minimize my risk of complications.” 

How do we move beyond benchmarks toward our highest purpose? By listening to our patients. They consistently tell us what they want:

  • Help me to live my very best life
  • Make it easier for me to be a patient
  • Make my care affordable

Moving from benchmarks to outcomes

Benchmarks are a necessary journey in our evolution. But many of our benchmarks fall short in ensuring we are helping our patients live their very best life. Becoming outcome-focused can help move us toward greater clarity. Over the last several years we have experienced a broad push for patient-centered outcomes in three major areas:

  1. Mental/brain health
  2. Physical health
  3. Disease-related health

In each of these areas we have significant data, and over the coming months I hope to share some of what we’ve found. You will start to see a more traditional project management approach moving forward as we understand how to best organize ourselves to take the next steps in our outcome-oriented strategy: to help our patients live their very best lives.

These steps orient us, I hope, toward our greater purpose. Yes, they will have metrics of their own. Some of those metrics will certainly be failed proxies for what we are trying to achieve. The threat of surrogation is a snare, as Harris and Tayler call it. But a snare, or trap, becomes easier to avoid once we can sense it.

Images credit: Marcie Hopkins and Kim Mahoney, U of U Health.

Contributor

Bob Pendleton

Chief Medical Quality Officer, University of Utah Health