The ethics of performance measurement

For years I have argued that performance measurement has significant potential for unintended consequences.  But today, I read an article that crystallized my concerns in an important new light.  The article is written about the ethics of studying work hours – Leaping without Looking — Duty Hours, Autonomy, and the Risks of Research and Practice.  As I read the article, the implications of the ethical arguments stimulated my thoughts about performance measurement.  While I hope you will read the entire article, these lines have particular relevance here:
Bioethicist and legal scholar Michelle Meyer has described our “tendency to view a field experiment designed to study the effects of an existing or proposed practice as more morally suspicious than an immediate, universal implementation of an untested practice.” She argues that people in power often rely on intuition in creating and implementing wide-reaching policies.
Most physicians would argue that people in power (CMS and insurance companies) have relied on intuition in creating and implementing performance measures.  Please reread the above paragraph and consider seriously the problem here.  Performance measures have had serious untoward consequences.  Patients have suffered because of overly aggressive diabetes control, overly aggressive hypertension control and the 4 hour pneumonia rule.  In the Britain’s NHS P4P program – care improved only slightly for targeted care but deteriorated f...

Source: DB's Medical Rants - February 25, 2016 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs