The Tyranny of Metrics

by Jerry Z. Muller

In medicine, Peter Pronovost’s Keystone project demonstrates how effective diagnostic metrics can be in lowering the incidence of medical errors, when what is measured accords with the professional values of practitioners. The success of the Geisinger medical system illustrates the remarkable improvements made possible by computerized measurement when integrated into an institutional culture based on cooperation, where the setting of measurement criteria and the evaluation of performance are done by teams that include physicians as well as administrators. In both cases, metrics were used in ways that appealed to intrinsic motivation and to professionalism. But elsewhere in the medical system, as we’ve seen, the use of reward for measured performance sometimes proved fruitless or led to perverse outcomes.