How Do You Measure Success When You’re Driving a Clunker?

Posted on | June 6, 2007 | Comments Off on How Do You Measure Success When You’re Driving a Clunker?

When you have as much money as the Bill & Melinda Gates Foundation, the question becomes “How do you spend it wisely?” The foundation’s answer? Prove that a strategy or approach works.

But to prove it, you have to define the outcomes, then measure them. And as anyone who’s been in the quality management business over the past two decades knows, that’s easier said than done in health care.

Nonetheless, some have developed a reputation for this type of work, like Don Berwick at the Institute for Health Care Improvement and Jack Wennberg at the Center for Evaluative Clinical Services at Dartmouth. Add to them Christopher Murray who will now run the $125 million (including $105 million from Gates) Institute for Health Metrics and Evaluation in Seattle.

The Gates Foundation wants “statistical measures to determine the effectiveness of its grant giving.” Murray says, “We’re so far behind the norm in other sectors.” Armed with 130 employees and a high-flying advisory board, the institute will soon be measuring away (if its global targets provide access to the data).

But here’s my concern. Measures that derive from a fatally flawed process (whether by poor design or leadership), don’t in and of themselves (even if the data is accurate) fix the problem. Perhaps we would be better served by targeting the resources and the critical and statistical expertise toward new designs — build from the bottom up, rather than further fueling this health care machine, whose parts are antiquated and out of sync with each other.

If Bill and Melinda Gates are willing to provide the gas, it would be nice not to be fueling a clunker.