High stakes metrics and human nature

Eli didn't want to wade into the VA waiting-time crisis, so I'll just do it instead.  Because we’ve covered this ground before. Whenever a metric is tied to a high-stakes incentive or disincentive (monetary bonus or penalty, job security, etc.), gaming of that metric is inevitable. College test scores, crime rates, HAI rates, the dynamic is the same. 

So forgive me if I’m not shocked, shocked, that VA administrators used various ways to game their waiting-time metrics in response to what this NY Times report describes as “pressures to excel in the annual performance reviews used to determine raises, bonuses, promotions and other benefits.” Fudging dates, creating “ghost clinics”, keeping two sets of appointment books—all are being reported to have occurred in some facilities. If you think this is the scandal, you are missing the point. The scandal is that the VA has too few physicians to see an expanding number of veterans needing care (see Eli’s post for more on the trends contributing to primary care shortages).

So I hope lawmakers begin working to fix that problem, once they finish expressing their outrage for the cameras. The VA is an excellent healthcare system, one that matches or outperforms the private/non-VA sector in many measures of care quality and safety. I’m sad that this is getting lost in the current media frenzy—read this piece for a nice counterpoint.