It goes “When a measure becomes a target, it ceases to be a good measure.” How does that work in practice?
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A real life example: I work in healthcare. “Central lines” are a type of IV that goes in a “central vein,” frequently the jugular vein in the neck. Germs can get on these devices and cause bad infections. Because they’re bad and largely preventable with good hand hygiene and aseptic technique, rates of central line associated infections are nationally reported and tracked metrics for hospitals. Medicare, Medicaid, and most (probably all) private insurers will not reimburse hospitals for *any* of the costs of a patient’s care if they develop a central line associated infection.
The way to diagnose a central line associated infection is to remove the culprit line and send it to the lab, where they cut the tip off of it and see what, if any, germs grow from it in culture. I have personally removed central lines from patients, handed them to the nurse assisting me, and said “please send this to the lab for culture.” They throw it in the trash and tell me they can’t do that or they’ll be fired.
There’s literally an institution-wide policy in every hospital I’ve ever worked in that says you are not allowed to culture central line tips.You are banned, under threat of firing, from making that diagnosis because having a central line associated infection rate higher than zero affects their bottom line. Therefore every hospital “officially” has no central line associated infections. By making a target (zero infections), they made the metric worthless.
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