The Department for Health in England is running a consultation through the Nuffield Trust on whether “aggregate ratings” (which are more commonly referred to as composite indicators and indeed are indistinguishable in pragmatic terms from league tables) would be a good idea for health and social care providers.
Like many statisticians, I have in the past been interested in this, felt aggrieved at how unscientific and potentially dangerous the composite indicators were, and then gradually lost interest because nothing we say seems to penetrate the mist of political obsession with the league table.
But, confronted with the prospect of the most egregious of these systems returning to haunt us, I feel I should force myself to pen something and send it in (in the manner, I’d like to think, of a movie detective being called back from retirement for just one more job… or more likely that’s a role for Harvey Goldstein, I’ll be one of the extras in a police uniform). I’ll post it here in due course as it will pull together a number of key references on the subject that it would be nice to have in one place.
But for now I leave you with two thoughts:
- Performance indicators create perverse incentives, without exception, and we have inadvertently trained and rewarded a generation of health service managers to spot the loopholes and exploit them.
- Sports league tables work well, motivating players, coaches and managers to work hard and achieve promotion or avoid relegation; health league tables do not work because nobody gets promoted or relegated (indeed if you make an absolute pig’s ear of your hospital, you will be rewarded with a bail out), unless you adopt Stalin’s approach of having the bosses of the lowest-producing coal mines shot every year.