“Not everything that can be counted counts, and not everything that counts can be counted.
Albert Einstein
In 1975, British economist Charles Goodhart made a now-famous observation:
“When a measure becomes a target, it ceases to be a good measure.”
This axiom soon became known as Goodhart’s Law, and it explains a problem that many of us on the frontlines feel but struggle to name.
When organizations become fixated on improving a specific metric, the integrity of that measure often collapses.
Take a simple example: If you measure workers by the number of nails they produce, you get thousands of tiny, useless nails. Switch to weight, and suddenly they’re turning out a few massive, impractical ones.
The goal distorts the work.
The same is true in healthcare: If you measure success by how quickly patients are discharged, teams may start prioritizing speed over safety—sending people home before they’re truly ready.
Change the measure to readmission rates, and suddenly there’s pressure to keep patients longer than necessary.
The metric starts shaping behavior, often in unintended ways.
Sound familiar?
Metric Whack-A-Mole
Every summer, my family hits the beach—and the local arcade. One of my favorite stops is the Whack-a-Mole game. It’s oddly satisfying and stressful at the same time. You smack one mole down, and two more pop up. You go after those, and another appears. It never ends.
After years in healthcare, I’ve seen the same thing happen with key performance indicators (KPIs).
One year it’s all about patient falls. Then the focus shifts to hospital-acquired infections. Next comes patient experience. Then finances. Then back again.
You “fix” one area, but suddenly others start slipping. It’s a vicious cycle of chasing metrics without addressing root causes—a system playing Whack-a-Mole with its most valuable resource: its people.
From How to Why
Recently, I had the chance to hear author Dan Pink speak to a group of healthcare leaders. One line stuck with me:
“Leaders need to have fewer conversations about how, and more about why.”
It seems simple, but it’s a powerful mindset shift. Instead of asking:
- How can we improve patient experience?
We should be asking: - Why is the experience poor in the first place?
When we start with how, we tend to pile on checklists, training modules, and documentation—often creating more non valued added work for the people doing the work.
Why takes us upstream. It helps us understand the systems, workflows, and barriers that drive those metrics in the first place.
No healthcare worker I know begins their shift thinking, “How can I make this patient’s experience worse today?”
The problem isn’t will—it’s design. And design problems require deeper questions than most dashboards are set up to answer.
Go to the Work
Throughout my career, I’ve worked alongside some incredible performance improvement professionals. The best ones all share a common trait: they go to the source.
In Lean methodology, there’s a concept called the Gemba —a Japanese term meaning “the real place.” It’s about going where the work happens, observing, and listening to the people closest to the problem.
Solutions crafted in boardrooms, far removed from the clinical floor, rarely stick. But when you include the people doing the work, the solutions are not only better—they’re sustainable.
Dashboards Don’t Fix Leaks
Fancy dashboards don’t fix broken systems. They just display them in color.
If my car’s oil pressure light comes on and I just add oil to make the light go away—without fixing the leak—I’ve done nothing to solve the real problem. I’ve just made my dashboard look pretty.
That same principle applies in healthcare.
It’s Time to Go Upstream
If we want to become truly high-reliability organizations, we must stop playing KPI Whack-a-Mole and start looking for sustainable solutions, not band-aids.
We need to stop burdening staff with one-off fixes and start addressing why the problems exist in the first place.
Because chasing metrics might make the dashboards look good, but you risk burning out the people doing the work.
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