title: Metric-driven harm: an exploration of unintended consequences of performance measurement.
abstract: Performance measurement is an increasingly common element of the US health care system. Typically a proxy for high quality outcomes, there has been little systematic investigation of the potential negative unintended consequences of performance metrics, including metric-driven harm. This case study details an incidence of post-surgical metric-driven harm and offers Smith's 1995 work and a patient centered, context sensitive metric model for potential adoption by nurse researchers and clinicians. Implications for further research are discussed.
authors.affiliation: University of Vermont, College of Nursing and Health Sciences, Burlington, VT 05405, USA. Electronic address: betty.rambur@uvm.edu.
authors.forename: Betty
authors.initials: B
authors.lastname: Rambur
authors.forename: Carol
authors.initials: C
authors.lastname: Vallett
authors.forename: Judith A
authors.initials: JA
authors.lastname: Cohen
authors.forename: Jill Mattuck
authors.initials: JM
authors.lastname: Tarule
mesh_terms: D017146:Models, Organizational; D019982:Organizational Case Studies; D018802:Patient-Centered Care; D011787:Quality of Health Care
keywords: Metric-driven harm; Performance measurement; Public reporting of health care outcomes; Quality improvement; Unintended consequences