Improve the Design and Implementation of Metrics From the Perspective of Complexity Science Comment on "Gaming New Zealand’s Emergency Department Target: How and Why Did It Vary Over Time and Between Organisations?"

Abstract

<jats:p>From the perspective of complexity science, this commentary addresses Tenbensel and colleagues’ study, which reveals varied gaming behaviours to meet the New Zealand Emergency Department (ED) metric. Seven complexityinformed principles previously published in this Journal are applied to formulate recommendations to improve the design and implementation of metrics. (1) Acknowledge unpredictability. When designing a metric, policy-makers need to leave room for flexibility to account for unforeseen situations. When implementing a metric, they need to promote sense-making of relevant stakeholders. (2) Sense-making shall be encouraged because it is a social process to understand a metric, align values and develop a coherent strategy. Sense-making is important to (3) cope with self-organised gaming behaviours and to (4) facilitate interdependencies between ED and other departments as well as organisations. (5) We also need to attend to the relationship between senior management and frontline staff. Additionally, to address one of the methodological weaknesses in Tenbensel and colleagues’ study, (6) adaptive research approach is needed to better answer emerging questions. (7) Conflict should be harnessed productively. I hope these recommendations could limit gaming in future metrics and encourage stakeholders to view inevitable gaming as an improvement opportunity.</jats:p>

Decolonising global health by decolonising academic publishing

“…Distortion during data collection24 and the ‘arithmetic gymnastics’25 sometimes used to fit data to a metric, often obscure ‘on-ground’ reality 26 27. In not being end-user responsive, the data used to derive metrics are prone to being ‘gamed’ 28. Further distortions are introduced during visualisation and storytelling 24.…”

If Gaming is the Problem, Is "Complexity Thinking" the Answer? A Response to the Recent Commentaries

“…Authors' affiliations 1 School of Population Health, University of Auckland, Auckland, New Zealand. 2 Auckland District Health Board, University of Auckland, Auckland, New Zealand.…”

“…e would like to thank the authors of each of the three commentaries [1][2][3] for their very useful and thought-provoking comments on our article on the gaming of New Zealand's emergency department (ED) target. 4 We were heartened by Lisa M Lines' comment that 'performance measure developers, healthcare providers and administrators, policy-makers, and researchers in the field would do well to be both humbled and encouraged by this research. '…”