Key Performance Indicators are used to measure and monitor performance outcomes across many industries. Generally quantitative in nature, healthcare has become a place that lives and dies with compliance. The use of KPI’s is disguised as transparency, an outward expression to the consumer how reliable and safe a service is. There is however a darker side to performance measuring.

To the general public KPIs describe learning and improvement opportunities, they show how quickly a person can expect to receive care and how well or bad their local services perform against their peers. The reality, in many instances is that KPIs are used as bargaining chips, proverbial big sticks and tools to accelerate individual careers. Political pressure maligns the work of the very people the leaders are there to protect. Underperformance triggers expectations to work harder, cheaper and faster rather than smarter, and the tragedy is that often times the root cause of the issues are not addressed and resolved. In an industry reliant on people to care for people it is easier to blame the people rather than support them.

Key People Investment should be the way we re-invent the discussion. Investment in the people, by supporting them to acquire the skills they need and providing the tools they need to do their jobs lifts performance every time. This takes time and investment, a luxury often ignored by the public sector.

Over the years my resolve to empower, educate and edify leaders has strengthened. I have seen individuals and groups of leaders re-claim their confidence and accept their role accountability. I have witnessed cynicism turn to optimism; caution turned to courage and people embrace leadership with enthusiasm.

I have done this without the support and encouragement of my bosses, mostly I believe to an unwillingness to invest in the long term. Public sector limps form financial year to financial year, 12 months which pass in a flash will never allow the broader thinking required to create real change. This is where the perverse use of KPI’s is most evident. With the longevity of an executive or politician’s tenure being based on KPI outcomes, it is not surprising that behaviors such as micromanagement, manipulation, bullying and denial emerge.

I have met less than a handful of executives who would risk their perceived status or next career move to be bold and daring enough to acknowledge and foster true investment in their staff. We have become an industry where your worth is measured on how you meet the KPIs, not how you contribute as a human being.

Of course, measuring and monitoring performance is important, and the public must be able to make informed choices about their healthcare. But when KPI’s get manipulated to tell the story the government wants the public to hear, their utility becomes obsolete because trust is lost.

I have stood between my staff and executives many times debating certain KPI directives, choosing to listen to the staff at the bedside and assessing the situation in front of me to make decisions. I have created conflict between myself, the executive, my peers and at times the government of the day and I have no doubt my bosses have despaired over my unwillingness to compromise. As I reflect on these times, I am sure it would have been much easier to push the pressure down and just get the job done but I sleep easier knowing that I did not compromise my integrity nor did I risk the wellbeing of many people over the years.

As with many things in life there is a balance to be achieved when measuring how we perform against expectations, sometimes we just have to acknowledge it can’t always be done in the moment. As leaders our role is to find the balance, prevent harm to best of our ability, and find ways to improve outcomes collaboratively with our people.