When Metrics Become Punitive - Emerging Nurse Leader

By Rose O. Sherman, EdD, RN, NEA-BC, FAAN

What happens when our performance metrics become punitive?

This is unfortunately happening in some healthcare environments. I have recently talked with two nursing directors who are on disciplinary performance plans because of low patient experience scores in some clinical areas under their supervision. Both feel that there are many issues outside their control driving the low experience scores in their organizations. Nurse leaders are being singled out for punitive action on disappointing outcomes that are more of a systems issue. Both their organizations are having a significant challenge with the employee experience largely due to initiatives to drive down costs. Nurse engagement rates are low, turnover has increased and the use of contract labor has soared. That is not a recipe for great patient experiences. Patients and families can quickly sense when staff is not happy and lose confidence when teamwork is not present.

Authors Michael Harris and Bill Taylor warn leaders in this month’s Harvard Business Review Don’t Let Metrics Undermine Your Business that some organizations are letting metric numbers drive strategy to their detriment. They would contend that the strategy should be to provide a truly exceptional patient experience. Instead, many organizations are just focused on the patient experience numbers which can significantly fluctuate as they represent the whole experience that patients/families have with an organization. Both nurse leaders that I spoke with are in organizations where executive leaders want a quick (and inexpensive) fix for a complex problem. Neither have patient advisory councils to help guide strategy. Low patient experience scores are a symptom of larger problems in the organization and a lack of focus or concern for the staff experience. Maximizing patient satisfaction as a regulatory target will not necessarily result in an improved healthcare system.

There is a substantial body of leadership literature to suggest that punitive measures rarely result in performance improvement and are demotivating to staff. What we have learned about safety in healthcare has shown us that most problems should be viewed and corrected at the systems level beginning with the culture of the organization. The impact of current system problems needs to be honestly addressed.

The nurse leaders I spoke with have both been with their organizations for a number of years. They take their work seriously yet now feel that their leadership has been devalued. They are being bullied because they are seen as easy targets to blame for a complex issue. In both settings, the CNOs have little control over the actions of the CEOs. The level of incivility about the way the problem is being managed would have been unthinkable even a few short years ago. One or both of these directors may be driven out of their positions leaving behind stunned nurse managers who are unlikely to stay in the organization. Both are looking for other positions. This is not a formula for a healthy work environment nor is it likely to result in a sustained improvement in patient satisfaction.

Read Rose Sherman’s new book available now – The Nurse Leader Coach: Become the Boss No One Wants to Leave