In medicine, an iatrogenic disease is one that is brought on by a medical treatment itself. An example would be when a physician treating a minor condition fails to properly wash his hands and as a result gives the patient an infection more serious than the original problem.
It strikes me that iatrogeny also occurs in the management reporting and control systems of businesses and other types of organizations. A particularly awful example was reported in Britain a couple of years ago: hospitals were being measured on time from a patient’s entry into the emergency room until the time that patient was seen by a physician. It appears that in quite a few cases, the optimization of that measurement for the hospital was achieved by leaving the patient in the ambulance, in some cases for as much as five hours, so that the clock on the measurement would not start until the criterion was certain to be achieved.
So a measurement intended to improve patient service had the opposite effect. It directly caused unnecessary pain and danger to the individual ER patient who was kept in the ambulance while harming the effective utilization of expensive vehicles and skilled personnel, while at the same time providing upper management with a distorted picture of what was really going on.
Smirk not, fellow capitalists. While this particular example of iatrogeny was perpetrated by a government entity, plenty of examples can also be found in the private sector. Indeed, I saw an interesting example in a Target store just the other day.
Targets have customers service telephones scattered throughout the store. If you need help in finding something, you pick up a phone. A voice response system says “Welcome to Target” and then directs you to press one key if you want to talk to a store operator and a different key if you want someone to meet you where you are.
I question the overall design of this system–very few people like interacting with voice-response systems, and having to deal with one of these things when you’re already in the store is probably mildly irritating to many. But the really interesting part of Target’s internal customer service system begins when you select the “meet me here” option. Fairly quickly, an employee does come trotting over–and his immediate concern is to push the reset button on the phone. Obviously, there is some sort of timer which is measuring response times, and a “response” is assumed when the reset button is pushed. The employee is usually in such a hurry to push the button that he does it before even greeting the customer, much less asking the customer what he needs. Sometimes I have observed an employee almost run over the customer in his hurry to get to the button.
On Saturday, the employee came quickly after I requested help. He pushed the reset button, and the system did not reset. He then pushed it several more times. Still, nothing happened, and the timer was apparently in the “no response yet–still running” mode. He then did the right thing, turning away from the telephone and asking me what I needed. Almost immediately, his walkie-talkie started squawking, with a woman demanding to know why the call hadn’t been answered and then telling him in no uncertain terms to get the thing reset. She also apparently told him some alternate way of getting the system reset, which finally was done.
The message this scenario sends to customers–and employees–is that Target cares far more about optimizing its internal measurement of customer service than it cares about optimizing actual customer service. And this is not a problem with individual employees or with individual store managers. Almost certainly, the correct diagnosis would be serious cluelessness on the part of senior executive management.
The harm done by Target’s iatrogenic measurement system is of course trivial compared with the harm done by the bad measurements applied to British emergency rooms. But both are symptomatic of the same kind of problem, and the aggregate harm done by measurement and incentive systems which misdirect is surely very substantial.
Designing effective measurement, incentive, and control systems is hard work. You have to really think about what kind of human behavior the system is likely to encourage, and then watch it and see what it actually does–and make changes when necessary. Too often, these systems are put in place and feedback from local management and front-line employees is ignored or even discouraged.
What other examples of iatrogeny in management control systems have you encountered or heard about?