09 November 2017

Tick The Box

A system for the simple.

By John Watson

It is always illuminating to read the Shaw Sheet’s “Diary of a Corbynista” and last week’s column was no exception. One of the areas on which it cast light was the NHS tracker which tells you how your local hospital has done against certain government targets: that 95% of accident and emergency admission should be treated or admitted within four hours, that 85% of cancer referrals should begin treatment within sixty-two days, and that 92% of planned operations should take place within an eighteen week period.  I immediately looked up my own local hospital, which happens to be UCH.  Although it’s overall rating was “good” it was outside all three targets and anyone looking at the tracker alone might think that it seemed a sleepy sort of hospital and decide to go somewhere else.

The trouble is that they would be wrong.  There is nothing in the slightest sleepy about it.  I have been in and out of UCH on a number of occasions and have always been hugely impressed by the professionalism, expertise and the quality of care.  Everyone else from round here says the same and we all congratulate ourselves on being fortunate enough to have such a world-leading facility on our doorsteps.

And yet if you just read the tracker you might be tempted to go somewhere else, where perhaps they take a little less time checking out their accident admissions and as a result hit that particular government target.  You would have been misled by perfectly accurate statistics whose only weakness is that they do not give a full enough picture.

Moving on through last week’s Shaw Sheet I came upon the same point in a different guise. J R Thomas in his piece “Greed and the City” focused on short-termism, contrasting the demand for immediate returns by most financial institutions, pension funds and private investors with the longer views taken by strategic investors such as Warren Buffett of Berkshire Hathaway.  As Thomas points out in the context of bank shares, if management will not provide short-term returns then they will find their hand forced by corporate raiders.

This all makes it difficult for the chief executive.  If he uses his cash to pay dividends or to return money to shareholders, he will be the darling of his investors.  If he invests his cash in the business, the value of his shares may decline because of the importance of short term investor cash flow in valuation.

It is a different form of the hospital point.  Prospective dividend yield is a crucial element in share valuation but it only tells you so much.  The rate of treatment of accident and emergency patients is important but it does not define the service provided by the hospital as a whole.  The risk in each case is that we take a perfectly good piece of information but then attach too much importance to it.

Of course medicine and business are not alone in this.  Schools have their position in the tables and take great care to brush up on the things which will be reflected in their scores, occasionally at the expense of other things more crucial to their pupils.  Universities too are now highly graded with much emphasis, often survey based, on the student experience.  We live in an age of check sheets and box ticking with carefully set tests continually being gamed by those who wish to get a particular result.

The rise of the scorecard has resulted in a change in the way in which people appraise things.  Once upon a time they would have looked at an institution as a whole or at least listened to those who had undertaken an overall review.  Now they look at tables of figures which are simply the aggregate result of a whole lot of box ticking.  It is valid information, of course, but it derives from a mechanical process rather than from judgement.  It is therefore more likely to give a distorted view.

It is easy to see how we got here.  Experienced people with judgement do not grow on trees and a box ticking exercise can be carried on by functionaries.  A move towards the latter makes things simpler and more verifiable.  No judgement is needed so there is no question of blaming an individual if things go wrong.  The authorities can just set a new check list or two and claim to have acted.  What is more the move saves costs because the people who compile the figures need to be much less educated and perceptive than experts.  One day most of them will not be people at all but merely computers.

The movement towards checklists may reduce the quality of the information reaching the user, but it has a supply-side implication as well.  Commentators on the effect of computerisation on jobs tend to soothe their readers’ anxieties with the idea that there will be more interesting jobs left for humans.  That must mean a demand for roles requiring judgement, so we will need to provide lots of these; perhaps a start would be for us all to rely less on the aggregation of tick sheets and more on human perception.

 

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