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Instrumentality in health care: a response to Adam Oliver

Published online by Cambridge University Press:  06 February 2015

Sandra J. Tanenbaum
Sandra J. Tanenbaum*
Affiliation:
Department of Health Services, Management and Policy, College of Public Health, The Ohio State University, Columbus, OH, USA
*
*Correspondence to: Professor Sandra Tanenbaum, Department of Health Services, Management and Policy, College of Public Health, The Ohio State University, 1841 Neil Avenue, Columbus, OH 43210, USA. Email: tanenbaum.1@osu.edu
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Abstract

In his paper, ‘Incentivizing improvements in health care delivery’, Adam Oliver discusses recent efforts to manage the performance of health care workers in the United States and United Kingdom. Overall, the results of performance management seem to be mixed, but Oliver’s discussion hints at a more fundamental question about this approach, specifically: what are the limits of a focused instrumentality in a context as rich, fluid and collaborative as the delivery of health care? Might performance management schemes actually frustrate the efforts of conscientious health care workers? Indicators make few allowances for the heterogeneity of treatment effects or patient values or preferences. Health care workers may also face pressure to appear to satisfy indicators that are actually impossible to satisfy.

Type
Special Section
Information
Health Economics, Policy and Law , Volume 10 , Issue 3 , July 2015 , pp. 361 - 365
Copyright
© Cambridge University Press 2015 

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