Is Measurement Destroying What Matters in Healthcare?

Healthcare is driven by measurement; tracking performance, improving efficiency, and meeting targets. But in our obsession with data, are we losing sight of what really matters? When clinicians spend more time filling out forms than listening to patients, we risk turning healthcare into a system that processes people rather than truly caring for them. If measurement isn’t improving patient experience, who is it really for?

The Measurement Trap: Missing the Big Picture

Healthcare is obsessed with measurement. Every aspect of patient outcomes, waiting times, treatment effectiveness is tracked, analysed, and optimised. The goal is to drive improvement, increase efficiency, and deliver better care. Today 30% of all the world’s data is healthcare data at the same time that the total amount of data being generated is increasing exponentially.

But in our relentless pursuit of metrics, are we losing sight of what truly matters?

Measurement is at the Heart of Healthcare Quality Improvement Processes.

Measurement: The Cornerstone of Quality Improvement according to Institute for Healthcare Improvement. It is the way we determine if an intervention is successful or not. It allows us to control and improve our healthcare system to make it ever better, or determine if it is getting worse. Measurement is crucial to how we improve healthcare as it enables us to take a deliberate scientific approach to improving the quality of care.

Is Measurement in Health Too Much of a Good Thing?

Clinicians now spend more time inputting data than engaging with patients. (Journal of Internal Medicine) The focus on hitting targets and meeting key performance indicators (KPIs) risks turning healthcare into a box ticking exercise. With the ranking of hospitals likely to exacerbate this problem. As we focus on processes, something vital is being eroded the human connection between clinician and patient.

The Cost of Ignoring ‘Connective Labour’

Dr Allison Pugh of Johns Hopkins University calls this crucial human connection ‘connective labour’; the time spent listening, understanding, and responding to a patient’s individual needs. Seeing the patient and not just their data. This isn’t something that fits neatly into a spreadsheet. It’s about relationships, trust, and deep insight; things that can’t be reduced to numbers.

When we prioritise measurement over connection, we risk missing the nuances that shape health outcomes:

• Mental health struggles that remain invisible in a system designed for quick fixes.
• Healthcare inequalities that deepen when standardised approaches ignore the unique needs of marginalised communities.
• Chronic illness management that becomes about medication adherence rather than quality of life.

The reality is that when patients are rushed through a system designed for efficiency, they often feel unseen and unheard. We might be treating symptoms, but we’re often not hearing our patients and addressing the root causes of ill health. As I’ve pointed out in a previous article, data and understanding experience are not the same thing.

Measurement Not Understanding

Healthcare is becoming more about measurement than understanding. Clinicians’ time is focused on collecting, analysing the data, filling in forms and ticking boxes. Instead of building deeper insights and understanding of their patients. Our ever more data hungry processes of measurement and efficiency are squeezing out meaning and understanding of our patients. 

Why More Measurement Won’t Fix the Problem

The irony is that in our quest for improvement, we may be making things worse. The more we measure, the more we risk missing the point. We are focusing on numbers and not people.

Connective Labour is About Measuring the Unknown.

At heart the ‘connective labor’ is not something you can measure. It is exploring the unknown. You cannot predict insight or relationships, only set the conditions for it to happen. It is emergent and unpredictable. 

You Cant Gain Insight Through Force.

Dr Pugh argues that insight and relationships can’t be forced; they emerge when conditions allow. But modern healthcare systems are designed to eliminate unpredictability. These insights and learnings are often not something you can ‘make happen.’ If you try too hard instead of fostering deeper understanding, we’re driving patients towards automated, surface-level responses; what behavioural scientists call System 1 thinking.

People go back to their default answer vs the system more explorative considered response. When patients are asked about their health in rushed, structured interactions, their responses are often automatic: justifications, denials, or standard answers. It’s only through time and trust that we uncover the real issues. But in an efficiency driven system, that time simply doesn’t exist.

Missing the Invisible Problem

The patients very often don’t feel seen, don’t feel heard, don’t feel noticed. They just feel processed and we are treating the symptoms and not the causes. In chasing productivity and building the connections that better enable us to understand our patients’ needs, we risk treating the wrong thing. When we define the problem for our patients. We focus on the symptoms and not the cause.

Hitting the Target, Missing the Point

Toby Lowe, a leading advocate of Relational Public Services, warns against this measurement first approach. He argues that too much emphasis on test-and-learn strategies risks hitting the target but missing the point.

For example:

• NHS targets for A&E waiting times mean patients are often moved from one part of the system to another simply to stop the clock, rather than receiving the right care at the right time​.
• Mental health services are overwhelmed, yet treatment pathways are designed around fixed assessments rather than flexible, patient-led support.
• Social determinants of health—poverty, isolation, inequality—remain ignored, because they don’t fit into the current measurement frameworks.

And while we chase productivity, our population is becoming physically and mentally sicker.

Reclaiming the Human in Healthcare

The challenge is clear: if we continue to prioritise measurement over meaning, healthcare will become more disconnected from the people it serves. To create a healthcare system that truly meets patient needs, we need to shift focus:

• From rigid measurement to meaningful engagement. Listen first, measure second.
• From efficiency to effectiveness. A faster system isn’t necessarily a better one.
• From standardisation to personalisation. Health isn’t one-size fits all.

There’s no simple solution. But if we want a system that truly supports wellbeing, we must move beyond the illusion of control that measurement provides. We need to put love at the centre of our healthcare system. Because real health improvement isn’t about numbers,it’s about people.

The question is if we are not meeting patients’ needs, who are we measuring for? 

Conclusion

In our quest for measurement and efficiency, we’ve overlooked the value of human connection that should be at the heart of healthcare. True care demands understanding, not just data collection. By shifting our focus from rigid targets to meaningful engagement, from standardisation for speed to patient centred interactions, we can reclaim healthcare as a practice rooted in relationships, trust, and insight. Measurement should serve people not the other way around.