Games People Play: Lessons on Performance Measure Gaming from New Zealand Comment on "Gaming New Zealand's Emergency Department Target: How and Why Did It Vary Over Time and Between Organisations?"

Lisa M Lines

doi:10.34172/ijhpm.2020.41

Abstract

For decades, observers have noted that gaming of performance measurement appears to be both endemic and endlessly creative. A recent study by Tenbensel and colleagues provides a detailed look at gaming of a health system performance measure—emergency department (ED) wait times—within four hospitals in New Zealand. Combined, these four hospitals handled more than 25% of the ED visits in the country each year. Tenbensel and colleagues examine whether the New Zealand ED wait time target was set appropriately and whether we can trust any performance measure statistics that are not independently verified or audited. Their thoughtprovoking examination is relevant to anyone working in quality improvement and provides a valuable set of tools for detecting gaming in performance measurement.

Highlights

Lines Email: llines@rti.org In Gaming New Zealand’s Emergency Department Target: How and Why Did It Vary Over Time and Between Organisations?, Tenbensel and colleagues provide a detailed look at gaming a health system performance measure—emergency department (ED) wait times—within four hospitals in New Zealand.[1]
Those hospitals saw more than 25% of the ED visits in New Zealand between 2006 and 2012
Measures for describing time spent during ED visits may refer to visit lengths or lengths of stay ([LOS] – total time spent in the ED) or wait time

Summary

Introduction

The target set by the New Zealand Ministry of Health for ED wait times, defined as number of minutes between when a person arrives at the ED and when that person is treated by a provider, was 6 hours or less for at least 95% of patients.

Results

Conclusion