Wide-Angled Metrics for Health

There’s something that happens when you spend enough time working in a field that fosters true wisdom. When you’ve had the chance to see the fruits of your labour and the cycles and patterns of your domain of practice, the best metrics emerge.

I didn’t appreciate the wisdom of experience enough when I was younger. I put far too much emphasis on knowledge — the facts, the evidence, and the synthesis of the two. In other words: “received” wisdom.

It’s one of life’s lessons that I share widely, and that is thinking I know and understand more than I do about life. Interestingly, the more I know and understand, the less I feel I know and understand. What’s come from this is an appreciation for how commonplace things are so poorly designed.

One example is how we measure the performance of our health systems. By health systems, I mean everything from health care and preventive medicine to public and community health. The more we look at their task, the stranger and larger the gap between what they measure and produce becomes.

New Metrics of Performance

Health systems are designed to keep people healthy. To do this, they perform functions presumably about repairing and restoration or prevention. To assess performance, these systems use a variety of metrics, and many of them are just fine. Wait times, time to recovery, prevalence and distribution of a condition are all appropriate metrics. Others are a little more nebulous and, while discussed, are rarely used as leading indicators for health system performance. Take Quality of Life; how often have you seen a health system use some measure of Quality of Life as a leading, prominent performance indicator?

Some of this is tied to how we define things. For example, our healthcare system might be more accurately called an illness treatment and injury repair system because most of what we do is treat injury and illness, not promote health. (Illness and injury treatment is essential and helps us return to health, it’s not usually health promoting which is something different).

This disconnection between health promotion and health treatment is one of the reasons why many complementary or alternative care systems attract people as much as they do: because much of their perceived benefit is a sense of health. Built into most of these non-allopathic approaches to health treatment is a sense of care lacking at a systemic level in conventional healthcare systems.

What we measure determines much of what we manage in our organizations, so it matters whether our metrics include care experience, satisfaction, or quality of life. I want to go further and suggest we would benefit from a system that was as focused on widening our lives as much as lengthening them. Satisfaction is a start; what about joy?

Wide-angled living

I recently bought a bike. It is nothing like I’ve owned before: a used Dutch bike. If you’ve ever ridden a Dutch bike, you’ll know they are different than typical bicycles. Many have walk-through frames, and almost all have you sitting upright. These are city bikes that are designed mainly as a means of transportation and for urban living. They are usually made of steel frames (not lightweight aluminum or titanium), they have few speeds (1-3 are typical), and many (including mine) use a coaster system for brakes. These bikes are reminiscent of the first ones I had as a kid, only they are designed to be functional forms of transportation.

I love my new bike. Even though it’s quite different than what I’m used to, it immediately brought a smile to my face the first time I rode it. Every time I get on the seat and peddle it brings me a little joy. Joy is what gives my life width. I can live long in years, but am I living a wide life?

The joy we have savouring a coffee and pastry, playing with our dog or kids or grandkids, listening to the birds sing in the morning, or sitting at a cafe with your favourite notebook and pen and writing down your thoughts. These are all things that add width to our lives

Width comes from laughs with our knitting club, cheering on our favourite sports team, gardening, Singing karaoke with friends, or getting lost in the music playing through our headphones or at a concert. Width reflects the things that make life worth living.

This is more than quality of life; it’s a richness of living. Having a job that I don’t hate, treats me fairly, and pays me enough to survive is a sign of my quality of life. Having a vocation that brings energy and excitement to my days, allows me to make a valued contribution (and to see results), and challenges me in ways that prompt my growth and development (make me a better person as I define it) is richness. When I can share this with others, that’s even more richness. That widens my life.

This brings me back to the start of this story. I started my career doing a lot of things, performing well, and creating a lot. I was productive and by nearly every measure I performed well. I also was miserable for many of my days.

Looking back, how many of those things made a difference? How many of those added width to my life, the life of those involved, and the community? I’m not sure I know. I do know that it’s not evident to me. That’s not to say they were worthless, instead, I’d say the metrics of worth used at the time were about measuring length, not width of performance. The metrics that were used to judge my work were about more, not better.

Metrics of Care, Depth, and Width

I know the two people who sold me my bike, took time to walk me through options, let me ‘play’ with the bikes to try them out, and chatted with me about our shared love of cycling increased the width of my life that day and probably every day afterward when I ride my new Dutch bike. These are two people who both work in the health system as part of their ‘day jobs,’ and while I don’t know what else they do daily, I can say confidently that most people who leave their shop will have the width of their lives expanded because of the bikes they provide. None of what happened in their shop was connected to their official role in the health system.

As an evaluator, I could measure their sales, throughput on inventory, and followers on Instagram, which might all indicate their business success. I could also capture the smiles, the joy, the stories of rides taken, and how having a bike that’s loved increases the width of people’s lives. That’s what will last as much as the steel and rubber sitting outside the cafe where I’m writing this waiting to be ridden again.

What if we designed our care systems to widen and lengthen lives? We have metrics that can do this. If we measure it, we’ll manage it. If we manage it, we’ll create it.

I’ll be writing more on this in future posts.

My take home is that we often get drawn to measure less important things because we anchor our metrics to growing things (length), rather than enhancing depth (width). It’s worth considering what makes your life and work wider as well as longer.

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  • As an entirely unpaid promotion, I’d like to give a nod to Bas and Carlos at Go Dutch Cycle in Toronto. They bring over pre-loved (and new) Dutch bicycles from the Netherlands, give them a tune-up, and sell them to people looking for something different. This is upcycling at its finest and a way to keep bikes that are made to last on the road so we can take more vehicles off the road. And in the process, they bring a lot of joy to their customers. Check them out.
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