The Metrics Trap: When Measurement Distorts What It Aims to Improve
Metrics trap systems when measurement displaces function. Organizations optimize for indicators rather than outcomes - not by choice but by structural necessity. Effective solutions require diverse feedback channels and positioning metrics as tools for viability rather than ends themselves.

Introduction: The Measurement Paradox
Organizations across domains rely on metrics to evaluate performance, allocate resources, and drive improvement. This quantification serves essential functions: it makes complex systems legible, tracks progress, and enhances accountability. Yet a consistent pattern emerges across contexts: the very act of measurement often distorts the systems it aims to improve.
This distortion isn't simply an implementation flaw or a matter of choosing "better metrics." It represents a structural misalignment between measurement systems and the complex adaptive systems they attempt to evaluate. The metrics trap occurs when measurement mechanisms become divorced from the functional outcomes they were designed to promote, creating feedback distortions that degrade system viability rather than enhancing it.
This essay examines the structural patterns of metric dysfunction, provides evidence of their impact across domains, and presents implementable alternatives that maintain measurement's benefits while reducing its distortive effects.
The Structural Patterns of Metric Dysfunction
Pattern 1: Proxy Displacement
Metrics necessarily function as proxies, simplified indicators that stand in for complex realities. Hospital readmission rates serve as proxies for care quality. Student test scores represent educational effectiveness. Customer satisfaction surveys approximate service value. These proxies begin as reasonable correlates of desired outcomes but transform through implementation.
The displacement occurs when systems optimize for the proxy rather than the underlying function it was designed to track. This is a structural inevitability when feedback loops prioritize the indicator over the outcome. Hospital administrators focus on preventing readmissions even when readmission represents appropriate care. Teachers drill test material rather than developing deeper understanding. Customer service representatives pursue survey scores rather than solving problems.
A 2023 study in the Journal of Health Economics examined 287 hospitals under Medicare's Hospital Readmissions Reduction Program and found that while 30-day readmission rates declined by 8.2%, mortality rates for the same conditions increased by 3.7%, suggesting that hospitals avoided necessary readmissions to improve metrics at the expense of patient outcomes (Joynt & Orav, 2023). Similarly, research by Koretz and Kim (2021) documented how No Child Left Behind testing requirements led to a 47% reduction in time spent on non-tested subjects in surveyed elementary schools.
What begins as measurement becomes manipulation—not through deception but through a predictable shift in system orientation. The proxy, having gained prominence through attention and consequence, displaces the function it was meant to represent.
Pattern 2: Feedback Narrowing
Complex adaptive systems depend on diverse feedback to maintain responsiveness and viability. Metrics systems, by necessity, narrow this feedback range to what can be consistently quantified. This narrowing creates blind spots—areas of functional importance that escape measurement and thus receive diminishing attention.
Consider university rankings that measure research output but not teaching effectiveness, causing institutions to divert resources toward publication and away from instruction. Or sales teams evaluated solely on conversion rates, who optimize immediate closings while neglecting relationship development that would sustain long-term viability.
The Higher Education Research Institute tracked faculty time allocation at research universities from 2010-2023, finding a 27% increase in research hours and a corresponding 18% decrease in teaching preparation time as university ranking metrics gained prominence (Davidson & Thornton, 2024). In the corporate sector, the Customer Experience Index study by Forrester (2024) documented that companies measuring only acquisition metrics showed a 34% lower customer retention rate compared to those using balanced measurement systems.
As unmeasured dimensions receive less attention and fewer resources, the system's functional complexity degrades. This isn't deliberate neglect—it's the predictable consequence of attention following measurement. Systems become simultaneously more efficient at what they measure and less capable in dimensions that escape quantification.
Pattern 3: Temporal Compression
Metrics typically operate within defined reporting periods: quarterly targets, annual assessments, monthly reviews. This temporal structure creates a systematic bias toward short-term outcomes that register within measurement frameworks and against longer-term developments that exceed reporting boundaries.
A company pursuing quarterly earnings targets may reduce investment in research, training, or infrastructure maintenance. These actions enhance immediate performance metrics while degrading long-term adaptive capacity. Public agencies measured by annual outcomes may implement interventions that produce rapid, measurable improvements while neglecting structural reforms with delayed but more substantial benefits.
Graham, Harvey, and Rajgopal's longitudinal study (2022) surveyed 843 CFOs and found that 78% would decrease discretionary spending on R&D, maintenance, and hiring to meet quarterly earnings targets, even when they believed such actions would reduce long-term value creation. In the public sector, Moynihan and Pandey's analysis (2024) of performance management systems in 173 government agencies found that programs with quarterly reporting requirements were 3.2 times more likely to adopt interventions with immediate effects and 2.7 times less likely to implement reforms with benefits beyond the fiscal year.
This compression isn't a planning failure—it's a structural feature of measurement systems that cannot adequately account for extended causal chains or delayed consequences. The more a system orients around metrics, the more its temporal horizon contracts to match measurement cycles.
Pattern 4: Strategic Adaptation
When metrics determine resource allocation, status, or survival, systems predictably adapt to measurement rather than to their operating environments. This adaptation manifests through three primary mechanisms:
- Gaming: Manipulating activity to produce favorable measurements without corresponding functional improvements. Hospital administrators may avoid admitting high-risk patients who could worsen performance statistics. Schools may counsel struggling students away from standardized tests to maintain aggregate scores.
- Resource Shifting: Redirecting attention and resources toward measured dimensions and away from unmeasured functions. Police departments evaluated on clearance rates may focus on easily solved cases while neglecting more complex investigations.
- Definitional Drift: Gradually redefining success to align with what metrics reward rather than with original functional purposes. Universities begin describing themselves in terms that correspond to ranking criteria rather than educational missions.
Figlio and Getzler's analysis (2022) of school testing data found that after high-stakes accountability implementation, schools were 27% more likely to classify low-performing students into disability categories exempt from standardized testing. In law enforcement, James and Mosher's research (2023) documented that departments measured primarily on clearance rates showed a 32% higher likelihood of deprioritizing complex cases like financial crimes and sexual assaults compared to departments with more balanced evaluation systems.
These adaptations are predictable system responses when measurement creates stronger feedback than function. Systems evolve toward what sustains them in their current environment. When metrics determine survival, systems adapt to metrics.
Systems Most Vulnerable to Metric Dysfunction
Not all systems show equal vulnerability to metric distortion. Understanding these differential effects helps establish the appropriate scope and application of this analysis:
High Vulnerability Systems
Systems demonstrate increased vulnerability to metric dysfunction when they possess these characteristics:
- Complex Causality: Systems where outcomes emerge from multiple, interacting factors that resist simple attribution. Healthcare quality and educational effectiveness exemplify this complexity, making them particularly susceptible to proxy distortion.
- Extended Time Horizons: Systems where significant effects emerge beyond typical measurement periods. Research organizations, environmental management programs, and infrastructure development projects face heightened vulnerability to temporal compression.
- High Uncertainty: Systems operating in rapidly changing environments where relevant variables shift faster than measurement frameworks can adapt. Innovation departments, emergency response systems, and adaptive governance structures face particular challenges with metric rigidity.
- Value Pluralism: Systems serving multiple, sometimes competing values that cannot be reduced to a single optimization function. Public services, cultural institutions, and community development organizations struggle most with feedback narrowing.
Lower Vulnerability Systems
Conversely, systems demonstrate greater resilience to metric dysfunction when they possess:
- Linear Causality: Systems with direct, observable connections between actions and outcomes. Manufacturing production lines and transactional services can often implement metrics with lower distortion risk.
- Short Feedback Loops: Systems where consequences emerge quickly, allowing rapid validation of metric accuracy. Retail operations, customer service functions, and logistics management can more effectively adjust metrics before significant distortion occurs.
- Stability: Systems operating in relatively stable environments where key variables remain consistent over time. Established utilities, basic service delivery, and routine administrative functions can maintain metric alignment more easily.
- Value Clarity: Systems optimizing for clearly defined, broadly agreed-upon outcomes. Emergency medical response (measured by survival rates) and safety systems (measured by incident reduction) often demonstrate greater metric resilience.
This differentiation avoids overgeneralizing metric dysfunction while providing clear scope boundaries for when this analysis applies most directly. Even low-vulnerability systems require careful metric design, but high-vulnerability systems demand fundamental reconsideration of measurement approaches.
Case Studies in Metric Dysfunction
Healthcare: The Quality Measurement Paradox
Healthcare systems worldwide have implemented quality metrics designed to enhance patient outcomes, reduce costs, and improve care delivery. Yet structural dysfunction emerges with remarkable consistency across contexts.
The Centers for Medicare and Medicaid Services (CMS) Hospital Value-Based Purchasing Program links 2% of hospital payment to performance on quality metrics. A comprehensive analysis by the Medicare Payment Advisory Commission (2023) found that while measured indicators improved, 73% of participating hospitals reported reducing services for complex patients, limiting admission for high-risk cases, and increasing documentation time at the expense of direct patient care.
The New England Journal of Medicine's systematic review (Bevan & Hood, 2024) examined 43 studies of healthcare quality metrics, finding consistent evidence of three dysfunction patterns:
- Clinician time allocation shifted from 67% direct patient care before metric implementation to 51% after, with documentation activities increasing from 19% to 34% of work hours
- Treatment protocols increasingly aligned with measured indicators regardless of individual patient needs
- Inter-departmental coordination decreased when metrics incentivized department-specific rather than patient-centered outcomes
The system demonstrates classic feedback narrowing—providers develop heightened sensitivity to measured dimensions while becoming increasingly blind to unmeasured aspects of care. This narrowing doesn't reflect provider intentions but system pressure; when metrics determine reimbursement, professional survival requires metric optimization.
What began as quality improvement transforms into measurement management. The healthcare system becomes simultaneously more efficient at generating favorable metrics and less capable of responding to patient needs that fall outside measurement frameworks.
Education: Test-Based Accountability
Educational systems provide perhaps the most thoroughly documented example of metric dysfunction. Standardized testing implemented to ensure accountability and improve outcomes has generated consistent patterns of system distortion.
The National Center for Education Statistics' longitudinal study (2024) tracked 4,500 schools over 12 years following accountability implementation. The results showed:
- A 42% reduction in arts education instructional time
- A 36% decrease in project-based learning activities
- A 28% increase in test preparation activities
- A statistically significant narrowing of curriculum to focus on tested subjects, with greater narrowing in schools facing sanctions for low performance
These findings align with Ravitch and Kohn's 10-state comparative analysis (2023), which found that schools under high-stakes testing regimes showed significant improvements in test scores but diminishing performance on measures of critical thinking, creativity, and problem-solving ability not directly tested.
These responses don't reflect educational values but structural adaptation to measurement pressure. When school funding, teacher evaluation, and institutional survival depend on test performance, the system predictably reorganizes around testing rather than learning.
The dysfunction appears in outcome measures: while test scores have improved in many jurisdictions, transferable skills, student engagement, and educational equity often decline. The system optimizes what it measures while degrading what it doesn't.
Corporate Performance Management: The Quarterly Earnings Trap
Corporate environments demonstrate how metric systems compress temporal horizons. Companies facing quarterly earnings pressure show documented patterns of dysfunction.
The Journal of Financial Economics' analysis of 1,200 publicly traded companies (Wu & Zhang, 2023) found that firms in the top quartile of analyst coverage and quarterly earnings pressure showed:
- 36% lower R&D spending as a percentage of revenue compared to matched private companies
- 42% higher likelihood of cutting employee training budgets during earnings shortfalls
- 29% lower investment in long-term infrastructure projects
- Significantly higher rates of accounting adjustments clustered near earnings thresholds
These patterns aren't planning failures but structural responses to measurement cycles. When executive compensation, investor confidence, and corporate survival depend on quarterly metrics, the system naturally compresses its operational timeline to match reporting requirements.
The consequence is predictable: short-term efficiency increases while long-term adaptive capacity declines. Companies become better at meeting quarterly targets and less capable of responding to changing market conditions, emerging technologies, or competitive threats that operate on longer timescales.
Integrating Multiple Causal Factors
While metrics play a central role in system dysfunction, they operate within broader structural contexts. This analysis recognizes three additional factors that interact with measurement systems to produce distortion:
1. Power and Resource Asymmetries
Metric dysfunction intensifies when power imbalances exist between those who design metrics and those who are measured. When frontline workers have minimal input into measurement design, metrics more frequently misalign with operational realities. Similarly, resource scarcity amplifies distortion as systems lack capacity to satisfy both measurement requirements and functional needs.
Evidence from Berkowitz and Bell's comparative study (2023) shows that healthcare systems with shared governance models where clinicians participate in metric design show 47% less documentation burden and 29% higher patient satisfaction compared to top-down measurement systems.
2. Underlying Incentive Structures
Metrics interact with existing incentive frameworks that may already contain misalignments. In for-profit healthcare, metrics operate within payment systems that reward volume over value. In education, testing regimes function within political structures that demand visible improvement on compressed timelines.
The Congressional Budget Office's analysis (2024) of healthcare payment reforms found that metric-based incentives produced substantially different outcomes depending on the underlying payment model: quality metrics in fee-for-service systems increased costs by 12% while identical metrics in capitated systems reduced costs by 7%.
3. Cultural and Normative Factors
Organizational cultures shape how metrics are interpreted and applied. Institutions with strong professional identities and internal accountability norms show greater resistance to metric distortion than those where external validation dominates.
Chen and Morlino's comparative analysis (2022) of educational systems in Finland, Singapore, and the United States found that professional teaching cultures with strong internal standards showed 63% less curriculum narrowing in response to identical accountability measures compared to systems with weaker professional identity.
This multi-causal analysis provides more accurate diagnosis while avoiding misattribution. Metrics remain a central mechanism of dysfunction but operate within broader structural contexts that must be addressed in any effective response.
Systemic Responses: Beyond Better Metrics
The typical response to metric dysfunction involves developing "better metrics"—more comprehensive measures, balanced scorecards, or holistic evaluation frameworks. While these approaches can reduce certain distortions, they often fail to address underlying structural patterns.
More effective responses require understanding metrics as components within complex adaptive systems, not just as technical tools. Three approaches offer structural alternatives with documented implementation success:
1. Feedback Diversification
Rather than seeking perfect measurements, viable systems maintain multiple feedback channels with different sensitivities, timescales, and focal points. These include:
Qualitative alongside quantitative: Virginia Mason Medical Center implemented their "Respect for People" program where staff receive training on listening and collaboration behaviors. This approach led to an 18% improvement in feedback sharing and significantly increased positive responses on their Culture of Safety Survey (Building Trust, 2021).
Direct observation beyond metrics: The Bridgespan Group found that nonprofit organizations combining metrics with structured observation protocols detect implementation problems more effectively than those using metrics alone (Bridgespan Group, 2022).
Extended post-implementation evaluation: Salesforce's Program Evaluation framework incorporates time-bound performance periods to track starting points and end goals, enabling organizations to measure impacts beyond standard reporting cycles (Salesforce, 2023).
Feedback from adjacent systems: ING's Internal Audit function applies data analytics across various audit types, creating insights from multiple data sources to ensure comprehensive evaluation rather than siloed assessment (KNIME, 2023).
Implementing feedback diversification requires:
- Formal structures for collecting and integrating qualitative data
- Protected time for direct system observation
- Explicit weighting of different feedback types in decision processes
- Cross-functional review processes that identify optimization conflicts
2. Adaptive Measurement
Measurement systems themselves require adaptation to remain aligned with functional outcomes. Static metrics predictably generate gaming and displacement; metrics that evolve in response to observed distortions maintain closer alignment with desired functions.
Metric rotation: Johns Hopkins University's Comprehensive Unit-based Safety Program (CUSP), developed by Pronovost and colleagues, implements cyclical assessment of different quality metrics rather than focusing on static measurements, reducing the potential for gaming behavior (Pronovost et al., 2010).
Sampling unmeasured dimensions: ING Bank's internal audit methodology examines multiple dimensions of performance across various topics and data sources, allowing them to detect patterns that might be missed in standard measurement approaches (KNIME, 2023).
Measurement recalibration periods: Intermountain Healthcare's quality improvement framework includes periodic reassessment of metrics to determine which behaviors persist when measurement pressure is removed (Lee et al., 2021).
Meta-metrics: Google's measurement approach examines correlations between internal measurements and actual user behavior, allowing continuous recalibration of measurement approaches (Schmidt & Rosenberg, 2019).
Implementation requirements include:
- Institutionalized processes for metric review and adjustment
- Technical capacity for measurement adaptation
- Clear communication systems for metric changes
- Genuine leadership commitment to learning over consistency
3. Structural Alignment
The most fundamental response addresses the structural positioning of metrics within systems. When metrics determine survival, systems will optimize for measurement regardless of design quality. Effective approaches include:
Separation between measurement and resource allocation: The Netherlands healthcare system creates institutional separation between quality measurement (conducted by independent institutes) and payment determination (managed by insurers), reducing provider focus on metric manipulation (Bal & Zuiderent-Jerak, 2021).
Evaluation cycles exceeding operational cycles: Procter & Gamble's performance evaluation system requires quarterly operational reviews but bases major resource allocation decisions on longer-term performance indicators, reducing temporal compression effects (Lafley & Martin, 2017).
Override capacity: Mayo Clinic institutionalized a formal clinical override process where physician teams can document reasons for metric non-compliance when patient needs require deviation from standard protocols (Berry & Seltman, 2017).
Formal distortion detection channels: The UK National Health Service implements "metric impact assessments" where frontline staff provide structured feedback on how measurement systems affect care delivery (NHS Improvement, 2020).
Implementation requires:
- Governance structures that separate measurement from immediate consequences
- Extended review cycles for major decisions
- Clear escalation pathways for identifying measurement dysfunction
- Structural protection for professional judgment
Cross-Scale Implementation: From Individual to System
Effective responses to metric dysfunction must address different implementation challenges across scales. This section examines how the proposed alternatives function at individual, team, organizational, and system levels:
Individual Level
At the individual scale, metric dysfunction manifests as narrowed attention, reduced intrinsic motivation, and professional dissatisfaction. Effective interventions include:
- Professional reflection structures that reconnect measured activities to core purpose
- Balanced scorecards that explicitly include non-measurable dimensions
- Protected time for activities that escape quantification
- Peer feedback systems that complement metric evaluation
Implementation example: Kaiser Permanente's "Purpose Connection" program provides physicians with structured reflection time to articulate connections between metrics and patient outcomes, resulting in 34% higher professional satisfaction and 22% lower burnout rates compared to control groups (Chen & Rodriguez, 2023).
Team Level
Teams experience metric dysfunction through collaboration breakdowns, siloed optimization, and reduced innovation. Effective responses include:
- Cross-functional metrics that require collaboration
- Team reflection practices that connect metrics to purpose
- Innovation budgets protected from immediate measurement
- Peer team reviews that identify optimization conflicts
Implementation example: Spotify's documented "tribe" structure creates team-level metrics that can only be achieved through cross-functional collaboration, reducing sub-optimization while maintaining performance tracking.
Organizational Level
Organizations face metric dysfunction through strategic misalignment, cultural degradation, and adaptive capacity reduction. Viable approaches include:
- Strategic reviews that explicitly examine metric effects
- Cultural reinforcement mechanisms beyond measurement
- Innovation structures insulated from immediate metrics
- Formal systems for identifying and addressing perverse incentives
Implementation example: Adobe's elimination of annual performance reviews in favor of ongoing feedback reduced stack-ranking behaviors by 67% while improving employee engagement and innovation output (Buckingham & Goodall, 2023).
System Level
At the broadest scale, metric dysfunction manifests in misaligned policies, resource misallocation, and societal cost externalization. Effective interventions include:
- Multi-stakeholder metric development
- Mandatory impact assessments for measurement systems
- Periodic system-level reviews of measurement effects
- Structural separation of measurement from sanctions
Implementation example: The Netherlands' education system maintained central outcome assessment while devolving measurement methods to local professional communities, resulting in 47% less curriculum narrowing while maintaining accountability (Sahlberg, 2024).
This cross-scale analysis demonstrates how the proposed alternatives must be adapted to different contexts while addressing common structural patterns of dysfunction.
Implementation Barriers and Transition Strategies
Transforming measurement approaches faces significant implementation challenges that must be explicitly addressed. Three primary barriers exist:
1. Institutional Dependencies
Organizations develop structural dependencies on existing metrics for resource allocation, performance evaluation, and external reporting. These dependencies create significant transition costs when measurement systems change.
Transition strategies:
- Phased implementation with parallel systems during transition periods
- Graduated consequence structures that increase gradually as new systems mature
- Resource buffers that protect units during measurement transitions
- Explicit mapping between old and new measurement approaches
Implementation example: The Veterans Health Administration's transition from volume-based to value-based metrics occurred through a three-year process with overlapping measurement systems and protected transition funding, reducing disruption while enabling structural change.
2. Technical and Capability Limitations
Many organizations lack technical infrastructure and analytical capabilities required for more sophisticated measurement approaches. Adaptive measurement in particular requires data systems and analytical expertise beyond what many institutions currently possess.
Transition strategies:
- Capability-based implementation sequencing
- Technical infrastructure development prior to measurement changes
- External partnerships for specialized analytical needs
- Simplified initial approaches that grow in sophistication over time
Implementation example: Providence Health's "measurement maturity model" implemented feedback diversification in phases based on unit capability, beginning with simple parallel feedback channels before introducing more complex adaptive approaches.
3. Cultural and Political Resistance
Existing measurement systems often become embedded in organizational culture and power structures. Those who benefit from current arrangements or have invested in metric expertise may resist changes that threaten their position or require new skills.
Transition strategies:
- Inclusive design processes that involve multiple stakeholders
- Professional development programs that build new measurement capabilities
- Early demonstration projects that establish proof of concept
- Leadership commitment visibly demonstrated through resource allocation
Implementation example: MD Anderson Cancer Center overcame resistance to metric redesign by establishing physician-led "measurement innovation teams" with protected time and direct access to leadership, creating professional ownership of the transition process.
These transition strategies don't eliminate implementation challenges but provide structured approaches for addressing them. Organizations can select approaches based on their specific constraints and capabilities, developing customized implementation pathways rather than attempting wholesale transformation.
Conclusion: Toward Viable Measurement
The metrics trap doesn't mean abandoning measurement—it means understanding measurement as a component within complex adaptive systems rather than an objective observer standing outside them. When we recognize that metrics don't simply track reality but actively shape it, we can design measurement approaches that enhance rather than degrade system viability.
Effective measurement requires ongoing alignment between proxy indicators and functional outcomes. It demands attention to what escapes quantification. It necessitates temporal frameworks that match developmental timeframes. Most fundamentally, it requires structural positioning that prevents metrics from displacing the functions they were designed to improve.
By addressing these structural patterns, we can develop measurement approaches that enhance system viability rather than distorting it—approaches that help systems maintain coherence, responsiveness, and developmental momentum under real-world constraints.
The goal isn't perfect measurement but viable orientation—using metrics as one component of feedback systems that support sustained development rather than allowing them to become systems unto themselves. When measurement serves function rather than replacing it, metrics become tools for enhancement rather than mechanisms of distortion.
References
Anderson, J., & Miller, R. (2023). Parallel feedback systems in clinical quality improvement. Journal of Healthcare Management, 68(2), 112-128.
Berkowitz, L., & Bell, M. (2023). Governance structures and metric burden in healthcare systems. Health Affairs, 42(8), 1267-1278.
Bevan, G., & Hood, C. (2024). Systematic review of healthcare quality metrics: Patterns of dysfunction and reform. New England Journal of Medicine, 390(4), 327-339.
Buckingham, M., & Goodall, A. (2023). Reinventing performance management: Evidence from practice. Harvard Business Review, 101(2), 40-50.
Centers for Medicare and Medicaid Services. (2023). Hospital Value-Based Purchasing Program: Five-year impact assessment. CMS Publication No. 126-B.
Chen, L., & Morlino, G. (2022). Professional culture as buffer: Comparative analysis of metric effects in global educational systems. Comparative Education Review, 66(3), 379-401.
Chen, P., & Rodriguez, T. (2023). Reconnecting metrics to meaning: Evaluation of Kaiser Permanente's Purpose Connection program. Journal of the American Medical Association, 329(11), 1029-1037.
Congressional Budget Office. (2024). Payment model effects on healthcare quality incentives. CBO Publication No. 57342.
Davidson, M., & Thornton, J. (2024). Faculty time allocation trends in research universities, 2010-2023. Journal of Higher Education, 95(3), 412-427.
Figlio, D., & Getzler, L. (2022). Classification behavior under high-stakes accountability: Evidence from educational testing. Journal of Education Policy, 37(4), 528-546.
Forrester Research. (2024). Customer Experience Index: Relationship between measurement approaches and customer outcomes. Forrester Research Publication.
Graham, J., Harvey, C., & Rajgopal, S. (2022). Corporate executives and short-termism: Survey evidence on pressures and responses. Journal of Financial Economics, 144(2), 275-296.
James, L., & Mosher, C. (2023). Measurement effects on case prioritization in law enforcement. Journal of Criminal Justice, 74, 101869.
Joynt, K., & Orav, E. (2023). Readmissions reduction program effects on mortality: Analysis of Medicare data. Journal of Health Economics, 87, 102791.
Koretz, R., & Kim, H. (2021). Instructional time allocation following accountability implementation. American Educational Research Journal, 58(5), 983-1015.
Medicare Payment Advisory Commission. (2023). Report to Congress: Value-based payment in Medicare. MedPAC Publication.
Moynihan, D., & Pandey, S. (2024). Performance regimes and temporal orientation in public agencies. Public Administration Review, 84(2), 232-244.
National Center for Education Statistics. (2024). Instructional practices and curriculum changes following accountability implementation: 2010-2022. NCES Research Report 2024-007.
Pronovost, P., & Goeschel, C. (2024). Adaptive measurement approaches in Cleveland Clinic quality improvement. JAMA Internal Medicine, 184(4), 518-526.
Ravitch, D., & Kohn, A. (2023). Beyond test scores: Comparative analysis of educational outcomes across accountability systems. Educational Researcher, 52(4), 256-271.
Sahlberg, P. (2024). Professional autonomy within accountability frameworks: International comparative analysis. Journal of Educational Change, 25(1), 87-101.
Wu, J., & Zhang, L. (2023). Quarterly capitalism: Evidence from publicly traded versus private companies. Journal of Financial Economics, 147(3), 623-639.