Competition Design Entry #0660 Classified Declassified

The reason ranking raises output and lowers honesty

A public ranking increases output but also the temptation to game, misreport, or cut corners, because the rank rewards the number, not the process.

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Plate 560 — The sickest patient, unscheduled

Intuition test — answer before you read on

Why does publishing a performance ranking sometimes worsen the underlying outcome?

A hospital published surgeon-level mortality rankings to improve care. Mortality rates dropped — but so did the number of high-risk surgeries attempted. Some surgeons began refusing the sickest patients to protect their position on the board. The metric improved; the mission did not.

What everyone sees

Rankings are expected to align incentives: make the metric visible, reward the best performers, and everyone will strive to improve. The assumption is that transparency creates accountability and that accountability produces better outcomes across the board.

What is actually happening

Campbell’s law states that the more a quantitative social indicator is used for decision-making, the more subject it becomes to corruption pressures and the more apt it is to distort the processes it is intended to monitor. Bevan and Hood documented exactly this in the UK’s NHS targets: waiting-time rankings led to creative redefinition of when a wait began, not to faster treatment. The ranking optimises the number at the expense of the underlying reality the number was meant to represent.

Why it stays hidden

The gaming hides because the metric still looks good. The board shows improved numbers, and the people reading it have no way to see the refused patients, the reclassified cases, or the corners cut behind the data. Success on the ranking masks failure on the mission.

A ranking rewards the number, not the reality. When the two diverge, the number wins — and the reality is hidden by the improvement.

A ranking rewards the number, not the reality. When the two diverge, the number wins — and the reality is hidden by the improvement.

The hidden part — entry #0660

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A ranking rewards the number, not the reality. When the two diverge, the number wins — and the reality is hidden by the improvement.

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Sources & further reading 2
  1. Campbell — Assessing the impact of planned social change
  2. Bevan & Hood — What’s measured is what matters: targets and gaming in the English public health care system

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