“If you measure my behavior in illogical ways, don’t complain about my illogical behavior”*

The federal government has implemented a poorly designed pay-for-performance system in health care. Specifically, the government set standards for patient outcomes that are directly tied to Medicare funding. Also, the ratings are very important for the hospitals’ reputation and standing in the community. As a result, hospitals started throwing out donated organs that weren’t perfect. They began refusing to operate on severely ill patients. Because if the hospital were to take those types of risks, their success rate would decrease, and so might their government funding. These contingencies put hospitals in an impossible situation. Doing the right thing could potentially hurt the hospitals’ ratings, reputation, and income.

Although this phenomenon is not widely recognized by BCBAs, there is a lot of research on this topic. A few examples are this book, or another recent one, or in the field of economics. In my view, they are worth studying because similar unintended outcomes frequently occur when BCBAs attempt to implement OBM-type systems, although not as dramatically as in hospitals. On this blog, I’ve talked about this problem in several areas like:

Teaching staff to accept feedback appropriately,
Measuring the number of trials conducted daily,
The use of assessment devices.

I’ve attended many trainings and read lots of books and articles on organizational behavior management (OBM.) The concepts seem so easy to understand; anyone should be able to do it. Yet, if you look into the details of how OBM is implemented in many organizations, it often leads to unexpected negative outcomes. The problem is that these negative outcomes aren’t usually captured in the measurement system, so everyone is celebrating a failed program that looks successful.

One simple question every BCBA should ask before implementing a new OBM system:

Is there any way that this measure can be improved while doing something that is not in the best interest of the client?

If so, we should either:

(a) Eliminate that measurement, or

(b) Add other measurements that ensure that the negative effect won’t happen.

*The title is a quote from Eli Goldratt – author of The Goal

Behavior analytic services should only be delivered in the context of a professional relationship. Nothing written in this blog should be considered advice for any specific individual. The purpose of the blog is to share my experience, not to provide treatment. Please get advice from a professional before making changes to behavior analytic services being delivered. Nothing in this blog including comments or correspondence should be considered an agreement for Dr. Barry D. Morgenstern to provide services or establish a professional relationship outside of a formal agreement to do so. I attempt to write this blog in “plain English” and avoid technical jargon whenever possible. But all statements are meant to be consistent with behavior analytic literature, practice, and the professional code of ethics. If, for whatever reason, you think I’ve failed in the endeavor, let me know and I’ll consider your comments and make revisions, if appropriate. Feedback is always appreciated as I’m always trying to Poogi.