In healthcare, there are really only two metrics that matter: life expectancy and quality of life. That’s it. Everything else—insurance coverage, hospital throughput, satisfaction surveys—is secondary. Those things can be helpful indicators, but when they become the focus, they begin to poison the system.
When the Wrong Metric Becomes the Goal
As an example, let’s consider healthcare policy. If you drop in on a debate about the effectiveness of the Affordable Care Act, the it sounds like this:
"Look at all the people who now have insurance!"
"But they might as well be uninsured! High deductibles and escalating prices!" My response to that: "Cool! Are people living longer and are they living better?" For the first time in modern history, even before COVID, U.S. life expectancy started to decline in the 2010s. That's an embarrassment. And that’s what happens when you make a secondary metric primary. Here’s a simple thought experiment. Imagine you find a genie in a bottle who offers 3 wishes to fix healthcare. What do you ask for? If you say, “I want more people to have health insurance,” you’ve wasted your wish. Because you can imagine an evil genie who takes it literally. Everyone gets insurance, but it’s all UnitedHealthcare or Cigna, with high deductibles, poor networks, and declining outcomes. Technically, your wish came true. Functionally, the system got worse. You should say, “I want people to live longer, healthier, happier lives.” The primary metric is "the genie metric." You see the same story with MIPS, a bundle of well-intentioned secondary measures like hypertension tracking or annual screenings. They look good on paper, yet they’ve done little to make people healthier. Chronic conditions are up, affordability is down, and every new policy seems to double down on the same mistakes.
It's Happening to Your Company
This problem isn’t unique to public policy. It’s everywhere, including your business. Every company has its own version of MIPS: metrics that feel important but lead you in the wrong direction.
Engineering
Consider software engineering. How do you measure productivity? Lines of code? Pull requests? Tickets closed? Those might be fine indicators, but when they become the ultimate goal, everything warps around them. I once worked at a company that gave every developer a “developer score.” The top 20 and bottom 20 were posted publicly on a leaderboard for everyone to see. It didn’t take long for people to figure out how the scoring worked. You earned more points for new features and greenfield projects than for bug fixes or refactoring. Incentives led developers to chase new projects to rack up points at the expense of the core modules that paid the bills.
Product
Product teams have their own version of this trap. Maybe their guiding light is daily active users. That sounds healthy until you realize they’ve started engineering addiction with constant notifications, gamified streaks, and little dopamine hits that keep people coming back. The dashboards look fantastic. But are users actually getting value? Or are we just training them to check the app compulsively? When the metric becomes the mission, you can lose sight of the mission entirely.
Sales
It is really easy for this to happen in sales. Tell your team that win rate is the top priority, and they’ll find ways to make that number look good. They’ll discount heavily, loosen contract terms, or chase customers who don’t fit your model. It works for a quarter or two, but the long-term damage can be huge. The metric improved, but the company didn’t.
Why It Happens
There are two main reasons this happens over and over again.
1. Our obsession with leading indicators
Leaders crave early signs of progress. So we hunt for metrics that tell us things are moving in the right direction. The problem is that optimism can blind us. Demo calls are up? Maybe that’s good, but maybe we’re talking to bad prospects. Win rates are improving? Great, unless it’s because we’re selling to the wrong customers. We start chasing indicators that, in a vacuum, don’t actually indicate anything. That’s why executives need strong intuition. You have to be able to look at a deck of metrics and say, “This doesn’t tell me anything important.” If you can’t do that, the noise will drown out the signal. The charts will keep improving while the mission quietly dies.
2. Departmental politics
The second reason is politics. Departments protect themselves. They optimize for survival. There’s an old joke that if you release a lion into a room, you don’t have to outrun the lion. You just have to outrun the person next to you. That’s how departments behave. They don’t have to be excellent; they just have to look a little better than the next one. So they manipulate metrics to stay off the radar. They create dashboards that flatter them but mean nothing. You see this constantly in customer service. You call support, wait 45 minutes, get disconnected, never get your issue resolved, and yet they proudly report “A+ SLA compliance.” That’s because “time to first response” includes the automated email that says, “We’ve received your request.” They flood their queue with easy tickets, like password resets, to inflate their close rate while hard problems sit unresolved for months. The numbers look great. The experience is terrible. I’ve seen departments that were toxic to the core. Gossiping, backbiting, undermining others. But they had perfect retention numbers. No one left because they were too insular. From the outside, the department looked like a shining example of culture and stability. On the inside, it was rotting. That’s what happens when retention becomes the goal instead of culture or alignment with the mission.
The Cure
You must focus on the primary metric that can't be misconstrued by an evil, manipulative genie. What is the one metric that, if improved, proves your company is meeting its objective no matter how you slice the data. At Calvient, we talk about this constantly. People are tired of hearing me talk about "laser focus." It means we say no to many sidequests. No to vanity charts. No to fake progress. No to initiatives that look good in a quarterly report but don’t serve healthcare operators or the patients they serve. Our mission is the filter. Everything else goes to the cutting room floor. Businesses never drift into success. They don’t stumble into mission-mindedness. They get there through focus, intention, and the discipline to keep primary metrics primary.