Missing in action: the key KPI for government
Posted by Dave Bath on 2009-11-18
"Life, liberty, and the pursuit of happiness" is an oft-quoted phrase describing rights of persons and therefore the duties of government, yet these are not measured as directly, nor as often, as much more indirect and much less relevant measures of government performance.
Perhaps the best way of assessing government performance quarter by quarter is to provide an indicator of the frequency and depth of depression in the community. We might not be able to measure how successfully everyone in the community is pursuing happiness, but we can certainly measure how many are in the clutches of misery.
If a government is doing its job to perfection, then there would be zero incidence of depression that is a reaction to external circumstances, although there would be a small incidence of endogenous depression that would happen to a few unfortunate individuals however pleasant their circumstances. Conversely, if nearly everyone has some degree of depression, even if only mild, and there are no signs of improvement, then any government that has been in power for more than a few months deserves to be ousted for incompetence (or malice).
It is fairly easy to measure depression incidence and depth as a number of indices exist, some of which can even be self-scored by patients and used as a quick screening tool. These indices should also be used as a screening tool for government competence.
One of the many rating scales for depression, the Major Depression Inventory has been designed for consistency with the WHO ICD (World Health Organization International Classification of Diseases, used by health agencies in Australia for reporting) and the DSM (Diagnostic and Statistical Manual of Mental Disorders), and considered very suitable for epidemiological or population studies.
How hard can it be for the ABS (Australian Bureau of Statistics) to select a statistically valid sample, collect the results of the Major Depression Inventory, and report them every quarter, a period roughtly consistent with the time a person’s underlying mood can change? It is surely easier and more reliable than metrics such as "Business Confidence" or "Consumer Confidence", less subject to fudging than the Consumer Price Index that is sensitive to the selection of the items in the basket.
It is also reasonable to consider indices of population depression as lead indicators, even as lead economic indicators. Depressed workers are less productive. While complicated by the real (and sometimes helpful) phenomenon of "retail therapy", community-wide depression can affect consumer confidence, sales in shops, and housing prices. Stress and depression can affect incidence of domestic violence, drug dependencies, other crimes, and suicide attempts, and thus provide input into forward estimates for health and welfare budgets.
So, given that there are easily collected metrics that are direct indicators of the performance of a government in its basic duties, why does the ABS not report on these more frequently, why do the politicians not include them in media releases as KPIs (Key Performance Indicators), and why should they not receive just as much, if not more prominence in the media as quarterly trade flows, economic activity indices, and the like?
Why when I use Google to look for documents within the ABS mentioning both the words "depression" and "mental" over the last year do I get only a couple of dozen documents returned? Why are the ABS Statistics 4326 and 4327 which relate to National Surveys of Mental Health and Wellbeing (included in the health subdivision of social indicators), only available for 1997 and 2007, even though basic moods of people can change in only a few months? Why do these Mental Health Statistics have such a large focus on indirect indicators (such as divorce rates, etc) rather than have a statistic that concentrates on the direct indicators of misery levels?
The reason for the lack of collection and publication of these statistics is not the difficulty in collecting them, not the difficulty of interpreting the results, even if you do break them down by age, geographic region, and the frequencies of different score ranges. The more likely reason is that the politicians know that collection and publication of such statistics, the KEY Key Performance Indicator of government action, would leave the politicians red-faced.
If a government was competent, especially after a change of government, we’d have ministers proudly showing graphs and trending figures about how much they were lowering misery, in as many press conferences as they could muster, pushing the sound bites into the news. We don’t see that.
Instead, on the key business of government, the happiness of citizens, we get spin on indirect indicators, announcements claiming a deep concern, with the only real figures put before the public that amount of money politicians are spending, however uselessly, on the problem of misery.
A recent report from the Victorian Auditor General on the handling of Mental Health Crises, crises being defined as times the individual is a risk to themselves or others, had the following in the summary of findings, each paragraph separated from the others in the report:
There is a lack of information showing the effectiveness of triage and CAT services, and police and ambulance responses to mental health crises. This prevents quantitative analysis and robust performance monitoring, allowing service gaps to go unaddressed
DOH lacks useful data about triage and CAT service responses to mental health crises. CAT services have run for 15 years, but DOH does not know the number of urgent referrals received, how services respond, their timeliness or the outcomes.
Until agencies have access to robust information about response effectiveness, they cannot identify successes or areas to improve in their own crisis response operations, nor can they review their joint performance to identify system-wide issues.
Thus, even for crises that have a huge impact on not only the individual in the crisis, and if not handled correctly, contribute to further crises, but also affect the families and friends of those unfortunate people, perhaps pushing others into misery and possibly crises, almost no useful data is available to assess performance and effectiveness.
There is a truism in management and performance improvement: "If it isn’t measured, it can’t be managed". Our politicians must understand this, but use the corollary: "If it isn’t measured, we can weasel our way out of accountability".
The auditor mentions 15 years. For a system to be in place that long, and yet there to be no useful data to demonstrate effectiveness, is not mere incompetence, which would probably have taken 5 to 10 years to produce decent data collection systems. It seems likely that this lack of information is the product of deliberate inaction by politicians, or perhaps the intentional sabotage of the efforts of the competent and well-meaning public servants across a range of departments who would be wanting to get the data, assess the effectiveness of measures, and institute improvements where so often necessary.
While depression is not the only mental health issue, depression and associated stress are major contributing factors to other mental health disorders becoming visible in an individual, changing from a subclinical condition to something more obvious, touching the lives of all around them.
With the Victorian Auditor General noting that "nearly one in five Victorians experience mental illness each year", the domino effect upon families and friends, the consequent impact on budgets for health and policing, as well as the consequences for workforce productivity, it is fairly obvious that prominent quarterly depression incidence statistics would be useful indicators of government performance as a whole, could force governments to be accountable and take action.
If a political party seeking office has the courage to promise frequent publication of such indicators, to ask voters to use these to assess government performance, then we might not be able to judge ability to make a difference, but we can at least conclude that they think they can govern well, manage perhaps the most important duty of a government, the happiness of the citizenry.
Until we get such promises, we can be assured that no major political party has the intent to govern in the public interest or the confidence that they can perform their core duty.