Faster is not the only outcome
A service may reduce average intake time by shortening conversations. That could improve throughput while leaving some people less able to understand the next steps. Monitoring only speed would miss the tradeoff.
The balancing measure should reflect a plausible consequence, not an unrelated statistic added for completeness.
Pair the change with a concern
| Intended improvement | Possible balancing question |
|---|---|
| More appointments | Does staff overtime rise? |
| Shorter waiting time | Are complex cases being deferred? |
| Digital enrollment | Are people without internet access excluded? |
| Lower delivery cost | Does participant burden increase? |
These are prompts for selecting measures, not assumptions that the harms will occur.
Measure where the burden moves
A task removed from staff may be transferred to participants or caregivers. Organizational efficiency and total burden can therefore move in different directions.
Decide what happens if the tradeoff appears
Before launch, identify who will review the measure and what would prompt investigation or revision. A balancing measure is less useful if it is collected but cannot influence the decision.
Improvement work benefits from a family of measures, as IHI describes. The aim is a better overall process, with the desired outcome and its consequences visible together rather than celebrating one favorable number in isolation.
