Dancing the Measures of Transformation
Peter Drucker said that 95 percent of what matters in an organization cannot be counted. J. K. Galbraith said, “If it is not counted, it tends not to be noticed.” Demming estimated that 95 percent of the time within an organization is spent on measuring or counting something. The implications of these facts are obvious. In addition, Drucker (1994) said that no time in recorded history has seen such a radical social transformation as our own. Many of us share a purpose of supporting social and personal transformations, in part because of the additional sense of meaning such activity brings to us, and in part because we all share a sense of frustration that the disconnections of our world are too frequently increased rather than improved by conventional efforts to ameliorate them.
As we attempt something new in the world of philanthropy, we must ask several questions:
- What really matters to people struggling to transform their lives?
- How do we know that it matters?
- How do we know what works as the transformation occurs?
- Can we replicate success?
- Can we, or should we, count what counts?
- Can we create a space in which to connect others to these reflections?
Just as a reminder: more than two billion people in the world live without electricity; four billion rarely make a phone call; three billion have never seen a doctor; more than a billion are illiterate. The poorest people in our world live on a dollar or less per day, and the buying power of their income is decreasing (North and Swider, 2001). Now more than ever, Dr. Jonas Salk’s question, “Are we being good ancestors?” is a critical one for us to answer.
An earlier paper by this author (which bears the same title as this one) (Ion 1995) considered the measures used to assess the impact and value of prenatal care. That paper looked at the average number of insurance claims paid for mothers’ prenatal visits as related to birth weight and the costs of medical complications experienced, to derive an understanding of the standard of care commonly given women during pregnancy. Curiously, the study found that once the aggregate number of five visits was accepted, an understanding of the effectiveness of those five visits or the content of what took place at any visit was not pursued as part of the assessment of quality and has rarely been explored. What counts in pregnancy is the mother’s health and a healthy baby, but what is typically measured is the cost and frequency of episodic encounters with a disease-care system.