The doublespeak crowd have confused matters by confusing process metrics with quality metrics. This is a commonplace problem and usually goes unmentioned. The difference generally does not matter. It matters in medicine primarily because decision makers are making bad decisions because of misunderstandings about the difference.

Automobile manufacture has a great many similar examples. One
quality metric of an automobile is rust resistance. The quality metric is years without rust while in normal use. This cannot be measured in the factory. So the factory must pick a process measurement, such as ounces of rust coating applied per car, that they can measure. From time to time someone finds a better process metric, such as measuring coating thickness.

As long as all involved remember that the goal and final arbiter is
the field experience of years without rust, this works well. The
factory uses process metrics and changes them when better metrics are found. The explanation to the factory workers is “we can’t measure years without rust, so we measure this instead. If you think of something better, let us know. We will change and use it.”

This needs to be the attitude for most of the healthcare metrics.

Unfortunately, the decision makers in government and senior
management do not understand this. Rather than understand that the real goal is patient health, they make the goal these process metrics and cast them in concrete. There needs to be the
realization that most patient health metrics can only be measured
retrospectively. This means that process metrics will be needed.
But they must be understood as process metrics, and participants
encouraged to find better process metrics that more accurately
predict patient health outcomes.