Meaningful vs Measurable

It seems like I’ve been fighting the battle of the measurable objective for decades. I don’t think I can ever recall  a JCAHO survey or state site visit in which somebody didn’t say that our objectives weren’t measurable enough. When asked for examples of good measurable objectives,  typically we would get something   chock-full of measurements and time frames that  seemed totally unrealistic and inappropriate for our outpatient setting. The more measurable an objective was,  the less meaningful it seemed.  Unless you were are working with very granular behaviors using applied behavioral analysis techniques most of these objectives border on the ridiculous. Few if any of our clients were  going to monitoring their behavior that closely or accurately.  

I always had great hopes that the electronic medical record would finally put this issue  to rest, but no such luck.  In our organization we plan to spend several hours over the next month editing all of the objectives in our treatment templates, so that they can meet the requirements of the managed care companies with which we work. 

I have always assumed that the push for measurable objectives was based on the assumption that they lead to better treatment outcomes, although I don’t think I’ve ever seen a study that supports that notion. Perhaps some of you readers can cite some research that shows that measurable objectives are actually evidence-based.  I would be interested in how they define measurable. I was wondered if the objective with an actual  number in it  is somehow more effective  the one that lacks a number.

Also do the patients who have “measurable objectives” in their treatment plan actually show lower suicide rates, better grades in school, more subjective well-being, decreased work suspensions, fewer  psychiatric hospitalizations, fewer arrests, increased satisfaction with relationships, or any other meaningful outcome.  Or is all this hubbub about measurable objectives just  an excuse  for Medicaid or  Managed  Care company to stiff providers. Measurable objectives certainly seems to make therapy appear rational, directed, and even scientific. But I still wonder if meaningful objectives are more important than measurable ones.

 In theory,  being able to reduce depressive thoughts from six times per week to two times per week over a period of three months might just do the trick, but that seems to involve a lot of math for most therapists  and patients. While I certainly agree that treatments needs to be focused and outcome orientated I’m just not sure throw some random numbers into the mix is the best way to do that.