Innovations in Measurement


Setting clear goals and finding measures that will mark progress toward them can improve the human condition – Bill Gates

Innovations in education, nutrition, drugs, and technology can be a powerful force for improving health.

But an innovation has no impact unless it reaches the people who need it. 

We need to find new ways to deliver services and tools to the people who need them most.

Bill Gates says that the first step is innovation is to look at the way we measure.

I’ve never been a Microsoft fan – not that they would lose any sleep about that – but I have become a great Bill Gates fan.  

The Bill and Melinda Gates Foundation is the largest private foundation in the world. It is largely funded by the extraordinary philanthropy of Gates and Warren Buffett. It has funds of about $36 billion. Bill Gates has devoted himself to oversight of the operations of the foundation since he stepped down from Microsoft in 2008.

The primary aims of the foundation are to enhance healthcare and reduce extreme poverty. It provides, for example, a significant proportion of the funding to eliminate polio. The number of polio cases dropped by 99 percent from 1988 to 2000, from 350,000 cases to less than 1,000. India, once home to the majority of polio cases in the world, has been polio-free since 2011, thanks to innovative approaches to eradication. There are now just three countries that have never eliminated polio: Nigeria, Pakistan, and Afghanistan

I highly commend to you the 2013 Annual Letter from the foundation, written by Bill Gates, which makes the case for using a tool of business to improve the health and welfare of more of the world’s people.

In it he stresses the critical role of measurement in achieving any worthwhile goal.


 “In the past year I have been struck again and again by how important measurement is to improving the human condition. You can achieve amazing progress if you set a clear goal and find a measure that will drive progress toward that goal—in a feedback loop.

“This may seem pretty basic, but it is amazing to me how often it is not done and how hard it is to get right.”

“In previous annual letters, I’ve focused a lot on the power of innovation to reduce hunger, poverty, and disease. But any innovation—whether it’s a new vaccine or an improved seed—can’t have an impact unless it reaches the people who will benefit from it. That’s why in this year’s letter I discuss how innovations in measurement are critical to finding new, effective ways to deliver these tools and services to the clinics, family farms, and classrooms that need them”

The Way Forward

“The lives of the poorest have improved more rapidly in the last 15 years than ever before, yet I am optimistic that we will do even better in the next 15 years. After all, human knowledge is increasing. We can see this concretely in the invention of new medicines like HIV drugs and the way their prices have come down, and in the creation of new seeds that allow poor farmers to be more productive. Once these tools are invented, they are never un-invented—they just improve.

“Skeptics point out that we have a hard time delivering new tools to the people who need them. This is where the innovation of using measurement is making a big difference. The process I have described—setting clear goals, picking the right approach, and then measuring results to get feedback and refine the approach continually—helps us to deliver tools and services to everybody who will benefit. This innovation to reduce the delivery bottleneck is critical. Following the path of the steam engine long ago, progress isn’t “doomed to be rare and erratic.” We can, in fact, make it commonplace.”


The science of measurement has often been neglected in the design of our health services, particularly in primary care.

Measuring the outcome of the care we provide is a critical tool in improving our practice systems. It is time for ‘innovations in measurement’ to be a focus of our clinical redesign.

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