HAI Surveillance: Still Searching for the Sweet Spot with Goodhart's Law in Mind

Professor Charles Goodhart

It seems with much of what we do in infection prevention, we are searching for the sweet spot, whether it is a in how we isolate patients with contact precautions or how we order diagnostic tests (test stewardship).

I read with great interest this article in Clinical Infectious Diseases on partially automated vs. fully automated surveillance systems for hospital acquired infections. No system is perfect and both approaches have some value.

My personal bias: we should standardize and automate as much as possible but only for clinically relevant outcomes with agreed upon infection prevention risk reduction processes.  Why aggressively monitor what we are unable to change (with the current state of science)? An ongoing element of manual review seems inevitable for now.

Last, beware of gaming. As referenced in the article, any surveillance system is subject to Goodhart's Law, named after British economist Professor Charles Goodhart (London School of Economics): 

‘ Any observed statistical regularity will tend to collapse once pressure is placed on it for control purposes because actors will change their conduct when they know that the data they produce will be used to control them.'

We are still searching for the HAI surveillance sweet spot.