In general, people often forget that if your target is a ratio, you can attack the numerator or the denominator. Often the latter is the easier to manipulate.
Even if it's not a ratio. When any metric becomes a target it will be gamed.
My organization tracks how many tickets we have had open for 30 days or more. So my team started to close tickets after 30 days and let them reopen automatically.
Meanwhile that's not necessarily a bad outcome. In theory it makes the data better by focusing on deaths that might or might not have been preventable, rather than making every hospital look responsible for inevitable deaths.
Of course the actual behavior in the article is highly disturbing.
