But metrics tend to be most successful for those interventions and outcomes that are almost entirely controlled by and within the organization’s medical system, as in the case of checklists of procedures to minimize central line–induced infections. When the outcomes are dependent upon more wide-ranging factors (such as patient behavior outside the doctor’s office and the hospital), they become more difficult to attribute to the efforts or failures of the medical system. Jerry Z Muller, the Tyranny of Metrics, FebruaryOne of the advantages of the Social Policy Bond idea, in my view, is that they could target things that are outside the remit of most existing institutions. So, for instance, holders of bonds targeting the health of a population would have incentives to encourage non-medical health-improving practices. Not limited to the more obvious interventions - exercise and diet, for instance - bondholders could, for instance, aim to lobby local authorities to make neighbourhoods more walkable, or to subsidise employment for people who would otherwise be at high risk of becoming depressed. And not only in medicine: the most efficient ways of solving our social and environmental problems may currently lie outside the remit of any of our existing institutions. Only a broad, long-term approach, as encouraged by Social Policy Bonds, would encourage people to investigate this possibility.
What Social Policy Bonds would do, in effect, is redraw the boundaries of the organisation to take in factors that are currently untargeted, or targeted only incoherently and unsystematically. By focusing on broad metrics, applying to large populations, the bonds would encourage investors to consider all the important potential influences on the value of their bonds. A new type of organisation would come into being, composed of a protean coalition of bondholders, all of whose activities would be devoted to achieving our social goals as efficiently as possible. They would have powerful incentives to investigate and implement measures that achieve these goals regardless of whether or not they currently fall under the remit of existing bodies. Under a Social Policy Bond regime, efficiency and effectiveness in meeting our challenges would determine the structure and composition of our goal-achieving bodies.