A further thought, this time on 'bedside manner'. It is interesting that the study Petagny refers too finds 'bedside manner' important in influencing the extent to which outputs (consultations, interventions, etc.) contribute to the achievement of policy objectives (e.g. improved health outcomes for patients). The importance of 'bedside manner' was recognised at least as far back as Samuel Pepys in the 17th century - and no doubt much further back in the annuls of time too. Pepys had surgery for the removal of a gallstone in 1658. The account of this is fascinating (not least the concept of major surgery in the absence of anesthesia). Perhaps the most interesting part of the account is the emphasis at that time on the surgeon spending time getting to know the patient and the patient, in turn, getting to know and (crucially) to completely trust the surgeon in question ... ' .. the sick person was advised to cultivate a calm frame of mind and to avoid anger or sadness; he should feel confidence in the surgeon, even affection ...' (a quote from Claire Tomalin in her account of Pepys life where she refers to what contemporary medical manuals had to say about these things). Fortunately for Pepys, his surgeon was 'at the hight of his powers', operating successfully on thirty patients in that year. His first four patients of the following year all died, however, probably as a result of some contamination of his instruments. So, much to learn from the 17th century about not only the role of 'bedside manner' in properly specifying outputs and objectives but also about the importance of specifying standards for cleanliness, sterilisation and contamination.
But how on earth would one specify 'bedside manner' in a practical and applicable manner, and in particular, in such a way that it would not result in unintended consequences and/or perverse incentives?