Successful organisations optimise performance, quality, outcomes and standards. We want our organisations to continuously learn, adapt and improve. Anyone who has worked in a large organisation will have had some experience of being assessed with performance measures and targets that do not accurately reflect what they actually do. Wherever there is a target, there is someone trying to manipulate the statistics. It is often said that you can’t measure complex services, for example the many different functions and interactions in healthcare. The good news is that you can. If you think of the organisation not as a machine but as a conscious living system, the solution becomes apparent. Imagine that you could make the formal structures, titles, business processes, computers and organisational structures invisible and just see it as it is-a bunch of intelligent, well trained, well-motivated human beings acting together in a network of relationships. For example, if you want to measure the effectiveness of a particular clinical service, map out the relationships. This will include the patients, relatives, clinicians within the service, general practitioners, social services, police, employers, the finance department and directors. Interview a selection of each of those people, asking, ‘How do you know whether or not clinical service X is effective?’ Usually the person will look bored, look at their watch and make an excuse to leave. They may say, ‘I don’t know the formal policy and I haven’t read the policy on that.’ Then say, ‘No not that. I want to hear about how you determine the effectiveness of the clinical service, using your personal and professional judgement.’ A light switches on. The person gets a glint in their eye. They say, ‘Oh, you actually want to know what I think! I’ve never been asked that before.’ They then pause, because the criteria that they use to determine effectiveness (I call them Authentic Outcome Measures) are usually either unconscious or semiconscious. With patient listening and interviewing, they reveal a wealth of knowledge and experience. The answers will be a combination of objective and subjective, qualitative and quantitative, knowledge and experience, academic research and anecdote. Collate the results and you’ve got some Authentic Outcome Measures that closely align with human nature and the reality of the task.