The productivity illusion: performance measurement and the invisibility of digital clinical work.

Clinical value is now produced in two distinct registers: one that requires physical presence, and one that does not. Performance measurement frameworks, however, were built for mainly the first. Where digital work is counted, it is rarely counted equitably; where it is counted equitably, it is rarely connected to the outcomes it produces. This structural gap, which is termed here value-time-place misalignment, gives rise to the productivity illusion: a system that appears busy, measurable and accountable, while systematically failing to capture the outcomes that it purports to deliver. Drawing on teleconsultation, artificial intelligence (AI)-supported decision-making, remote multidisciplinary teams and digital follow-up, this paper demonstrates how current metrics penalise efficiency, suppress innovation and render care increasingly illegitimate to the patients it serves. Redefining the unit of healthcare work is not a technical adjustment; it is a foundational one.