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Adam Kureshi

Adam Kureshi

Business transformation, behavioral health, healthcare systems & digital strategy professional exploring systems and organizational growth.

Who Decides What Value Is?

14 min readOct 24, 2026

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The Value Paradox | Part I

Why organisational success depends on more than the results we report.

I remember a conversation with a colleague that began with a deceptively simple question:

What constitutes success?

The discussion soon turned into a debate about impact and outcomes. What distinguishes one from the other? Must an outcome take two or three years to materialise? And at what point does a change become significant enough to be considered an impact?

Eventually, we worked our way backwards to outputs, the more immediate and tangible products of an intervention.

But the further we explored these distinctions, the more interesting the question became.

If an organisation delivers everything it promised, has it succeeded? If those outputs produce measurable outcomes, is that sufficient? And if those outcomes eventually contribute to a broader impact, does that settle the question?

Somewhere in the discussion, we arrived at something more fundamental.

Where, in this progression from outputs to outcomes and impact, does value actually emerge?

It seemed like a natural extension of our conversation. Yet the more I thought about it, the less straightforward the answer appeared.

Organisations have developed elaborate ways of measuring what they do and what changes as a result.

But determining whether those changes are genuinely valuable is an altogether different exercise.

And perhaps that is where our understanding of success begins to become complicated.

When Measurement Becomes Meaning

Organisations like things they can measure.

Projects have milestones. Companies have performance targets. Government departments have reporting obligations. Development programmes have results frameworks.

These mechanisms are necessary. They help organisations allocate resources, monitor progress, and demonstrate accountability.

But they can also influence what organisations understand success to mean.

The OECD’s Glossary of Key Terms in Evaluation and Results-Based Management for Sustainable Development (2023) provides a useful starting point for distinguishing outputs, outcomes, and impacts.

In simplified terms, outputs are the products or services an intervention generates. Outcomes concern changes to which those outputs contribute, while impacts refer to broader, significant effects.

Time is relevant. Some changes become visible quickly; others require years to emerge. But a reporting horizon is not, by itself, sufficient to explain the nature or significance of a result.

Imagine a hospital introducing a new patient referral process.

The guidelines are developed. Staff members are trained. A revised procedure is introduced.

These are outputs.

Within a few weeks, clinicians begin following the process. Unnecessary referrals decline, and patients experience shorter waiting times.

These are potential outcomes, provided the changes can reasonably be linked to the intervention.

They do not become outcomes simply because a predetermined reporting period has elapsed.

But even this distinction leaves another problem.

Suppose the hospital reduces average consultation time by 30%.

Management might regard this as an improvement in efficiency.

Yet imagine that shorter consultations lead to missed symptoms, unresolved concerns, and more repeat visits.

The hospital has improved one indicator while potentially making the overall service worse.

The reported change may be real. Its value is questionable.

An outcome tells us what changed. Value asks whether that change was worthwhile.

And that distinction takes us beyond measurement into something considerably more complicated.

The Same Intervention, Different Definitions of Success

Consider a private hospital investing in a new inventory management system.

Executive leadership expects lower operating costs and improved working capital.

The finance department wants fewer expired medicines and emergency purchases.

Clinical staff want essential supplies to be available when patients need them.

Patients want reliable treatment without unnecessary delays or additional purchases.

Everyone is evaluating the same investment.

But they are not necessarily evaluating the same benefit.

A system that reduces inventory costs by keeping stock levels extremely low might satisfy financial targets while increasing the risk of shortages.

Conversely, maintaining additional stocks of critical medicines may appear inefficient from a narrow financial perspective while improving the hospital’s ability to deliver safe care.

Neither perspective is automatically wrong.

They are concerned with different consequences.

Now consider a public institution receiving technical assistance to improve its operations.

A funding organisation may focus on agreed objectives, accountability, and responsible expenditure.

An implementing partner may assess whether the required technical outputs were delivered.

Government leadership may judge the intervention against institutional priorities.

Frontline officials may be concerned with whether the proposed changes are practical.

Citizens may only experience value if public services become more accessible, reliable, or effective.

Again, one intervention. Several legitimate interpretations of success.

This is not simply a disagreement about performance indicators.

It reflects a more fundamental question:

Value for whom?

Creating Value Is Not the Same as Capturing It

In private enterprise, value is frequently discussed through profitability, productivity, growth, and competitive advantage.

These are essential considerations. A business must generate sufficient economic returns to remain viable.

But financial success does not necessarily provide a complete account of the value an organisation creates.

A company may increase profits by improving productivity, developing a better product, or reducing waste.

It may also increase profits by reducing service quality, transferring costs to suppliers, or taking advantage of customers who have limited alternatives.

Both approaches may improve financial performance.

Their wider consequences are very different.

This distinction connects to R. Edward Freeman’s Strategic Management: A Stakeholder Approach (1984), which helped establish stakeholder theory as an influential perspective on organisational strategy.

Freeman’s work draws attention to the relationships between organisations and the various groups that affect or are affected by their decisions.

Customers, employees, investors, suppliers, and communities do not necessarily experience organisational success in the same way.

A business may capture additional financial value without creating an equivalent improvement for its customers or wider stakeholders.

Public institutions face a related challenge, although their purposes differ.

A government hospital is not ordinarily established to maximise profit. Its responsibilities may include improving access, delivering safe care, protecting vulnerable populations, and using public resources responsibly.

A service may be expensive while generating substantial social benefits.

Equally, a programme may remain within budget while failing to address the needs it was established to serve.

Mark H. Moore’s Creating Public Value: Strategic Management in Government (1995) offers an influential perspective on this problem.

Moore’s approach considers public value alongside legitimacy, support, and operational capacity. Public institutions must pursue worthwhile objectives, secure the authority and support necessary to act, and possess the capability to deliver.

The distinction between private and public value is important, but it is not absolute.

Businesses must consider relationships, legitimacy, and long-term consequences. Public institutions must consider costs, efficiency, and the practical use of scarce resources.

Both can become exceptionally good at demonstrating performance against internal measures without necessarily improving what matters most to those they serve.

When Everyone Can Claim Success

Imagine a consultancy engaged by a manufacturing company to improve productivity.

The consultants conduct an assessment, identify bottlenecks, redesign workflows, and submit an implementation roadmap.

The client accepts the deliverables. The engagement closes successfully.

Six months later, productivity remains unchanged.

Was the consultancy successful?

If its responsibility was limited to diagnosis and recommendations, it may have fulfilled the contract.

But if the purpose of commissioning the work was to improve productivity, the absence of improvement still demands an explanation.

Perhaps management never implemented the recommendations. Perhaps the proposed changes were impractical. Perhaps the organisation lacked the resources required to act.

These explanations matter because they point to different problems.

Contractual completion is not necessarily evidence of organisational improvement.

Nor does the absence of improvement automatically establish that the consultants failed.

Now imagine a government department receiving support to strengthen institutional planning.

A framework is developed. Procedures are documented. Employees attend training.

Yet the department continues to operate much as it did before.

Again, several explanations are possible.

The assistance may have addressed the wrong problem. The recommendations may not have been adopted. Institutional constraints may have prevented implementation.

Or the intervention may have created capabilities whose benefits are not yet visible.

Simply counting completed deliverables cannot distinguish between these possibilities.

The distinction between producing work and demonstrating improvement is not unique to consultancy engagements. It is relevant to digital transformation, organisational reform, public programmes, and almost any initiative intended to change how an institution performs.

The International Institute of Business Analysis makes a useful distinction in its Business Analysis Body of Knowledge (BABOK Guide), Version 3, particularly within its Solution Evaluation knowledge area.

Evaluating a solution involves more than establishing whether it performs as intended. It also requires examining the value delivered, identifying limitations, and considering opportunities for improvement.

A technically functioning solution may still fall short of its potential.

The difficulty, then, is not always that organisations lack methods for evaluating value.

Sometimes, it is that the people commissioning, implementing, using, and judging an intervention do not share the same understanding of what that value should be.

When the Evidence Cannot Tell Us What Changed

This distinction is not merely theoretical.

In its Results and Performance of the World Bank Group 2025, the World Bank’s Independent Evaluation Group examined the effectiveness of advisory and analytical services.

These activities can include research, technical advice, policy analysis, and institutional support intended to inform decisions and strengthen capabilities.

The evaluation examined thousands of such activities and identified a significant weakness in how their results were documented.

It reported that approximately 40% of completion summaries did not discuss results achieved in their intended outcome areas.

That finding deserves careful interpretation.

It does not mean that 40% of those interventions failed.

It means that the completion reporting did not establish whether the intended changes had occurred.

The evaluation also highlighted the difficulty of assessing advisory work at the point of completion, when its influence on institutional decisions and practices may only become visible later.

This creates an important distinction.

An organisation may successfully deliver the work it was commissioned to produce while remaining unable to demonstrate whether that work achieved its underlying purpose.

Equally, an intervention may create genuine benefits that its evaluation system is not equipped to capture.

The absence of demonstrated value is not necessarily evidence that value was absent.

Sometimes, the disconnect lies not in the intervention itself, but in the relationship between what was delivered, what changed, and what the organisation was capable of recognising.

The Value Disconnect

I have come to think of this as the Value Disconnect.

It describes situations in which the value an intervention promises, the capabilities it enables, the benefits it produces, and the value stakeholders recognise do not fully align.

Four questions help make the disconnect visible.

1. What value was promised?

Every intervention begins with an expectation.

A company invests in automation to improve productivity. A hospital introduces a system to strengthen patient safety. A government department receives technical assistance to improve institutional performance.

But expectations are often expressed in broad terms.

Efficiency. Transformation. Capacity building. Institutional strengthening.

These may be legitimate objectives. Yet without a clear explanation of what should improve, and for whom, success becomes difficult to evaluate.

2. What value was enabled?

An intervention may create a capability without immediately producing the intended benefit.

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A consultancy develops an operating model. A hospital acquires an information system. A government department receives a planning framework.

These achievements may be necessary.

But they represent opportunities for improvement, not necessarily realised improvements.

A system can be installed without being adopted. A framework can be approved without influencing decisions. Training can be delivered without changing behaviour.

3. What value was realised?

This is where we examine actual consequences.

Did productivity improve? Did costs decline without compromising quality? Did patients receive better care? Did the institution become more responsive?

We also need to consider who benefited and who incurred additional costs.

An intervention that improves one department’s efficiency by transferring substantial work to another may produce a smaller overall benefit than its headline indicators suggest.

4. What value was recognised?

Finally, we must examine how stakeholders interpret the results.

An intervention may produce genuine benefits that some stakeholders do not acknowledge.

It may also receive enthusiastic support despite limited evidence of meaningful improvement.

Recognition is influenced by expectations, incentives, experience, and institutional priorities.

Press enter or click to view image in full size
The Value Disconnect: Four dimensions of organisational value. Framework by the author; visual created with AI assistance.

The four dimensions are connected, but they do not necessarily progress in a neat sequence.

Stakeholder expectations can influence adoption. Early experiences can alter perceptions. Recognition may emerge before benefits have been properly demonstrated.

The Value Disconnect is not a new theory of benefits realisation.

Established approaches already distinguish expected benefits from achieved results and recognise the importance of organisational conditions.

What interests me is another dimension of the problem: the possibility that the people who define value, enable its creation, experience its consequences, and judge its worth are not the same people.

The resulting disagreements are not always failures of measurement.

Sometimes, they arise because stakeholders are answering different questions about the same intervention.

That is the disconnect the framework is intended to make visible.

Why Recognition Matters

There is a temptation to treat stakeholder satisfaction as the final verdict on whether an intervention has created value.

If the intended recipient does not consider it useful, surely it has failed.

But perception and value are not necessarily identical.

Consider a new reporting system introduced in a public institution.

Frontline employees may regard it as an administrative burden. Management may value the improved visibility it provides. Citizens may benefit indirectly if the information leads to better services.

The system could generate genuine improvements while also imposing unreasonable demands on employees.

Both observations may be true.

Michael Lipsky’s Street-Level Bureaucracy (1980) offers an important perspective on why organisational changes do not simply move from policy to practice exactly as intended.

Lipsky examined how frontline public servants exercise discretion under conditions of limited resources, heavy workloads, and competing demands.

His work reminds us that implementation takes place within institutional realities, not idealised organisational charts.

Resistance may reflect legitimate concerns about feasibility and workload.

It may also reflect incentives to preserve established arrangements.

Neither possibility should be assumed without investigation.

Equally, strong institutional support does not guarantee that an intervention creates meaningful value.

A project may be popular with senior leadership, meet its milestones, and receive positive feedback while producing limited improvement for its intended beneficiaries.

Stakeholder perceptions are important evidence, but they are not substitutes for examining actual consequences.

The challenge is to take people’s experiences seriously without assuming that any single perspective provides the complete picture.

Who Has the Authority to Define Value?

This brings us to a question that is often less visible than the performance indicators themselves.

Who gets to decide what counts as success?

In a private company, executives may approve investments and establish performance targets.

Employees may have limited influence over those decisions, even though they are responsible for implementing the changes.

Customers may experience the consequences without participating in the original discussion.

In public institutions, the distribution of authority can be even more complicated.

Political leadership, government departments, funding organisations, implementing partners, frontline workers, and citizens may all have legitimate interests.

But they do not necessarily have equal influence.

Some control resources. Others control administrative approvals. Some define reporting requirements. Others carry the responsibility for implementation.

And the people most affected by an intervention may have the least influence over how its success is defined.

This creates a distinction between those who define value, those who authorise or enable its creation, and those who experience its consequences.

These groups may overlap.

But when they do not, disagreement becomes more likely.

Consider a public-sector reform that improves administrative efficiency but reduces access for communities that are already underserved.

From one perspective, the intervention has succeeded.

From another, it has failed.

Resolving that disagreement requires more than selecting a preferred indicator.

It requires examining the institution’s purpose, legal obligations, resource constraints, and the distribution of benefits and burdens.

Value is therefore not simply a technical question.

It is also a question of legitimacy, authority, and whose interests are considered when decisions are made.

Not Everything Valuable Is Easily Measured

Some forms of value are relatively straightforward to demonstrate.

Procurement savings can be calculated. Processing times can be measured. Production capacity can be counted.

Other forms are more difficult.

What is the value of institutional trust?

How should an organisation assess improved decision-making capability?

What is the benefit of a public health institution becoming better prepared for an emergency that may never occur?

These questions are difficult, but they are not necessarily less important.

Even private businesses depend on benefits that do not immediately appear as profit.

Customer trust can influence retention. Employee capability can improve adaptability. Better processes can reduce operational risk.

Public institutions may generate value by improving resilience, accountability, equity, or preparedness.

The benefits may emerge slowly or be distributed across groups.

But difficulty in measurement should not become an excuse for avoiding evaluation.

If an organisation claims to have strengthened institutional capability, we should be able to ask what the institution can now do that it could not do before.

If a company claims to have improved customer experience, we should examine what customers actually experienced.

If a public programme claims to have strengthened service delivery, we should investigate changes in access, quality, responsiveness, or outcomes.

Not every benefit needs to be converted into money.

But claims of value should be open to examination.

The Question Behind Every Intervention

Organisations frequently begin initiatives by asking what needs to be done.

What systems should be introduced?

What processes should be redesigned?

What frameworks should be developed?

What training should be delivered?

These are legitimate questions.

But they concern the means through which improvement is expected to occur.

They do not necessarily establish why that improvement matters.

A more useful starting point might be:

What should become better, for whom, and how would we recognise that improvement?

This question does not eliminate disagreement.

Businesses face financial constraints. Employees have legitimate interests. Customers value different aspects of service. Public institutions must balance efficiency, equity, access, and accountability.

Not every decision can benefit everyone equally.

But defining intended value makes these trade-offs visible.

It also helps prevent an organisation from becoming so absorbed in delivering an intervention that it loses sight of why the intervention was undertaken.

Because once resources are committed, project teams established, and reporting mechanisms introduced, activity develops a momentum of its own.

Meetings continue. Reports accumulate. Milestones are completed.

And the original question, what are we trying to make better?, can quietly disappear behind the work being done.

From Defining Value to Demonstrating It

There is something reassuring about a completed project.

It has a beginning and an end. It produces tangible evidence of effort. It allows organisations to demonstrate that commitments were fulfilled.

Value is less accommodating.

It may emerge slowly. It may be distributed unevenly. It may depend on decisions made long after the original intervention concludes.

Sometimes, despite considerable effort and expenditure, it may never materialise at all.

This is not an argument against consulting, technical assistance, digital transformation, or institutional reform.

These interventions can produce substantial benefits.

It is an argument for being more precise about what those benefits are supposed to be, and more curious about whether they have actually emerged.

I find myself returning to the conversation that started this line of thinking.

We began by discussing success, moved into impact and outcomes, and worked our way back to outputs.

But the most important question was not where one category ended and another began.

It was whether the changes we were discussing had made anything meaningfully better.

Perhaps the question is not simply whether an organisation has created value.

It is what kind of value was created, for whom, at whose expense, and according to whose definition of success.

Because organisations do not merely disagree about whether change has worked.

Sometimes, they disagree about what the change was supposed to accomplish in the first place.

And even when that disagreement is resolved, another problem remains.

How do we know that the promised value actually materialised?

That is where the distinction between delivering work and creating value becomes impossible to ignore.

Author’s Note

This is Part I of The Value Paradox, a three-part series examining how organisations define, create, demonstrate, and sustain value across private enterprise, public institutions, and organisational transformation.

The reflections and interpretations presented here are my own, informed by professional observations, established research, and published evidence. Organisational examples are hypothetical unless otherwise identified. They are intended to illustrate broader systems challenges rather than comment on any particular organisation, project, or individual.

The Value Disconnect is an author-developed conceptual framework that draws on established ideas in stakeholder theory, public value, business analysis, and benefits realisation.

Any views expressed are personal and do not represent those of any organisation with which I am or have been associated.

References & Further Reading

  1. OECD (2023). Glossary of Key Terms in Evaluation and Results-Based Management for Sustainable Development. OECD Publishing.
  2. Freeman, R. E. (1984). Strategic Management: A Stakeholder Approach. Pitman.
  3. Moore, M. H. (1995). Creating Public Value: Strategic Management in Government. Harvard University Press.
  4. International Institute of Business Analysis (2015). A Guide to the Business Analysis Body of Knowledge (BABOK Guide), Version 3.
  5. World Bank Independent Evaluation Group (2025). Results and Performance of the World Bank Group 2025.
  6. Lipsky, M. (1980). Street-Level Bureaucracy: Dilemmas of the Individual in Public Services. Russell Sage Foundation.

Next in the series: The Illusion of Value Creation

Why completing the work is not the same as solving the problem.

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Adam Kureshi
Adam Kureshi