Survey Snapshot: What the High Performers Have to Say

Insights Report · August 10, 2018

In the recent NEJM Catalyst Insights Council survey report on high-performing organizations, Kaiser Permanente, the Cleveland Clinic, and Intermountain Healthcare receive top mentions as high-performance role models. Insights Council members from each of these organizations say they are flattered to be considered high-performing, but they believe there is still so much room for improvement.

“I think we’re on the right path as a national health care system, trying to become more patient-centered and to streamline efficiencies that for decades have not been there,” says Jacob McKeegan, MD, Medical Office Chief for the Arapahoe Medical Office of Colorado Permanente Medical Group, a division of Kaiser Permanente in Centennial, Colorado. “The more data that comes out, though, the more work there is to be done. Physicians are getting burned out and patients are getting less value from their care. We need to stop carrying that trajectory forward.”

Survey respondents largely believe that there are few high-performing organizations — 74% say less than 20% can be called high-performing.

Few Truly High-Performing Health Care Organizations

From the Leadership Insights Report: High Performing Organizations. Click To Enlarge.

“To be a [high-performing organization], we need to be able to deliver the same care to every patient every day,” says Robert Estridge, Jr., PA-C, physician assistant and APP Director of the Express Care at the Cleveland Clinic in Ohio.

Estridge says the Cleveland Clinic, which has over 52,000 employees, is constantly working at this goal. For instance, the organization recently mandated a universal safety protocol checklist after several safety events revealed a lack of standardization of protocols around policies and procedures. “Now, every bedside process, every procedure, and every injection requires a safety checklist to be filled out,” Estridge says.

The Cleveland Clinic also has eliminated hierarchies when it comes to patient safety, enabling all caregivers to “stop the line” and speak up about potential dangers, Estridge says. When he recognized inadequate staffing in one department and brought it to the attention of executives, he says, “the Institute Chairman then led the charge to staff the department appropriately.” Implementing these forward-thinking, patient-centric rules, Estridge says, moves the organization deeper into high performance.

Robert Ferguson, Jr., MD, FACS, Chair of the Department of Surgery at Intermountain Medical Center in Murray, Utah, agrees that to be considered high-performing, you have to excel organization-wide. “The seed for high performance can come from an individual department and their success can be inspiring, but you have to have cross-pollination, applying what you learn to other areas and other departments,” he says.

Cynicism is to be expected, Ferguson says, especially by caregivers who have either worked for their entire careers in a single health system, or who have always done things a certain way, but, “how leadership deals with that cynicism is how you get to a culture of excellence,” he says.

Key Attributes of High-Performing Organizations

From the Leadership Insights Report: High Performing Organizations. Click To Enlarge.

A culture of excellence is respondents’ top ranking of key attributes of high-performing organizations, but McKeegan looks at culture of excellence (74%), aligned goals among all stakeholders (61%), and stellar leadership (37%) as more of a bundle than piece parts. In his role as a clinical leader, he is “trying to empower the front line — the people doing the work — to come up with solutions” that align with the organization’s goals and contribute to a culture of excellence.

For instance, going to the front line enables the organization to find out the patient perspective and nurse perspective on why a patient is having difficulty achieving diabetic control. That authenticity and transparency illuminates “the areas we’re doing well and the areas in need of improvement,” he says, which includes looking at data from other health systems. “We need to be critical of ourselves and be aware of our own weaknesses — we can’t rest on our laurels,” he says.

Where Kaiser Permanente and Colorado Permanente Medical Group thrive, he says, is in clearly stating the goal of being high-performing, which puts him among the 55% of respondents who report their organizational goal is stated. “If we didn’t state that part of being high performance is to be patient-centric, we would revert to being more physician- or provider-centric. We need to pay more attention to patients,” he says.

Estridge is torn on whether there should be a standard definition of high performance, as he believes the concept is unique to each organization. “Consolidation in the market might change this, but for right now, what each organization does in the market is so different that we need to live up to internal standards more than industry standards,” he says.

Call for submissions:

Now inviting expert articles, longform articles, and case studies for peer review


A weekly email newsletter featuring the latest actionable ideas and practical innovations from NEJM Catalyst.

Learn More »

More From Leadership
The Largest Share of Organizations Do Not Have a Formal Strategy for Clinician Engagement

Leadership Survey: Why Clinicians Are Not Engaged, and What Leaders Must Do About It

Clinician engagement is vital for improving clinical quality and patient satisfaction, as well as the job satisfaction of clinicians themselves. Yet nearly half of health care organizations are not very effective or not at all effective at clinician engagement.

Rowe01_pullquote - clinician well-being - fighting clinician burnout and creating culture of wellness takes all stakeholders

Defending the Term “Burnout”: A Useful Tool in the Quest to Ease Clinician Suffering

Health care leaders must take a preemptive approach to clinician well-being that is supported by all stakeholders and prioritized on an equal footing with essential clinical and financial measures.

Screenshot from the NewYork Quality Care Chronic Condition Dashboard

Success in a Hospital-Integrated Accountable Care Organization

How NewYork Quality Care achieved shared savings — by strengthening collaboration, enhancing care management with telehealth, and transparently sharing performance data.

Miller03_pullquote social determinants whole-person

How a State Advances Whole-Person Health Care

Pennsylvania addresses social determinants of health by bringing together managed care and social services organizations to expand access to vital resources.

Abigail Geisinger Scholars Program for Medical Students -Ryu02_pullquote

Why a Teaching Hospital Offers an Employment-Based Tuition Waiver Program

Geisinger Commonwealth School of Medicine subsidizes medical students’ education in exchange for their willingness to practice at Geisinger Health System.

Michael Dowling and Charles Kenney headshots

Rebooting Health Care: An Optimistic Outlook

The U.S. health care system may seem broken, but it’s on its way to greatness, according to the authors of Health Care Reboot. They discuss their optimism for U.S. health care reform, particularly on the social determinants of health, payment, consumerism, and technology.

Action Steps for Risk-Share Contracts for Medical Devices

Challenges and Best Practices for Health Systems to Consider When Implementing Risk-Share Contracts for Medical Devices

When done right, value-based contracting for medical devices can ameliorate shrinking margins at health systems, leading to a virtuous circle.

Health Care Organizational Culture Emphasizes Patient Care Only Slightly More Than the Bottom Line

Survey Snapshot: Who Should Lead Culture Change?

NEJM Catalyst Insights Council members feel that culture change at their organizations is heading in the right direction, but differ on who it should come from, and reveal too much balance between emphasis on bottom line and emphasis on patient care.

Culture Change Within Health Care Organizations Is Changing for the Better

Leadership Survey: Organizational Culture Is the Key to Better Health Care

Although three-quarters of Insights Council survey respondents say culture change is a high or moderate priority at their organizations, survey results show a lot of work on organizational culture remains to be done.

Metraux01_pullquote - dinners to combat burnout in the health care community

“Breaking Bread” to Combat Burnout

Can a simple dinner create community among health care providers?


A weekly email newsletter featuring the latest actionable ideas and practical innovations from NEJM Catalyst.

Learn More »


Leading Teams

170 Articles

Survey Snapshot: How Do You Know…

The NEJM Catalyst Insights Council discusses strategies for clinical engagement.

Team Care

110 Articles

Survey Snapshot: How Do You Know…

The NEJM Catalyst Insights Council discusses strategies for clinical engagement.

Rating the Raters: An Evaluation of…

Some promising innovation is taking place among organizations that rate hospital performance, but major systemic…

Insights Council

Have a voice. Join other health care leaders effecting change, shaping tomorrow.

Apply Now