Leadership Survey: High-Performing Organizations

Insights Report · July 24, 2018

Analysis of the NEJM Catalyst Insights Council Survey on Leadership: High-Performing Organizations. Qualified executives, clinical leaders, and clinicians may join the Insights Council and share their perspectives on health care delivery transformation.

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Advisor Analysis

By Stephen Swensen and Namita Seth Mohta

Health care is rife with metrics and rating systems that purport to differentiate the good, bad, and mediocre. Every clinician and leader wants to be affiliated with a high-performing organization. A recent review found that “Purchasers, payers, and policy makers are increasingly measuring and rewarding high-performing health systems.”

A Majority of Health Care Organizations Have Stated Goal to Be High-Performing Organizations

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

In a survey of the NEJM Catalyst Insights Council, more than half of respondents — who are a qualified group of U.S. health care executives, clinical leaders, and clinicians — say their organizations have a stated goal to be high-performing, while another quarter say the goal is tacit. The journey to excellence is difficult, however; three-quarters of respondents believe that only a small fraction of health care organizations today are actually high-performing.

But what constitutes high performance in health care? Three-quarters of Insights Council members say there is little consensus around a definition. Yet there is some agreement on the key elements and indicators. A culture of excellence is the top attribute of a high-performing organization, followed by aligned goals among all stakeholders.

Very few respondents say that individual stars among physicians and staff create high performance. We find this heartening; it is a validation of the industry move toward integrated, team-based care. Plentiful finances also fell low on the list of key attributes. Lack of financial resources need not be a deterrent in becoming a high-performing organization.

We were surprised, however, by how survey respondents weighted cost considerations in the value equation of high performance. Almost all respondents says high quality and excellent patient safety are extremely important, but low cost falls to the bottom of the list of indicators. These results do not reflect the Triple Aim of health care, which values high-quality care, population health, and low cost equally.

Cleveland Clinic, Mayo Clinic, Kaiser Permanente, and Intermountain Healthcare are among Insights Council members’ top role models for high performance within the health care industry. Outside of health care, they consider the aviation/aerospace industry, the high-end hospitality industry, Amazon, Apple, Google, and Disney as exemplars.

In a written comment, one clinician refers to the procedures and structure of air traffic control: “As a group, this workforce is mindful of their performance and reflects on their near misses. When actual accidents occur, there is appropriate multi-service (pilots, airlines, flight controllers, etc.) assessment of the sequence of events to identify root cause of failure. In this specialty, all controllers and managers are on an equal plane of responsibility and functionality. The controllers are well-trained and there is an equal approach to performing their responsibilities.” Another clinician admires Amazon’s ability to put the customer at the center of the business plan, and comments that being reliable and efficient, as Amazon is, provides a great learning opportunity for the health care community.

Ultimately, high performance is a process rather than a goal achieved once. As an industry, we need to relentlessly improve and continually do better by our patients, our teams, and the communities we serve.


What is a high-performing organization or industry that the health care industry can learn the most from, and why?

“Health is not an assembly line and should not be measured like one. Without the tools for motivated physicians, nursing staff, and allied medical staff to function, middle management will destroy the ability to maintain quality medicine in an attempt to grind the numbers of a false illusion of success, while destroying the clinical base of medical care, and lowering the engagement of frustrated quality clinical staff. These people will leave, and their ranks will be filled by ranks of substandard clinicians.”
— Clinician from a large community hospital in the Midwest

“Amazon and other major internet companies that strive for good customer service and happy employees and seem to put profits second knowing they will come based on the first two criteria.”
— Clinician from a small for-profit clinic in the Northeast

“I believe we have learned what we can from aviation and nuclear energy — turns out they are a lot simpler than what we do. We have to figure this out ourselves going forward. And we have so many distractions (compliance, etc.) that we are unlikely to fix it in the current environment.”
— Chief Medical Officer for a large community hospital in the West

“I think the Mayo Clinic and similar tertiary care centers in which transparency among consultants, flow of information, and excellence in staff, reputation, etc., influences their success as a high-performing organization. They have also proven to be financially secure as well.”
— Clinician at a small for-profit clinic in the South

“Honestly, I don’t know any organization that is all that great since all are still beholden to third party payers. We as physicians must step up and take care of the patient first and not the corporate wallet and not the third party payer. As a DPC physician, I can now see what I dealt with in corporate medicine very clearly and realize how broken the ‘system’ really is.”
— Executive at a small for-profit physician organization in the South

Download the full report for additional verbatim comments from Insights Council members.

Charts and Commentary

by NEJM Catalyst

We surveyed members of the NEJM Insights Council – who comprise health care executives, clinical leaders, and clinicians – about high-performing organizations in the health care industry. The survey explores whether there is consensus around the definition of high-performing health care organizations, the importance of indicators in measuring and rewarding high-performing organizations, key attributes of high-performing organizations, organizational goals to be high-performing, performance ratings, and barriers against becoming high-performing organizations. Completed surveys from 740 respondents are included in the analysis.

Little Consensus Over Definition of High-Performing Organizations in Health Care

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

Three-fourths of Insights Council respondents agree there is little consensus around the definition of high-performing health care organizations. One clinician respondent offers a definition as “providing quality despite high variability,” pointing to military health care as an example. Many respondents point out that it is challenging to create a single definition for high performance because health care organizations operate in different environments.

High quality and excellent patient safety top the list of indicators that purchasers, payers, and policymakers should use to measure and reward high-performing organizations. Low cost is the least important, with only 46% rating it as extremely or very important. However, more executives (53%) than clinicians (41%) rate low cost as extremely or very important, and a higher incidence of Council members 45 or younger (54%) than those 46 or older (44%) rate low cost as extremely or very important.

Download the full report to see the complete set of charts and commentary, data segmentation, the respondent profile, and survey methodology.

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