OSF HealthCare reinvented its system for measuring and reporting performance—and in doing so, promoted a culture of enhanced transparency and higher-quality care and service.


At a Glance

OSF HealthCare's executive dashboard provides:

  • A detailed view of top-level measures to frame OSF's mission and vision for all stakeholders
  • An easily understood, holistic snapshot of performance
  • An assessment of relationships among system goals, initiatives, and results
  • Explicit understanding of the organization's priority performance measures and the extent to which they need to improve
  • A vehicle for transitioning to a value-based business model

In early 2011, leaders for OSF HealthCare, an integrated delivery system owned and operated by The Sisters of the Third Order of St. Francis, Peoria, Ill., were experiencing information overload. 

Having spent two years designing and implementing the organization's electronic health record (EHR) and developing an enterprise data warehouse, OSF finally had achieved the ability to integrate data across the enterprise. This accomplishment enabled leaders to view the performance of the organization—which comprises nine acute care facilities and two colleges of nursing—across all points of care and better understand performance from the patient's perspective. By May 2011, senior leaders also had redefined the organization's goals and had refreshed the health system's vision to more clearly articulate how OSF would successfully meet the challenges ahead.

But as OSF leaders began planning for FY12, reviewing performance measures and results at the organizational, regional, and operating unit/service line levels, CEO Kevin Schoeplein and health system president Sister Diane Marie McGrew began to ask key questions about OSF's performance measurement and reporting system:

  • "Does it measure the right things to drive our strategic agenda and vision?"
  • "Does it help us evaluate whether we are improving performance with adequate speed and effectiveness for success?"
  • "Does it accurately frame OSF's mission and vision to engage, enroll, and empower our community of caregivers?"

Together with OSF's board of directors, they concluded that OSF needed to reinvent its performance measurement and reporting system to deliver greater value to all stakeholders and create a culture of transparency and clinical excellence. OSF leaders set to work developing an executive dashboard to evaluate performance across the organization. Today, the dashboard provides:

  • A detailed view of top-level measures to frame OSF's mission and vision for all stakeholders
  • An easily understood, holistic snapshot of performance, including alignment with and progress toward the "One OSF" vision
  • An assessment of relationships among system goals, initiatives, and results
  • Explicit understanding of the organization's priority performance measures and the extent to which they need to improve
  • A vehicle for transitioning to a value-based business model

Exhibit 1

Conger_Exhibit1

Designing the Executive Dashboard

Formerly, OSF's performance measurement and reporting system included a daunting number of measures for each of the health system's five "ministry goals"—system goals that support the organization's mission and vision. The sheer number of measures made it difficult for senior leaders and board members to analyze progress toward goals and in key measures.

OSF's performance measurement and reporting system also lacked a board-level summary. Instead, quarterly reports summarizing progress and results were submitted for board review using a variety of reporting tools and formats.

But selecting the "vital few" measures by which performance will be judged is hard work that can produce endless debate over which measures are the "best," and this process can lead to significant confusion and conflict. At OSF, some leaders were concerned about how the performance of their unit or service line would be perceived once the new measures were adopted. To gain top-level leadership support, OSF CEO Schoeplein assured leaders that he was not seeking perfection; rather, he said, the goal of the initiative was to more tightly focus OSF's efforts on the delivery of value to purchasers.

Measurement subgroups were established to recommend the "right" measures for each of the organization's five systemwide goals. Subgroups that featured participation from executive-level subject-matter experts were led by OSF's chief strategy officer and a small team from OSF's performance improvement division. These subgroups focused on the following objectives:

  • Identify measures that reflect OSF's transition to a healthcare system focused on the delivery of value.
  • Define measures that adequately reflect and support achievement of the system goals.
  • Review comparative benchmarks and conduct research necessary to recommend appropriate targets for improvement.
  • Present collective recommendations to the "One OSF" leadership cabinet.
  • Share the final recommendation with OSF's board of directors.

Looking back, participants describe their work as painful, tedious, intense, and draining. However, all agree that the clear expectations for the initiative that were set by OSF's executive leaders helped participants overcome major hurdles to consensus while producing more collective learning than they had thought possible.

Exhibit 2

Conger_Exhibit2

Identifying System Goal "Owners"

OSF leaders quickly learned that to achieve the rapid transformation desired, they would need to establish clear ownership of and accountability for each system goal and its associated measures.

System goal "owners" were identified and appointed by the CEO. These team members proved essential for facilitating engagement of staff and leaders in working toward the goals and in assisting the One OSF cabinet executives in acquiring and acting on measures related to each goal. System goal owners advanced OSF's performance-management infrastructure by leveraging OSF's internal expertise and relationships to drive results while maintaining expectations for accountability and alignment. Initially, the goal owners were given responsibility for leading the measurement subgroups. In the fall of 2012, system goal owners' responsibilities were expanded to include:

  • Assuming responsibility for ministry-level performance of their assigned measures
  • Reporting performance variance, status, and action plans to the One OSF cabinet
  • Championing key improvements related to their assigned measures
  • Identifying and removing barriers to improvement
  • Collaborating with executive leaders and other goal owners on ministrywide improvement activities and results sharing

Developing the Dashboard

The extensive preparatory work that went into developing OSF's EHR later enabled OSF to leverage its EHR data for performance measurement and reporting. This work was accomplished by a talented, largely hidden group representing the organization's analytics and reporting, business intelligence, data warehousing, IT, planning, and performance improvement functions. As OSF's need for an executive dashboard became more compelling, these team members collaborated to build a prototype dashboard and accomplish critical work around data architecture, measurement definition, source systems, data validation, change management, and project management.

Exhibit 3

Conger_Exhibit3

Measurement definition teams were formed to precisely define and document each measure, while local subject matter experts established rational targets for each. Teams compared current performance with benchmarks and internal best practices to guide target setting.

In March 2012, the team presented the prototype dashboard to OSF leaders across of the organization.

Executive leaders found that the prototype helped them gain a better understanding of the analytics talent that existed within the organization, and they were pleased with the powerful new performance measurement and reporting capabilities available to them through the prototype. They were eager to move forward with the development of dashboards, scorecards, and drill-down capabilities to support performance improvement priorities in their areas of responsibility. Meanwhile, managers used the dashboards to gain perspective on the relationship between OSF initiatives and outcomes.

Transition to the new performance measure-ment and reporting system and the executive dashboard was supported with education, documentation, and continued use of paper reports, using the standard format and performance data provided by the new reporting tool. The executive dashboard summary report was produced quarterly. The report included:

  • A summary of key information including report purpose, goal owners, and highlights of changes to the dashboard during a defined period
  • A snapshot report of executive dashboard measures (including composite breakouts) for each OSF goal providing the baseline performance, One OSF targets, and color-coded period performance at ministry, regional, and entity levels
  • A detailed report for each measure, including performance toward the ministry goal, a dashboard screenshot of the measure, the rationale behind the measure, color-coded results for the current period compared with the previous reporting period, and a brief analysis of the results achieved

Exhibit 4

Conger_Exhibit4

How the Dashboard Transformed OSF's Culture

At the outset of this initiative, it became clear that part of the power of the executive dashboard lay in the transparency it offered to leaders and staff regarding performance measurement and outcomes.

The dashboard recorded performance on each measure by individual entities as well as the health system as a whole. At any time, leaders could view OSF's overall performance on key measures, which were precisely defined, and understand the impact of collective challenges in meeting specific goals. Seeing "One OSF" performance in an interactive model produced a shared understanding of gaps that naturally stimulated collaborative learning and impressive teamwork.

Executives quickly realized the value of the dashboard in providing quick access to data and visual reports that could identify opportunities for achieving breakthrough improvements and help to engage employees in initiatives for improvement. Leaders who previously had asked why a change in performance measurement and reporting was needed began to ask for more detail, more reports, and more support for their entity's improvement priorities. Their requests were prioritized, and additional dashboards and scorecards were developed over time. Today, OSF's dashboards track progress in many different areas, including accountable care, patient safety, pay for performance, revenue cycle and overall financial performance, OSF's cardiovascular service line, productivity, and emergency medicine.

Adoption of the executive dashboard had a cultural impact on OSF. Some of the benefits evidenced during the first year after implementation include:

  • Improved ability to communicate system priorities
  • More tightly aligned priorities, measures, and action plans at all levels
  • Criteria for prioritizing requests for additional reports and drill-down levels
  • Development of systemwide improvement portfolios by goal owners
  • Sharing of internal best practices to improve performance

As an example of the impact of the executive dashboard on OSF's culture, during the planning process at an annual retreat for one entity's patient care division, the chief nursing officer (CNO) used the executive dashboard to develop an action-and-measurement "cascade." By clearly demonstrating the alignment of the division's participation in system and entity-specific initiatives and its performance on priority measures for each point of care, the CNO secured buy-in from division managers, who then became actively engaged in supporting success in these areas. Over the next year, the CNO and division managers continued to use the alignment approach to help staff understand the value of their contributions to patients and to the system's overall success.

Lessons Learned

A number of key factors supported the success of OSF's executive dashboard initiative.

Demonstrate top-level support for the initiative. CEOs and other senior leaders should appreciate the magnitude of change their executives will experience during the move to a performance measurement and reporting initiative and then develop effective plans for change management and tactical support. However, senior leaders also should realize there is no substitute for top-level presence, and therefore frequently communicate the urgency of the need for change and their expectations for the initiative. These leaders alone can motivate organizational change by words and actions that clarify what change is required, when it will need to happen, and what level of involvement is required to ensure a successful transition.

OSF's CEO, Schoeplein, and its president, Sister Diane Marie, set expectations by ensuring that discussion of the executive dashboard was at the top of leadership agendas. When the executive dashboard was implemented, Schoeplein made clear that he would not accept a different scorecard or measures from his direct reports—the dashboard would be considered the single source of truth. In addition, both Schoeplein and Sister Diane Marie monitored usage of the dashboard during the transition and followed up with anyone who was having difficulty using the tool.

Be mindful of reactions of leaders, clinicians, and staff to enhanced transparency. The sudden increase in transparency brought about by implementation of the executive dashboard created more initial tension and feelings of vulnerability than OSF leaders anticipated. Shifting much of the reporting function from individual entities to a central team was uncomfortable at first because measurement in health care is complex and rarely perfect. Using a new data source or even a different report from a trusted data source often produces dramatic variances in performance results. Once these concerns were shared and acknowledged, OSF was able to gain consensus on the value of learning together by building internal measurement and analytics competencies. The organization's senior leaders continually supported a successful transition by communicating to all stakeholders the intention to use the dashboard to create "light, not heat," so that OSF could be more nimble and responsive to improvement needs.

Recognize the complexity of measurement. Across the industry, organizations are struggling to identify the best measures of performance. OSF found it helpful to establish guiding principles for measurement selection and to emphasize four essential realities of performance measurement at the outset:

  • There are no perfect performance indicators.
  • Precise measurement is rarely possible.
  • Very good performance indicators are available and provide directionally accurate and reliable information.
  • New measures that are introduced should not be solely hospital-centric, but should have a system focus that accounts for the organization's future state.

Next Steps

Looking forward, OSF will develop service line and operational dashboards and will seek to establish point-of-care scorecards for use across the enterprise and in managing care for key populations. Such scorecards will better enable OSF's community of caregivers to understand their impact on outcomes and prioritize their performance improvement activities. OSF also will work to better understand the relationships between process measures and results measures and between strategic initiatives and outcomes. Developing a "patient perspective" scorecard also is a priority.

Other future areas of focus include alignment of human resource processes for compensation and performance appraisal criteria across the enterprise. For example, executive incentive compensation for FY14 was aligned to executive dashboard performance, and some entities have aligned the management incentive and staff team award measures with the operational dashboard. Health system communications and organizational structures also will be arranged in support of the organization's high-performance culture.


Michelle Conger, MS, is senior vice president, performance improvement, and chief strategy officer, OSF HealthCare System, Peoria, Ill.

Melissa Knuth is director of planning, performance improvement, OSF HealthCare System, Peoria, Ill.

Jody McDonald, RN, BSN, MBA, formerly was strategic publishing planner, OSF Healthcare System, Peoria, Ill.


The authors would like to recognize the outstanding leadership of this effort by Sister Diane Marie McGrew, president, and Kevin Schoeplein, CEO, OSF HealthCare System. They also would like to thank the following OSF HealthCare leaders for their support and contributions to the executive dashboard: Mark Hohulin, senior vice president, healthcare analytics; Roopa Foulger, executive director, data delivery; Becky Buchen, executive director, performance improvement division; and Sandi Morris, analytics effectiveness program manager.

Publication Date: Friday, August 01, 2014

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