OKR Case Study: The Cleveland Clinic

Posted on June 19, 2023.

I’m always looking for great examples of organizations using Objectives and Key Results. More often than not the case studies come from the world of tech or general business. You can imagine how happy I was, then, to find that The Cleveland Clinic has been using OKRs for a while and shares their top-level goals publicly. Let’s take a look at how they write and use their OKRs. 

OKRs in Healthcare

The Cleveland Clinic is a 100+ year old healthcare organization based in the United States and headquartered (perhaps not surprisingly) in Cleveland, Ohio. According to Wikipedia, The Cleveland Clinic, “… is a nonprofit American academic medical center based in Cleveland, Ohio. Owned and operated by the Cleveland Clinic Foundation, an Ohio nonprofit corporation established in 1921, it runs a 170-acre (69 ha) campus in Cleveland, as well as 11 affiliated hospitals, 19 family health centers in Northeast Ohio,and hospitals in Florida and Nevada.” This doesn’t take into account their international operations as well which span the UK, UAE and Canada. You would expect an organization of this size to set goals. What surprised me is that this organization, one firmly established in a highly regulated environment and spanning so many services, would be using Objectives and Key Results to set those goals. 

The CEO of The Cleveland Clinic publishes their OKRs publicly every year. The goals are set for the year and cover both patient-focused goals as well as internal, staff-focused goals. They use a mix of rate-based key results as well as absolute numbers to measure their performance while ensuring their objectives are inspirational, aspirational and qualitative. Here are a few that I like from their 2022 OKRs:

Objective: Best place to receive care anywhere

*Key Result: Rate of serious safety events is .22

Key Result: Plan of care visit frequency 85%

*(I ignored the one about sepsis simply because I don’t know enough about it to comment on it)

You can’t argue the objective isn’t aspirational and inspirational. Who wouldn’t get out of bed every day to create the best place to receive care anywhere? The next step is to determine how we know we’re achieving that goal. The first ratio is focused on how often a serious safety event happens in the hospital network and the goal is to continuously improve that, in this case down to .22%. That number as compared to previous years is an improvement that ensures fewer people experienced any kind of safety event while in the care of the clinic. 

85% visit frequency following the prescribed plan of care means that the patients (arguably the “customers” of the clinic) are committed to their healthcare results. They are showing up for their appointments and ensuring they continue to recover and improve. If patients are following through on their care plan, it follows that the clinic is providing great care. 

OKRs can focus on employees as well

I’ve noted on this blog before that OKRs can also face inward, focusing on the company’s staff. The Cleveland Clinic does this with their OKRs as shown in this example:

Objective: Best place to work in healthcare

Key Result:  Would recommend as a place to work 84%

Key Result:  Diversity of new leaders 26%

Again, the objective here is inspirational and aspirational. If you’re working to build a place where employees thrive and feel a part of something bigger than themselves this is your goal. Measuring it, in this case, comes down to staff recommending the clinic as a place to work to their friends and colleagues. It also means increasing the diversity of the leadership team. You can see the clinic adjusting their goals over the years based on predictions and actual achievements as they work towards fulfilling the objective. 

It’s worth mentioning that I’ve been paying attention to the Cleveland Clinic’s OKRs for a couple of years now and it’s worth pointing out that their objectives have remained fairly consistent while the key results they’ve chosen have varied a bit from year to year. While I’ve not spoken to anyone who works there I would speculate that priorities have shifted over the years as certain key results were optimized to “as good as they were going to get” and new goals arose. 

OKRs work in regulated environments

One of the regular pushbacks I hear for using OKRs is the regulated environments many companies operate in. Healthcare is one of the most regulated and yet here is an example of a global organization putting OKRs to use, top down, to drive continuous improvement in their external offerings as well as in the culture and happiness of their staff. As the case study shows, any company, in this case a hospital, can rethink their goals in terms of human behavior. Nowhere in this CEO OKR spreadsheet does it say how the clinic is expected to fulfill these goals. The leadership, teams and staff will figure that out on their own. Their goals are clear and if the policies, programs and initiatives they put in place don’t shift behaviors in those directions, they’ll need to change course. In essence, this is an agile hospital. Kinda cool.