What Had to Change Before a Healthcare System Saved $580,000
- Carole W. Kamangu
- 12 hours ago
- 6 min read
Healthcare leaders have an enormous responsibility. Every day, they make decisions that affect patients, employees, finances, quality outcomes, regulatory compliance, and the organization's ability to fulfill its mission. To understand whether the organization is moving in the right direction, leaders rely on scorecards, dashboards, reports, and performance indicators that give them a big-picture insight of what’s happening across the system. While those metrics are important, they don't always tell the entire story.
I worked with a large healthcare system that saved over $580,000 within a single fiscal quarter while also improving important organizational outcomes. Whenever I share this story, people naturally focus on the financial impact. A result of that size gets attention, especially when it happens within a 3-month period. My focus, however, is not on the number as an isolated metric but as one of the many successes the organization achieved after leaders discovered what was negatively impacting organizational outcomes.
At the time, several organizational indicators tied to quality and performance were deteriorating rapidly. The downward trends were concerning because they had implications that extended beyond the executive dashboard and affected every part of the organization, including patient care, operations, and goals that leaders considered important to serving their community. Like many organizations facing a similar situation, leadership wanted to understand what was happening and what needed to occur to reverse the trend quickly. As I spent time examining the situation, I realized that the performance indicators were showing us what was happening but couldn’t tell us why it was happening.
What Performance Indicators Can and Cannot Explain
One thing I've noticed throughout my work is that leaders often become aware of a problem when a metric changes. That’s understandable because metrics give an insight into how the organization is performing. The challenge is that by the time a performance indicator begins moving in the wrong direction, the decisions, behaviors, competing priorities, and operational realities influencing that indicator have often been present long before anyone notices the trend. Leaders should focus on understanding what is negatively affecting their organization’s performance.
For this organization, everything seemed perfect on the outside; they had talented employees, committed leaders, and a clear mission that everyone was diligently working to fulfill. Leaders throughout the organization were making decisions they believed supported organizational goals, but as my conversations moved across different levels of the system, it became clear that people were describing risks, priorities and experiencing the situation differently depending on where they worked within the organization.
Executive leaders were paying attention to organizational outcomes and system-level priorities, clinical leaders were focused on quality and patient care, and operations leaders were managing the realities of day-to-day performance. Frontline teams were responding to the daily demands of their work and providing care the best possible way they knew how. Each part of the system was working exactly as intended and “staying in its lane”. However, because of their different vantage points, they were creating more silos that increased the gap between what leaders were set to accomplish and what people could to meet those goals. This ultimately led to the negative outcomes they were seeing throughout the system.
Questions Leaders Rarely Ask Early Enough
Experiences like this are one reason I encourage leaders to spend time understanding what is happening around the work happening on the frontline, not just what’s happening in the data. When an important priority begins losing momentum, one important question leaders should ask is whether different parts of the organization describe the priority similarly. They don’t have to use the exact same language but there should be a shared understanding of what the organization is trying to accomplish and why it matters. When people attach different meanings to the same priority, the effects often appear long before anyone notices them on a dashboard.
Another place to look is whether people can clearly connect their daily work to organizational priorities. Most employees can explain the responsibilities they carry out every day but remain unclear about how those activities contribute to larger organizational goals. When they don’t see the connection, priorities can unintentionally compete with one another because people naturally focus on what feels most urgent rather than what may be most important to the organization.
Leaders should also examine what’s happening around the work, not just the outcomes. Most organizations are already spending time reviewing performance indicators. The challenge is that those indicators cannot explain everything contributing to the results. Resource allocation, competing priorities, workflow expectations, communication patterns, and day-to-day decisions all affect performance. By the time a metric begins moving in the wrong direction, many of those factors have already been influencing the outcome for quite some time. That's one reason performance indicators rarely tell the entire story. The answers leaders are looking for are often hidden inside the work itself, long before they become visible in a report or on a dashboard.
“Most organizations are already spending time reviewing performance indicators. Leaders should also examine what’s happening around the work, not just the outcomes.”
What Contributes to Tangible Results
In this healthcare system, as leaders got a clearer understanding of how the issue was being experienced throughout the organization, the conversations began to change. Instead of focusing primarily on the performance indicators themselves, discussions increasingly centered on the conditions influencing the indicators. Leaders spent more time looking at how organizational priorities were being communicated, how those expectations were being interpreted, and how day-to-day decisions were affecting the goals they were trying to achieve.
“Leaders spent more time looking at how organizational priorities were being communicated, how those expectations were being interpreted, and how day-to-day decisions were affecting the goals they were trying to achieve.”
Over time, the changes became visible throughout the organization. Leaders became more consistent in how priorities were discussed and expectations became clearer for frontline teams. Individuals also began to understand how their actions contributed to outcomes that mattered to the organization and departments that previously approached the challenge from separate perspectives began seeing how their work influenced one another. What I found particularly interesting was that the work began changing before the metrics fully reflected those changes. The conversations, behaviors and organizational culture also changed the way that work was done and eventually, the data improved.
What Turns Priorities into Results
In this organization, before improvements were achieved, several areas across the system were negatively affected: quality outcomes, patient safety interventions, workforce performance, and operational costs. Within three months, compliance with critical frontline practices increased by approximately 20%, quality outcomes improved by more than 30%, and the organization generated approximately $580,000 in cost savings within a single fiscal quarter.
The financial impact got the leaders’ attention but it wasn’t the most important part of the story. Looking back, what interested me the most through this experience was that the culture started changing before the outcomes fully reflected it. Leaders were communicating differently, departments were collaborating more intentionally, and frontline teams had greater clarity regarding expectations. By the time the organization generated approximately $580,000 in cost savings, leaders were already paying attention to aspects of daily operations that they couldn’t see before the performance indicators began deteriorating.
What This Means for Healthcare Leaders
Many healthcare organizations are currently operating under significant pressure with increasing financial constraints, workforce challenges, regulatory expectations, competing priorities, and growing demands for services that continue to impact how leaders make decisions. In these environments, it becomes increasingly important to understand what’s happening between organizational priorities and the work required to achieve it.
When an important priority isn't producing the results leaders expected, it's often tempting to focus on the priority itself. One thing I encourage leaders to pay attention to is what happens after a priority is established. How is the priority being interpreted throughout the organization? What decisions are being made because of it? How is it affecting the work people do every day? Those questions may seem simple, but they often reveal factors influencing performance long before they become obvious in the data. When organizations can confidently answer those questions, they’re often able to make meaningful progress.
Through the IP PROPEL™ Framework, I help healthcare and public health leaders focus on the connection between what they're trying to achieve and what is happening every day throughout their organizations. Those conversations often reveal opportunities, risks, and challenges that are difficult to see by looking at performance indicators alone.
What Can Leaders Do Now?
If this story feels familiar, I encourage you to spend some time examining how one of your organization's most important priorities is being experienced throughout the system. The answers may be very different depending on who you ask.
Some leaders prefer to start by reflecting on their organization's current state independently. If that's you, the Strategic Health System Alignment Scorecard™ can help you evaluate how strategic priorities, organizational decisions, and daily operations interact across your system.
Others prefer to talk through what they're seeing with someone who has worked with healthcare and public health organizations facing similar challenges. If you're responsible for an important organizational priority that isn't producing the results you expected, I'd be happy to have a conversation. Sometimes a brief discussion can help leaders identify questions they haven't considered, patterns they haven't noticed, or operational realities that may be influencing performance more than they realize.
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