In this episode, Jason & Aaron sat down with Tyler Barnett and Matthew Nichols, PhD, from University Hospitals in Cleveland, OH. They discuss the powerful goal-setting framework known as OKRs, or Objectives and Key Results. As leaders within the Population Health and Analytics team at UH, and with expertise in OKRs, Tyler & Matt dive deep into the OKR methodology, share specific examples of how UH has successfully implemented OKRs, and provide insights on how your organization can benefit from OKRs.
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Production & Editing: Nyla Wiebe
Show Notes & Transcription: Aaron C Higgins
Social Media Management: Jeremy Miller
Hosts: Jason Crosby & Aaron C Higgins
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Aaron Higgins (00:00):
Welcome to Beyond the Stethoscope Vital
Conversations with SHP.
As we take a break this summerto gear up for an exciting
Season 5, we're diving into ourarchives to bring you some of
the most impactful episodes fromour prior seasons.
In this episode, originallyaired in Season 2, jason and I
had an enlightening conversationwith Tyler Barnett and Matthew
Nichols, phd from the UniversityHospitals in Cleveland Ohio.
(00:22):
As leaders within the PopHealth and Analytics team, thank
you to drive performance andachieve strategic goals.
Don't miss this opportunity torevisit a classic episode filled
(00:46):
with valuable knowledge andpractical advice.
And remember if you enjoy thisepisode, please rate and share
our podcast in your favoritepodcast app.
It really helps us reach morelisteners.
Thank you for joining us, andnow let's revisit our vital
conversation with Tyler Barnettand Matthew Nichols.
(01:19):
Welcome to Beyond theStethoscope Final Conversations
with SHP.
In this episode, jason and Isat down with Tyler Barnett and
Matthew Nichols, phd, fromUniversity Hospitals in
Cleveland Ohio, where theydiscussed the powerful
goal-setting framework known asOKRs, or Objectives and Key
Results.
As leaders within the pophealth and analytics team at UH
(01:43):
and expertise in OKRs, they divedeep into the OKR methodology,
share specific examples of howUH has successfully implemented
OKRs and provide insights on howyour organizations can benefit
from OKRs as well.
So get ready for this vitalconversation and join us as we
explore the power.
Matthew hey everyone.
Jason Crosby (02:09):
This is Jason Crosby of Strategic Healthcare
Partners and your host fortoday's episode.
We are joined by Tyler Barnett,manager of Population Health
and Data Science Analytics forUniversity Hospitals in
Cleveland Ohio.
Matt Nichols, aco ReportingAnalyst, also with UH.
Today we're going to discussobjectives and key results, also
known as OKRs, goal SettingFramework and Leadership Tool
(02:30):
for those that are unfamiliarwith it.
So let's just jump right in,tyler.
Why don't you start us off andgive us some background on
University Hospitals?
Tyler Barnett (02:38):
Thanks, jason.
This is Tyler.
Tyler University Hospitals is alarge, integrated academic and
community health system inNortheastern Ohio.
We have 21 hospitals, over 50health centers and outpatient
facilities, over 200 physicianoffices spread out through
(03:00):
Northern Ohio.
We are Cleveland's hometownteam, which is our commitment to
the patients and community thatwe serve, or that University
Hospitals serves, inNortheastern Ohio.
For a bit of context andbackground, matt and myself work
(03:25):
in University Hospital'sstrategic planning office and we
support the population, healthand value-based initiatives of
our health system as we arepreparing for taking two-sided
risk contracts with our variousgovernment and commercial payer
(03:48):
partners and we use the OKRframework as our choice,
goal-setting approach for themany convoluted transformative
efforts that we work on withinthe Office of Clinical
Transformation under theleadership of Dr Peter Pronobost
, our Chief ClinicalTransformation and Quality
(04:12):
Officer.
Matt, anything to add about ourinstitution, perhaps our
history?
Matthew Nichols, PhD (04:21):
This is Matt, and I think one thing that
was maybe left out there thatmakes university hospitals
relatively unique within thespecific framework of our
organization is that we arereally a collection of local
hospitals, and so I've actuallygrown up, sort of born and bred,
in Northeast Ohio and havegrown up in many of the counties
(04:45):
that these hospitals served andhave sort of watched the system
at large, you know, acquiresome of the smaller community
hospitals and really organizethe collective system into one
focus, if you will, and so thatreally has led to the OKRs, to
(05:08):
the use of the OKRs, and reallyspeaks to a number of the
efforts that Tyler and I areboth involved in just relative
to systemness and orientationaround the system and how teams
can leverage that orientationwhen they are setting goals,
looking to improve performanceand so forth.
Jason Crosby (05:29):
Great, really helpful.
Appreciate that, and we're gladto have someone you guys on the
provider side and in adifferent market than some of
our others, so we're sure we'regoing to get a pretty good
perspective there.
All right, now let's dive rightin.
Okay, so healthcare is alphabetsoup.
We all know that.
Let's look at defining andclarifying, if you will, what is
(05:51):
the framework that is OKR, andthen the why and how you guys at
university are leveraging thatframework.
We'll start over with Tyler.
Certainly.
Tyler Barnett (06:00):
From its origin, the OKR framework.
From its origin, the OKRframework.
(06:27):
We attribute all of ourlearnings directly to John Doerr
, who has leveraged he jokinglyrefers to companies as a
deceptively simple, two-pronggoal-setting framework that
leverages both declaration ofyour overall objective, which,
when done appropriately, shouldbe exciting and really show this
is the destination of whatwe're passionately here to
(06:50):
accomplish, to, just, you know,bring up an emotional excitement
out of those who are workingtowards an objective and then a
separate set of key results,which would be your measurement
sticks or your milestones thatyou know are verifiably true
(07:11):
whether or not you are makingprogress towards your objective.
The whole framework is designedto be agile in nature so that
you are constantly reviewing thekey results you're striving
towards and then, on a recurrentbasis, typically quarterly,
(07:32):
adjusting your key results,learning why you did or did not
meet those key results, to thenmake sure that you're
continuously accountable to seteven further key results in the
next quarter.
The last component I'll close inon on the introduction is the
(07:52):
framework is designed tospecifically allow yourself to
set stretch goals, so theintention is to not meet 100% of
your key results.
In fact, that doesn't reallymake it any different than any
other goal setting framework,rather to set yourself for the
(08:26):
best possible results you canstrive for with the hopefully
that takes you farther towardsyour destination of what you are
trying to achieve than if youset very realistic key results
along the way.
Similarly, I'll share that theylike to refer to the facts or
the focus.
Alignment, commitment,transparency and stretch the
(08:48):
FACTS is what we hope youremember in the alphabet soup,
but in its totality.
The reason why UniversityHospitals has chosen the OKR
framework is because of thenature of our industry has a lot
of people working on a lot ofdifferent projects and
(09:10):
interdisciplinary orcross-functional roles and often
very little clarity on what theoverall organizational focus is
that we are aligning ourresources on.
So we understand each other'scommitments with transparency
such that we can stretchourselves to really offer our
patients the highest valueservices that we're here to
(09:37):
serve to our community.
Jason Crosby (09:39):
And so is OKR.
Is it a new rollout orinitiative of university, or is
this something that has beengoing on for some time?
How old is this used within theUH world?
Tyler Barnett (09:53):
It's part of our overall ambition that we refer
to as we want to believe, belongand build together.
So first, we want to inspire thebelief that we can actually
make the patient health outcomesand patient safety issues that
(10:21):
plague our industry.
We really want to believe thateach one of us individually
actually belongs as part of thejourney, if you will, to really
make the change or theinnovations that we're here to
serve at UH.
And the third piece of that usbuilding together is the
(10:42):
infrastructure of usingobjectives and key results to
use objective measuring sticksto organize the insanity of all
the different transformative andimprovement initiatives we have
in the system.
So we've been using OKRs Forabout two years, but in the last
(11:04):
six months, since August of2022, we have really focused and
zeroed in on this framework tomanage our entire journey to
Medicare break-even initiativeunderneath this umbrella of the
(11:26):
objectives and key results.
So we can share examples, butthere's roughly 20 specific
objectives with their keyresults that we're measuring
towards both to lower the totalcost of care per discharge on
the inpatient side and thenlower the total cost per member
(11:47):
per year on the accountable careorganization side of our book
of business.
Jason Crosby (11:54):
So it sounds like it's somewhat early in its use
and adoption within the system,yet mature enough to where you
guys are applying it on both aclinical, quality and cost side,
kind of a triple aim partner interms of how you're utilizing
it.
So you mentioned a veryapplicable focus there the
(12:14):
Medicare breakeven initiative,any other areas of use within
university that you guys canthink of in those first two
years where it's been used?
Tyler Barnett (12:27):
Examples of different objectives we are
striving towards.
We are using the OKR frameworkto enhance our quality
performance in our ACO contractsor Medicare Shared Savings
Program or Medicare SharedSavings Program.
To that note, uh is one of thetop performing MSSP programs
(12:50):
nationally year over year, whichisn't directly attributable to
the OKR framework.
However, our larger focus, ifyou will, of what the OKRs
connect to definitely has ablend of rectal management that
(13:17):
Matt can describe in more detailas well.
But to list some more of thoseinitiatives, we use the OKR
framework for qualityperformance in our accountable
care contracts.
We're leveraging it forimproving our patient experience
on all the differentmeasurement systems that the
health system is accountable forin their various programs.
We're using OKRs to redefinewhat we call our chronic disease
(13:41):
systems of excellence, wherewe're completely re-engineering
the care continuum of how aprimary care provider and a
specialist coordinate to givethe most excellent care for
diabetes, copd, heart failure,hypertension and CKD.
(14:03):
As early as this morning we hadfive clinical leadership teams
physician dyads explaining toour weekly huddle where we
review our OKRs.
We brought in a physician dyadboth primary care provider and a
(14:23):
specialist to explain their keyresults that they are striving
towards to truly revolutionizethe way that we offer our
services, for more preventive,proactive care supported by
clinical practice guidelines andevidence-based medicine.
But we use the OKR framework fortheir communication mechanisms
(14:47):
so that they can discuss the keyresults they're striving
towards, very similarly toanother initiative that we have
which would be optimizing ourappropriate SNF and IRF, or
skilled nursing facility andinpatient rehab facility
utilization, which is verycritical to our value-based
(15:11):
contracting performance but is,as I trust you all can
understand, a very, verydifferent initiative.
There's different stakeholders,there's different operational
components to how we optimize,better utilize our next site of
care performance, similarcommunication structure to folks
(15:48):
doing something, such asreducing potentially avoidable
ED utilization, which we have anobjective of reducing by 10% in
this year, and we have a seriesof key results across our
primary care practices, ourtelehealth services and also
within our urgent care offeringsto help them.
(16:08):
Those leaders understand thedata that lives within the ACO
world but that we can align onthe set of key results to
measure our capabilities to makea 10% reduction in, hopefully,
one year's time on ourpotentially avoidable ED
utilization performance.
Jason Crosby (16:29):
There are more but I'll stop there.
That's impressive in terms ofyou hear ED utilization, then
you hear ACO contracts, right,you kind of hear.
You think of those in polaropposites, almost in terms of
the conversations you might havein our industry or folks you
talk to.
You normally wouldn't eventhink of those in the same
(16:49):
concept or thinking, even if itis a management you know
framework.
So now let me ask you guys,matt and Tyler, what, what makes
in the world of alphabet soup,right?
Oftentimes when I saw you guyscome up with OKRs or using it, I
tend to think of KPIs, right.
Or I've lived in the world ofSix Sigma and Aaron, who's with
(17:12):
me, lives in the world of MIPS,like there's so many other.
You know quality-based, gearedmilestone project management
type orientations.
What makes OKR different fromsome of these other goal setting
frameworks that you guys areusing?
Matthew Nichols, PhD (17:26):
So I can comment on that, and certainly
we've also been familiar withall of the other frameworks that
you had just mentioned, and Ithink one of the interesting
things with OKRs really is whatOKRs are and what they are not.
And so if we step back just asecond and look sort of at the
(17:49):
macro level OKR picture acrossour organization and, as we were
speaking a little bit earlierabout developing an enhanced
level of systemness, okrs are auniversal language for
performance improvement.
Kpis, or key performanceindicators are typically
performance tracking, and sowhat OKRs allows us to do as an
(18:12):
organization is to speak thesame language around projects,
as different as they may be.
So we mentioned reducing EDutilization or looking at our
ACO contracting performance.
We can use the same frameworkfor vastly different performance
(18:34):
improvement content and soforth, and so there is an
obvious benefit there.
There's a leveraging that wecan really tie into across.
You know, irregardless of thecontent of the performance
improvement, folks that haveeither gotten very familiar with
the OKR process and workingthrough the OKR process, or are
(18:55):
more familiar with, maybe, bitsand pieces of it, or have some
things that they have learneddown the line, they can share
those learnings across theorganization, again,
irrespective of the content.
Tyler Barnett (19:07):
Build on that, if I can.
What we found in the applieduse of OKRs is that any one of
the quality improvementframeworks whether it's Lean,
Six Sigma, Denaic we use focusedPDSA cycles within our quality
institute here at UH.
They're phenomenal tools fordefining and measuring
(19:30):
improvement on known problems,but you only get incrementally
better.
They're perfectly designedtools that I am a fan of and a
practitioner of.
However, they solve problems inisolation and then they help
healthcare get a little bitbetter at a particular
(19:51):
performance indicator, whereaswhen we're trying to completely
transform or implement entirelydifferent ways of designing our
healthcare system.
We chose the OKR frameworkbecause the health systems can
no longer just make smallimprovements.
(20:13):
We truly do need to look withinourselves and make 180-degree
turns on some offerings that weprovide to our community and our
patients and our stakeholders.
So what I like to share is alot of KPIs and different
(20:34):
performance tracking tools thathealthcare is very accustomed to
are phenomenal, but what theykind of miss that objectives and
key results help with is makingthat aspirational, exciting
goal known in the objective tobring the joy back into our
workplace.
When anyone could searchBecker's or any listserv to see
(20:56):
the burnout rate in healthcareis intense, and it's a problem,
and quality improvement is notnecessarily the top funding
mechanism coming into healthcare.
However, using objectives toelicit the excitement of what
we're here to improve upon andthen using key results to share
our progressive milestonesallows us to both excite
(21:20):
ourselves but then also solveproblems with visibility.
There's a classic designstatement that you don't want to
solve a problem in isolation,and that happens all too often
in the silos of healthcare.
So we're using OKRs to getbeyond breaking down silos and
(21:41):
towards carving clearcommunication pathways across
teams.
Jason Crosby (21:47):
That sounds like as you're talking through.
That.
It made me think back quite abit of ways.
You know project management andthe PMBOK.
You know project managementbook of knowledge but you always
got was a little leery using itbecause it spoke in terms of
several thousand hours anddefining of a project in this
large scope Sounds like withOKRs it's not dependent on size
(22:13):
of project and functionality ofproject, like as Matt you're
just saying.
Right, you can hop between theED utilization and ACO contracts
.
Ed know ED utilization can be.
You know several-houranalytical project ACO reviews
can be.
You know tons of hours.
So with all that, can I speakto your point previously, matt,
(22:37):
on downside and upside of OKRsand talk to us about some of the
struggles maybe you guys haveseen while going through it as
well over the last couple ofyears.
Matthew Nichols, PhD (22:46):
So I think the OKR framework being new
within university hospitals andwithin the larger landscape of
health care, that, or perhapseven the population health space
that's in a rapid state of fluxright now, it's another new
tool.
There's a natural inclinationto sort of push back on.
You know one more newinitiative, one more acronym, if
(23:12):
you will, and you know, withthe, tyler and I were actually
in a meeting with a gentlemanfrom ambulatory that's been with
the organization a little bitlonger than we have and he
pointed out you know, thefractal management system.
The OKR framework that you guyshave, or that the group has
collectively embedded within thefractal management system, is
(23:34):
the eighth iteration, theseventh or eighth management
system that you know the systemhas rolled out in, you know, a
given time period, and sothere's certainly those sorts of
hurdles.
I think folks are some folksare, you know, suspicious of
change or maybe apprehensive ofchange up front.
If you layer that in with justconstant change, you know
(23:58):
there's some suspect involved.
And so what Tyler and our grouphas been working towards is
just getting out there, makingit visible, educating folks
again on what it is, what it isnot, how flexible it is One of
the beauties of OKRs, at leastin my mind.
(24:19):
I've been in several goalsetting activities, if you will,
in this organization and inprior organizations that have
leveraged things like KPIs ormaybe a more traditional goal
setting framework, and you sortof get stuck with OK, here's
what we want to do, how are wegoing to measure that?
Well, maybe we don't have areally great measurement for
that, so should we reorient thegoal?
(24:41):
And you sort of get buried intothat, that that measurement
piece, whereas OKRs is just justvery different from from that
vantage point.
It really comes up and says,okay, where do we want to go
aspirationally, where do we wantto go?
And then, how do we know thatwe're going to get there?
What are the, what are the keyoutcomes that that are going to
(25:02):
to happen to tell us that we'vebasically arrived.
And that's very different than,okay, here's a goal, here's the
activities.
It's sort of a three-stepinstead of a two-step and I find
that very beneficial.
But change, changes reallycan't be understated within this
(25:23):
space and it is certainly abarrier.
And, um, we have a large system, so there's there's a lot of uh
, you know, socializing of thisframework to be had.
Jason Crosby (25:35):
Yet yeah, always challenges with adopting
something new, and especially ifit's a new management sort of
push out.
How maybe add to that, matt.
Go back how was OKRs?
How was it rolled out touniversities of where?
Because it sounds like now,after that initial period that
(25:58):
you just covered, it feels likeit's successfully deployed,
systematically, right.
So, which is pretty phenomenala couple of years within such a
large organization, how has thedeployment been?
What was it like?
Matthew Nichols, PhD (26:12):
or what has it been like, you know?
I think Tyler could probablyspeak to that more pointedly
than I could.
Tyler Barnett (26:17):
Our journey to OKRs at university hospitals was
certainly spearheaded by ourchief clinical transformation
and quality officer.
We've essentially been workingto infect the system with.
This thought process has beenprobably a two or three prong
(26:42):
approach we had.
Our call to action is themacroeconomic state of affairs
in the United States.
There's so much pressure onhealth systems to remain
(27:21):
financially viable and theimpending transformation on a
reimbursement mechanism isneeded on a societal level,
saying we're going to recognizethat and we're going to own our
business through a managementsystem, because management
systems are quite lacking inhealth care.
There's some strong literaturethat suggests the level of
accountability on theoperational management side of
health care is not as strong asit is in other high reliability
and industries, and so what wechose to do was address that
(27:48):
macroeconomic reality and then,on a weekly clinical
transformation huddle, weorganized basically 20 teams
that each have their ownobjective and key results they
manage towards and they'recalled in to report out on their
progress towards their keyresults on a routine basis.
(28:09):
So what we have there is ourfearless leader saying this is
the approach we would like totake from his level of
leadership.
And then for the mid-levelmanagement, such as myself, what
we have done is we have learnedto teach and co-create
(28:33):
objectives and key results withvarious different teams to
really partner with those teamsso that the people who are
leading their own strategiesaren't managing to a strategy
that was written by somebody inthe strategy office.
The whole point there is thatideas are great but execution is
everything.
(28:53):
So those who execute on theirkey results should be the same
people, right, who write theirkey results, then partnered
(29:19):
assistants from our analyticsand our performance management
teams to then go and meet withall of the stakeholders to work
with them not to teach them theframework, but just start
working on it with them.
And the really exciting part ofthat journey is we get to watch
folks who typically thinkthrough tasks and work output to
manage towards.
And that's the most difficultpart of the OKR framework is
(29:44):
retraining your own brain tothink not in terms of work
output but in terms of outcomesthat add value to our patients,
to our payers, to our communityand to our government.
So we have a very clear valueframework that we operate within
to define what value means tous, and then we leverage the OKR
(30:08):
framework to set an excitingdestination of where we're
trying to go and then the keyresults of how we're trying to
get there.
An off-topic answer, but anotherexample it becomes easier the
more we practice the methodology.
It becomes easier to the pointwhere, on Friday, I was called
(30:29):
in to work with our childhoodpsychiatric access committee.
I am not an expert in thisspace, but I can quickly meet
with them and explain.
Here's how we're using OKRs.
Here's a few examples of howwe're doing it in these other
transformative initiativeswithin our institution.
Here's the philosophy, here's atemplate.
(30:53):
If you write some OKRs, we cancome back in three weeks to look
at them to ensure that they are, you know, written to the
specifications that the rigorousphilosophy hopes we use, and
then, within a month's timewhere we can use that framework
(31:16):
to improve upon our access forchildhood psychiatric and
psychology services.
Matthew Nichols, PhD (31:23):
One quick add to what Tyler's already
stated and maybe a bit of a plugto come back and talk with
Jason and Aaron again.
But another way that OKRs havebeen socialized around the
organization is sort of thereinforcement across multiple
areas of engagement, one beingthe fractal management system
which Tyler had alluded topreviously Quite frankly a whole
(31:46):
other conversation in and ofitself, but Tyler and I are both
on that team as well, and thatis a system-wide management
system and OKRs have found theirway and certainly found their
place within that system.
Pillar one there's four pillarsand pillar one is declaring
your goals, so that framework isavailable to folks as they work
(32:07):
through that system and whatthat system does.
Again, we've talked a littlebit about systemness,
generalizability of performance,improvement, frameworks across
the organization.
Fractal management the crux ofit is looking at the
organization as a system ofsystems born out of fractals
which, if you're familiar withfractals in nature and the
(32:29):
biomimicry, space and all ofthat, fractals are a simple
structure that are iterative andrepeating and can really handle
complexity quite beautifully.
And so that what is naturallyoccurring in nature has been
applied in a framework and hasreally allowed us a lens, if you
(32:50):
will, to look at a system of30,000 people and really break
it, break it out into systemsand systems of systems and
within the realm of performanceimprovement, looking at both who
we may work with on a dailybasis but who we may want to
engage across the organizationthat perhaps we don't work with
on a daily basis.
(33:10):
Where are the content experts,who you know has the content
knowledge or who has the theinstitutional knowledge to you
know, arrive at a better outcomewith a particular performance
improvement framework.
So OKRs have a natural placewithin that fractal management
system and that's another waythat we've reinforced its use,
(33:30):
if you will.
Jason Crosby (33:31):
Yeah, we'll definitely carve out a part two
of this and talked about thatportion as well.
So a lot of our audience areyour typical physician practice
administrators.
You've got hospitaladministrators, cfos and revenue
cycle.
You know folks on those linesof work, maybe not at a
(33:54):
university hospital healthsystem size type organization.
So, talking to them for asecond, where would you point
our audience to first go learn alittle bit more?
Not that they haven't learnedenough from this podcast,
obviously, but where they shouldgo learn and maybe how best to
go implement OKRs within theirown organization, whether it is
a small physician practice groupor a lot of our audience is
(34:19):
your typical critical access25-bed type hospital.
So, with that in mind, whatsuggestions would you give to
them?
Tyler Barnett (34:25):
First and foremost, I would suggest going
to YouTube.
There are plenty of reallygreat examples or different
videos that John Doerr has inregards to the OKR framework.
Bono is using OKRs across hisfoundations and can give very
(34:48):
easy to understand examples ofusing the OKR framework, and
there is a huge amount ofcontent I would say outside of
the healthcare complex but thenwithin OKRs.
I think my recommendation wouldbe to try to bring an example
(35:08):
from your own personal life, forexample.
A great example is if myobjective is I want to improve
my relationship with my kids inthe mornings and my key results
might be all right, I'm going totickle them, I'm going to tell
them three jokes before they getto school and we're going to
have breakfast together.
The exciting part about that tome is you can verifiably
(35:32):
measure whether or not you didthose three key results within a
week or two.
Measure whether or not you didthose three key results within a
week or two and then see ifyou're getting any closer to
your objective of just havingmore fun with your children in
the mornings.
I use that example because ithelps me to see the agnostic
capabilities of the frameworkcan truly apply to anything that
you are excited about and thenthrow down some measurement
(35:56):
sticks of key results that youcan verify whether or not you
did or did not complete them.
It's remarkably simple, but it'sdeceptively challenging
sometimes to find the rightwords to include in both your
objective or within your keyresults.
So I think the best advice I'dhave is to not trip over perfect
(36:21):
to get to good enough and justpull out a sheet of paper, write
down your objective of whereyou want to be with excitement
and then write down your keyresults, and then you can ask
yourself you know there's aseries of questions that you can
test yourself to make sure thatyour key results are, you know,
verifiable binary um, to thesimplest point of saying yes or
(36:44):
no, did I accomplish this or not?
Which is remarkably difficulteven for folks who have been
managing um performanceimprovement work in their whole
careers.
It just astounds me at timeswhen it seems so much more
difficult than it really is.
Matthew Nichols, PhD (37:01):
The only thing I would add there is the
legacy that OKRs have.
So we're approaching nearly 60years since its formal inception
at Intel, and so there areplenty of anecdotes,
industry-related anecdotesaround OKRs, relative to Intel,
apple, google and many othersthat I think have been very
(37:24):
helpful in this journey, asTyler and I have really both
embraced the OKRs and havereally become OKR students, if
you will, to work through theprocess and, I think, to advance
our own understanding andcertainly the understanding of
your organization.
So plenty of content out thereto peruse.
Jason Crosby (37:44):
Folks are going to want to reach out and learn
more.
How do they do so?
How can they find you guys andlearn more about OKRs and maybe
need to reach out to you?
Tyler Barnett (37:52):
They should reach out to strategic health care
partners, or my contactinformation will be available
Tyler Barnett LinkedIn profile.
We have our email addressesposted and both Matt and myself
have been consulting internallywithin UH with our OKRs and we'd
(38:16):
be glad to discuss answer anyquestions because we truly
believe this is the rightapproach to solve the complexity
that is delivering healthcareservices in the United States.
Jason Crosby (38:29):
You got it Well.
Tell you what it's greatinformation, good conversation
with our friends from Ohio.
We could certainly go on foranother hour, so we'll have to
split this up into part two, sohopefully our audience will tune
in for that, as we talk moreabout fractal management and the
applicability of that system.
And so we really appreciateTyler and Matt joining us for
(38:50):
part one, and we thank youlisteners for joining, and we
obviously, as always, lookforward to our next podcast and
until then, everybody, have agreat rest of your day you've
been listening to beyond thestethoscope, vital conversations
with shp a production ofstrategic health care partners
for more information about ourpodcast, including back episodes
, show notes, transcripts andmore, visit our website at
(39:13):
shplccom slash podcasts and Iknow you've heard it before, but
please consider rating ourpodcast and your favorite
podcast out.
Aaron Higgins (39:21):
It helps make others aware of the show.
Jason Crosby (39:23):
And our podcast wouldn't be possible without our
wonderful team of folks.
Aaron Higgins (39:28):
Editing and production assistance by Nyla
Weave and myself, Aaron Higgins.
Jason Crosby (39:32):
And your episode hosts are Aaron Higgins and
myself, Jason Crosby.
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For more from SHP , consider following us on
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Jason Crosby (39:50):
And, as always, thank you for listening and have
a great, wonderful day.
Welcome to Beyond the Stethoscope Vital
Conversations with SHP.
As we take a break this summerto gear up for an exciting
Season 5, we're diving into ourarchives to bring you some of
the most impactful episodes fromour prior seasons.
In this episode, originallyaired in Season 2, jason and I
had an enlightening conversationwith Tyler Barnett and Matthew
Nichols, phd from the UniversityHospitals in Cleveland Ohio.
(00:22):
As leaders within the PopHealth and Analytics team, thank
you to drive performance andachieve strategic goals.
Don't miss this opportunity torevisit a classic episode filled
(00:46):
with valuable knowledge andpractical advice.
And remember if you enjoy thisepisode, please rate and share
our podcast in your favoritepodcast app.
It really helps us reach morelisteners.
Thank you for joining us, andnow let's revisit our vital
conversation with Tyler Barnettand Matthew Nichols.
(01:19):
Welcome to Beyond theStethoscope Final Conversations
with SHP.
In this episode, jason and Isat down with Tyler Barnett and
Matthew Nichols, phd, fromUniversity Hospitals in
Cleveland Ohio, where theydiscussed the powerful
goal-setting framework known asOKRs, or Objectives and Key
Results.
As leaders within the pophealth and analytics team at UH
(01:43):
and expertise in OKRs, they divedeep into the OKR methodology,
share specific examples of howUH has successfully implemented
OKRs and provide insights on howyour organizations can benefit
from OKRs as well.
So get ready for this vitalconversation and join us as we
explore the power.
Matthew hey everyone.
Jason Crosby (02:09):
This is Jason Crosby of Strategic Healthcare
Partners and your host fortoday's episode.
We are joined by Tyler Barnett,manager of Population Health
and Data Science Analytics forUniversity Hospitals in
Cleveland Ohio.
Matt Nichols, aco ReportingAnalyst, also with UH.
Today we're going to discussobjectives and key results, also
known as OKRs, goal SettingFramework and Leadership Tool
(02:30):
for those that are unfamiliarwith it.
So let's just jump right in,tyler.
Why don't you start us off andgive us some background on
University Hospitals?
Tyler Barnett (02:38):
Thanks, jason.
This is Tyler.
Tyler University Hospitals is alarge, integrated academic and
community health system inNortheastern Ohio.
We have 21 hospitals, over 50health centers and outpatient
facilities, over 200 physicianoffices spread out through
(03:00):
Northern Ohio.
We are Cleveland's hometownteam, which is our commitment to
the patients and community thatwe serve, or that University
Hospitals serves, inNortheastern Ohio.
For a bit of context andbackground, matt and myself work
(03:25):
in University Hospital'sstrategic planning office and we
support the population, healthand value-based initiatives of
our health system as we arepreparing for taking two-sided
risk contracts with our variousgovernment and commercial payer
(03:48):
partners and we use the OKRframework as our choice,
goal-setting approach for themany convoluted transformative
efforts that we work on withinthe Office of Clinical
Transformation under theleadership of Dr Peter Pronobost
, our Chief ClinicalTransformation and Quality
(04:12):
Officer.
Matt, anything to add about ourinstitution, perhaps our
history?
Matthew Nichols, PhD (04:21):
This is Matt, and I think one thing that
was maybe left out there thatmakes university hospitals
relatively unique within thespecific framework of our
organization is that we arereally a collection of local
hospitals, and so I've actuallygrown up, sort of born and bred,
in Northeast Ohio and havegrown up in many of the counties
(04:45):
that these hospitals served andhave sort of watched the system
at large, you know, acquiresome of the smaller community
hospitals and really organizethe collective system into one
focus, if you will, and so thatreally has led to the OKRs, to
(05:08):
the use of the OKRs, and reallyspeaks to a number of the
efforts that Tyler and I areboth involved in just relative
to systemness and orientationaround the system and how teams
can leverage that orientationwhen they are setting goals,
looking to improve performanceand so forth.
Jason Crosby (05:29):
Great, really helpful.
Appreciate that, and we're gladto have someone you guys on the
provider side and in adifferent market than some of
our others, so we're sure we'regoing to get a pretty good
perspective there.
All right, now let's dive rightin.
Okay, so healthcare is alphabetsoup.
We all know that.
Let's look at defining andclarifying, if you will, what is
(05:51):
the framework that is OKR, andthen the why and how you guys at
university are leveraging thatframework.
We'll start over with Tyler.
Certainly.
Tyler Barnett (06:00):
From its origin, the OKR framework.
From its origin, the OKRframework.
(06:27):
We attribute all of ourlearnings directly to John Doerr
, who has leveraged he jokinglyrefers to companies as a
deceptively simple, two-pronggoal-setting framework that
leverages both declaration ofyour overall objective, which,
when done appropriately, shouldbe exciting and really show this
is the destination of whatwe're passionately here to
(06:50):
accomplish, to, just, you know,bring up an emotional excitement
out of those who are workingtowards an objective and then a
separate set of key results,which would be your measurement
sticks or your milestones thatyou know are verifiably true
(07:11):
whether or not you are makingprogress towards your objective.
The whole framework is designedto be agile in nature so that
you are constantly reviewing thekey results you're striving
towards and then, on a recurrentbasis, typically quarterly,
(07:32):
adjusting your key results,learning why you did or did not
meet those key results, to thenmake sure that you're
continuously accountable to seteven further key results in the
next quarter.
The last component I'll close inon on the introduction is the
(07:52):
framework is designed tospecifically allow yourself to
set stretch goals, so theintention is to not meet 100% of
your key results.
In fact, that doesn't reallymake it any different than any
other goal setting framework,rather to set yourself for the
(08:26):
best possible results you canstrive for with the hopefully
that takes you farther towardsyour destination of what you are
trying to achieve than if youset very realistic key results
along the way.
Similarly, I'll share that theylike to refer to the facts or
the focus.
Alignment, commitment,transparency and stretch the
(08:48):
FACTS is what we hope youremember in the alphabet soup,
but in its totality.
The reason why UniversityHospitals has chosen the OKR
framework is because of thenature of our industry has a lot
of people working on a lot ofdifferent projects and
(09:10):
interdisciplinary orcross-functional roles and often
very little clarity on what theoverall organizational focus is
that we are aligning ourresources on.
So we understand each other'scommitments with transparency
such that we can stretchourselves to really offer our
patients the highest valueservices that we're here to
(09:37):
serve to our community.
Jason Crosby (09:39):
And so is OKR.
Is it a new rollout orinitiative of university, or is
this something that has beengoing on for some time?
How old is this used within theUH world?
Tyler Barnett (09:53):
It's part of our overall ambition that we refer
to as we want to believe, belongand build together.
So first, we want to inspire thebelief that we can actually
make the patient health outcomesand patient safety issues that
(10:21):
plague our industry.
We really want to believe thateach one of us individually
actually belongs as part of thejourney, if you will, to really
make the change or theinnovations that we're here to
serve at UH.
And the third piece of that usbuilding together is the
(10:42):
infrastructure of usingobjectives and key results to
use objective measuring sticksto organize the insanity of all
the different transformative andimprovement initiatives we have
in the system.
So we've been using OKRs Forabout two years, but in the last
(11:04):
six months, since August of2022, we have really focused and
zeroed in on this framework tomanage our entire journey to
Medicare break-even initiativeunderneath this umbrella of the
(11:26):
objectives and key results.
So we can share examples, butthere's roughly 20 specific
objectives with their keyresults that we're measuring
towards both to lower the totalcost of care per discharge on
the inpatient side and thenlower the total cost per member
(11:47):
per year on the accountable careorganization side of our book
of business.
Jason Crosby (11:54):
So it sounds like it's somewhat early in its use
and adoption within the system,yet mature enough to where you
guys are applying it on both aclinical, quality and cost side,
kind of a triple aim partner interms of how you're utilizing
it.
So you mentioned a veryapplicable focus there the
(12:14):
Medicare breakeven initiative,any other areas of use within
university that you guys canthink of in those first two
years where it's been used?
Tyler Barnett (12:27):
Examples of different objectives we are
striving towards.
We are using the OKR frameworkto enhance our quality
performance in our ACO contractsor Medicare Shared Savings
Program or Medicare SharedSavings Program.
To that note, uh is one of thetop performing MSSP programs
(12:50):
nationally year over year, whichisn't directly attributable to
the OKR framework.
However, our larger focus, ifyou will, of what the OKRs
connect to definitely has ablend of rectal management that
(13:17):
Matt can describe in more detailas well.
But to list some more of thoseinitiatives, we use the OKR
framework for qualityperformance in our accountable
care contracts.
We're leveraging it forimproving our patient experience
on all the differentmeasurement systems that the
health system is accountable forin their various programs.
We're using OKRs to redefinewhat we call our chronic disease
(13:41):
systems of excellence, wherewe're completely re-engineering
the care continuum of how aprimary care provider and a
specialist coordinate to givethe most excellent care for
diabetes, copd, heart failure,hypertension and CKD.
(14:03):
As early as this morning we hadfive clinical leadership teams
physician dyads explaining toour weekly huddle where we
review our OKRs.
We brought in a physician dyadboth primary care provider and a
(14:23):
specialist to explain their keyresults that they are striving
towards to truly revolutionizethe way that we offer our
services, for more preventive,proactive care supported by
clinical practice guidelines andevidence-based medicine.
But we use the OKR framework fortheir communication mechanisms
(14:47):
so that they can discuss the keyresults they're striving
towards, very similarly toanother initiative that we have
which would be optimizing ourappropriate SNF and IRF, or
skilled nursing facility andinpatient rehab facility
utilization, which is verycritical to our value-based
(15:11):
contracting performance but is,as I trust you all can
understand, a very, verydifferent initiative.
There's different stakeholders,there's different operational
components to how we optimize,better utilize our next site of
care performance, similarcommunication structure to folks
(15:48):
doing something, such asreducing potentially avoidable
ED utilization, which we have anobjective of reducing by 10% in
this year, and we have a seriesof key results across our
primary care practices, ourtelehealth services and also
within our urgent care offeringsto help them.
(16:08):
Those leaders understand thedata that lives within the ACO
world but that we can align onthe set of key results to
measure our capabilities to makea 10% reduction in, hopefully,
one year's time on ourpotentially avoidable ED
utilization performance.
Jason Crosby (16:29):
There are more but I'll stop there.
That's impressive in terms ofyou hear ED utilization, then
you hear ACO contracts, right,you kind of hear.
You think of those in polaropposites, almost in terms of
the conversations you might havein our industry or folks you
talk to.
You normally wouldn't eventhink of those in the same
(16:49):
concept or thinking, even if itis a management you know
framework.
So now let me ask you guys,matt and Tyler, what, what makes
in the world of alphabet soup,right?
Oftentimes when I saw you guyscome up with OKRs or using it, I
tend to think of KPIs, right.
Or I've lived in the world ofSix Sigma and Aaron, who's with
(17:12):
me, lives in the world of MIPS,like there's so many other.
You know quality-based, gearedmilestone project management
type orientations.
What makes OKR different fromsome of these other goal setting
frameworks that you guys areusing?
Matthew Nichols, PhD (17:26):
So I can comment on that, and certainly
we've also been familiar withall of the other frameworks that
you had just mentioned, and Ithink one of the interesting
things with OKRs really is whatOKRs are and what they are not.
And so if we step back just asecond and look sort of at the
(17:49):
macro level OKR picture acrossour organization and, as we were
speaking a little bit earlierabout developing an enhanced
level of systemness, okrs are auniversal language for
performance improvement.
Kpis, or key performanceindicators are typically
performance tracking, and sowhat OKRs allows us to do as an
(18:12):
organization is to speak thesame language around projects,
as different as they may be.
So we mentioned reducing EDutilization or looking at our
ACO contracting performance.
We can use the same frameworkfor vastly different performance
(18:34):
improvement content and soforth, and so there is an
obvious benefit there.
There's a leveraging that wecan really tie into across.
You know, irregardless of thecontent of the performance
improvement, folks that haveeither gotten very familiar with
the OKR process and workingthrough the OKR process, or are
(18:55):
more familiar with, maybe, bitsand pieces of it, or have some
things that they have learneddown the line, they can share
those learnings across theorganization, again,
irrespective of the content.
Tyler Barnett (19:07):
Build on that, if I can.
What we found in the applieduse of OKRs is that any one of
the quality improvementframeworks whether it's Lean,
Six Sigma, Denaic we use focusedPDSA cycles within our quality
institute here at UH.
They're phenomenal tools fordefining and measuring
(19:30):
improvement on known problems,but you only get incrementally
better.
They're perfectly designedtools that I am a fan of and a
practitioner of.
However, they solve problems inisolation and then they help
healthcare get a little bitbetter at a particular
(19:51):
performance indicator, whereaswhen we're trying to completely
transform or implement entirelydifferent ways of designing our
healthcare system.
We chose the OKR frameworkbecause the health systems can
no longer just make smallimprovements.
(20:13):
We truly do need to look withinourselves and make 180-degree
turns on some offerings that weprovide to our community and our
patients and our stakeholders.
So what I like to share is alot of KPIs and different
(20:34):
performance tracking tools thathealthcare is very accustomed to
are phenomenal, but what theykind of miss that objectives and
key results help with is makingthat aspirational, exciting
goal known in the objective tobring the joy back into our
workplace.
When anyone could searchBecker's or any listserv to see
(20:56):
the burnout rate in healthcareis intense, and it's a problem,
and quality improvement is notnecessarily the top funding
mechanism coming into healthcare.
However, using objectives toelicit the excitement of what
we're here to improve upon andthen using key results to share
our progressive milestonesallows us to both excite
(21:20):
ourselves but then also solveproblems with visibility.
There's a classic designstatement that you don't want to
solve a problem in isolation,and that happens all too often
in the silos of healthcare.
So we're using OKRs to getbeyond breaking down silos and
(21:41):
towards carving clearcommunication pathways across
teams.
Jason Crosby (21:47):
That sounds like as you're talking through.
That.
It made me think back quite abit of ways.
You know project management andthe PMBOK.
You know project managementbook of knowledge but you always
got was a little leery using itbecause it spoke in terms of
several thousand hours anddefining of a project in this
large scope Sounds like withOKRs it's not dependent on size
(22:13):
of project and functionality ofproject, like as Matt you're
just saying.
Right, you can hop between theED utilization and ACO contracts
.
Ed know ED utilization can be.
You know several-houranalytical project ACO reviews
can be.
You know tons of hours.
So with all that, can I speakto your point previously, matt,
(22:37):
on downside and upside of OKRsand talk to us about some of the
struggles maybe you guys haveseen while going through it as
well over the last couple ofyears.
Matthew Nichols, PhD (22:46):
So I think the OKR framework being new
within university hospitals andwithin the larger landscape of
health care, that, or perhapseven the population health space
that's in a rapid state of fluxright now, it's another new
tool.
There's a natural inclinationto sort of push back on.
You know one more newinitiative, one more acronym, if
(23:12):
you will, and you know, withthe, tyler and I were actually
in a meeting with a gentlemanfrom ambulatory that's been with
the organization a little bitlonger than we have and he
pointed out you know, thefractal management system.
The OKR framework that you guyshave, or that the group has
collectively embedded within thefractal management system, is
(23:34):
the eighth iteration, theseventh or eighth management
system that you know the systemhas rolled out in, you know, a
given time period, and sothere's certainly those sorts of
hurdles.
I think folks are some folksare, you know, suspicious of
change or maybe apprehensive ofchange up front.
If you layer that in with justconstant change, you know
(23:58):
there's some suspect involved.
And so what Tyler and our grouphas been working towards is
just getting out there, makingit visible, educating folks
again on what it is, what it isnot, how flexible it is One of
the beauties of OKRs, at leastin my mind.
(24:19):
I've been in several goalsetting activities, if you will,
in this organization and inprior organizations that have
leveraged things like KPIs ormaybe a more traditional goal
setting framework, and you sortof get stuck with OK, here's
what we want to do, how are wegoing to measure that?
Well, maybe we don't have areally great measurement for
that, so should we reorient thegoal?
(24:41):
And you sort of get buried intothat, that that measurement
piece, whereas OKRs is just justvery different from from that
vantage point.
It really comes up and says,okay, where do we want to go
aspirationally, where do we wantto go?
And then, how do we know thatwe're going to get there?
What are the, what are the keyoutcomes that that are going to
(25:02):
to happen to tell us that we'vebasically arrived.
And that's very different than,okay, here's a goal, here's the
activities.
It's sort of a three-stepinstead of a two-step and I find
that very beneficial.
But change, changes reallycan't be understated within this
(25:23):
space and it is certainly abarrier.
And, um, we have a large system, so there's there's a lot of uh
, you know, socializing of thisframework to be had.
Jason Crosby (25:35):
Yet yeah, always challenges with adopting
something new, and especially ifit's a new management sort of
push out.
How maybe add to that, matt.
Go back how was OKRs?
How was it rolled out touniversities of where?
Because it sounds like now,after that initial period that
(25:58):
you just covered, it feels likeit's successfully deployed,
systematically, right.
So, which is pretty phenomenala couple of years within such a
large organization, how has thedeployment been?
What was it like?
Matthew Nichols, PhD (26:12):
or what has it been like, you know?
I think Tyler could probablyspeak to that more pointedly
than I could.
Tyler Barnett (26:17):
Our journey to OKRs at university hospitals was
certainly spearheaded by ourchief clinical transformation
and quality officer.
We've essentially been workingto infect the system with.
This thought process has beenprobably a two or three prong
(26:42):
approach we had.
Our call to action is themacroeconomic state of affairs
in the United States.
There's so much pressure onhealth systems to remain
(27:21):
financially viable and theimpending transformation on a
reimbursement mechanism isneeded on a societal level,
saying we're going to recognizethat and we're going to own our
business through a managementsystem, because management
systems are quite lacking inhealth care.
There's some strong literaturethat suggests the level of
accountability on theoperational management side of
health care is not as strong asit is in other high reliability
and industries, and so what wechose to do was address that
(27:48):
macroeconomic reality and then,on a weekly clinical
transformation huddle, weorganized basically 20 teams
that each have their ownobjective and key results they
manage towards and they'recalled in to report out on their
progress towards their keyresults on a routine basis.
(28:09):
So what we have there is ourfearless leader saying this is
the approach we would like totake from his level of
leadership.
And then for the mid-levelmanagement, such as myself, what
we have done is we have learnedto teach and co-create
(28:33):
objectives and key results withvarious different teams to
really partner with those teamsso that the people who are
leading their own strategiesaren't managing to a strategy
that was written by somebody inthe strategy office.
The whole point there is thatideas are great but execution is
everything.
(28:53):
So those who execute on theirkey results should be the same
people, right, who write theirkey results, then partnered
(29:19):
assistants from our analyticsand our performance management
teams to then go and meet withall of the stakeholders to work
with them not to teach them theframework, but just start
working on it with them.
And the really exciting part ofthat journey is we get to watch
folks who typically thinkthrough tasks and work output to
manage towards.
And that's the most difficultpart of the OKR framework is
(29:44):
retraining your own brain tothink not in terms of work
output but in terms of outcomesthat add value to our patients,
to our payers, to our communityand to our government.
So we have a very clear valueframework that we operate within
to define what value means tous, and then we leverage the OKR
(30:08):
framework to set an excitingdestination of where we're
trying to go and then the keyresults of how we're trying to
get there.
An off-topic answer, but anotherexample it becomes easier the
more we practice the methodology.
It becomes easier to the pointwhere, on Friday, I was called
(30:29):
in to work with our childhoodpsychiatric access committee.
I am not an expert in thisspace, but I can quickly meet
with them and explain.
Here's how we're using OKRs.
Here's a few examples of howwe're doing it in these other
transformative initiativeswithin our institution.
Here's the philosophy, here's atemplate.
(30:53):
If you write some OKRs, we cancome back in three weeks to look
at them to ensure that they are, you know, written to the
specifications that the rigorousphilosophy hopes we use, and
then, within a month's timewhere we can use that framework
(31:16):
to improve upon our access forchildhood psychiatric and
psychology services.
Matthew Nichols, PhD (31:23):
One quick add to what Tyler's already
stated and maybe a bit of a plugto come back and talk with
Jason and Aaron again.
But another way that OKRs havebeen socialized around the
organization is sort of thereinforcement across multiple
areas of engagement, one beingthe fractal management system
which Tyler had alluded topreviously Quite frankly a whole
(31:46):
other conversation in and ofitself, but Tyler and I are both
on that team as well, and thatis a system-wide management
system and OKRs have found theirway and certainly found their
place within that system.
Pillar one there's four pillarsand pillar one is declaring
your goals, so that framework isavailable to folks as they work
(32:07):
through that system and whatthat system does.
Again, we've talked a littlebit about systemness,
generalizability of performance,improvement, frameworks across
the organization.
Fractal management the crux ofit is looking at the
organization as a system ofsystems born out of fractals
which, if you're familiar withfractals in nature and the
(32:29):
biomimicry, space and all ofthat, fractals are a simple
structure that are iterative andrepeating and can really handle
complexity quite beautifully.
And so that what is naturallyoccurring in nature has been
applied in a framework and hasreally allowed us a lens, if you
(32:50):
will, to look at a system of30,000 people and really break
it, break it out into systemsand systems of systems and
within the realm of performanceimprovement, looking at both who
we may work with on a dailybasis but who we may want to
engage across the organizationthat perhaps we don't work with
on a daily basis.
(33:10):
Where are the content experts,who you know has the content
knowledge or who has the theinstitutional knowledge to you
know, arrive at a better outcomewith a particular performance
improvement framework.
So OKRs have a natural placewithin that fractal management
system and that's another waythat we've reinforced its use,
(33:30):
if you will.
Jason Crosby (33:31):
Yeah, we'll definitely carve out a part two
of this and talked about thatportion as well.
So a lot of our audience areyour typical physician practice
administrators.
You've got hospitaladministrators, cfos and revenue
cycle.
You know folks on those linesof work, maybe not at a
(33:54):
university hospital healthsystem size type organization.
So, talking to them for asecond, where would you point
our audience to first go learn alittle bit more?
Not that they haven't learnedenough from this podcast,
obviously, but where they shouldgo learn and maybe how best to
go implement OKRs within theirown organization, whether it is
a small physician practice groupor a lot of our audience is
(34:19):
your typical critical access25-bed type hospital.
So, with that in mind, whatsuggestions would you give to
them?
Tyler Barnett (34:25):
First and foremost, I would suggest going
to YouTube.
There are plenty of reallygreat examples or different
videos that John Doerr has inregards to the OKR framework.
Bono is using OKRs across hisfoundations and can give very
(34:48):
easy to understand examples ofusing the OKR framework, and
there is a huge amount ofcontent I would say outside of
the healthcare complex but thenwithin OKRs.
I think my recommendation wouldbe to try to bring an example
(35:08):
from your own personal life, forexample.
A great example is if myobjective is I want to improve
my relationship with my kids inthe mornings and my key results
might be all right, I'm going totickle them, I'm going to tell
them three jokes before they getto school and we're going to
have breakfast together.
The exciting part about that tome is you can verifiably
(35:32):
measure whether or not you didthose three key results within a
week or two.
Measure whether or not you didthose three key results within a
week or two and then see ifyou're getting any closer to
your objective of just havingmore fun with your children in
the mornings.
I use that example because ithelps me to see the agnostic
capabilities of the frameworkcan truly apply to anything that
you are excited about and thenthrow down some measurement
(35:56):
sticks of key results that youcan verify whether or not you
did or did not complete them.
It's remarkably simple, but it'sdeceptively challenging
sometimes to find the rightwords to include in both your
objective or within your keyresults.
So I think the best advice I'dhave is to not trip over perfect
(36:21):
to get to good enough and justpull out a sheet of paper, write
down your objective of whereyou want to be with excitement
and then write down your keyresults, and then you can ask
yourself you know there's aseries of questions that you can
test yourself to make sure thatyour key results are, you know,
verifiable binary um, to thesimplest point of saying yes or
(36:44):
no, did I accomplish this or not?
Which is remarkably difficulteven for folks who have been
managing um performanceimprovement work in their whole
careers.
It just astounds me at timeswhen it seems so much more
difficult than it really is.
Matthew Nichols, PhD (37:01):
The only thing I would add there is the
legacy that OKRs have.
So we're approaching nearly 60years since its formal inception
at Intel, and so there areplenty of anecdotes,
industry-related anecdotesaround OKRs, relative to Intel,
apple, google and many othersthat I think have been very
(37:24):
helpful in this journey, asTyler and I have really both
embraced the OKRs and havereally become OKR students, if
you will, to work through theprocess and, I think, to advance
our own understanding andcertainly the understanding of
your organization.
So plenty of content out thereto peruse.
Jason Crosby (37:44):
Folks are going to want to reach out and learn
more.
How do they do so?
How can they find you guys andlearn more about OKRs and maybe
need to reach out to you?
Tyler Barnett (37:52):
They should reach out to strategic health care
partners, or my contactinformation will be available
Tyler Barnett LinkedIn profile.
We have our email addressesposted and both Matt and myself
have been consulting internallywithin UH with our OKRs and we'd
(38:16):
be glad to discuss answer anyquestions because we truly
believe this is the rightapproach to solve the complexity
that is delivering healthcareservices in the United States.
Jason Crosby (38:29):
You got it Well.
Tell you what it's greatinformation, good conversation
with our friends from Ohio.
We could certainly go on foranother hour, so we'll have to
split this up into part two, sohopefully our audience will tune
in for that, as we talk moreabout fractal management and the
applicability of that system.
And so we really appreciateTyler and Matt joining us for
(38:50):
part one, and we thank youlisteners for joining, and we
obviously, as always, lookforward to our next podcast and
until then, everybody, have agreat rest of your day you've
been listening to beyond thestethoscope, vital conversations
with shp a production ofstrategic health care partners
for more information about ourpodcast, including back episodes
, show notes, transcripts andmore, visit our website at
(39:13):
shplccom slash podcasts and Iknow you've heard it before, but
please consider rating ourpodcast and your favorite
podcast out.
Aaron Higgins (39:21):
It helps make others aware of the show.
Jason Crosby (39:23):
And our podcast wouldn't be possible without our
wonderful team of folks.
Aaron Higgins (39:28):
Editing and production assistance by Nyla
Weave and myself, Aaron Higgins.
Jason Crosby (39:32):
And your episode hosts are Aaron Higgins and
myself, Jason Crosby.
Aaron Higgins (39:36):
Our social media coordinator is Jeremy Miller.
Jason Crosby (39:39):
Our executive producers are also our
principals Mike Scribner andJohn Crew.
Aaron Higgins (39:44):
For more from SHP , consider following us on
social media, including Facebook, twitter and LinkedIn.
Jason Crosby (39:50):
And, as always, thank you for listening and have
a great, wonderful day.
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