News Release

Health system execs tend to rate their organizations as 'high performing' – but objective clinical measures disagree

Peer-Reviewed Publication

Wolters Kluwer Health

September 8, 2021Health system executives tend to rate the performance of their organizations more favorably and "higher performing" than objective clinical quality measures indicate – likely reflecting differences between what subjective and objective assessments consider as important metrics of health system performance, suggests a study in the September/October issue of the Journal of Healthcare Management, an official publication of the American College of Healthcare Executives (ACHE). The journal is published in the Lippincott portfolio by Wolters Kluwer.

The growing trend toward value-based payment for health systems and health care providers is fueling the need to define what constitutes high performance, according to the report by Dmitry Khodyakov, PhD, and colleagues of the nonprofit RAND Corporation. Their study finds a lack of agreement between how health system executives assess their health system’s performance and objective measures of performance, and identifies three levers for achieving high performance.

Mismatch may partly reflect unique insights of health system executives

The study team interviewed 138 C-suite executives from 24 health systems in four states: Washington, California, Wisconsin, and Minnesota. Executives were asked to describe their perceptions of the performance of their health systems as well as factors they believed contributed to high performance. Based on the responses, the researchers classified each health system as low, medium, or high performing.

The executives' subjective assessments were then compared with several objective metrics of clinical performance based on nationally endorsed clinical standards of care. The objective quality measures included cancer screening, diabetes treatment, vascular disease management, kidney disease screening, cardiovascular disease management, and patients' adherence to medications, among others.

Only 10 of the 24 health systems (42 percent) were classified in the same way using both subjective and objective performance assessments. For the remaining 58 percent, there was no agreement between the executives' subjective assessments and the objective clinical measures.

Objectively assessed performance was often less positive than subjectively assessed performance. Executives whose assessments of their health systems' performance aligned with objectively measured performance cited clinical quality, cost, and reliability/standardization as the basis for their subjective assessment.

“A comprehensive assessment of health system performance requires a broad set of performance domains and measures beyond clinical quality," Dr. Khodyakov and coauthors conclude. Indeed, this "greater breadth of factors" that executives consider in their subjective assessments of performance may partially explain the lack of agreement between subjective and objective measurements of performance.

Three levers for achieving high performance

When asked to think about health systems in general, executives identified "three key levers" for achieving high performance: organizational structure, organizational governance, and staff engagement. "The choice of levers, however, is health-system specific and reflects a system’s needs," the researchers write. Likewise, the executives stated that the identified levers for high performance were interconnected and interdependent, rather than independent from each other.

"Our results show that health system performance is clearly multi-dimensional," Dr. Khodyakov and coauthors conclude. "[I]ncorporating the perspective of health system executives could help develop novel performance measures and test hypotheses about key characteristics of high performing health systems and the levers used to achieve high performance."

Click here to read “PRACTITIONER APPLICATION: Alignment Between Objective and Subjective Assessments of Health System Performance: Findings From a Mixed-Methods Study”

DOI: 10.1097/JHM-D-20-00249


About the Journal of Healthcare Management

The Journal of Healthcare Management (JHM) is an official journal of the American College of Healthcare Executives (ACHE). Published bimonthly, JHM is a peer-reviewed publication dedicated to providing healthcare leaders with the information they need to manage complex healthcare issues and to make effective strategic decisions. JHM provides a forum for discussion of current trends and presentation of new research as applied to healthcare management.

About the American College of Healthcare Executives

The American College of Healthcare Executives is an international professional society of 48,000 healthcare executives who lead hospitals, healthcare systems and other healthcare organizations. ACHE's mission is to advance its members and healthcare leadership excellence. ACHE offers its prestigious FACHE® credential, signifying board certification in healthcare management. ACHE's established network of 77 chapters provides access to networking, education and career development at the local level. In addition, ACHE is known for its magazine, Healthcare Executive, and its career development and public policy programs. Through such efforts, ACHE works toward its vision of being the preeminent professional society for leaders dedicated to advancing health.

The Foundation of the American College of Healthcare Executives was established to further advance healthcare management excellence through education and research. The Foundation of ACHE is known for its educational programs—including the annual Congress on Healthcare Leadership, which draws more than 4,000 participants—and groundbreaking research. Its publishing division, Health Administration Press, is one of the largest publishers of books and journals on health services management, including textbooks for college and university courses. For more information, visit

About Wolters Kluwer

Wolters Kluwer (WKL) is a global leader in professional information, software solutions, and services for the clinicians, nurses, accountants, lawyers, and tax, finance, audit, risk, compliance, and regulatory sectors. We help our customers make critical decisions every day by providing expert solutions that combine deep domain knowledge with advanced technology and services.

Wolters Kluwer reported 2020 annual revenues of €4.6 billion. The group serves customers in over 180 countries, maintains operations in over 40 countries, and employs approximately 19,200 people worldwide. The company is headquartered in Alphen aan den Rijn, the Netherlands.

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