Carilion Clinic: A Decade of Healthcare Performance Excellence

Improving Community Health Through Strategic Performance Management

Based in Roanoke, Virginia, Carilion Clinic is a not-for-profit healthcare organization that has become a model for performance improvement in healthcare. With approximately 13,000 employees and around 1,000 providers, this level-one trauma center serves as a major healthcare footprint in Southwest Virginia, providing care to nearly 1 million people through over a million patient visits annually.

The clinic's mission—to "improve the health of the communities we serve"—and its vision of "better patient care, better community health, and lower cost" have driven a comprehensive performance management system that has evolved over more than a decade.

The Foundation: Building on Proven Methodology

Carilion's performance improvement journey began in 2007 when they developed their first scorecards for senior leadership. The initiative was championed by the clinic's former CEO, who had his leadership team study "The Balanced Scorecard" by Drs. David P. Norton and Robert S. Kaplan. This book continues to serve as the foundation of Carilion's performance improvement philosophy.

"When I use the term 'scorecard,' I'm referring to performance improvement opportunities that are part of overarching efforts to improve our overall quality, while lowering the cost of care to our patients," explains Darren Eversole, Director of Finance at Carilion Clinic.

Evolution of the Scorecard System

Early Development (2007-2010)

The organization started with a performance scorecard for senior leadership, then expanded a few years later to create specific scorecards for provider practices—both advanced care providers (ACPs) and physicians. The goal was to link compensation directly to patient-centered care, ensuring providers were rewarded for outcomes aligned with the clinic's mission.

Continuous Refinement

Over 13 years, Carilion has refined its approach significantly. What began as a single leadership scorecard with 70 measures has evolved into a sophisticated system with multiple scorecard categories. Through iterative improvement, they learned that fewer, more meaningful metrics drive better results—the clinic scorecard now tracks just 7 measures, each aligned with their Carilion Vision 2025 strategic plan.

"Having that refined list of only the most important measures and ensuring they link to your organization's strategy was a big lesson learned for us," Eversole notes.

Current Performance Management Structure

Today, Carilion manages approximately 300 scorecards through their system, organized into four distinct categories:

1. Clinic Scorecard

The organization's overall scorecard contains high-level metrics spanning the entire system. For example, "time from scheduling to time from service for new patients" demonstrates access to care by examining workflows, provider templates, and recruitment/retention efforts.

2. Department Scorecard

Each department has unique metrics applicable to teams of providers within that department. Metrics like "surgical site infection rate" apply across subspecialties that perform frequent surgeries.

3. Section Scorecard

These scorecards tie to specific teams within departments (such as Internal Medicine or Dermatology) and often include patient experience metrics like "physician kept you informed," calculated from patient survey responses.

4. Provider Scorecard

Individual provider scorecards contain measures tied to personal results, typically including patient experience and managed care measures.

The Implementation Process

Creating and maintaining these scorecards is a significant undertaking—a seven-month process annually that involves:

• Working with leadership, including Chairs and Section Chiefs of each department
• Defining performance measures and indicators that incentivize positive behaviors
• Developing cascading metrics from system-wide goals down to individual providers
• Establishing a three-year outlook with clear targets and roadmaps

Overcoming Challenges

Before implementing their current system with ClearPoint software, Carilion faced significant obstacles:

• A clunky system that made data loading and interpretation difficult
• Frequent errors that limited confidence in measurements
• Difficulty aligning staff to common goals due to unclear impact visibility
• Extensive manual tweaking required just to create basic scorecards

The transition to ClearPoint resolved these issues, providing:

• Automated report generation and distribution to 1,000 providers
• Advanced calculations that roll up to different measures
• API integration to automatically pull data from internal applications
• User-friendly interfaces that save significant time and effort

Compensation and Incentive Structure

A key driver of Carilion's success is tying 20% of provider compensation to performance management through what they call a "tier payment" system. This creates a standard for base compensation while providing at-risk compensation based on performance.

"If the provider understands what they are being measured on, we see tremendous success," Eversole explains. "This incentive has helped us drive positive behaviors and improve outcomes."

Measuring Success: Positive Results

The implementation of comprehensive performance scorecards has yielded significant benefits:

Enhanced Transparency

Scorecards are publicized widely, presented to multiple audiences including physicians, management, senior leaders, and board members. Plans are underway to post the clinic scorecard to the intranet for all employees.

Clear Expectations

Everyone knows what's expected of them and the metrics required to reach goals, leading to greater understanding of how compensation is affected.

Opportunity Identification

The scorecards serve as effective tools for identifying shortfalls and areas for improvement, with clear roadmaps for future targets.

Cultural Integration

Performance management has become embedded in Carilion's culture, with each person recognizing their role in the clinic's overall success. As Eversole notes, "Everyone is rowing in the same direction, physicians and providers have control of their results as an individual, which contributes to the overall performance of the scorecard."

Lessons Learned and Best Practices

Through their journey, Carilion has identified several key insights for other healthcare organizations:

1. Focus on What Matters

Don't add measures just to add them. Stay focused on what's important based on your organization's mission and needs. Quality over quantity is essential.

2. Understand Your Capabilities

Be realistic about your internal capabilities and the needs of your stakeholders. Larger organizations will need more scorecards, but they must be developed thoughtfully.

3. Invest in the Right Technology

Find a software product that not only offers a powerful system but also has responsive support. The right technology partner can significantly reduce administrative burden and improve accuracy.

4. Create Clear Line of Sight

Ensure providers and staff can see how their individual performance contributes to departmental and organizational goals.

5. Maintain Flexibility

Be prepared for continuous evolution. What works today may need refinement tomorrow as healthcare landscapes and organizational needs change.

Looking Forward

As Carilion Clinic continues to mature its performance management expertise, they're seeing increasing demand for scorecards from managers and directors who recognize their value. The challenge is managing this growth thoughtfully, ensuring that new scorecards track only the most important performance measures.

The organization continues to learn from best practices, leveraging their technology platform's capabilities and community resources. With their ability to create unlimited scorecards and robust data management capabilities, Carilion is well-positioned to continue expanding their performance improvement efforts.

Conclusion

Carilion Clinic's 13-year journey in performance management demonstrates that with the right methodology, technology, and commitment, healthcare organizations can successfully align individual performance with organizational goals. By tying compensation to meaningful metrics, maintaining transparency, and continuously refining their approach, they've created a culture where performance improvement is not just a management tool but a shared organizational value.

Their experience offers a roadmap for other healthcare organizations: start with proven methodology, invest in the right technology, focus on what truly matters, and be prepared for continuous evolution. Most importantly, ensure that everyone—from individual providers to senior leadership—understands their role in improving patient care, community health, and cost efficiency.