Outcome-Driven Thinking: Inteleos Nonprofit Case Study

Nonprofits face unique challenges when it comes to setting goals and measuring impact. With limited resources and complex social missions, simply tracking activities and outputs is not enough. Nonprofits need to embrace outcome-driven strategies that create real change in the world.

This case study of Inteleos, an international medical certification organization, provides valuable insights into how nonprofits can implement Objectives and Key Results (OKRs) to drive outcomes and further their purpose.

Inteleos’ CIO Juan Sanchez shares the step-by-step journey his organization undertook to shift from outputs to outcomes. He outlines the reasoning behind adopting OKRs, the challenges along the way, and the successes and lessons learned.

For nonprofits struggling to make the leap to outcome thinking, Inteleos' experience provides an inspirational model to follow.

The Case for OKRs in Nonprofits

Why did Inteleos, an established 50-year old nonprofit, decide to implement OKRs in the first place?

As Juan explains, several factors prompted the change:

• Increasing complexity: In 2016, the organization expanded from one brand into a family of brands serving different audiences. This growth in services and offerings caused strategy complexity to rise proportionally.

• From nonprofit to purpose-driven: Inteleos wanted to evolve beyond the limiting “nonprofit” label which defines organizations by tax status rather than purpose. The team realized that connecting to their underlying social mission would require new ways of setting goals and measuring performance.

• Global expansion: International growth plans required a robust goal setting framework to drive strategic alignment across borders.

• Disruptive innovation: Inteleos planned to bring groundbreaking new technologies to overhaul outdated industry practices. Significant innovation investments would be needed.

• Customer experience overhaul: Dramatically improving Inteleos’ customer and user experience became a priority.

In the face of these changes and ambitions, OKRs presented an ideal way for Inteleos to stay focused on outcomes that mattered, drive strategic alignment from the boardroom to the frontlines, and remain nimble in response to learning and new opportunities.

Other nonprofits who find themselves at inflection points due to growth, innovation efforts, business model shifts, or digital transformation can similarly benefit from the focus and adaptability provided by OKRs. When the path forward involves complexity and change, OKRs serve as guiding lights.

The Journey From Outputs to Outcomes

Inteleos’ OKR journey began in 2019 with a copy of “Measure What Matters”, the seminal book on Objectives and Key Results by John Doerr. Doerr’s straightforward case studies provide an excellent starting point for OKR newcomers.

However, as Juan discovered, truly embracing outcome-based thinking requires much more than reading a book. It necessitates new ways of goal setting, continuous learning, and shifts in mindsets that can be challenging even for experienced leaders.

During Inteleos’ multi-year rollout of OKRs, the organization undertook extensive education across all levels:

• 2019: Introduced OKR concept to executives via leadership retreats. Brought Board up to speed later that year.

• 2020: Conducted additional leadership retreats to deepen understanding of OKRs. Launched organization-wide OKRs starting in Q1.

• 2021-Present: Implemented regular OKR coaching. Continued education for existing and new leaders. Maintained Board engagement through quarterly OKR reviews.

This intentional, long-term approach to capability building enabled the OKR process to stick and take hold across the business.

When shifting to outcome-driven strategy setting, securing leadership commitment and providing ongoing training is crucial for success. Organizations should expect the journey to take years, not months. Creating a culture oriented around impact requires patience and discipline.

Tracking OKR Performance

As Inteleos rolled out OKRs over multiple years, tracking OKR performance provided valuable insights:

2020 (Year 1)

• Q1: 32 objectives, 81 key results (KRs). 31% objectives fully achieved.

• Q4: 28 objectives, 88 KRs. 31% objectives fully achieved.

Full Year 2023

• 82 objectives

• 193 KRs

• 36% objectives fully achieved

Observations

• By 2023, objectives had dropped to an average of 20/quarter (36% reduction) and key results had dropped to an average of 48/quarter ( 45% reduction)

• Fewer key results set as team sophistication grew, better definition of outcomes evolved, and focus increased

• Gradual improvement in % of successful objectives (from 31% to 36%)

While it may seem counterintuitive, a reduction in both total objectives and key results indicated the teams had started to understand the difference between outputs and outcomes. Teams evolved their thinking on what was most meaningful to track as OKRs and set more meaningful, impactful goals.

Tracking OKR measures over time provides critical insights that can help inform program improvements.

Connecting Mission to Execution

A pivotal moment in Inteleos’ OKR journey was building a bridge between frontline execution and overarching social impact goals.

Juan credits a strategic scenario planning exercise done between the executive team and the Board of Directors as the catalyst for defining long-term “Impact OKRs” aligned to Inteleos’ mission of ensuring equitable healthcare access and quality care.

These 5-7 year OKRs include audacious measures of success like:

• Increasing patients served from 1.5 million per day to 10 million per day

Doubling the number of assessments delivered by 2027 Meanwhile, shorter-term quarterly “Execution OKRs” moved the needle on those Impact OKRs through product initiatives, geographic expansion, and other strategic efforts.

This tiered OKR framework—with multiyear Impact OKRs anchored to mission and supported by annual and quarterly Execution OKRs—enabled Inteleos leaders, managers, and staff to connect their day-to-day work directly to the change they wanted to see in the world.

By linking OKRs across planning horizons, nonprofits can ensure organizational priorities reflect their core social purpose rather than short-term operational concerns. This fosters greater mission alignment at all levels.

Continuous Improvement

While the implementation of multi-tiered Impact and Execution OKRs represented major progress, Inteleos’ OKR journey did not stop there.

The organization has continued to refine and enhance their approach:

Program Developments

• New product teams are forming, requiring OKR realignment

• Annual company-wide OKRs introduced alongside quarterly OKRs to define focused annual objectives

• Started “OKR Weeks” where teams fully dedicate time to collaborate on drafting objectives and key results

• Extended Impact OKR duration from 5 years to 7 years

• Introduced “OKR Champions” to shepherd specific objectives

Mindset Shifts

• Moved away from making everything an OKR to prioritizing key outcomes

• Trained teams on leading versus lagging indicators to help uncover more meaningful metrics and increase the velocity of information back to the teams.

• Coached staff to identify “what we are trying to change” rather than tracking all activities as OKRs

Continuous learning and adaptation allow the OKR process to evolve as organizations change. What works in Year 1 may need revising by Year 3.

Built-in quality control mechanisms like OKR Weeks, OKR Champions that offer support, and regular objective calibration also help sustain outcome-focus as programs mature.

Key Success Factors

Reflecting on lessons learned, Juan highlights several factors as integral to smooth OKR adoption:

1. Leadership Commitment

• CEO passion and engagement with OKRs provided crucial support, especially during early stages

• Ongoing C-suite commitment maintained momentum in later years

2. Board Buy-In

• Investing time to educate Board members was essential since most came from traditional strategic planning environments

• Securing Board member support ensured alignment on long-term Impact OKRs

3. External Coaching

• Third party coaching accelerated capability building and reinforced outcome-focused habits

• Coaching would have been even more effective if started on day one in the journey

4. Strategic Scenario Planning

• The annual planning exercise created space for big picture thinking that gave rise to Impact OKRs

• Scenario planning and Impact OKRs combined to powerfully reorient strategy around social mission

In addition to these success factors, Juan also notes the importance of early executive communication. Initial messaging and framing from leadership helps set understanding of OKRs across the business from the outset.

Common Pitfalls

While reinforcing key success factors, Juan further cautions against three common pitfalls he encountered:

1. Outcome Thinking Underestimated

• The distinction between outputs and outcomes consistently proves difficult

• Avoid assumptions that the concepts are intuitive; expect to invest heavily in sustained training

2. Coaching Too Late

• Bring in external coaching at the start of the journey to build critical knowledge faster

• Waiting too long allows bad habits to cement

3. Performance Reviews Unchanged

• If performance management processes stay tied to outputs, OKR success will be limited

• Get ahead of linking goal setting, evaluation, and rewards to outcome achievement

Perhaps the biggest overriding insight was the persistence of output-based thinking even years after OKR adoption. The tendency to fall back on tracking activities rather than pushing for meaningful impact remains stubbornly tough to overcome.

Yet with sufficient education, leadership role modeling, and support structures, organizations can defy this inertia. Inteleos demonstrates that with concerted effort and commitment over multiple years, nonprofit teams can make the shift from outputs to outcomes.

Ongoing Efforts

Inteleos continues to build on their OKR foundation today through a focus on:

• Increasing clarity of OKRs to optimize their value

• Dedicating designated time for thoughtful OKR formulation

• Breaking down functional silos via cross-team collaboration

• Right-sizing expectations with not every initiative requiring an OKR

• Enhancing indicator balance between lagging and leading measures

Juan also notes how the struggle between outputs and outcomes spans across borders. Initially he assumed it was a distinctly American business phenomenon. However, upon working internationally with leaders across five continents, he discovered it was a universal challenge.

This revelation is strangely reassuring. It underscores how the obstacles nonprofits face on the journey to outcomes are not unique. With adequate support, guidance, and determination, organizations across the globe can overcome these hurdles.

As Inteleos learned, external coaching provides indispensable help for internal teams new to outcome-based thinking. OKRmentors' nonprofit coaching packages combine certified OKR coaching with nonprofit strategy experience to smooth the transition.

Final Words of Wisdom

Inteleos’ purpose-driven mission to expand healthcare access paired with Juan’s technology background made OKRs an obvious goal setting mechanism. The aligned outcomes and rapid iteration enabled by OKRs accelerated Inteleos’ global impact and innovation plans.

However, Juan quotes Christina Wodtke in noteing OKRs are “vitamins, not medicine.” They amplify existing strengths rather than cure underlying flaws.

Organizations should ensure reasonably sound structures already exist before layering on an OKR system. Culture challenges or leadership issues require other interventions first.

Juan also observes since learning about OKRs he would “be hard pressed to ever work at an organization again that does not use them.”

This realization after shepherding Inteleos’ multi-year adoption underscores the power of OKRs to fundamentally upgrade how businesses and nonprofits drive strategic results.

Once properly implemented and integrated, OKRs become an indispensable navigation system keeping organizations oriented towards their North Star. They provide the goals, accountability, and dynamism required to sustain urgency towards the outcomes that truly matter, not just the outputs that are easy to measure.

For nonprofits seeking the next level of effectiveness, efficiency, and impact, OKRs pave the path to get there.

Inteleos has increased its performance and improved its global influence by following the OKR roadmap. Your organization can chart a similar course. With clear objectives, early education, executive alignment, and external coaching, the journey awaits. Your most ambitious goals—and most meaningful outcomes—sit on the horizon. Let’s get started!