Using the HPO framework to guide healthcare transformation: evidence from a five-year organizational case study

Purpose High performance in healthcare requires coordinated improvement across leadership, culture, processes and outcomes; yet, few frameworks combine an organization-wide diagnosis with an explicit transformation process. This study examines how the high-performance organization framework was used to guide a five-year transformation at a Dutch addiction treatment clinic and what contribution the framework plausibly made to the changes observed. Design/methodology/approach A longitudinal organizational case study was conducted at the Tactus Intensieve BehandelKliniek. Two anonymous repeated cross-sectional diagnoses, conducted in 2017 and 2022, were combined with 22 semi-structured interviews, site visits, an internal progress review, an annual plan and operational indicators. The analysis reconstructed a document-supported chain linking diagnostic priorities, high-performance guided interventions, intermediate organizational changes and observed outcomes. Because respondent-level data and a comparison group were unavailable, the study does not estimate a causal treatment effect. Findings The Intensieve BehandelKliniek’s average high-performance score increased descriptively from 5.1 in 2017 to 7.2 in 2022, while interviews indicated stronger trust, role clarity, collaboration and process discipline. Contemporaneous organizational records show that changes in leadership, communication, multidisciplinary teamwork and quality management formed the action bundle selected, coordinated and monitored through the high-performance transformation process rather than unrelated parallel initiatives. Client-related and flow indicators improved by 2022. Financial results remained volatile, but Intensieve BehandelKliniek’s 1.1% margin in 2022 was positive and modestly above aggregate benchmarks for the Dutch mental healthcare sector, supporting a cautious conclusion of sector-relative stabilization rather than sustained financial improvement. Staff perceived established high-performance routines as helpful during the COVID-19 crisis, but the design cannot test whether the high-performance organization transformation mitigated the effects of the crisis. Originality/value The study contributes a five-year, mechanism-oriented account of how a high-performance organization framework can function as transformation architecture in healthcare. It identifies a contribution pathway from diagnostic sensemaking and focused prioritization, through managerial ownership, to the institutionalization of continuous improvement, while explicitly delimiting the causal claims that a single-case design can support.