"Buy A Bus"

In October of 2004, we acquired a facility in Orange County, CA. It was there that the idea of “becoming the Ritz Carlton of skilled nursing facilities” first struck us …

A couple weeks before we took over the facility, the Dept. of Health called us in to their office to talk. It was there that we first realized what type of facility we were getting … a train wreck. DHS informed us that it was among their worst facilities in the county in terms of complaints and surveys (annual inspections). When I asked them why they thought it struggled so much for so long, their response surprised us … mainly a problem of geography – that our affluent area limited the number of strong employees.   When I asked what they recommended, they said “buy a bus and bus them in from Santa Ana and Anaheim.” After years of “dealing” with that facility, DHS saw buying a bus as the most feasible option.  What immediately followed, ALMOST made me take up their advice …

A few weeks after we took over, DHS showed up for our annual survey. And, in keeping with tradition, we failed it. Fines, penalties, and denial of payment for new admissions … not to mention the stress in preparing for a re-survey.  By the start of the second quarter, we were in the hole and tired. Looking back, that thrashing was really necessary to “prepare the soil.” Because of that experience, we were desperate not to repeat the same failure year after year and we started looking for what would address these pains we were feeling:

– Survey/Department of Health
– New Management
– Growing Census
– Feeling “Stuck” (internally & externally)
– What makes our building different from our competition?
– Recruiting
– Staffing
– Morale
– Financial Stress
– Survival Mode
– Customer Complaints

I think most SNFs experience these to one degree or another. We just happened to feel them all intensely at the same time 🙂

We identified something that would, theoretically, address all of those pains — and we found it at a training offered by the Ritz Carlton hotels. I attended their training that summer of 2005 in Los Angeles and was blown away. The initial skepticism (“We don’t look or smell like a Ritz”) and (“Their customers actually chose to be their customers — unlike our patients/residents”) started to melt away as the day went on. My “yeah but” turned into “I wonder if” to “why not?” In addition to the Ritz, we studied Disney and the Four Seasons …

We knew that radical change/commitment would be needed in order to become the ritz carlton of SNFs. But, frankly, we couldn’t see any other way out. We developed our own framework — including our Mission, Employee Promise, Motto, Customer Communication Guidelines, Service Definition, Guardian Angel Program, and Standards. We also developed training modules for each of these which included a test at the end of the training that every employee/and new hire had/has to pass in order to continue employment.

I’ll go into more detail later about the model … but, the results have been awesome as we’ve seen major improvements in the following:

– Staffing/Recruiting
– Reduced Complaints
– Improved Surveys
– Reduced Turnover
– Stronger Reputation & Census
– Provided hard, written standards to hold staff accountable and promote excellence
– Improved communication flow through Q Shift stand-ups
– Improved Financial Performance

What sounded good/right on paper turns out to be good/right in practice in this case. No remodel, re-landscaping, re-naming, re-anything could have the powerful impact on an organization that a fanatical commitment to world-class customer service standards can and does.

I hope this blog will serve both you and me to discover proven strategies and principles to bust out of the mediocrity in healthcare and achieve world class results.