Act 2, Scene 1

Take your pick of metaphors …

Shifting gears
A clean slate
Starting a new journey
Passing the baton

 All of those metaphors apply to what I’ve decided to do … help grow a new Ensign-backed venture in a new segment of the healthcare industry: URGENT CARE.

I started this blog in 2007 to share lessons learned the hard way in healthcare administration in the long-term care setting.  I had run 3 skilled nursing facilities in Arizona and California.  Then I was asked to help reshape our Administrator in Training (AIT) program where we select, train, and place around 20 AITs per year.  Having not-too-long-ago gone through my own learning curves/new facility and having a small part in the training of over 100 AITs has given me a unique viewpoint of the ‘new healthcare leader.’ I’ve really enjoyed the platform and really appreciate the many friends, acquaintances, and opportunities that have come from it.  In some cases, it has helped people make the decision to join the industry.  In others, it has convinced people that it’s not for them.

During Q4 of 2010 I was getting very antsy to get back into the thick of operations.  My wife and I flew out to Boston (from California) several times looking at homes, facilities, the industry, etc. to see if I would attempt to open up a new Ensign-affiliated market there.  After 4 months of a roller coaster of emotions, we decided to stay put … I love what I do.  I love who I do it with.  I love where I do it.  Once I put that decision behind me, I re-engaged in a big way and 2011 became for me one of my favorite years at Ensign ever … The eprize! being a key ingredient in that.

2012 started as 2011 ended … incredibly excited about the year and the work on my plate: a re-design of our AIT program (3.0?), eprize! encore?, making HR a bigger force for good, etc.  Then, one morning everything changed …

My friend and colleague, Mike, recently branched away from skilled nursing to take Ensign into Urgent Care.  He met two urgent care industry giants: John Shufeldt and Glenn Dean.  Mike was the catalyst that brought John and Glenn and Ensign together to form a joint venture.  The original plan was to open up a handful of centers in one market.  While that’s still progressing, the ‘plan’ has expanded.  The joint venture acquired Doctors Express on March 1, which is the nation’s first and only franchise system of urgent care centers.  It has currently about 50 centers in 25 states (and counting).  The corporate office is near Baltimore, MD.

John/Glenn/Mike asked/offered me to join them in the joint venture by having primary responsibility for the franchise system.  At first I laughed it off.  It didn’t really register as real or possible.  I was so locked in to what I/we’re doing and have been doing for the last 10 years, I couldn’t really imagine it.  But, after a few days I started to feel like it was the right thing to do … much to my and my wife’s surprise!  What was really shocking was to see her feel the same way.  Whereas the Boston indecision was a 4 month roller coaster, this was a 4 day natural, fast decision.

It’s hard to articulate why the decision came so quickly.  It just felt like the right thing for me and my family.  We’re excited to move to Maryland and have some more elbow room for the family (5 kids).  I’m excited to be back at square 1.  I feel like an AIT again.  Having to learn a new industry — quickly (although 10 years of healthcare management experience helps).  I’m excited to be part of a very small new venture that has HUGE potential.  I’m worried about my ability to be/do what’s needed.  I’m, at times, overwhelmed by everything that needs to happen in a very short amount of time.  For the last couple months, life/work has been running at a frenetic pace.  I’m loving it.

I’ve replaced myself at Ensign someone who I call ‘The Upgrade.”  Talk about luck.  Once everything is squared away for his transition, he’ll be announced.

This Blog …

I’ve decided to continue this blog for the time being.  The title of “Transforming Long-Term Care” will have to change to something else.  But, I expect that the lessons I continue to learn the hard way in urgent care management will translate to any/all healthcare leadership as has been the case with the skilled nursing stuff.  I hope you’ll continue to value the thoughts, experiences, links, and mistakes I share here going forward.

On to Act 2 …

Act 2, Scene 1
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EnsignPrize! – judging behind the scenes

This has been one of my favorite weeks in YEARS in skilled nursing.  I’ve had the privilege to judge, in person, some of the finalists of the eprize in California and Colorado.  Below are a few photos from my time behind the scenes.  Unfortunate realization … I didn’t have many regrets about my time as an administrator until this week.  Seeing the great work that these leaders have inspired in their staff has been humbling.

Serious Tilapia. Administrator say, “Dave you don’t have to eat it all.” I say, “I wouldn’t if I didn’t want to. This is great.”
“Cheesecake Factory” quality cream of broccoli soup.
Wouldn’t believe it if I didn’t see it. Alzheimer’s facility in Colorado that I was afraid of years ago when we acquired it. Now, didn’t want to leave. What a great feeling. These people have become legit experts in meeting the needs of the cognitively impaired. There, “behaviors” is a bad word. Quote: Behaviors are simply unmet needs.  To have 8 residents with extreme dementia peacefully sitting together engaged in meaningful activities compared to how it was years ago was jaw-dropping.
Organic garden w/ help from local organic gardeners. Chef uses the produce in soups, dishes all the time. Residents help cultivate/grow.

The EnsignPrize! home stretch

At Ensign’s 2011 annual meeting I spoke about some personal feelings re: hitting 10 years with the organization and in skilled nursing. It was a time of deep reflection. It was then that I developed some of the thoughts I’ve shared here about burn out, empathy, and a hunger to do more after surviving industry-common career crushing experiences. Some of those thoughts are found here.

As “luck” would have it, while I was in that very reflective mood, I was hit by some new, related ideas during a couple early morning rides. I love to listen to NPR podcasts during those runs/rides and back then I listened to a Freakonomics podcast that was like lighting a fuse in my mind. When I got to the office that morning, ideas started to crystalize, as seen on my whiteboard:

I don’t expect you can follow the train of thought there. But, with the help and input of my colleagues at Ensign, what started as some 10-year angst turned into the eprize! … our organization’s $150,000 competition to transform the industry by transforming the day-in-the-life of our residents. At that 2011 annual meeting, I shared with my friends and colleagues the story of how the idea of the eprize! was born and then challenged them to run with it. And … they did.

The executive directors and directors of nursing upped the ante to $150k and all agreed to put money into the ‘pot’ from their own facilities to fund the award. For more details about the competition and why we did it the way we did it, see this “halftime talk” I gave to the organization about it:

Well … the applications are finally in and uploaded onto the EnsignEprize.com website and the contestant facilities are lobbying their communities hard to have them ‘vote’ for their application. The eprize! award winner will be announced in early April. As I’ve read through and watch the videos of some of the applications I’ve gotten emotional to see the small and big improvements in the systems we use to care for our residents and patients with more dignity, humanity, and choice. I hope you take a minute to go to the website and see what we’ve been up to for the last year as a group. And, please, by all means … share this with your friends. Better yet, challenge your own organization to do something similar!