Stooping To Greatness, Part 2

Yesterday, I ran into an “old” former colleague.  It had been years.  First thing he said: “How is that we look so old now?”  I never liked him.  Ha!  🙂

The truth is that it was great to reconnect.  Coincidentally, he’s in the midst of solving some of these same cultural puzzles for his new organization.  We talked about Part 1 over lunch.

A couple key points when beginning this new culture adventure …

  • There’s a huge difference between the sugar-rush, Diet Dr. Culture & Built-To-Last Cultures.

    Most staff have seen the Mission/Vision/Whatever that comes down from the Ivory Corporate Tower.  They are forced to attend the meetings and trainings, often delivered by corporate types or half-heartedly by facility leaders.  During those meetings, they are very quietly grabbing each others hands with a knowing nod: “This too shall pass.”  And, they’re right.  It won’t last because they (the staff) didn’t give birth to it.

No longer collecting dust on the wall.
No longer collecting dust on the wall.  You can’t make this up.  In the basement of my facility, I was looking around for some equipment.  I turned on the light and saw these artifacts from the prior facility occupants.  I don’t know what caused them to fail.  But they did.  Anecdotally, I’ve seen this play out time and again.  Where there is no vision, the people perish.  Without a vision/culture that actually inspires (or at least captures their hearts and minds), you’re programs become artifacts.
  • The GIVING BIRTH metaphor.

    I’m a guy.  I’m no expert.  I know.  But, I’m a father of 5, does that count for anything?!  Here’s the metaphor that fits so well here: Establishing your company/facility’s culture should be like giving birth.  There’s power in the creative process.  There’s a massive difference psychologically (for buy-in/commitment) if I’m able to participate in defining the culture (expectations, standards, rewards, etc.) as opposed to having Know-It-Alls present it to me.  If I go through the labor of wrestling with the words, values, mottos, standards, and behaviors that we want for our workplace, and then the delivery of agreeing to and training new hires in it, then I will be committed to the final product in a way that I simply can’t if it’s presented to me … let me illustrate:

    • Several years ago I went through this creative process for the first time at a building I ran in Orange County, CA.  Our before and after scoreboard made many in the organization take note and ask me to share our “secret sauce” as we went from worst to first in some key metrics like EBITDAR PPD.  I was more than happy to share.  It felt like I was on tour as I presented to more than 1/2 of our facilities.  I would spend an entire day with a facility’s leadership team – presenting to them the what, how, why, and when of World Class Service, which is what we labeled the culture we gave birth to.  The immediate response from those many facility teams was, by-and-large, enthusiastic.  They wanted to do the same thing at their buildings.  They wanted to do it right away.  I gave them our Mission & Standards documents.  I gave them our Orientation packet.  I gave them our Daily, Weekly, Monthly system for making the culture take root.Poster-BWC-[Converted]-Outline
    • Poster-BWC-Standards-[Converted]-OutlineAnd, then I left to the next facility.  I hit rewind and repeat.  Over and over again.  I personally felt tremendous excitement about making a difference beyond my facility.  I felt appreciation from ED/DNS partnerships who were looking for that missing thing to take them to the next level.  They found it.  They believed.  And, except for a handful of facilities, most of their efforts fizzed out within 3 to 6 months.Why?  I’ve thought a lot about that.  Ultimately, I believe two things are absolutely required in order to transform your culture into a transformative force:
      1. The Executive Director must be a “true believer(not the regional or the divisional or the owner at the home office)

      2. S/he must lead her/his facility through their own creative process.  They must reinvent the wheel instead of adopting someone else’s wheel (no matter how successful that wheel made that someone else).

If this is true, then the questions become what, why, how, and when to recreate the wheel.  The Birds And The Bees, if you will, of how cultures are made (I couldn’t resist).  Culture Birds & Bees.  That’ll be part 3 next.

Advertisements

Tail wagging the dog …

A very troubling sign indeed.  For those of you well-versed in the CMS 5 star rating system for skilled nursing facilities, after reading this I’ll bet you say, ‘I didn’t see this coming.’

A nursing home administrator recently told me that his census was in the decline.  It didn’t fall off a cliff.  It’s been a gradual fall.  From an average occupancy rate of about 94%, he’s down to about 73%.  His Medicare census is also down about 33%.  His building is a leader in its market.  What happened?  A major side effect of the 5 star rating system.  Here’s the story …

A relatively new 50-ish bed, all private room facility in the market was unhappy with its low star rating.  The Quality Measure component was killing them. (For a 5 star rating system introduction, check this out.) They reasoned that since the 14 day MDS data was hurting their score, they would simply discharge their Medicare patients on day 14.  Their new message to the market, ‘We have beautiful private rooms and we get you home faster than anyone else.’

Of course they don’t mention …

  • the harm they cause by sending patients home too soon.
  • They don’t publicize what percent of their discharges end up in the hospital again.
  • They don’t emphasize that these medicare patients are being cheated out of their rightful benefit of receiving therapy/care so that they heal fully before going home.

Nope.  Instead, they are sucking the long-term care patients out of the market and everyone else is suffering.  What’s an administrator to do?  How do you compete with that?  We came up with a game plan to go on offense in his market.  The good news is there’s quite a bit he will do and he’ll be fine.  The point of this post is to call attention to UNINTENDED CONSEQUENCES.  I’m sure CMS did not intend for this side effect of the 5 star rating system.  This story proves again that ‘we perform according to how we’re measured.’  A primary concern, therefore, as a leader is to be sure that your measures and rewards promotes the type of behavior you want.  Unfortunately, clairvoyance, isn’t bestowed with title of ‘Leader,’ so we have to be attentive and willing to change our measures/rewards as we discover these things.

Will CMS change the measure to avoid this side effect?  I hope so …

‘Speed of the leader …

… is the speed of the team.’ I heard that phrase for the first time about a year and a half ago when a young, new nursing home leader stepped into his first opportunity to run a skilled nursing facility in San Diego, CA. The opportunity was daunting … the facility was old, beaten-down, beneath a freeway overpass, across the street from a strip club, and competing with some of the best looking and operated facilities in southern california. Takers?


This guy jumped in and ‘owned’ it from day one … running fast. He modeled what he expected and later required from his staff — putting customer service/satisfaction (for residents, patients, doctors, vendors, etc.) above everything but quality care. The census and financial performance naturally followed. A year and a half later, the facility is neck-and-neck with the competition — enjoying clinical, census, and financial success like never before.

The speed of the leader is the speed of the team … is true, but only part of the story.

The speed of the leader and team are both dependent on the quality of care. What this San Diego leader and team had going for them, that many in their situation don’t, is a stellar Director of Nursing and care outcomes. That is basic and fundamental before attempting any radical transformation.

One of the secrets to their success was the personal attention the leader gives to doctor relationships. He, along with his team, work hard to convince skeptical doctors to send them a patient to ‘prove’ the hype is not hype, but true. Once that doctor’s patient arrives, her satisfaction becomes priority #1 which leads to a changed reputation for the facility … 1 MD at a a time.

Guardian Angels

The Guardian Angel program is a great way to accomplish several objectives at the same time:
* Provide an additional “friend” or contact for the patient
* Get to know the patients better
* Proactively solicit feedback daily from all patients
* Communicate with patients’ family weekly
* Check room for safety

Each department head is assigned as the “guardian angel” for a few rooms. Each day the GA is to visit the residents and patients in each of those rooms with the primary goal to build a good relationship. Get to know the patients, family members, etc. While there, the GA should be checking the room for safety and inquiring about customer service issues.

One great bonus for having this in place is during survey time. When the department of health asks you to arrange for a meeting with the patients of your choice, your guardian angels will be able to provide a broader perspective and deeper knowledge of the best candidates for that meeting due to the daily contacts.

A photo of each guardian angel is placed in the corresponding resident room with a brief description of the duties of the guardian angel (check out example above).