“You Don’t Have Credibility”

Ouch.  No, really.  That hurt.

Can you hear more humbling words as a new leader?  That’s what our CEO told me years ago when I passionately made the case for him to have me train anyone in the organization who would listen about creating a world-class service environment in their facilities.

I had just gotten religion and like any new convert, I was ready to evangelize.

ritz carltonAfter attending a Ritz Carlton day-long training, I was convinced that becoming the ‘Ritz Carlton’ of skilled nursing facilities would be the ultimate lever to pull to transform and turn around a facility that had failed survey 8 years in a row (under prior ownership) and lost us a lot of money out of the gate.  Not only that, but I had found my voice as a young leader in long-term care.  I came back to my facility after that training and, with my team, created our version of a world class service culture.

(Remind me to post on the process later b/c the process is where the magic lies, not the outcome).

After just a couple months of establishing the new culture, I made my pitch to our CEO.  I can get pretty animated when I’m talking/debating/evangelizing something I’m passionate about.  I knew this was the answer for my facility and, therefore, all of our operations.

One thing you got to know about him is that one of his greatest strengths, in my opinion, as a leader, is how he encourages entrepreneurship, innovation, intelligent risks.  He rarely says no to the enthusiasm of his partners.  So … after listening to me go on and on about world class service being the game changer for our group and my desire to hit the road to train all of our facilities in it, he said (to the effect of):

“You don’t have enough credibility — yet.”

[Dramatic Pause]

I was a combination of offended/disappointed/humbled/surprised.  Initially, I thought he was stupid.  I thought to myself (and out-loud to him): “how can you argue against elevating, systematically and massively, the level of customer service in our facilities?!  It’s going to pay off!”

Looking back, I’m EXTREMELY fortunate to have had this lesson taught to me in such a poignant way at an early stage in my career.  He was, in fact, not stupid at all.  He was totally right.  At the time I couldn’t see it.  But, just 18 months later it was crystal clear…

The facility had transformed.  In about 12 months time it went from worst to first in the org. financially and passed survey for the first time in 9 years.  Customer satisfaction was high.  Turnover was low.  We had RESULTS.  Those results are what caused my partners throughout the org. to PULL me to their facilities to share what we had done instead of me trying to PUSH my way on to their radars.

He was right.  Ideas and passion are important when it comes to bringing transformative ideas/culture to a facility or organization.  But, if presented prematurely — before the results or proof to back it up — the idea or idea giver won’t take root and won’t make the difference s/he’s so passionately trying to make.

18 months later, I began each training session on world class service with the results – Before on the left side of the white board and After on the right side.  I then put a big question mark in between.  The stark difference in the before and after is what brings the credibility … and causes the DEMAND for you and your ideas.

The Other Day …

It’s easy now to look back and see the wisdom of my CEO’s candid rebuke.  But, at the time it was devastating ego-bursting stuff.  I recently interviewed someone who wanted to be a regional resource.  He has a magnetic, positive personality and he knows his stuff.  His problem, however, is that his on-paper results are sub-par.  We talked candidly about the huge challenge he would have coaching/teaching others without being able to say, “Do this because I did and look at my superior results.”  For him, like me years ago, the timing isn’t right.  I’m sure he’ll get his shot … when his results match his enthusiasm.


Secret Service

One of the biggest complaints in hospitals and nursing homes is how long it takes to get the help you need. A fanatical commitment to world class service is the right way to solve this symptom. AND, there’s a way to cut call light/wait time in half while improving morale between direct-care staff — join the secret service!

Picture it … you’re a patient recovering from surgery. You are experiencing severe pain. You push your call light for the nurse. 3 minutes later, a nurse’s aide walks in and asks what you need. She tells you that she’ll go get the nurse for you. Unfortunately for the nurse aide and for you, the nurse is in her secret hiding spot in the facility where she can actually get some of her documentation done. The aide looks up and down the hall. No nurse. She goes to the med cart. No nurse. How is the aide feeling toward the nurse? More importantly, how are you feeling about the aide, the nurse, and the whole facility?

The best solution I’ve found to that (and hundreds of other) scenarios is a pretty simple technology that the secret service uses to protect the president. And … of course, we have a lot of fun telling the hospitals, doctors, and prospective residents that “if it’s good enough for the president of the United States, it’s good enough for our residents.”

Imagine having each of your nurses and aides with the secret service ear piece in one ear while they work. Then, that scenario above plays out like this … you ask for pain meds. The aide immediately presses her microphone button under her scrubs and says, “Roxanne, Mr. Jones needs a pain pill.” (Everyone hears that in their ear) Roxanne — in her secret hiding place — responds on her undercover mic, “Tell him I’ll be right there.”

Let’s do the math together to drive the point home:

Let’s take a 99-bed facility with 90 residents (high acuity). The day shift has the following in nursing: 5 licensed nurses, 10 nurse aides, 1 RNA. How many times during her shift does the nurse or CNA look for someone for assistance (ie, help with transfers, pain pills, showering, ADLs, wound care, room change, etc., etc., etc.)? Let’s say 20 times. On average, how much time does it take to find the person you’re looking for? Sometimes 20 seconds. Sometimes 10 minutes. Let’s say 5 minutes. Now let’s do the math …

– 16 staff in nursing x 20 searches for help x 5 minutes per search = 1,600 minutes/60 minutes = 27 hours.
LET THAT SINK IN! On one shift alone, your nursing staff is spending a collective 27 hours “looking for someone to help.” It’s insane! That equals:
– 54 hours/day (treating the next two shifts like one day shift due to fewer staff)
– 68 days/month
– 818 days/year

If you really want to pull your hair out, calculate the wage cost of that “looking for someone to help.” When I show this to Directors of Nursing, they have heart attacks. If your nursing staff/DNS is pushing back at all to the idea, do that math with them and you’ll see a change of heart. Just think of how much more care can be delivered if you had 54 hours/day more of nursing time available?!

The radios & headsets we use have benefited us in several ways …
– improved communication between nursing staff
– more efficient use of our time
– created buzz in the patient & labor market
– eliminated the hated/annoying overhead paging

Externally … this has been HUGE for us in our community for marketing. The DC planners, doctors, vendors, etc. are thrilled that a SNF is so progressive/pro-active to this very common problem in healthcare. If you preach/market customer service as your distinguishing characteristic and are able to back it up with the secret service ear piece action … buzz, buzz, buzz.

Post a comment/question or email me to find out more details about this solution. I have no vested interest in any technology solution provider by the way. I just can’t imagine delivering healthcare any other way anymore.

"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.