How to Achieve Sustainable Growth During Uncertain Times.
Recapping the February 22, 2022 Webinar.
Webinar Host: Sarah Balmer, Product Marketing Consultant at Curantis Solutions
- Cheryl Lovell, CEO of CLC Group
- Carla Braveman, Senior Clinical Consultant at Barry Dunne
- Joe Caruso, Principal at Caruso Consulting and Finance.
- Strategies for growth
- Balancing growth with clinical operations
- How staffing plays a central role and what to consider
- Cost implications and how to add value with limited resource.
Carla Braveman: What you need to do is make sure you’re operating at the most efficient point that you can from a clinical perspective. When you have more patients coming in than you think that you have staff for, what are your staff doing that somebody else could do?
Is your staff on the phone calling pharmacies and supplies half of the day? Couldn’t a team assistant do that? Can’t the team manager back at the office relay instructions from nurses to doctors and vice versa, rather than the nurse in the field?
You need to start looking at all the things that you do? Where can you save some efficiency?
I love to talk about the “ghosts of past surveys”: a surveyor comes in, you get dinged for one thing, you add seven questions to the admission process, seven questions to the clinical note, and all of those seven questions are not helpful for anybody. You’re not going to use them to determine the course of care, you just did it as a response to a ding on a survey. Addressing those seven questions takes away from time you can be doing something else.
Take a deep breath and ask what you really could change to make a difference to the staff. Ask the staff! Ask a couple of staff what we could do differently. You’ll get back the same answers and have a pathway to streamlining your processes.
Who is actually going out to do the admission? Medicare requires a nurse to go out within 48 hours of the admission. Can you send someone else who is well trained to explain what hospice is, get the consent signed, and save the nurse that hour?
Cheryl Lovell: Account managers are often the first people that patients learn to associate with your company. If they are well trained, they can do some of the admission process and save time. They can bring more real time perspective to patients and families.
Your account executives see the world a little bit differently than your clinical team. Their information can be very vital to the success of that patient’s episode. You may tell someone who is non-clinical more information about what your end-of-life personal goals are that can really personalize their care plan and take into consideration the family’s thoughts and concerns. They may not tell a a clinical person in a more clinical setting these things, but in a casual conversation when they’re figuring out what’s next. There’s such a great opportunity to engage in a way that supports the clinical team and give the team time to send the nurse out to start services. That salesperson is someone who they trust, who they signed on to hospice with.
Carla Braveman: I’ve always liked to see the admission process separate from the team manager. The team manager is in charge of all the admitted patients and the staff and making sure they have the tools to do a good job. And I may be more likely to say, “Oh, we can’t take that admission.” Intake staff who talks regularly with the clinical staff is not under that same burden.
Clinical staff may be visiting non-acute patience 2 times a week simply out of habit when some patients only need one visit. If the team manager were really to look at why staff were visiting and why they were taking that time with these patients—could a telephone call work instead of a visit? Maybe if you do that you have time to admit another patient.
I used to say that if I was in hospice and I only had a limited time to live, I wouldn’t want you take any more minutes than you have to.
Joe Caruso: These are all cost-cutting measures. You’re getting people to work at the top of their license, you’re eliminating extraneous things that eat up their time and cost you money to get done, you’re stretching your existing staff further. The more efficient you are the more profitable you are.
If every page of your 15-page admissions packet isn’t serving a purpose, cut it out. It’s taking up time and if your packet is on paper, you’re cutting printing costs. A long admissions process that isn’t value-driven isn’t doing anything for the patient either.
Carla Braveman: The relationships with patients don’t always have to look the same or look the same from week to week. It’s so hard for us sometimes to get out of that routine.
Balmer notes that the theme appears to be “working smarter.” Let’s look at the marketing side and growth strategies. What are some strategies for growth or adding value-added programs you’ve seen providers adding during the pandemic?
Carla Braveman: When a referral calls, all they want you to say is “give us a little information, and we will take care of this.” What they hate is when the agency says, “I’ll get back to you by tomorrow because I need to call this person and that person, and we’ll let you know.” They don’t have time for that, and 90 percent of the time, the agency that wins is the one that says, “Yes, let me take care of that for you.”
Going back to your key referral sources once a month – thank them for partnering with you. That’s a non-costly way to grow your business. Everyone likes to be thanked.
Cheryl Lovell: Excellent point, it’s that personal patient relationship experience. The doctors don’t always get to wrap up that end-of-life care with their patients who’s been their patient for 25-30 years and it can be a very empty experience for them. Arming your team with the information to go back to your partners and say “We just wanted you to know that Mrs. Smith passed peacefully at home surrounded by her loved ones…” They want to know. Physicians have a hard time letting that care go to hospice in the first place. If you can help make those transitions easier, share feedback from family and tell stories, you’ve done yourself a great service. They really want to know that we did a really good job for those patients and their families. Human beings all like closure.
Carla Braveman: Create a system always where the physician is informed of the death even if they’re not signing the orders. The biggest complaint I have always had from physicians is that “Nobody told me that Mrs. Smith died and then Mr. Smith came in and I looked like an idiot because I didn’t know.” It is a small thing, but it is incredibly important. And it gives you another opportunity to thank them for the work that they did.
Cheryl Lovell: The most highly respected hospices are those that have built highly successful relationships. They’re the ones that make it through when there isn’t a success. Providers might not remember every success that you’ve been through together, but they do remember every time there isn’t a success. Relationships needed to be strong enough to get over every dissatisfier.
Carla Braveman: What is your service recovery plan? When you know you’ve messed up, who’s going to call? Are you going to call and admit that you messed up and what you’re doing to make sure it get fixed? You’re partnering with them, and you would tell a partner what was going on. Admitting what and why and what you’re going to do about it makes a strong bond with a referral source.
Balmer notes that what she’s hearing is a lot about strong and thoughtful communication. Winding the conversation around to staffing. In the pandemic there has been so much talk about staffing and staffing shortages. Agencies have had to hire contract staff or traveling nurses. Can you comment on that?
Carla Braveman: Long-term use of contract staff is a moral dissatisfier for your staff. Short-term use is not a problem. Long term use, you’ve got someone who is making twice as much money as your usual staff. They’re not doing the entire job of your staff. Your regular staff has to pick up after them. They often don’t work weekends or holidays.
I go back to where I started today and ask, “What can you do to make your current staff most efficient?” How can you swing some of the job of an RN onto an LPN, for instance? Are you making more visits than you need to? Do you need more than one team assistants? Etc. It’s a hard line to draw.
Cheryl Lovell: It’s hard because our staff would like to see salary increases and they’re talking about it across the US.
You can reward teams for achievements and improvements which isn’t a permanent salary increase. Coming up with creative solutions with your CFO and financial people to add additional money to our employees without it being under the guise of overtime. That’s not how people want to make money. How can you give them some incentives for doing their jobs efficiently?
Joe Caruso: What does it cost you every time you turn over a nurse? What you’re paying for recruitment and what you’re paying them while they get up to speed—you should know what that costs you. You take those numbers; you look at what your travelers are costing you over your base staff costs and then you have an idea of what your parameters are. Find ways to reinvest that money into your staff who are long term. Productivity bonuses, find ways to pay for their student loans, decrease their benefit costs. What are the things that don’t really cost a lot that mean a lot to our employees?
Cheryl Lovell: Be creative. Here’s an example—this is the secret sauce. Find a pain point. Who doesn’t hate doing laundry? An organization provided laundry service to the staff—it was picked up and dropped off. And it was not a super expensive cost, but when these people were offered jobs elsewhere, they stayed for the laundry. It’s one thing you could give them for work/life balance. Another organization did meal delivery service. Those are very relatively low-cost but can really change someone’s perspective. It’s not always something involving bonuses and pay but be creative and think of something that is a pain point for your staff and alleviate it.
Carla Braverman: I have two ideas.
Employees are driving their cars all the time. One organization partnered with a car rental agency and a mechanic. If you needed an oil change, you got to the office, the rental was already waiting for you, the oil change people came and picked their car up, and it was back in the parking lot by the time they got back.
Hospice is an interdisciplinary team. You have meetings for each patient every week or every two weeks. How many times have those meetings really looked at coordinating the number of visits to strengthen the care of the patient and to diminish the number of unnecessary nursing visits? In hospice, nurses have to learn to see through the chaplain’s eyes or the social worker’s eyes because they may make a more meaningful visit than the nurse. Maximizing the entire team is better patient care.
Cheryl Lovell: In our meetings we spend a lot of time talking about problematic patients and families and not enough about solutions and what our goal of care is. We often get lost in the problem and not the solution. Everybody’s sick and tired of being sick and tired.
Carla Braveman: Do you give your staff an opportunity for support? IDG meetings are not to process your feelings about a particular patient. You need to have another way to have staff process working in hospice. If you don’t, that meeting is where it ends up happening.
Joe Caruso: And from the cost side, the fact that you have your entire team there complaining will send your financial people out of their minds. It should be an efficient use of time and efficient place to solve problems. Not burning all the salaries complaining about things.
Sarah Balmer: What are some of the greatest opportunities in cost savings or for investing in growth.
Joe Caruso: Finding your efficiencies. Leaders have to make the time and assess your process. If you’re finding yourself spending hours a week addressing a certain issue, spend a couple hours brainstorming how to solve this issue. You’ve now created a ton of extra time to do the next project. Track it and quantified that to show what you’ve saved, so you can call on investment for the next project. Start with the simple ones, take the easy wins.
Cheryl Lovell: Don’t be afraid of bringing your finance people to your clinical meetings. They see the world much differently than we do. Very valuable to have them included. Helps them connect all the dots.
Joe Caruso: I’m sitting in those meetings and I’m going to ask why we’re doing something the way we’re doing it. If you can’t tell me why or just say we’ve always done it that way, I’m going to challenge that.
Carla Braveman: We have a whole lot of other staff that we need to have metrics for. Having someone take a look at your organization from the back-office level is productive.
Sarah Balmer: What can we take away from the things that we’re learning in this pandemic?
Carla Braveman: The value of telehealth. It gives you much more than just a telephone call. Another thing is we adapted in a way we never thought we could. We made porch visits. We became very creative. We now know is that we have the capacity to do that. We know now as a community we can evolve and we need to listen to what the next generation wants from us.
Cheryl Lovell: You can run an entire organization without anyone being in the same space. Never thought that that would be possible. And you can’t just flip a switch and go back to the old way. You have to evolve as people become more flexible.
Joe Caruso: Embracing that will allow you to get better at recruiting and get better people. You’re opening up your hiring pool to people who don’t have to come into the office. I don’t care anymore where you live.
To catch the full version of the webinar, visit here!
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