Category Archives: Culture

Interviewing CEO Candidates: Questions for Strategy

I am currently serving on a search committee for a new executive director for the National Adult Day Services Association.  It’s been a long process where we have had to identify transitional leadership, do some significant strategic planning, and identify and then interview candidates.  I’ve learned so much during the last few months.

A friend of mine and a fellow search committee member sent our team a link to this article by James Citrin of Spencer Stuart: How Boards Interview CEO Candidates.

The article is an interesting guide for a board to use when hiring their next CEO or Executive Director or other leadership position.  He’s has hit on some great questions that cover a wide range of a CEO’s responsibilities.  In his interview guide, he covers the following areas:

  • Growth, Financial, and Operational Management
  • Strategy and Vision
  • Leadership and Team Building
  • Technology
  • Culture

He includes some additional interview questions that are useful, but a bit outside of the above categories.  The most important question according to Citrin: “What questions do you have for us?”

Read the article.  Here’s my question for the small business owner: can you answer these questions about your company?  In a resource constrained environment, how do you lead your company forward?

At least those were the questions I was asking myself.  I’ve got some work to do.

 

 

Care Partners: Fighting the three plagues of loneliness, helplessness, and boredom

With this blog, I’m interested in exploring senior focused businesses. Let’s face it, it may be just a bit too broad. My business is senior care.

A few weeks ago, I took a three-day class to become a certified to teach the Eden at Home curriculum. Going into the training, I was, more than anything, curious to learn about the Eden Alternative and The Green House Project. While I suggest learning more about these affiliated organization, they are noted for being leaders in the “culture change” movement, which basically means that they have been very influential in making nursing homes more humane.

The starting point for the Eden Alternative came when Dr. Bill Thomas was rounding at a local nursing, when he met a patient who poignantly said to him: “I’m so lonely.” He realized one major problem is that the culture of the institution forced care decisions for the benefit of the company, management of staff, and regulatory compliance. Juggling all these items is actually quite difficult and requires help from advanced computer programs. In the process, it is easy to lose track of the person.

I found the training fascinating from a business management perspective. Looking at the Web sites of The Green House Project and the Eden Alternative, a very different vision of the nursing home, assisted living, and senior care in general is presented. It requires different architecture. It requires different staffing models. It requires more involvement of the care recipient and the caregiving family. It’s different. But is it profitable? Can the business communicate it in its positioning and strategy?

In the world of adult day services, I think we tend to be person centered, if for no other reason than that we see our participant’s families on a regular basis, and in many cases, on a daily basis. Yet, there is something compelling in becoming more intentional about reimagining the relationship between the participant (care recipient), the family, the center, and other service providers as a care partnership. The three plagues in the title are real for both the care recipient and the care giver.

Should we adopt many of the ideas presented in the Eden at Home curriculum? There is much that is interesting and worthy of consideration. Perhaps we need to adapt the principles or use them to spark a conversation about what are culture needs to be, how we need to train our associates, and how we should improve our services, operations, and strategies.

Culture: Government Payment Centered to Private Customers Centered

In the adult day services arena, which consists of programs alternately described as social or medical model, adult day center, adult day health, or adult day care. It tends to be center based. In the United States there are approximately 5,000 centers. Center providers received compensation from families pay out of pocket (including long-term care and life insurance products, and loans), through grants and community fundraising, and through government payment sources such as Medicaid, the Veteran’s Administration, and other state and federal programs such as the Older American Act and the USDA’s Child and Adult Care Food Program.

Government payment sources are by far the most significant source of funding for adult day services. How does this affect the company’s culture? First, many of the government payment sources also have significant case management program in place with sophisticated intake and referral processes. Consequently, the customer becomes the case management system rather than the individual client. The center tries mightily to serve the participant and her family, yet the case manager is the one who has to be pleased: nurses and staff drop everything to take their calls; the case management care plans form the foundation of the center care plan so the center doesn’t get cited and lose money in recoupment; and significant energy is expanded to ensure documentation compliance rather than excellent care. The payments tend not to move up for years at a time (if not decades), so there is constant pressure towards cost cutting rather than staff and program improvement. The pressure is intense to have a culture responsive to mandates and regulatory compliance.

In Georgia, I’m seeing resistance from Centers. In some cases, programs are simply closing in response to the increasing costs, increasing regulatory requirements as it has become difficult to develop a viable business model. Others are bucking the system. For one non-profit, they decided to drop their participation in Medicaid and government payment programs. They had the ability to continue serving their existing Medicaid clients because they were able to raise money and they found significant savings when they focused on what they valued rather than regulatory compliance. Other centers have announced that they will no longer take new government payment clients.

This appears to be the change that most programs must adopt to become healthier businesses with reasonably levels of profitability.

The change is not easy. In conversations with NADSA members, this goal as proved elusive. Much money has been spent developing beautiful, upgraded physical plants; yet, the needle hasn’t been moved. They find competition from assisted living, in home care, nursing homes, and other senior care providers. It’s difficult to be successful in that market, because it is easy to become dependent on the sophisticated case management referrals.

The first change the adult day center has to be in the corporate culture. The culture that succeeds with government payment sources is not the same culture that succeeds with families determined to provide the best care for their loved ones with their own funds. The culture that will Wow the family with sufficient funds to care for their loved one is different. This is a person-centered environment, in which families expose intimate details of their lives as they become care partners with their loved ones. These customers won’t be impressed with a focus on private paying clients simply because the center needs a better source of revenue.

The next few entries will explore the adult day center’s corporate culture. Clearly, it is and must be unique to each organization, but it FEELS key to effort to change.

Let me know how corporate culture of your program impacts your ability serve and attract a healthy mix of customers.

Corporate Culture: the only thing completely within our control

I’ve been thinking about Corporate Culture for a while now. We find ourselves facing increased competition for employees. There have been times in our organization’s history, where it is very clear what the culture is, what is needed, and what is not acceptable. I’ve also found it very difficult to define our culture in a way that all can understand and embrace it. It became exponentially more difficult once we added a second location where employees had very little face to face interaction from one location to the other.

Because of regulatory and business environment changes, we’re in the process of proactively reacting and reexamining our operations. If as David Cummings suggests that corporate culture is really the only thing completely in our control, we’ll be starting there. We’ve struggled and worked at keeping our culture strong, but now it needs to be tweaked. To continue growing, we’ll need to move and pulse faster. As we hire, we’ll need to become more sophisticated ensure we’re bringing the right people on board. We’re large and spread-out enough that not everyone can be hired by one person. It’s been a long time since one person could supervise everyone on staff.

Over the next couple of posts, I’ll share some thoughts about our culture and some of the ways that I think we need to change.