Kenyon Connects

There’s no end to the information available today on leadership. Typically it is about how important it is. If it is written about so much and seems to be the secret for success, why isn’t great leadership present everywhere? Many people in management may manage processes and systems well, but they may not be great leaders or even leaders at all. So what does today’s healthcare market need in terms of leadership?

The Encarta World Dictionary defines leadership simply as “somebody who people follow, somebody who guides or directs others”. It sounds simple, but in working with groups and asking names of leaders that come to mind, there seems to be a void – few if anyone can come up with a name.

How we have led up to this point prior to health care reform isn’t necessarily going to work in the future. We will need to shift from managing an admission, episode or patient event to managing a population and achieve a quality, outcomes driven system. That means managers need to embrace leadership and be equipped with a different set of tools and skills in order to transform the healthcare system.

It is a time to reflect on oneself as a leader and improve any area that might prevent us from leading well. Are we leaders? If yes, how effective are we? How effective are we at embracing this new world? Do we know what the “new world” in healthcare might look like? How good are we at implementing new things and achieving a target, and sustaining it for months and years? How good are we at hiring well and systematically hiring for fit? How good are we at engaging people and having them enthusiastically follow you to achieve a goal? Are you an authentic and transparent leader? Are you a truth teller or do you tend to skirt away from an answer or bend the facts just a little toward your benefit? Are you able to speak up in opposition, respectfully? Do you have to be right? Do you take credit for wins or do you shine the light on others? Do you take feedback well that helps you improve?

Upon reflection of these questions, there is probably at least one each of us can identify with as an area and opportunity for growth.

No matter what healthcare arena we serve in, home health, homecare, hospice or another area, we need to be part of the solution in transforming the system. The start of transformation starts with good leadership.

We must be able to crystallize a vision of the future with the caveat that it requires revisiting since today’s leaders must be able to embrace ambiguity and uncertainty. What is clear is that tomorrow’s healthcare dream is to truly achieve a quality, value based system that is economical. Only courageous leaders will get us there. So what is needed?

First, find a trusted colleague or coach who can hold up the mirror and give you honest feedback to help you grow as a leader. To lead others well we must develop the habit of working harder on ourselves than others. While we must become masterful at coaching and mentoring others, it starts with ourselves. While in graduate school a few years ago, one instructor poignantly articulated the reality of the higher one goes up the hierarchical ladder in an organization, the less likely people will be honest with you. In positions of authority, this truth can’t be over-emphasized. I learned this the hard way and found it to be true.

Since all of us have strengths and weaknesses, it behooves us as leaders to know them and be good at improving both. The quest to become an effective and great leader can be lonely at times, eye opening in terms of other people’s perceptions of you compared to your own, a constant learning journey, highly rewarding if you listen and put what you have learned into practice.

Frankly, these transformational times are exciting. To think that at even government levels we are embracing the word “innovative” is unprecedented and should give hope. It is an opportune time to challenge current thinking. It is a time to lead with courage into a future that doesn’t have known details. The only known is that we have the requirement to provide a quality service with defined outcomes. Our customer’s lives depend on us succeeding. What a laudable goal to achieve. As leaders, a goal such as this doesn’t get better, does it?

Terri Wallin, CEO and Consultant Wallin Enterprises,
Transforming the way you do business.

Wallin Enterprises formed because of Terri’s drive to help organiza­tions succeed with culture and sys­tem transformation. With extensive experience in clinical, adminis­trative and executive operations, Terri is highly skilled in leading system design. Terri is sought out by leaders to speak to and coach others on improved business and system/process implementation. She is a published author on ar­ticles related to quality and busi­ness outcomes as a result of system transformation changes. She can be reached at terri@wallinenterprises.com or 206.755.7747. You can connect with Terri at www.linkedin.com/in/wallinenterprises

Nothing is more unsettling to a home care organization than the loss, or impending loss, of an essential leader. Home care agencies that fail to plan for this event experience major disruptions in their business; initiatives lose momentum or are completely lost, uncertainty increases staff resignations, and business drops off causing a decline to the bottom line. To avoid this problem, a home health, or hospice organization must have both an emergency succession plan, as well as an established succession plan.

What is a Succession Plan? A sound home care succession plan is an ongoing process that contains the following:

1. Identification of critical positions needed for your home care agency.

2. Determination of the requisite skills needed for those positions.

3. Identification and assessment of potential successors or sources capable of providing individuals with the requisite skills.

4. Management and leadership involvement at all levels throughout your home care agency in developing the plan.

5. Ongoing commitment to developing internal talent and monitoring their progress.

A successful home care agency leadership succession plan identifies the environment, prepares for contingencies, and minimizes disruptions. Therefore, effective succession planning must be an ongoing process of regularly identifying, assessing, and developing talent to ensure leadership continuity for all key positions in a home care agency. The process must be in keeping with your home care or hospice agency’s ongoing strategic goals and objectives. This may mean that the kind of leadership style, skills, and behaviors needing to be developed and promoted might be different in the future from those in the existing culture. Therefore, the plan must be visited yearly and updated to match what your home health or hospice agency needs going forward.

“It must be understood that “succession planning is not a “replacement” strategy. A properly prepared succession plan is a proactive, systematic effort designed to ensure the continued effective performance of an organization, division, department, or work group.”

Christopher Simoneau, The Business Review

With an up-to date succession plan, a situation creating one or more vacant leadership positions is less of an emergency for your home care agency. If, however, individuals within your home care agency are not capable of taking the helm and leading your organization, an alternative will need to be implemented as soon as possible to prevent damaging disruptions to your business. This replacement frequently is an interim home care manager with the requisite skills to fill the position.

With both an emergency and a succession plan in place, the selection of an appropriate interim home care manager is considerably easier. The requisite skill sets have been identified and updated, and the essential work elements are in place with all staff on board with their identified responsibilities during the interim home care manager’s time with your agency.

As with all things in our lives, planning makes a big difference. We never want to think of disasters occurring, but we all know that they do. People experience fires at their homes and business, hurricanes occur, earthquakes happen, and people become ill or die. How we plan to meet these times dictates the outcome. As interim home care managers, we too often see the failure to plan.

Kenyon HomeCare consulting can assist agencies with succession plans that help them through leadership transitions and lay the groundwork for when an interim manager is needed to fill the gap until a permanent leader can take the helm. It you need assistance with either developing succession plans or interim management, call Kenyon HomeCare Consulting at 206-721-5091 or e-mail gkenyon@kenyonhcc.com. We are here to help.

Over the years, we have provided numerous interim home care managers for home care executive level positions. On a few occasions we have been told that the cost of using a senior home care executive is more than they can afford. This has always intrigued me, because when a cost of service comparison is conducted, we frequently find that by the time all the benefits and overhead burden are calculated, the interim home care executive costs about the same and in a couple of situations less than what their actual cost of a permanent replacement.

What we have found is that some home care organizations only look at the monthly salary of the previous executive and measure against that number alone. If the employee burden of an organization is 20% or more, the cost of using an interim home care manager is about the same, or depending on the salary of the previous executive, a little less. There always needs to be a comparison of apples to apples when calculating the cost of an interim home care manager for a senior level position.

Cost, however, is only one area that a home care organization needs to think about in using an interim home care manager. The benefits prove to be so beneficial that, in retrospect, a vacated executive position gives an organization the opportunity to really look at themselves, their weakness and strengths, and develop a meaningful and effective strategic plan to carry the agency forward.

When you fill an interim home care manager position, it requires that an organizational assessment be accomplished in order to make sure that the interim management services are meeting the needs of the home care agency. An initial organization assessment also ensures that the interim home care executive has focused on the issues and goals that need attention.

It’s not uncommon for an organizational assessment to uncover issues and problems that were not apparent to the higher level managers of the home care agency. Sometimes we find that the staff filling certain positions are either not competent for the position or their personality and style are disruptive to the team. This makes it difficult to build a cohesive and effective management or staff team. In other situations, we have found that the home care organization has a very dedicated and competent staff, but the systems of the organization have not kept pace with changes in the environment and the implementation of required processes or software.

In these cases, time-consuming “work arounds” have been developed by the staff to accomplish what they know needs to be done. These situations are costly to a home care agency and frequently remain unidentified because the work is getting done.

An objective outside consulting firm, with interim mangers conducting the organizational assessment, provides you the invaluable benefit of identifying these types of issues, along with recommended solutions . You will then have some direction on how these can be resolved to the benefit of the agency.

Finally, the benefit of using an interim home care manager is that your agency does not lose momentum on previous projects and initiatives. It allows your agency to continue to function effectively and maintain your progress toward organizational goals and objectives. It also gives stability to the organization in a time of stress and flux. Using a seasoned interim home care executive assists the staff to move forward with confidence and know that they will be okay.

The biggest mistake that an organization makes is to allow a key position such as the Director, Administrator, or CEO to go unfilled for 4 to 6 months. Referrals drop, collections fall off and this distresses the business. Without a leader at the helm, critical things fall by the wayside. There is no one at the top with the view of the “world” of the agency. An agency without a leader is an agency afloat on the sea with no one at the rudder.

If you are in a position with an executive level position open and need help during this time of change, call or e-mail Ginny Kenyon at 206-721-5091 or gkenyon@kenyonhcc.com. We are here to help.

Home Health agencies that have been in business for a few years can relate to the issue of growing pains. It is almost like you hit a ceiling and cannot grow beyond the increased competition, changes in payor rules and reimbursement amounts, increased regulations and shortages of skilled staff.

So what is happening?

As with all issues, there is never just one cause, but numerous ones that contribute to this problem. It could be that there is more competition, funding sources have changed, a shortage of caregiving staff, a business model that is no longer viable or a mismatch of needed skills with current staff. Any or all of these could be contributing to a decline or a flat line of business growth.

In business as in life, we need to constantly re-evaluate our position and make plans and appropriate adjustments. However, what we see in many home health agencies is that home care organization has never changed or modified their plans, their services or their internal staff. They have continued without any major modifications and are now at a standstill or are declining. What worked when the business was started years ago may no longer be a fit for the environment, the pay sources, the new knowledge in both clinical services and organizational function or skills needed for the new world that is emerging. This is particularly true at this time in our country where health care is undergoing major changes.

The agencies that survive will be those that can re-create themselves to match the changes that are coming. To do this, the agency must first assess their environment.

• What are the challenges and opportunities?
• Where does the agency fit in all of these changes?
• What must the agency do to prepare for the future?

To accomplish a comprehensive analysis, the agency must look inside, as well as outside, to really have a vision for the future. What we have found is that most agencies are fairly good at doing external analysis and making decisions on changes in regards to the service delivery and the financial issues associated with those changes. The area where we find agencies struggling is with the internal operations and staffing. Very frequently, we find that even though the environment has changed and field services have been modified to meet the changing needs, internal structures and most of all the internal home care staff has remained the same.

This is one of the hardest processes for a home care owner or administrator to go through. Many times we see that an employee is kept because of loyalty by them, even though they are not able to perform the needed functions of the new and emerging roles. As painful as this is, an employee analysis must be done if the organization is to survive and thrive in the future.

It all begins with an objective analysis. First, doing an internal function and skills needs assessment requires that the management focus strictly on the functions and skills needed to accomplish those functions. Secondly, evaluate the skill set of the staff in the internal operations to determine the fit or non-fit of the existing home care internal staff. In order to objectively accomplish this task, it requires that the manager eliminate names with positions and only focus on the function of the role. Finally, an objective list of skills that will be needed to achieve success in the role will need to be developed. Only after this is done can an objective review of current staff skillset be done.

If education and training can achieve the needed skills for the re-designed job, then the existing staff may be able to remain in their revised roles. However, it must be clear that failure to achieve results in the re-designed job will mean that the individual will no longer be employed with the organization. This is as important for the managers to understand as it is for the employee.

If you find that making these critical decisions on re-design of internal operations and subsequent job re-alignment and change is a problem, and feel you could use some help or coaching, call Ginny Kenyon at Kenyon HomeCare Consulting, 206-721-5091 or e-mail to gkenyon@kenyonhcc.com. We are here to help