Home Care U - How the Top 5% of Home Care Providers Communicate and Implement KPIs (Stephen Tweed Pt. 2)

Episode Date: May 21, 2024

KPIs are more than numbers on a spreadsheet; they're accountability metrics embedded in your company culture. In this episode with returning guest, Stephen Tweed, we'll focus on the communication, implementation, and sustainability of the right KPIs for a home care business.Enjoying the show? Send me a text and let me know!Learn more about Careswitch at: careswitch.comConnect with the host on LinkedIn: Miriam Allred This episode was produced by parkerkane.co

All right. Welcome, everyone, back to Home Care U. I hope everyone's having a great week. It's good to be with all of you. I am Miriam Allred, your host and also the head of partnerships here at CareSwitch. It's my pleasure to be back hosting week after week with all of you. Really is a highlight of my week to be back with great guests and with all of you attending live with us. So thank you for being here. Just a quick note about CareSwitch here at the top. For those of you who don't know, I still get questions, you know, about the podcast, about CareSwitch and how those things come together. So I just want to call it out here at the top. For those of you who don't know, CareSwitch is the only AI powered operating system for home care

businesses. So we do quite literally replace your agency management system, CareSwitch is the only AI powered operating system for home care businesses. So we do quite literally replace your agency management system with CareSwitch. And for those that are interested, we are out of pilot mode. A lot of you have seen that we were running pilots last fall and into the start of the new year, but we are officially out of pilot mode, taking on new business. We're best suited today for private pay businesses. So if that's kind of where a lot of your dollars are coming from, that's who we're best suited to. And so if you're interested in exploring a new software partner and seeing how AI can assist

in documenting, scheduling, billing, reporting, reach out to me. We'd love to have a conversation with you. So all that being said, we have got the wonderful Steven Tweed, the founder and CEO of Leading Home Care and the founder of the Home Care CEO Forum with us today. I hope everyone enjoyed last week's episode.

Stephen has been in this industry, I said, for longer than I've been alive. So he knows a thing or two about home care. And it's one of my joys to be able to speak with him and get his brain and his information and knowledge in front of all of you. So Stephen, thank you so much for being back with us this week. Thank you, Miriam. It's always a pleasure to be with you and thank you for rubbing it in how old I am, how long I've been doing this. Not my intention, but speaks to your wisdom. Before we jump into today's topic, Stephen, we did an extended introduction of you last week, but I want to give you just a couple minutes for those who didn't listen for you to introduce yourself briefly in just a couple of minutes.

Well, you said, Miriam, I'm the CEO of Leading Home Care, Tweed Jeffries Company, and I've been working in the home health hospice and home care space since 1982. And then in 2002, my son and I created this part of our company called Leading Home Care. And we quickly focused on serving companies that provide non-medical home care, mostly on a private pay basis. And, of course, now that's evolved to large companies that work with Medicaid and Medicaid beneficiaries. Then in 2012, we founded the Home Care CEO Forum. My wife, Elizabeth Jeffries, is a professional speaker and author and executive coach. And we actually met through our National Speakers Association. And through NSA, we were involved in several mastermind groups for professional speakers.

And so we thought, well, what if we introduced this to the home care industry and got together a group of companies, CEOs and COOs. So we held our first mastermind meeting in February of 2013. So we're now 11 years old. And that group is what we call today the top 5% mastermind group. These are company at the 95th percentile of revenue based on the HomeCare Pulse benchmarking studies. And then we have four other groups of companies. And each group is made up of companies that are similar in size and that do not compete because they're in different geographic markets. And so we have about 55 companies that are part of our mastermind groups. They're all independents. We do not have any franchises in our groups yet, although we've been requested to start some new groups for franchises.

And we'll let you know when that comes down the road. So that's who I am and what I've been doing for a long time. And it's a real joy to work with these entrepreneurs in the industry who are really making a difference in the lives of their clients, in the lives of their caregivers, and in their communities. So amazing. Well, thank you for all that you've done. I have worked also with a lot of those people in your mastermind groups, and I hear only good things. And I think, you know, rising tide lifts all boats. And so the more collaboration we see amongst different owners, operators, the better. And that's part of kind of the thinking behind this podcast is let's get the best practices

out into the open. I've heard from providers, you know, 10, 20, 30 years ago, there was a lot of people just siloed in their own market and didn't have resources and webinars and events and masterminds. But, you know, we're changing that and we're all kind of opening the door to opportunities and best practices. So thank you for your pioneering in that regard, for lack of better words. So let me kind of preface today's topic and then let's get into it. You have referenced last week and countless times, I think a lot of people know you for your love of data and your interest in data and research and the KPIs of this industry.

And so today I want to kind of look at things from the lens of that top 5% group specifically, you know, the 95 percentile, what are they thinking about? How are they operating? You know, what's kind of maybe the secret sauce up with those agencies. And I want to talk about the why and the how of metrics. I want to talk about kind of the strategy, the buy-in, the execution of KPIs and metrics. There's a lot of content. I did an episode with Jensen just a few weeks ago about kind of the what or which metrics specifically, but today I want to take kind of a different angle that you're really well-suited to talk about, which is more of the strategy, the buy-in and the execution of KPIs. So I want to just start with kind of an open-ended question. And that is how do these top leaders, home care leaders in

the industry talk about KPIs? How are they framing their business around KPIs and what does that look like? Well, I think it goes back to a mindset and the mindset of these entrepreneurial leaders who are really thinking big picture. They see themselves as leaders of large companies. They see themselves growing. And my mantra, wherever and ever, and I repeat it whenever I speak to a group, is what gets measured gets managed, what gets rewarded gets repeated. And these leaders use their metrics as a tool for communication and a tool for getting everybody on their team on the same page. And then as a way to reward performance, whether it's performance of the whole team or performance of individuals on the home care team. And so it really, I think, goes back to this big picture notion that it begins with communication. And your question was sort of, well, how do they communicate? Well, as we just talked about, I'm old and I've been doing this a long time.

And I worked with 500 different home care and home health companies over the last number of years. And prior to that, I came out of corporate America. And before I started my home care consulting business, I worked with some Fortune 100 corporations. I worked with some big manufacturing organizations. I work with some banks, some retail. I don't know if I've worked with a thousand different corporate entities over the last 40 years. I can safely say, and I rarely use always and never, but all of these companies have had a communication problem. And people say, well, we have a communication problem. And it's like, well, why is that? If somebody doesn't do something, there's only three reasons

why they don't do it. One, they don't know how. Two, they don't have the ability, that is the skills or the tools. Or three, they don't want to. It's an attitude thing. And yet I've worked with these amazing corporate leaders all across corporations, but particularly for the last 20 years in home care, and these are really bright people. They know how and they have the skills and they want to. So why is there a communication problem? And there's two parts of it. One is expectations.

People say we have a communication problem because they want to know more than is provided to them. And so therefore, since they don't get what they want, they say we have a problem. But the second part of it is they don't have a system for communicating. And so as I studied this and I work with these big corporations and now with these top 5% home care leaders, we realize that having metrics is a way to facilitate communication. And so if you have regular meetings for the purpose of communicating, and you have a regular agenda, and part of that is looking at metrics that measure whatever it is you're working on, now you have some basis to say, how are we doing?

How's that going? What's working? What's not? What do we need to do differently? And I know you've seen me put up this slide with the quote, my favorite quote from W. Edwards Deming, who was a quality guru in Japan and America after World War II. And his quote was, without the data, you're just another person with an opinion. And so we talk about communication in big organizations, people either have the data or they have an opinion. And highly effective leaders cut through the opinions and get to the facts. And so with that sort of underlying background, then we look at top tier home care companies. And so in our top 5% group, these are companies between 10 and $30 million in annual revenue. And some of them are relatively

new, 8, 9, 10 years old. Some have been around a little longer than that. But this whole industry is relatively new. So these entrepreneurial leaders have gone from zero to 10 million or 20 million or $30 million in a matter of 10 or 15 years. And so part of that is they have this ability to craft a huge vision for their organization, to share that vision with other people, to set goals, to measure performance, and to use those metrics as a tool for communicating. And then we go back to cadence and rhythm. A number of years ago, probably 10 years ago, I was sort of in a stuck spot where I just, things weren't going the way I wanted it. I needed to do something different. And I was talking to my wife and business partner about it.

And she's an executive coach, by the way. She coaches physician leaders and academic. She said, you need an executive coach and I'm not in. And we laughed about it. And she was right. And so I reached out to a colleague who we knew from the professional speaking business and literally engaged them. He wanted to do it for free. I said, no, this is a professional relationship. And so for two years, we met every other week. And one of the things he taught me in our coaching relationship was the idea of cadence and rhythm and setting up communication on a regular basis. And that changed my life in a couple of ways. One is, I think you know my daughter, Jill Scott, works with me as our

manager of member services. And she's been with us about 12 years now. And so when my friend, Tom, my coach, suggested this idea of rhythm and cadence, I said, yeah, you're exactly right. And so she and I set up literally a daily check-in. And so for seven years, we met every day at 12 noon, unless I was on the road or things come up. And so creating that rhythm and cadence for communication that includes looking at the metrics. And so as we've looked around at our top 5% mastermind members, I think I can safely say all of them have a regular process for communicating that has that rhythm. It may be daily, it may be weekly. I think almost everyone has some kind of weekly meetings. And then you have a monthly leadership meeting and orderly strategy sessions.

And so you develop that rhythm and cadence. And that's what I see missing in a lot of the smaller companies in the industry. So that's a long answer to a short question, but that sort of sets the theme for what we're talking about here today. I really like how you're connecting KPIs to communication. I think that connection is a good place to start because it could often be overlooked how those two things come together. The other word that comes to mind for me while you were speaking is clarity. A lot of dissatisfaction in the workplace happens. You mentioned kind of those reasons why. I think it's a lack of clarity on their role, on their responsibilities, and on the outcomes

that they're supposed to drive. And so to me, yeah, KPIs kind of fuel communication and clarity for the individuals. One question that I'm thinking about is what are the roadblocks to this communication? What's stopping owners from having this kind of open communication, this open dialogue, this cadence of meetings? What are the roadblocks? Why isn't it more obvious to owners? I think the biggest roadblock is having the discipline to do it every time as scheduled. It's real easy for entrepreneurial leaders, particularly in smaller companies who are working in the business every day, to get caught up in busy activities and to say, well, gee, I can't do the Monday morning meeting this Monday morning because I've got to go see a client. I've got to do an assessment visit. I've got to talk to this bank trust officer or whatever. So we're not going to

meet this Monday. And then next Monday, something else. And pretty soon the whole rhythm is broken. And the leaders at the top tier of our industry are working on the business and they recognize that this communication and facilitation of conversation is an important part of their role as leaders. And so they develop the discipline to have those meetings and they set the expectation that the meeting is going to happen whether I'm here or not. So if I'm the CEO and the meeting is every Monday morning and I'm there and I'm going to be there next Monday, I'm saying, I'm not here next Monday, but go ahead and have the meeting anyway. And my chief operating officer will be the designated leader or will pick someone. And in fact, some leaders with some of their groups will actually rotate the facilitation of the meeting. And so it doesn't have to be the leader by title,

but it could be a facilitator who is a member of the group and they take turns and you have an agenda. So you're following the same agenda. And part of that facilitation is asking good questions. And the thing that I learned in this mode goes back to my very first client in 1980, a small manufacturing company in Bedford, Pennsylvania. And I met with them every month and we set up their KPIs and they had six of them. They didn't have computers, so they were gathering the data manually. And once a month, we had this leadership meeting. And I remember the CFO sitting in his office with an overhead transparency. I don't know.

Are you old enough to remember overhead transparency? Way before PowerPoint, way before slide decks, we had these things called overhead. And he would sit in there with a felt marker and draw a line on the graph representing the numbers for that month. And when they first started having their monthly meeting, he would get up and put up the transparencies on the screen and talk about the numbers. Then the CEO would comment. He would give his opinion.

And so I was coaching him and I said, Bob, let's try something different. Instead of having Bill, the CFO, present the numbers, let's have the team or the individual who owns that number talk about it. And instead of you commenting on it, I want you to just ask questions. And it changed the whole scope of the meeting because now the individual who owned that number put up the transparency, talked about it. And Bob would say, well, this number went the wrong direction this month. What happened? What have you thought about doing?

What have you learned by digging into the numbers more deeply? And by asking those questions, it caused those people to understand the numbers. The first time he'd ask a question, it was like deer in the headlights, stunned silent. And then they said, next time I better be prepared. And so they began studying and learning and growing. And so they learned more about their business, their area of responsibility by having to look into what caused that number to go in the right direction. Now, I want to go back to something you just said a moment ago about role clarity.

One of the tools that we created as part of our executive strategy retreat process is called the role clarity worksheet. And it goes along with building an accountability chart or an organization chart. And so you have all of the boxes on the organization chart, but now for each role, we work with this role clarity worksheet. And it says that the title of the position, if there's an incumbent, the purpose of this position, five key accountabilities, and the metrics that will be used to measure the performance of the individual in that position. And so by looking at your whole organization chart and working with the individual in that role to

define those five key accountabilities and the metrics that will measure performance, now the role gets really crystal clear. Unlike job descriptions that have 27 bullet points, and then the last one at the bottom always says, and other duties as assigned. This focuses on what are the big outcomes that come from this position, from this job. And only five of them. If you can't define a job in five key accountabilities, then you're getting too detailed. You're getting into tasks and duties as opposed to accountability. And so that process has really helped a lot of our members go back and look at each role in the company and the metrics that go with that role. And that then leads back to an earlier question

about, okay, how do you get people in the office to buy into measuring performance and using it as a tool to facilitate communication? Because it starts with their own job. How am I doing in my job? And what are the numbers that tell me? And of course, there's the argument that, well, some things can't be measured. That's true. There are some qualitative indicators, but our approach is if you can't measure it, you can't manage it. And so therefore, what are the elements of the role that we can measure and are those indicative of that person's contribution to the whole company? Mm-hmm. As I talk to and interview some of these top providers in the industry, this might be single handedly one of the things that they talk most about is developing leaders inside of

their staff. There's this kind of turning point when you as the owner are responsible, accountable, putting out fires. If things go wrong, it's on you. But then there's kind of this paradigm shift as you scale, which is you have to develop leaders, you have to put metrics in place, accountability, you know, higher fire reward based off those metrics. And that is a really big turning point for any for a business. And I think a lot of larger providers talk about this, but the principles here apply for the smaller businesses, the newer businesses, as you hire, you know, your, your

number two, your number three, your number four, same principle applies, which is like you mentioned this kind of worksheet, get crystal clear on what their roles, responsibilities, metrics, accountability is based around and everyone wins. You know, It's very obvious when things are going right, when things are going wrong, and it's easier to have those conversations when things are going wrong because everything was spelled out from the get-go. One thing that's coming to mind, you and I were mentioning a couple of names of these larger providers that we both talk to and work with. This doesn't come naturally to everyone. The top 5% of the industry, some may think, oh, they're all from corporate America. They're all business people. There are nurses,

teachers, coaches, the full gamut of backgrounds up in the top 5% of this industry. And so I just want to call that out because this doesn't necessarily come naturally to these leaders. A lot of them have had to develop themselves, you know, learn how to develop leaders, learn how to implement KPIs through trial and error themselves. So I say that because there's a lot of diverse backgrounds in this industry. And so, you know, you may think that the best of the best, this comes naturally as easy to them, but that's not actually the case. My next question for you, Steven, is around this buy-in, you know, for small, mid-size, even large agencies that are struggling maybe to get buy-in from their team member. Maybe they've been doing things a certain way for a long time and to implement something so maybe concrete like this, so structured like this would be difficult. How do you get buy-in from members of the admin team specifically? Well, it goes back to the mantra, what gets measured gets managed. And the second part, what gets rewarded gets repeated. And so if there's certain behavior that you want repeated, then you have to find out how to reward that. And that could be tangible rewards in terms of compensation or tangible benefits,

or it could be appreciation showed informally through communication and affirmation. And I think both are appropriate. When we look at what gets rewarded, gets repeated, we again go back to this communication process of let's look at the metrics. In our executive strategy retreat that we lead from time to time, we have a tool called the vision worksheet. And we look at what's your vision for your company five years from now. If you could wave your magic wand and make your company anything that you want it to be, what would it look like?

And one of the elements of that is identifying what I call your vision critical metric. What's the one number that everything else revolves around? And in home care, the currency is hours per week. It could be dollars. But the reason that I encourage people not to use dollars is it's really hard to motivate a front level office team member to generate more money so that the owner can buy a second vacation home or a new luxury car. And so the whole money thing gets a little tricky. But if it focuses on hours per week, and then we look at clients served in hours per client per week, and we drill down into the metrics, people can get behind that. We talk about the philosophy of why grow our business. And there's two parts of that philosophy. One, the bigger we are, the more resources we have to work on the business instead of in the business. But the other is, if we really believe in what we're doing, that the care we provide

makes a difference, then all those older people out there that need care should want to work with us because we believe we're the best in the business. Obviously, we have to live up to that and deliver on that promise. So we can get a team of people focused around, we're really good at this. We're really making a difference in people's lives. We want to serve more clients. We want more hours per week. And so that hours per week becomes the driving metric. And so if we want to get people involved in this communication and this tracking of metrics, we start with one number, and that is hours per week. And the most common reward for an office team is to set up a bonus pool, and we call it the burst the balloon bonus.

And so if you're at 1,000 hours a week, and so you set a goal that says at 1,200 hours a week, we're going to burst the balloon. We sit down and calculate, and we come up with a bucket of dollars that we put into a bonus pool, and we hit 1,200 hours a week. We burst the balloon. Everybody in the office gets a bonus. Now we've got their attention. Even if it's $100, that's $100 they didn't have before. And so we then begin to create that, what we call pay for performance model, where above and beyond their base pay is driven by these metrics and how they see themselves contributing to that. And that's part of the communication and part of the role clarity is how does this recruiter who's struggling to find more caregivers contribute to hours per week?

How about the scheduler? How about the biller back in the back office? How do they contribute to hours per week? And so we start helping people see how their role fits into the big picture, how it fits into the accountability chart, and that they are in fact contributing to this goal of 1,200 hours per week. And when we hit it, we're going to burst the balloon and everybody gets a bonus. Now, the key is you can only burst that balloon once. So if you're at 1,200 and you go to 1,250, then you fall back to 1,100, then you hit 1,200 again. You don't get a second bonus for 1,200. But maybe the next milestone is 1,400 hours per week. And so now we have the balloon and I walked into office and there's a whiteboard on the wall with this week's hours, next week's hours, last week's hours.

And they're focused on that balloon. Some literally have a balloon drawn on the whiteboard with the number in it, knowing that when they hit that 1400 hours, they're going to pop the balloon, everybody gets a bonus. So again, it's what gets measured,400 hours, they're going to pop the balloon, everybody gets a bonus. So again, it's what gets measured gets managed, what gets rewarded gets repeated. Yeah, I love the visual element of the balloon. And I think everyone can relate to that. When your whole team is like rowing in one direction, it's amazing how quickly everyone gets pretty motivated. I've witnessed that in my own, in companies that I work for. I've seen that across home care is, you know, as soon as you get the whole team rallied behind a metric, and like you said, ours is probably the most holistic one that the whole office

contributes to. Soon as you get something like that in place, it's pretty amazing how quick, you know, people got to hop in their step and want to get to that next milestone. And so I think I like how you talked kind of holistically about, you know, this metric that the whole company can get behind. One of the things that Jensen mentioned, and I think you would say the same as, you know, it's usually just two or three metrics that the whole company is working towards. You don't want six, you don't want 10, you don't want 15. That's where, you know, everything can break down. It's really one, two or three metrics that everyone is working towards. Then of course, by department, by individual, same rules apply, find a metric that that department,

it all contributes towards, set a goal, you know, put some rewards in place for that department. And then down to the individual level. The thing that I was going to mention too, is, you know, everyone's motivated by different things. I think in home care, there's a lot of people that are in it because they have the heart. There are people that are motivated by money. There are people motivated by satisfaction. I've heard, you know, some people want, you know, maybe that NPS score, ENPS score to be at a certain level because what they care most about as a business is satisfaction. And so I think there's a lot to be said around conversations with your team, with your administrators, by department, with individuals, find what

motivates them and then use that to your strength in that you put a metric in place that they individually are highly motivated to achieve. So any thoughts on that, Stephen? No, I think you're exactly right. And your point about not everybody in home care is motivated by money, and we clearly see that, that if people wanted to make a lot of money, they would probably go to do something else. Now, obviously, owners and CEOs of home care companies that grow and they look at

the net income at the bottom line and how they're compensated, people can make a really nice living for a lot of money growing and owning a home care company. And then, of course, we talked about mergers and acquisitions and consolidation. You sell your business, so you make a lot of money. But for most of the people that I know, that's not their primarily motivation. It really is about making a difference in the lives of their clients. And in these last couple of years, as we see companies shifting from a client-first culture to a caregiver-first culture, there's a whole lot of emotional value that comes from making a difference in the lives of your caregivers, giving them regular employment, treating them

well, helping them work through their economic fragility. There's a lot of positive things. It's frustrating, but there's a lot of positive things. So generally, while money is important, and when I do my program on scaling your business with data-oriented decision making, I have a slide that says, no money, no mission. And it's a lesson I learned from the Catholic nuns who ran Catholic hospitals early in my career. And while they were very compassionate and faith-based, they also said, this hospital has to make money or we go out of business.

And so that little saying has really helped us make a rational decision about an emotional conversation about why we're doing this and where does money fit in and all of those pieces, is that when our business is financially successful, now we have the resources to reinvest in the business. We can put in new systems, new software, new tools. We can pay our caregivers differently. We can provide bonuses. We haven't talked about bonuses for caregivers, but we have a number of members who have set

up a pay for performance bonus system for their caregivers. And so if you've been with the company more than a year or some other criteria and the company achieves certain milestones, maybe we burst the balloon at the end of the year, we take a portion of that and we pay it out as bonuses to caregivers with some criteria. You have to work so many hours a week and you have to have been here for a certain period of time because again, what gets rewarded gets repeated. We want to reward longevity and retention. And so part of participating in those bonuses is caregiver retention, caregiver longevity. And so the pieces come together. And when members of the office team see that caregiver retention, caregiver satisfaction is a factor or is a metric that plays into their bonus pool,

now we find that they treat caregivers very differently. Thanks, Dan. And so all of these pieces sort of come together to create the kind of organization that is in that top 5%. Yeah, I love that. Earlier in the conversation, you were talking about cadence and consistency, and I think that's an easy pitfall for people when it comes to KPIs. It is easy for KPIs and communication around KPIs to become all consuming almost to the point where people are like exhausted about thinking about it, talking about it can almost push people in

the wrong direction. In your mind, what's kind of the healthy balance of like meeting structure? I know you kind of called out like weekly, monthly. I'm just curious if you could just kind of quickly break down what kind of a healthy meeting cadence based around KPIs looks like for, you know, kind of a mid or large office. Well, that's a great question. Clearly, I think there's a weekly meeting cadence that happens frequently in larger home care companies, where the salespeople meet once a week, the scheduling team meets once a week, the recruiting team meets once a week, and they're looking at it. And we have a sample meeting agenda that we provide for our coaching clients. And it's typically a 30-minute meeting. And it starts with good news. Give me some good news

in your area of responsibility. And then it looks at the scorecard. Let's look at the metrics. And again, depending on the team and the group of people, there might be five to seven core metrics that they're looking at. As Jensen said, two or three that really set the tone and then some others that give you a little bit more depth. But also knowing that if you're looking at three and you have the availability of seven, there's a whole bunch of other data underneath that and having the ability to dig down in and analyze the data. So if something's gone wrong with metric number one, and you look at three, four, and five, now you have to figure out, okay, what's going on deeper down in the data that will help us

understand what has happened so that we can make some correction. So we have that weekly meeting, and we have a handful of metrics. We've literally have a number of members who have a daily stand-up meeting in some key departments. Recruiting, for example, might have a daily meeting that says, okay, how many new hires do we have coming on? How many new applicants did we get yesterday? How many do we have scheduled for interviews this week? How many are scheduled for orientation? And they literally stand up and they have the metrics at hand and they go through those key things and then they go on to their daily activity. So it really depends on, I guess, the leaders and what they're most comfortable with in terms

of that rhythm and cadence. Yeah, that's great. I think, yeah, the key word here is probably consistency. You know, there's a variation in the cadence. I think what I've seen is probably most common, a weekly meeting, but even you called out like by department, you know, depending on the size of your admin team varies widely, you know, depending on the size of your business, but a weekly meeting potentially broken down by departments if you're at that size. And then, yeah, I think that even just calling out kind of a daily standup, that might be something that's suited for your team, or maybe not. I think that's probably on a business by business cadence, but I think the weekly standup meetings taking place in bigger companies where you have, you know, five or seven

people in a department. And so they're coming in and they're standing up at 8 a.m. every morning for 15 minutes with a cup of coffee in hand and the whiteboard or some of them have big screen TV monitors with the metrics scorecard up there. And they're looking at a regular basis. And again, it's part of developing that rhythm and cadence of let's get our day started by looking at what happened yesterday and what are we working on today and what are we going to be talking about tomorrow morning at this time. I want to ask about how do you get someone that's not data-oriented, for example, maybe a nurse or someone that really is in it because they have the heart for it. That's not maybe conditioned to like the business side of things

or the data side of things. How do you, you know, maybe tactfully start to get people to become more data driven, to make data driven decisions? How do you teach or train or coach someone that's not, you know, kind of in that headspace to become like this? I think it begins with getting to know that person and to know a little bit about how they think and the extent to which their thought process is oriented toward information and data. But then it's to find things that appeal to them that resonates with their previous experience. And you mentioned nursing. We tend to think,

well, nurses aren't numbers people because they don't want to talk about money and whatever. And that's true. But with nurses, we look at vital signs. So nurses are going to come in, they're going to look at blood pressure, at respiration, at pulse rate. They're going to look at blood sugar levels because they know that those numbers are indicators of the health of the body. And so we use that metaphor of vital signs to say, okay, what are the vital signs of our business?

Or what are the vital signs of our marketing department or our recruiting department? And then those folks that sort of understand the concept of vital signs in a human being can apply that to other things. So it really becomes a matter of helping people make that connection. Now, you're right. There are some folks who are going to come here and have no basic understanding of numbers and math and formulas. And part of the question that we ask ourselves is, well, how much is that knowledge of numbers and math a skill that's required for this

role? And what we may find as we go forward, that there are some people that are not a good fit for our organization because they don't have the ability to think and work with those numbers, or they don't have the willingness. It's an attitudinal thing. And so at some point, you say, you know what, maybe this person isn't a good fit. Maybe we need to help them go be successful somewhere else. And that becomes a hard part. And again, I think going back to your communication and numbers piece is that there's a tendency to look past that at the person and say, she's a really nice person and she's been very loyal and we don't want to upset the apple cart. So we're going to tolerate the fact that she can't add and she can't multiply and she doesn't have any idea how her activity on the job contributes to the outcome. But at some point, if the person's not

able, and again, we go back to those three things. Do they know how? Are they able? Are they willing? And if one of those three pieces is missing, if it's knowledge, you can teach people with training and education. If it's skills, you can help develop skills through training. If it's attitude and they just don't want it, then that's a much more difficult thing. And you may say, you know what? It's no longer a good fit. We were talking about this at our 5% Mastermind meeting in Phoenix a couple of weeks ago. Somebody was lamenting that they had to separate from a longtime employee who was loyal and dedicated and a good friend, but wasn't able to grow with the business. And I said to them, I don't know if it's any consolation, but every CEO of a top tier

home care company has told me the same story. That when they started their business, they hired this person and it was a lovely person and became a good friend and was loyal for 10 years. But they're no longer able to grow. And now their behavior and their attitude is getting in the way. And it's not just we're having to carry them. They're not carrying their own weight, but they're getting in the way of other people. And that's when it becomes time to do that separation. And every person that's done it has said,

I hated doing it, it was the worst thing I ever did. As soon as it was done, there was this huge sigh of relief and I said, why didn't I do that two years ago? As we think about that experience, it helps us understand how we get to where we are in some situations and how, back to your question, it's hard to get buy-in from certain people. And then it's a question of, is it because they don't know, they're not able, they're not willing. And if we can't help them, then we have to invite them to move on.

Yeah. I think you brought that full circle really well. I think in most cases, we can train, coach, help people become data driven decision makers. Obviously, they're the edge cases where we can't and that's okay. I think it's, it's pretty common in this industry to promote people from within, you know, it's not uncommon for a caregiver to work their way into the office. And that's a ripe opportunity where, you know, they're so used to their day-to-day role in the home, you know, coming into the office, it's a very different ballgame. And, you know, you'll have to teach them, train them, get them to think about and look at the data with a certain set of eyes. And so I think that was great. And most, in a lot of cases, you know, we can train these people. In some cases, we can't. But I think that's a big part of being a leader and scaling your

business is, you know, teaching others to have this data driven mentality so that the entire business can grow and thrive. Earlier, just briefly, you mentioned qualitative versus quantitative. In home care, there is both. We are dealing with real people in their homes, and there's a lot of satisfaction or dissatisfaction that can take place there. So I'm curious to hear your take on qualitative metrics. How do those fit in here? How do you balance both? How do you balance hours, revenue with maybe satisfaction or dissatisfaction? How do those two things coexist well? Yeah. Well, when we think about qualitative, we're looking at assessing a situation that doesn't have numbers attached to it. Now, you're familiar with the caregiver and client satisfaction surveys where we ask questions that are subjective,

qualitative, but we ask enough people enough questions and now we have some data and we track that over time. And so we get, you talked about net promoter scores. And so a net promoter score is a metric that measures attitude and satisfaction of a consumer toward a company or a product. But let's go back to the qualitative part that comes before we start measuring that. So for example, we were looking at improving 90-day retention. Home care pulse data suggests that 57% of turnover happens in the

first 90 days. And so back in 2021, Jensen Jones and I dug into a project to really look at improving 90-day retention. We formed a caregiver quality mastermind group, and we spent a year really looking into that. And we discovered that there were three big causes of 90-day turnover. The first was bad hires where people weren't doing a good job of selection and they were hiring people and they quit in 14 days because they weren't a good fit or they had a bad attitude and didn't show up for work. The second big thing was what we call paycheck balance. And that's where the caregivers are getting enough hours to get a take-home paycheck that matches their financial needs. And then the third was caregiver engagement. Did they feel connected to the company? Did they feel

valued and appreciated? We did a best caregiver study a couple of years ago. And the number one reason that best caregivers stay with a home care company is doing meaningful work. Number two was feeling valued and appreciated by their client. Number three was feeling valued and appreciated by their immediate supervisor. So now we're into qualitative kinds of issues. We looked at how do we engage those caregivers? And what came out of that was a tool that Jensen Jones created called the caregiver care plan. And it's basically a 90 day plan for how are you going to care for your caregiver, just like the plan of care that you have for how are you going to care for your client. And so while there are some metrics in there, because we're going to make a certain number of touches every week and a certain number of calls, which we can

track and measure, but it's really that qualitative look at the process of engaging with those caregivers and helping them to feel valued and appreciated. And the metric, of course, is retention. How many of them make it through 90 days? And so we're ultimately able to measure the outcome of our activities that are involved with increasing the level of engagement with those caregivers. Yeah, I love that example. When Jensen told me about the caregiver care plan, I just just had like my own aha moment because to me, that was just like such a paradigm shift. You know, we thought we talk about and think about care plans on the client side, you know, that directly translates to how we take care of a caregiver, you know, for the first 90 days. So I absolutely love that. I love that example.

My, my just kind of general observation on this point is the largest, most successful business in this industry are really good at striking this balance of quality and quantity. They know, you know, they could tell you on a dime, their revenue, their hours, their finances, their payroll, they know that information, but they are also so in tune with client and caregiver and office staff satisfaction, and they are carefully monitoring and just managing both. And I say that because I've seen the reverse. I see a lot of businesses that are just in it for the heart that are solely focused on the qualitative. And I've also seen the flip side. You see businesses that are just focused on the finances and And I've also seen the flip side. You know, you see businesses

that are just focused on the finances and the revenue, those people that maybe do get in it because of, you know, the hypothetical money that can be in it. You know, people are in it for maybe the wrong reasons, but I really do believe that the most successful businesses are really cognizant of both managing, monitoring both. And that leads to, you know, the ripple effect of all of their success. So I think you called out some really good points and examples on that topic. I think the one that I want to close with, you've mentioned a couple of times rewarding. I think there's a lot to be said around implementing rewards and bonuses based off these KPIs. And so how have you seen the most successful businesses implement rewards and bonuses based off these KPIs. And so how have you seen the most

successful businesses implement rewards and bonuses tied back to KPIs and performance? Well, again, it starts with a simple bonus plan, like the burst of balloon when you hit a certain number of hours. But then we look at more sophisticated pay for performance programs for all office staff. Whenever I think about it, I vividly go back to one of our top 5% mastermind members who was with us for many, many years as one of the original charter members of the group. They sold their business a couple of years ago, but we would take mastermind groups there. We created a concept a number of years ago called the private duty field trip, and we'd go visit successful companies, and we would do a number of them there. And they really studied this pay for performance, and they created a pay for performance program for all of the people in their office. And they were divided into a couple of groups. So the HR people had their own plan. The scheduling department had their own plan.

The salespeople had their own incentives. But there were three core elements to each of those incentive plans. One was hours per week. And again, that vision critical metric. Second was home care pulse client satisfaction scores. And the third was caregiver retention. And so every department within the company had a bonus plan, but those three metrics were core elements of their incentive. And so people got a base pay, and then they got incentive based on the performance of the company and of their group in the company. We talked about metrics as a tool for facilitating communication.

You're very much interested in knowing what the metrics look like when you know that your check at the end of the quarter, your bonus check is going to be influenced by hours, client satisfaction scores, and caregiver retention. And then you start looking at clarifying roles. So again, they worked on the 90-day retention issue, and particularly they worked on 30-day retention. And so they had a dedicated person who worked with new hires through orientation and through the first 30 days. Then they turn those caregivers over to a caregiver retention manager who worked with those caregivers for the rest of their career. And obviously the caregiver retention manager had then communication with schedulers and care coordinators and intake people to get the benefit of how we work together to keep those caregivers

because everybody's pay is tied to caregiver retention. And so if a scheduler is being inappropriate or impolite or rude or whatever to a caregiver, and the caregiver retention manager calls up and says, hi, how's it going? How are you feeling? And the caregiver says, well, I'm not very happy. So-and-so, the scheduler was pretty nasty to me today and made me feel like I wanted to quit. Obviously, now we need to figure out what's really going on here. And is that something that that individual did or said? Was she having a bad day or is this part of her personality or style? And how do we address those issues?

And so again, it facilitates that communication. And it's not about blaming and pointing fingers, but it's about helping everybody understand that what they say and do contributes to one of those three metrics or to all three of those metrics and that everybody's compensation is connected to how well we do as a group in those three areas. And so there's a certain amount of peer pressure that comes when a person is not behaving or performing appropriately and that it negatively affects one of those three metrics. Now we have to figure out how we're going to deal with that person. And as you said a moment ago, sometimes it's education

and training. Sometimes it has to do with attitude and we have to check on, okay, what's going on in their background? Are they having a bad day? Did they have a flat tire? Their kid's sick, whatever's going on. And how do we show some empathy and compassion and help that person work through whatever's going on? Or if it's simply they're not a good fit, now we have to do something different. I think there's a lot of validity to performance-based compensation and a lot of opportunity in home care to implement this across the board. I am curious, is there ever,

in your opinion, is there ever a time or a place where performance-based compensation does not make sense for maybe a specific role or department or setting? I'm not sure. In your opinion, is there kind of a place where it doesn't make sense? As an entrepreneurial leader and somebody who works with entrepreneurial leaders, I go back to my mantra, what gets measured gets managed, what gets rewarded gets repeated. And there are certain organizations out there where people say, well, you can't measure what I do and I'm the expert and you can't judge me. And those are the kinds of organizations that I think create all kinds of issues around getting the outcomes that they're supposed to be getting.

Don't get me started, but universities are probably a classic example of that. And so you begin to look at those places that say, well, my compensation shouldn't be based on numbers or metrics or whatever. But the reality is, in my opinion, they probably should be. And if we really got into looking at how do we track the outcomes for an organization, there are things that we can measure. And sometimes we measure it by collecting opinions from a large group of people. And so a client satisfaction survey like Home Care Pulse asks subjective questions to individuals, but then they transfer it to a rating scale. And then you ask enough individuals. Now you have some data to get an indication of how this company does versus this

company. I think there's always that opportunity to reward people for their performance in terms of compensation, but also in terms of engagement and affirmation and appreciation and celebration and awards. It's not all dollars and concrete recognition. Some of it is informal appreciation. It's handwritten notes. It's birthday cards. It's remembering the names of your grandchildren.

Those are all things that are part of that reward mechanism. Yeah, maybe that seems like a funny question or a contrarian question to ask. It's just, I agree. I think we're both pretty data-minded. And so in our minds, there's always a case to be made for performance-based rewards and compensation. But I ask it because maybe there's something that I hadn't thought of, of a time or a place where it does not make sense.

But yeah. The other part of this, Miriam, it goes back to the culture of the company. And we've done a lot of work over the last decade around company culture. And culture is the way we do things around here. And it's driven by four factors. The leadership style of the CEO, the core values that guide our decisions and actions, the behavior we expect, and the behavior we permit. And so we talked about the role clarity worksheet and key accountabilities and the metrics. So here's what we expect, and then the behavior we permit. And my wife, who I mentioned, is an executive coach and works now mostly with physician leaders in academic medicine. And one of her messages to all of her coaching clients is the behavior you permit, you promote. Are there positions that you can't measure or that shouldn't be rewarded with compensation? And the inverse of that is, are there people who you have no way to affect their behavior

because they feel like they're untouchable or you can't judge me or I'm the expert? And then they demonstrate behavior that's not consistent with the culture you're trying to create. And so the two things go together. What gets rewarded gets repeated, and what you permit, you promote. Having those positive expectations and giving immediate feedback of somebody's behavior or their performance is not what we expect. Yeah, that was really well said. I'm glad you added that there at the end. I know we're just at time, Stephen. This has been wonderful. You have so many examples, stories, nuggets. Things

roll off your tongue so naturally, and it's honestly just amazing to me, and I hope everyone listening to this. Just in closing, I want to give you maybe just a minute here. As owners are listening to this, thinking about KPIs, communication, implementation, buy-in, what's just maybe the last piece of advice that you'd give owners as we walk away from this conversation? I always like to share the concept of learning from OPE, other people's experience. And that means being with other people who are doing the same kind of thing that you're doing and being able to have these kinds of conversations among owners of home care companies that are similar size and that don't compete.

And so they can have very open conversation. And this is my little pitch commercial for the home care CEO forum and our mastermind groups. But we have seen these companies just make amazing leaps forward as a result of coming together with other leaders in similar size companies in similar positions. Because as a CEO of a company, you're sort of all alone. There's nobody to talk to. And in home care, nobody gets this business, right? And so your neighbors and your friends and your people at your church, they look at you like, I have no idea what you're talking about. And so being together with other people who do what we do

and learning from other people's experience and having these conversations about metrics and measurement and qualitative outcomes is all part of what happens when we get together and share ideas and solve problems and support one another. For anyone that is interested in learning more about these groups, what's the best way for them to find out more? Go to homecareceo.com and you'll learn about what's going on there. And Jensen Jones is the CEO and is really doing a great job of taking that company forward and scaling that business. And there's a button up on the top of the page on mastermind groups.

And you can see information about the five groups that are operating today and get some more insights into the benefits that come out of that. There are some great videos of some of our members talking about how they have benefited from being part of a mastermind group. Perfect. And if you're not connected with Stephen on LinkedIn, I highly recommend it. He shares insights and data all of the time and so if you want more where this came from, make sure you connect with him there. Stephen's also written a book. He's got all sorts of research on his website

so connect with him, reach out to him, look up these websites to make sure you can learn more. So Stephen, it's been an absolute pleasure. Thank you so much for giving two hours of your time the last couple of weeks. I wish you all the best. I look forward to seeing you at conferences and events later this year. It's always a pleasure. So thank you so much. Thank you, Mary. I appreciate all you all are doing for the industry.

Awesome. Well, we'll go ahead and wrap there. We'll look forward to seeing everyone back same day, same time next week. Have a great week. Goodbye for now. That's a wrap. This podcast was made by the team at CareSwitch, the first AI-powered management software for home care agencies. If you want to automate away the menial of your day-to-day with AI so that you and your team can focus on giving great care,

check us out at careswitch.com.