I am all about analogies. It’s a curse. It’s my go-to. I have a problem. But, sometimes it really just works. (I’ll get to it … hang with me).
Nursing Home Administrators are easily seen by their care-giver/clinician staff as only caring about the financial aspects of the facility. Years ago I became very reluctant to share financial information with my staff out of fear that they would think that’s all I cared about. I also feared they would mishandle the information.
As though they weren’t sophisticated enough to appreciate the need for the facility to ‘make money.’
So, instead of educating staff on the financial fundamentals and enlisting their help to eliminate waste and be efficient as co-owners of the facility and their departments, we ration out just enough information to get them to do what we want. We give them a budget for hours or expenses for the month based on our projected census. They toil away under your close management, trying to hit that budget WITHOUT understanding the larger picture. I’m not saying that doesn’t ‘get the job done’ b/c in many cases it does. But, they deserve more. And with the trust you give them (along with the education), something powerful happens … they come alive and take MORE ownership of their responsibilities. They take pride in their new understanding and they become more creative problem solvers, now that they see the whole problem to solve and not just their little piece.
Here’s what I’ve concluded …
… if presented properly, sharing the financial realities (challenges and successes) are an empowering, trust-building lever administrators should pull in their management of the facility.
The key phrase, of course, is ‘if presented properly.’ I’ve been burned by sharing facility financial information. So … the best way I’ve found to empower my staff with this lever is to use the analogy of the 3 Legged Stool. Here’s how the conversation went at a recent all-staff meeting at a facility that has been losing money ….
Me: What do you think I care most about?
Them: [Thinking: I'm not stupid enough to answer that question ... Suspicious smile ... long pause]
Me: Really. It’s ok. What do you think I care most about in running this facility?
Them: [Still Thinking: I don't know him well enough to be honest. He's just like all the rest, probably. Money. The answer is money]. ”Patient Care.”
Me: Yes. What else?
Them: [Oh, there's more than one answer. I'll say it ...] Profits.
Me: Yes. What else?
Them: [What a dork. He can't care MOST about more than one thing!] Ummm … Customer Satisfaction?
Me: Yes. But, how can I care MOST about more than one thing? Have any of you ever seen a 3 legged stool?
Them: Yes, of course.
Me: Which leg is most important? Which leg do you care most about when you sit on it?
Them: The one that’s going to break.
Me: Put yourself in my shoes. If you were me, what would you say make up the 3 legs holding up our facility?
Them: Money, Patient Care … and … ?
Me: And … customer & employee satisfaction. Which one do you think I think is most important?
Them: Whichever is weakest?
Me: That’s right. That’s exactly right. You’ve heard me talk a lot lately about some our financial challenges. You’ve seen me tighten up our processes around approving overtime and tightening our belt in other ways too. We’ve had to flex staffing to appropriate levels that match our lower census. Our patient care is great. Our customer satisfaction is high. Our turnover is low. But, financially, the facility has been losing money for a few months in a row because we haven’t adjusted our spending appropriately to our low census. Right now, the leg that’s weakest … the leg’s that’s breaking is the financial one and we have to strengthen it. Here’s what we’re doing (overview of efficiencies we’re trying to regain). What else do you suggest we try? What can you do to help?
(I then asked if any of them had ever been ‘cancelled’ or sent home early from a shift. 100% of their hands shot up. I asked if they understood the rationale for flexing hours. If they understood nursing hours PPD and the state minimum requirements. They did not. I explained how the hours PPD number is calculated and we calculated it for our facility). They saw – and understood – how high we were staffed. They began to ask insightful questions about staffing for acuity and skilled mix and how we derive our goals/staffing targets (which the director of nursing determines based on acuity, by the way).
The feedback from the meeting was very positive. They went to work the next day with a sounder understanding of what makes me/us tick and WHY we’re managing the financial side of things so tightly right now. I finished the meeting focusing on the other two legs. I reaffirmed to them where my heart/passion lie … in creating an environment where they are free to thrive as caregivers. An environment that creates a surprising experience for our patients and their families. I concluded with the Cab Driver story. That’s at an all staff meeting.
1:1 meetings with department heads allow for deeper education on the financial management of the facility and their departments. I recommend we stop rationing crumbs to the ‘leaders’ of the facility. Let’s let them eat at the table. (See? I had to throw in another analogy!) Let’s be more transparent with our P&Ls so they can take ownership, and eventual PRIDE in the successful operation they’re responsible for shaping.