If We Build It, They "MIGHT NOT" Come
Friday, December 13, 2013
Posted by: Joy Ingram
by Brian Hadlock, CEO, Upper Valley Community Healthcare
[Editor's note: We asked Brian Hadlock to write a first-person account of his experience as he led the effort to completely transform an Idaho CHC with poor performance and get it "in the black" in less than two years. Here is his account.]
As we look at the community health model of doing business, there is no question that the playing field has changed. As budget cuts loom and assaults to PPS rates continue, we have witnessed an evolution that has taken providing care from a treatment plan to a financial plan. For years many have clung to the idea that if we simply build a building to treat patients, they will come.
Upper Valley Community Health services started out as a free clinic operating one evening per week, using donated time and supplies. From the beginning it was obvious that the need was greater than the ability to provide care. In 2008 a grant was awarded and a Community Health Center was born for southeast Idaho. With a single mid-level provider, the organization grew right from the beginning and within three years added two more providers as well as a dental facility. The vision had been realized and a fully staffed facility was offering everything from sports physicals to OB care.
During the third year the organization began to see a trend that ultimately destroys businesses. The health center was spending more than it was making. Most businesses in the United States fail within the first year. The remainder last only another year or two depending on how deep the pockets of investors are; a single percent actually become sustainable.
Grants had helped offset the costs for Upper Valley Community Health in its first few years, but the clinic was failing and becoming dependent on loans and debt. In the spring of 2012, after a detailed site review, it was obvious the small clinic built for so many could not survive the damage done. The Board of Directors, out of desperation, hired me to be their new director, knowing there was a strong possibility the clinic would not survive.
Diagnosing the Problems
As a businessman from the private sector, I had little healthcare exposure but brought years of business experience. Once I was able to review the financial records from the previous two years, and having owned several successful businesses of my own, I was astonished that the organization had lasted as long as it did. Over-staffing with endless redundancy among positions was an obvious issue, but what was most concerning to me was the lack of productivity.
For a facility located in a region where most other health care was at least 20 miles away, it seemed people had been driving that extra distance - and going right past the health center in the process! The idea that "If we build it they will come" just doesn't offer a sustainable plan, as many would suppose, considering it offered a reduced cost model of care.
In order to prevent total collapse of the organization, two things had to happen: decrease cost and increase revenue. The first of these items is fairly simple if done properly. We applied the "LEAN method" to all positions and quickly made decisions that reduced staff by 20% and surprisingly reduced payroll by 35%. In other words we identified the low hanging fruit and plucked it. There just seemed to be a lot of high-paid low-hanging fruit.
The next steps required a complete transformation of the Board of Directors all the way down to the patient. Author Simon Sinek says it best, "People don't buy what you do, they buy why you do it." Using this as our guide, we knew a complete change had to occur within every single board member, employee and patient. It went beyond accountability and well beyond trying to convince people to adapt.
It Came Down to Vision
A belief is not necessarily taught or learned. It is developed. My belief in what we do in community health drives my passion to succeed for the benefit of others. Not everyone will or even can buy into why we do, but over a year's period we slowly transformed.
From Meaningful Use to PCMH and every other overwhelming program and initiative available, we developed an idea of who we are and why we do what we do. Most people show up to work because they need a job. We all need jobs, but what if we could have employees that came to work because they believe in what they do? What if they chose to be here for fear they would miss an opportunity to assist a young mother or father seeking care for their children who have been turned away from other facilities?
So this became the challenge: Identify why we do it - a belief that becomes a passion. Community health is more than just a place for underserved or un-insured to receive care. It is a place for everyone.
When I became involved with Upper Valley Community Health, my first impression of the facility and the care offered was that it was "average." The building was old, and the quality of services was good but not great. The majority of the staff was there just to be paid. This is the reason people were driving by without stopping, and this was the reason the health center was failing. Average quality by average people produces average results. I don't know about you, but when it comes to my health, I want more than average, and I think most people expect it.
Vision translates to action
We completely transformed the workplace and staff in the first six months. Through volunteer efforts and employees who were willing to put in time on weekends for no pay, we accomplished an amazing amount of work in a very short time. Employees were beginning to believe in who we are, what we do and why we do it. A noticeable change began to happen almost like a domino effect of employees encouraging others and setting goals to accomplish what just six months ago seemed impossible.
The most important factor in our success, I have come to realize upon reflection is that, after I surrounded myself with capable staff I was willing to listen to and depend on, answers were found. People must have input in order to have buy-in. Without input, all that remains are tasks assigned with no expectation other than to fulfill the task.
The old way of doing business is old for a reason. Heads of companies have always controlled almost every aspect of decision making and have had the last word. The new model requires the leader to become a true team leader. Every employee in our organization is a leader regardless of the position. They all have input. Without this reinforcement, staff loses interest in what you do and why you do it. It becomes just a job without passion.
I have two things on my office wall. The first is a statement I use to remind me of the responsibility I have agreed to in my position. It says, "Never be the excuse; always be the example." That commitment requires being there before anyone else arrives and being the last one to leave.
The second thing on my wall is a single word. "HOPE." There is nothing more powerful that will motivate a person to change more than hope when it has been lost. We are privileged to work in a field that provides hope to so many, and as long as we can do that, the need for Community Health Centers will be in great demand. So go out and create something great, build something grand, and give hope to people who need it the most.
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