Latest / Becker’s Healthcare Podcast / Rewiring Excellence and Solving Healthcare’s Staffing Crisis with Dan Collard

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Rewiring Excellence and Solving Healthcare’s Staffing Crisis with Dan Collard · Becker’s Healthcare Podcast

• 0:00
  This is Scott Becker with the Becker's health
• 0:02
  care podcast.
• 0:03
  Hey. I'm thrilled today to be joined by
• 0:05
  one of my favorite people in health care.
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  We're joined today by Dan Collard.
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  Dan is the cofounder
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  with Quint Studer,
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  of health care plus Solutions Group, and both
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  of them have had just brilliant careers,
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  also brilliant writers.
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  And and, Dan, talk to us a little
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  bit. First of all, give us the background
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  on on Health Care Plus Solutions Group, and
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  then let's talk about the term rewiring,
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  rewiring excellence and and a lot more. Dan?
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  Yeah. Thanks, Scott. As always, thanks for having
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  me. You know, Quint and I got back
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  together a couple years ago. And what we
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  really wanted to do this time is take
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  a much more diagnostic view
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  of the industry. You know, as we came
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  in out of the pandemic, we knew forever
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  the industry had been changed. And and rather
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  than think of the path of a one
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  size fits all, we wanted to be much
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  more diagnostic. So if you look at any
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  of our work today, whether it's our writing,
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  whether it's the assessments that we've designed, we
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  sort of walk in the path of the
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  the physician, you know, diagnose before prescribe. And
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  that that that's really how I'd sum it
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  up today.
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  And and talk about this term rewiring
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  and and where that came from and how
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  you see it applied in health care leadership
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  because it it makes so much sense. But
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  talk just intuitively. It sounds like it makes
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  so much sense. But talk about rewiring and
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  rewiring in health care. Yeah. You know, it
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  it clearly was a a bit of a
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  play on words from the old hardwiring
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  era. You know, the the the book hardwiring
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  excellence was such a seminal body of work
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  in the industry.
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  And and when you really think about it,
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  the the notion of rewiring is really the
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  essence of great process improvement.
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  You know, very few organizations
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  today deploy the same processes that they would
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  have twenty years ago.
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  And yet, in some cases,
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  we tend to be so literal in our
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  learning in our industry, and and you take,
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  you know, take rounding on staff and rounding
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  on patients, for example. Some folks, you know,
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  because they read it in our work all
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  those years ago, they're still doing it the
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  same way or or even some cases
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  in a more complicated fashion.
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  And and so we wanted to sort of
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  take the rocks out of the backpack for
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  folks. We wanted to lighten the load.
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  And and so the premise around rewiring
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  today
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  is that if whatever you're doing is working,
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  you know, stick with it.
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  But if you're not getting the results that
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  you wanted to get or the results you
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  wanted to see, maybe this rewired
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  approach,
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  you know, sort of right time, right place.
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  And what rewired really means is we're not
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  throwing the baby out with the bathwater, but
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  maybe some fine tuning or tweaking of the
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  processes.
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  And it's just been met with such, you
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  know, wonderful reception for folks because it it
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  really does make the day easier.
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  Well, in in in the concept of rewiring,
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  making some pivots, make some changes, but keeping
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  what's working right
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  is such welcome advice. Because as people like,
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  when you come to people and say you
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  have to change everything,
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  they're just overwhelmed, and that's daunting. And and
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  almost somebody can do that. Even though it
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  sounds good on its face, we're gonna change
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  everything.
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  You you need to incrementally rewire and take
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  different pieces of it.
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  You you had written originally
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  a book called
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  Rewiring
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  Excellence.
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  It's now in a second edition.
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  Mhmm. What's changed or been added
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  when we think about
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  rewiring?
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  Yeah. You know, the the original book came
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  not from, you know, out of our heads,
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  but by spending the time in the field
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  looking for these rewiring
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  opportunities. And so when we wrote the original
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  book,
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  we made a promise to the readers. We
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  promised that this would genuinely be a living,
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  breathing body of work. And when we had
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  enough to officially make it a second edition
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  now that, you know, you're in the publishing
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  business too, you you know, you have to
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  create
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  x percent of new material to officially get
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  a second or third edition.
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  And so we've really kept our eyes open.
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  We really kept our ears to the ground.
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  And and this living, breathing body of work,
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  you know, we wanted to keep our promise.
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  So the new content
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  really isn't our content. It's what we've learned
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  from the folks in the trenches,
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  which is where Quint and I have always
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  you know, it's where we've always enjoyed being.
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  And, you know, earlier this year, you always
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  wonder if the work that you're doing has
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  an impact. You never wanna believe your own
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  press. And we got some really neat news
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  earlier this year.
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  American College of Healthcare Executives has an annual
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  award that they call the James Hamilton Award,
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  and it's essentially their book of the year.
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  And we got some news earlier in January
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  that rewiring
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  second edition
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  is the recipient of the James Hamilton,
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  annual book award by ACHE. So when we're
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  in congress in in Houston in a couple
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  weeks, we'll, we'll have a chance to, receive
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  that award, not not on our on behalf
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  of ourselves,
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  but but on behalf of all the folks
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  that we continue to learn from in the
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  field, which is really where the book came
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  from.
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  Well,
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  one of the beauties of yourself and Quint
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  is you're two of the most gracious people
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  ever who are able to keep the ego
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  at the door. So it really does feel
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  very sincerely about others in the lessons you're
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  learning in the field and what you're seeing
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  from people and in the trenches.
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  Take one moment, Dan. When we talk about
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  rewiring
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  and some of the newer thoughts that have
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  come into the second edition, do any examples
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  or thoughts that come top of mind to
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  you
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  of things that particularly of our interest to
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  you as you as you look at this
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  next edition and also just at,
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  as you've come back to this so fully
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  this next time around with you and Quint,
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  what are some of the new lessons you've
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  or or or new observations?
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  Yeah. You know, let's take the three top
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  issues in health care today, staffing, staffing, and
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  staffing.
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  You know, as we think of, workforce
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  challenges in health care,
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  there are very few organizations that have really
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  cracked the code. And and we often joke
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  we get so good at talent selection
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  because we're not so good at talent retention.
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  So we we have to always use the
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  talent selection muscle
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  because we don't tend to retain as well
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  as we should. And and so there are
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  some really neat new things in the book
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  about specific tools and tactics that are incredibly
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  easy to deploy
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  relative to retention. And so most organizations,
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  Scott, you know, will take a look at
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  less than one year turnover
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  in the post acute world, sometimes even less
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  than ninety day turnover
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  here before they see the churn. So we
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  wanted to bring forth a couple of really
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  quick tips, a couple of nuggets that if
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  you read the book, you could go back
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  and do it tomorrow. And I'll give you
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  a couple of examples. We we have a
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  colleague named Abby Spence who runs a skilled
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  nursing facility over in Tennessee.
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  And when Abby first came to one of
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  our sessions and learned about this, she went
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  back to her skilled nursing facility
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  and and her big pain point was less
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  than ninety day turnover.
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  So she deployed not all 10 of the
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  tools, but just two of them.
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  One of them was an element of what
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  we call emotional onboarding. How do you begin
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  to bring people into the organization
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  emotionally,
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  sometimes even before the the first day that
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  they're there? How do you invite them into
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  the organization?
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  The second's a really neat tool called the
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  personal retention plan, and it's sort of the
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  perfect illustration of rewiring. You know, for years,
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  we've coached once you hire someone, it's very
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  valuable to have a conversation with them at
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  thirty days and then at ninety
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  days. Well well, the problem is in some
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  organizations, they're not there for the ninetieth day.
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  And so what if we could create
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  a day one conversation? So in the book
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  and on our website, you can get it
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  for free,
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  is is a really cool tool called the
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  personal retention plan. And what it does is
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  it takes the concept of retention,
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  and it completely personalizes
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  it down to the individual. So if I
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  have that conversation with you on day one,
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  then for the next several months when we
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  run into each other, when I'm rounding on
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  you, I actually already know the answers to
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  the test. I know what brought you here,
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  and I know what'll keep you here.
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  Abby put those into play in July.
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  And by December, when I had her on
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  one of my podcast,
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  she had actually reduced her less than ninety
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  day turnover 37%.
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  And Right. And, of course, we all know
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  that's real money,
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  and it's real impact on clinical outcomes as
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  well. Oh, it's it's it's real real money.
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  It's real stress reduction. It's better continuity on
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  a million levels. And, Tika, when you look
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  at the under 90 8 turnover,
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  a large percentage of that is at the
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  sort of what is almost a transitory part
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  of the workforce, which you don't want to
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  be transitory,
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  which you want to be more long term
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  in part of the institution
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  versus in and out and see if you
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  could fix that. And I take it their
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  stance on, once somebody stays for ninety days,
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  a hundred and twenty days, a hundred and
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  eighty days, there's probably a much greater chance
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  that they stay for two, three, four years.
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  And your point on emotional engagement early
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  is so important. Because if the engagement is
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  you got your paycheck in two weeks, but
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  you didn't really connect with them to be
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  at work, you didn't really feel at home
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  at work, then then it's it's it's probably
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  very hard for people to feel like this
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  is an environment they could thrive in and
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  be a part of and stay comfortable in
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  while they're taking care of. And they take
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  it that workforce that turns over that much
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  has so many other stresses in life that
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  that trying to make it is
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  get performance and trying to make people comfortable
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  is so so important to longevity
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  in those positions. Yeah. There there's a brand
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  new piece of research that just came out
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  that's very strong evidence that says, basically,
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  as an employer,
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  you've got forty four days. The the evidence
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  in this body of research said people
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  may were making up their mind as to
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  whether or not this was a good decision
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  to come work here in forty four days.
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  And and so that window of time to
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  reduce the transitory nature of our workforce
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  has narrowed even more.
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  And and so if we can just give
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  leaders one or two things to do instead
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  of bringing in a whole new change management
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  effort for them to try to, you know,
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  absorb and then put into their everyday work
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  when they've got all this other stuff going
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  on. We just find that it's doable, and
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  and I was just talking with Abby the
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  other day because we're always concerned about
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  sustainability.
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  And, it was kinda cute. She was just
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  named the, skilled nursing facility CEO of the
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  year for her region, and a lot of
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  it had to do with what she had
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  done in in meeting the workforce challenges. And
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  she said her job now and this is
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  kinda neat when you think about it. Her
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  job has gotten so much better because she's
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  experiencing
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  less churn in all of her in all
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  of her team. And, you know, if you
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  can do it in a post acute facility,
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  you can just about do it anywhere.
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  No. It's simply remarkable. It's it's and that's
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  so important because right there, that one thought,
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  hey. I better be really attentive those first
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  forty five days. I can't let people float
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  through because they they already made their decision
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  after forty five days that this isn't the
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  right fit for me. If they're not embraced,
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  they don't feel comfortable. They don't feel it's
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  a place they could thrive or at least
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  live while they're taking care of the rest
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  of their life and so forth. I I
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  love that.
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  This is your second edition of rewiring.
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  You and Quinta had tremendous success with this
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  line of thinking. You've you've really built companies
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  around it, quite frankly, because it's so so
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  important.
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  What is so attracted to leaders about this
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  concept? And I heard a lot of it
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  when you started off. So I I I
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  grasped why it's so popular. It makes so
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  much sense. You know, when change management could
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  be so tough sometimes,
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  why does this work so well? And why
• 11:57
  has it been so impactful? I mean, people,
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  you know, you know, that you go throughout
• 12:00
  the country, and people preach the gospel of
• 12:02
  Quint and and Deanne and what you folks
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  have done. So so talk about why this
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  is so impactful
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  and why this is so attractive to leaders.
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  Well, I I think it's just a truth.
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  I I feel health care leaders are genuinely
• 12:16
  more busy than they've ever been. They're busier
• 12:18
  than they've ever been in this industry. So
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  anything new that we bring
• 12:23
  needs to be doable, and doable is a
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  word that we've sort of also landed on.
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  Because if it's not doable,
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  folks just keep looking for the next shiny
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  new object.
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  Secondly, the idea that we're not making large
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  scale change
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  in this body of work versus fine tuning,
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  tweaking, you know, iterative change there,
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  it just makes sense to leaders. So if
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  you take the average leader today, whether they're
• 12:48
  clinical or nonclinical,
• 12:50
  they've got all these headwinds coming at them,
• 12:53
  and large changes can just seem daunting. I'm
• 12:55
  gonna throw the towel in on day one.
• 12:57
  But if we can bring them things that
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  are
• 13:00
  iterative, they're essentially, you know, how do you
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  eat a cookie a bite at a time?
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  We just find that the acceptance rate and
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  and then quite frankly, the success rate follows
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  like that.
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  You know, and I and I love that.
• 13:13
  It's something we talk about in technology
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  all the
• 13:17
  time. If the user experience is easy, people
• 13:20
  are much more likely to use the technology
• 13:22
  and really optimize it. It's very similar to
• 13:25
  what you're talking about. If if if if
• 13:26
  EAPI can come to work and make a
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  couple minor changes, oh, I really gotta focus
• 13:31
  on the first forty five days. I really
• 13:33
  gotta have
• 13:34
  an early discussion on personal retention plan, and
• 13:37
  that it's a priority. We want you to
• 13:38
  be here for the long run. We don't
• 13:39
  just want you to the door. We want
• 13:40
  you over the long run, and and and
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  just make some
• 13:44
  not not huge
• 13:45
  changes that are exhausting and daunting, but small
• 13:48
  changes that could have a big impact. That's
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  what we're all looking for, isn't it? Small
• 13:51
  changes could have a big impact that you
• 13:53
  could leverage significantly.
• 13:55
  You have a conference coming up on rewiring
• 13:57
  health care, the foundation to the future.
• 14:00
  Tell us a little bit about that. Well,
• 14:02
  you know, again, it's a message we've heard
• 14:04
  from the field. We've been asked by our
• 14:06
  partner organizations, folks that we've worked with over
• 14:09
  the course of time, when are you gonna
• 14:10
  bring back your conferences? Because, you know, at
• 14:13
  at the height of our previous work, we
• 14:14
  were doing about fifteen, sixteen conferences a year.
• 14:17
  And, my gosh, you know what it's like
• 14:19
  to put conferences on. And what we always
• 14:22
  realized is it was less about them coming
• 14:25
  to see us on stage
• 14:27
  nearly as much
• 14:29
  as we had a we they they came
• 14:31
  to be around like minded,
• 14:33
  like hearted leaders all in the same room.
• 14:36
  Just the fact that you could sit next
• 14:38
  to somebody you you'd never met before in
• 14:39
  your life, and you were you were still
• 14:42
  pursuing
• 14:42
  the same, you know, line of success. They
• 14:45
  we we were all looking to get better.
• 14:48
  So when folks ask us to bring our
• 14:49
  conferences back, we heard the same thing. They
• 14:51
  said, we just wanna be in the same
• 14:53
  room with people like us.
• 14:55
  And and we also know that, you know,
• 14:58
  those kinds of dollars are tighter than ever.
• 15:01
  You know, the the the the headwinds on
• 15:03
  the expense structure in health care means that
• 15:06
  discretionary
• 15:07
  spending comes under greater scrutiny than ever before.
• 15:10
  So as we've done with the with the
• 15:12
  new organization, we we didn't wanna let money
• 15:14
  get in the way. So we decided to
• 15:17
  not create a conference that would be a
• 15:19
  massive revenue stream, but create a conference that
• 15:22
  would, number one, be affordable.
• 15:25
  Number two, it's not just Dan and Quint
• 15:27
  on the stage. It's it's our entire team
• 15:30
  bringing
• 15:31
  our body of work to the stage there
• 15:33
  as well. And each segment,
• 15:35
  of the conference has a little bit of
• 15:37
  that rewiring. We have a colleague, Regina Shoop,
• 15:41
  who we've known for years. Just we just
• 15:43
  published her new book, rewiring the emergency department.
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  So when Regina's on stage,
• 15:49
  a couple of times during the conference, she's
• 15:50
  gonna talk about what's an emergency department need
• 15:53
  to look like in 2026.
• 15:55
  And so there will be not just the
• 15:58
  theory that we bring to the conference, but
• 16:00
  folks that come will be able to stick
• 16:02
  a couple of things in their hip pocket
• 16:03
  and take it back and use it the
• 16:05
  next day.
• 16:06
  Dan, it's remarkable what you do and how
• 16:09
  you do it. I I'm always struck by
• 16:11
  the incredible sincerity and grace that you and
• 16:13
  Quint handle yourself with and your entire team,
• 16:16
  I should say.
• 16:17
  It's really remarkable. I love this concept of
• 16:20
  rewiring excellence, and and I love the concept
• 16:23
  of look. It's about
• 16:25
  I I I use the word user experience
• 16:27
  now
• 16:28
  so much because it's so important in the
• 16:30
  technology world, the health care, and everything. Yeah.
• 16:32
  But this idea of we're providing guidance
• 16:35
  that doesn't take,
• 16:37
  a a a tremendous amount of work to
• 16:38
  start putting to use, that that people could
• 16:40
  use it. And then, of course, it builds
• 16:42
  on itself because people love that. If they're
• 16:44
  seeing results, it's so much easier to keep
• 16:46
  on going
• 16:47
  and and without it being daunted.
• 16:49
  Dan Collard, we love what you do. When
• 16:51
  is the conference? When is the first conference
• 16:53
  that we were honoring excellence conference?
• 16:56
  Yeah. The conference is gonna be April.
• 16:59
  We we we put all of our thought
• 17:01
  into this. Number one, it's just a day
• 17:03
  and a half. Because a lot of times
• 17:04
  when it's a full two day conference, folks
• 17:06
  start cutting out to catch their flights, you
• 17:08
  know, towards the end of the day. So
• 17:10
  it's a day and a half, April.
• 17:12
  It's also incredibly convenient. We're having it in
• 17:15
  Atlanta
• 17:16
  at one of the, venues that's right there
• 17:18
  on the campus of the Atlanta Airport. So
• 17:20
  you don't even have to grab an Uber
• 17:21
  or a car or anything. You come to
• 17:23
  the airport, and you grab the shuttle like
• 17:25
  you're going to the rental car location. About
• 17:27
  halfway there is what they call the Gateway
• 17:29
  Conference Center, and it's at the Atlanta Gateway
• 17:32
  Marriott.
• 17:33
  Phenomenal. Again,
• 17:35
  Dan Coward is with us today,
• 17:37
  one of the cofounders of Health Care Plus
• 17:40
  Solutions Group, also the author of Rewiring Excellence,
• 17:44
  now in its second edition. Dan, I'm so
• 17:46
  thankful for you joining us. It's always great
• 17:48
  to visit with you. You're the best. Thank
• 17:50
  you so much for joining us. Yeah. Likewise,
• 17:52
  Scott. Thanks.