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Why Empathy Shapes Stronger Care Teams · Hearts of Excellence

• Gregg Fuller (00:00): The biggest, even change in myself over the last three or four years is really asking myself, what am I willing to accept and what's the expectation? And if I'm accepting lesser of an expectation, then I'm going to get lesser. No one's going to work down to a bar. You want them to work up to that next level of bar. Chelsey Gheyara (00:20): You're listening to Hearts of Excellence brought to you by Majestic Care, where real stories from long-term care come to life. Well, welcome Mr. Paul Pruitt, CEO of Majestic Care and Gregg Fuller, Senior Executive Director. Welcome to the Hearts of Excellence podcast. Gregg Fuller (00:39): Thanks for excited to be here. Chelsey Gheyara (00:40): Yes. I'm so excited for this conversation. I'm sure Paul, gosh, you just told Gregg. I'll have you repeat that. Why were you congratulating, Gregg? Paul Pruitt (00:50): Again, as what's interesting as an administrator myself, I always dreamed of the day of having a deficiency-free survey. Never got there. My lowest was three, but I never got there. But last year we got to celebrate Gregg and his facility because they did have a deficiency-free survey. And while I was there, I got to hear all his care team members basically set the standard like, "We're going to do it again next year." Chelsey Gheyara (01:13): And Paul Pruitt (01:14): Again, as an administrator myself, okay, that's a great goal, but in my head I'm thinking don't over get too excited here because it probably won't happen. Guess what? We did it. Chelsey Gheyara (01:25): It happened. Paul Pruitt (01:25): They did it again. So they have another deficiency survey. Chelsey Gheyara (01:29): So congratulations. And with that, we'll introduce you formally because the listeners need to know who you are and why we're so happy that you're here. Paul Pruitt (01:38): Can I just interject? Yes. So one thing is we do the introduction as Gregg gets into his story and his journey, but it's not a building that is your traditional model building. So it's a building that, again, goes back to what we're called to do is take care of people. But the people he takes care of on a day-to-day basis do have a lot of psychosocial issues, a lot of emotional issues, a lot of all those other things. And I hate using the word behaviors because I think that's too defining. But for people listening, that's the word you would use. And again, to have a deficiency free and we as administrators know that's tough because you have a lot of dynamics happening in the building. So again, not only deficiency free, congratulations, but just even on what you do on a day-to-day basis is amazing. (02:25): Thank you. Chelsey Gheyara (02:25): Congratulations. And with that, today, as I mentioned earlier, we are joined by Gregg Fuller. He is our senior executive director for Majestic Care. He was over Majestic Care of Fort Wayne. We'll talk more about what you're doing now and how you're filling your time these days and where you're leading, but Gregg has dedicated his career to leading teams in the long-term care industry, overseeing multiple nursing facilities in the greater Fort Wayne area. With the focus on quality care and operational excellence, he's passionate about fostering environments where both residents and staff thrive. In this episode, we will hear your journey, Gregg, from your hands-on leadership style and managing at a large scale organization today, and how you integrate empathy and strong team culture to create lasting change in our industry. So welcome again. And again, just very excited to be here with you today. The first question I want to start our conversation with today is, Gregg, you have spent years leading teams across multiple skilled nursing facilities. (03:31): Can you tell us about a moment early in your career when you realized the importance of seeing residents more than just a number or a case, but as people with unique stories? Gregg Fuller (03:43): Sure. I would say probably about two years. I've been doing this for 23 years, CNA for 26. So I've been around a little bit. Probably two, maybe three years into my career, we fell into a situation that led to immediate jeopardy, which first time newer ED, I started at 24. So trying to get in your head wrapped around that whole circumstance. At that moment is when you had to have some pretty compassionate moments with a family member. It was a younger resident who had been a TBI in a car accident. So these families had raised this child that she's been nursing home bound. And so to have those kind of conversations, it made you realize these are bigger than census numbers and financials. Combining that with my CNA background, it just really made me realize there's a lot more to this. Paul Pruitt (04:27): Yeah. So how long are you a CNA? Gregg Fuller (04:29): Since 1999. Paul Pruitt (04:30): Wow. So how long were you before you became an ED then? Gregg Fuller (04:34): It was pretty much all through college at Purdue. So four and a half years CNA and then just kept it since then. My very first building, we had no staff. I was doing showers. I was helping feed residents. And still to this day, when we're staffing challenge, that's where I'm going to go. Do Paul Pruitt (04:49): You keep it up? So you keep your CNS certification. Chelsey Gheyara (04:52): That's awesome. Yep. Where were you a CNA at Purdue? What nursing home were you at? Gregg Fuller (04:57): It was a little bitty mom and pop. It was a doctor and an architect who owned a Catholic based nursing home there downtown. And so just was by chance I actually Chelsey Gheyara (05:06): Was- Is it called St. Anthony's? Gregg Fuller (05:07): It is. Chelsey Gheyara (05:08): Okay. I started my nursing career in Lafayette. So that's why I was like, so I was like, I wonder if we worked at the same skilled Gregg Fuller (05:14): Nursing facility. I did my CNA at St. E's right next door. Chelsey Gheyara (05:17): That's awesome. Gregg Fuller (05:18): So yeah, my girlfriend, later wife at the time, her sister was a CNA and I wanted to get in the medical field and needed a job. Toys R Us wasn't cutting it. And so I decided to start being around nurses and doctors. And so gave her a call. Chelsey Gheyara (05:30): Awesome. Gregg Fuller (05:31): It was a big eye opener. Chelsey Gheyara (05:32): So how did you ... I mean, you just mentioned Toys R Us wasn't cutting it, but what moment for you did you go from, I'm a student at Purdue University, which in itself is a big deal to, I'm going to go be a CNA now while keeping up on your studies and everything. Walk us through that because that's not very common for students, Gregg Fuller (05:54): Especially Chelsey Gheyara (05:54): On an Ivy League school. Gregg Fuller (05:56): We grew up financially challenged, so there wasn't a lot of extra money. So in order to have spending money or to get through, keep those bills down, again, had to have a job. I needed something that had more flexibility, CNAs twenty four seven, so with some opportunity. And like I said, I wanted to get into the medical field because that was where I was going. I have a bachelor's in health science. I was looking at med tech at one point looking at going down the NP route possibly and then got into the medical field there, not knowing what a CNA was. She explained it, but it didn't make sense to me. And I was like, "This sounds good. I can do anything." And about three to four hours in, it was a real eyeopener once you got certified what that is. And yeah, I guess some family members, some residents in my head right now that taught me real fast what a CNA was. (06:39): So I've had a lot of respect ever since then. Paul Pruitt (06:41): Wow. All I knew when I became a CNA was my dad and my siblings all worked in the foundry from factories and I knew I didn't want to do that. So someone offered like, "What about this? " And I'm like, "I don't know what that is, but that has to be better than that. " Yeah. Chelsey Gheyara (06:54): Another Gregg Fuller (06:55): Option. And my family's the same. My dad was a factory worker too. And I worked in the factory the summer a couple times and said, "This 150 degree heat is not for me. Paul Pruitt (07:02): " Yes. Gregg Fuller (07:03): And yeah, it was a very eye-opening experience. And luckily I had, because it was a mom and pop, the administrator through the course of my time there took me under his wing. They had no IT department. They had no contracting department. So through my time I got to do, started doing his reportables and helping out with contract work and then slowly leaving the floor, still worked until the end on the floor, but eventually got into the AIT. Yeah. Chelsey Gheyara (07:24): Oh, that's awesome. Do you still stay in contact with them today? Gregg Fuller (07:28): I have not. He and I crossed past probably 10 years into my stay. He was looking for an opportunity and I happened to be at a place that had an opportunity and so we reconnected for a little bit there. Chelsey Gheyara (07:38): Which is really cool. That's really cool. Gregg, was there a particular turning point when you decided you wanted to make a broader impact, not just for individual residents, but for entire communities and the teams that care for them? Gregg Fuller (07:50): I would say probably when I ran a facility, it was inner city. We had deficiency free there. I've had three in my career at this point, but that one was probably the eye-opener. We took a lot of more challenging cases, homeless, lived in tents, under bridges. And again, going back to that compassion piece, they're all people. They all have stories and some of their stories are a lot more impactful than some that may have been born in better circumstances. Chelsey Gheyara (08:14): So Gregg Fuller (08:14): I think that building, watching, get involved, start to turn around, seeing the impact that I could have on it, I truly have with a team, not that we hadn't made progress before, but that was the one where I realized, wow, it is achievable. It is doable Paul Pruitt (08:29): And Gregg Fuller (08:29): You really can make a home. We ended up being, like I said, deficiency free, 100% occupied, got the star rating where it needed to be. We were financially very successful in a building that is very inner city Fort Wayne that historically hadn't been. Paul Pruitt (08:42): So when you said the facilities, because again, I'm not familiar with Indiana fully, but so when you started your career, was it in Indianapolis or was it- Gregg Fuller (08:51): Lafayette. Lafayette. So my first CNA job was in Lafayette and then I did my AIT through Walkerton, which is up north near South Bend Goshen area, and then went to Plymouth and did some way to take my license. And then my first building was actually in Valparaiso. Chelsey Gheyara (09:08): Yeah. So Purdue is in West Lafayette, but then across the bridge, literally there's- Literally Gregg Fuller (09:14): Bridge. Chelsey Gheyara (09:15): Lafayette. So Lafayette and West Lafayette just separated by a bridge. And I was picturing Gregg on Purdue's campus going to class doing his homework and then he's, "I've got to shift." Then he's going to go be a CNA on the other side of town. Gregg Fuller (09:29): And for not knowing town, so you would cross the bridge and it starts at 1st Street. I lived on 10th Street and Chelsey Gheyara (09:33): The Gregg Fuller (09:33): Building was on 11th or 12th Street. So it was an easy transition all the way across and then all the way back. Chelsey Gheyara (09:39): That's really cool. When you mentioned earlier, you said these people are all people and that really hit me my heart because you mentioned, we talk about this a lot, you mentioned something along the lines of they didn't get a pick how they grew up. I think that is such a huge reminder because we talk about this all the time is they're people. We have to care for them. But I don't know. It just for you just speaks a lot to your character to realize that. Gregg Fuller (10:05): And I think that's what's big about where I am now is that these are, and again, we don't want to use behaviors, but mental health behaviors. They've had societal challenges where they lived under the bridge or their family couldn't handle them anymore or they've gotten into a medical situation where they can't stay at home anymore. Unfortunately, a lot of families through the course of their 30, 50 years of life have unfortunately cast them off because of the abuse sometimes because of the mental health problems, which we can then now provide them a home and they're not the abstract piece of art anymore. They're the norm. So our building's full of the norm. And the more traditional places they don't fit, but they can flourish in ours. And we truly look at it from a mental rehab standpoint to where they have a much better quality of life. Paul Pruitt (10:47): What a great term, mental Gregg Fuller (10:48): Rehab. Yes. Paul Pruitt (10:49): I listened to one time a conversation and someone used the word, they said behaviors, that's an outcome. I have a negative stimuli, so I'm having a behavior. Good. So it's not a medical say, okay, you're diagnosed with behaviors, you're diagnosed with other things, but that's your outcome. So again, what other word can we use versus say, let's behavioral building? Chelsey Gheyara (11:12): Like labelings. Paul Pruitt (11:13): Well, I have behaviors then because if somebody, if I have a bad day, I have a behavior. Chelsey Gheyara (11:18): Absolutely. We all do. Paul Pruitt (11:21): So again, so Chelsey Gheyara (11:22): Don't- That's a great perspective, Paul. Paul Pruitt (11:23): Don't define me by, because I'm having a rough day. My wife and I are fighting. The kids ticked me off. The dog just pooped in the house, whatever. Guess what? I'm having a bad day. Gregg Fuller (11:32): And that's the difference is I think sometimes those traditional facilities don't know how to look at the environment and process through what's going on. Why are they doing it? We miss the why so much I think in mental health especially. Chelsey Gheyara (11:45): And I'm certainly, for the record, not a psychologist or a therapist by any means. However, those behaviors that could have stemmed from early on in their years before, I don't know, they say what, before they're six years old or before they're 10. So now because of that trauma or whatever happened, that's their behavior. That's how they have to feel okay. It's like a whole, I think they say like behavioral loop. That's what they have to do to then make themselves feel safe. So I like that you brought that up because we do label. We label a Paul Pruitt (12:18): Lot. And again, we go back to healthcare. And again, as an ED formerly, and just even as a therapist, sometimes we don't know their names. We just know them by their room numbers. To your point about the question, room 108, no, what's their name? Their person. They have a story to tell. Gregg Fuller (12:35): And I think it goes back to what you said too. I ran a CCRC before and there's so much high rehab, it becomes a number because it's 108's got married today and next week it's got Steve. It's fast though, but they turn over. And that's the biggest piece for me where I found my niche with these smaller, and more mental health focuses that you can make an impact every day on someone's life. Every day, every moment. I can walk in the morning and I have a resident right now who can't wait to see me just so I can charge his tablet, but he just knows it's me and I was off on PTO for a few days. He was like, "You're back." And I'm like, "Did they charge your tablet while I was going? " He's like, "The did, but I want you to do it. (13:10): " And so again, it's just that routine for him that makes him successful. And he was at a sister facility and completely didn't fit the norms and had some outbursts. And my building's been phenomenal. And his dad even came in and was like, "This is a whole different kid. He has a better relationship with his father today because he's in a place that gives him consistency." Chelsey Gheyara (13:29): Yeah, he can thrive. Paul Pruitt (13:30): And that's huge because now he's a dad and he's not a caregiver or he's not that internal stress of what else can I do trying to fix. And I use that in quotations. His son, he can now just be a dad, show up and be present. So kudos to you and your team, Gregg, because again, all of us just want to be parents. We just want the best for our kids. So to give them that is just huge. Chelsey Gheyara (13:54): And it does humble you because it could be your mom. It could be your kid. When it gets personal, the story changes. It does make me sad to hear that sometimes, but we have to always humble ourselves. That could be- Gregg Fuller (14:07): But as us as administrators and leaders as a whole, it's our job to tell the story. (14:11): And so if we don't dig into those people's story, I have someone recently who was an IU professor, you would never guess that ever. And then maybe rooming with someone who was completely homeless and poor. So the more my staff and my management team and even the surveyors are aware of what their story is, it makes them more embedded in their life and wants to invest in them. And I think sometimes we miss that. Again, going back to my first building as a CNA, I can think through a handful of people that I invested in and they invested back in me that to this day, I'm sure they're 20 plus years later, we're not with us anymore, but it's like they still have impacts. I still have sayings in my head from things that they've told me. Yeah, Chelsey Gheyara (14:46): That's awesome. It Gregg Fuller (14:47): Makes a big deal. Chelsey Gheyara (14:48): We are going to transition to the heart of it. So Gregg, your journey has clearly been more than just managing operations. It's great to see all that you're creating this meaningful experience for your residents and that home that you speak of, as well as your care team members. We'll talk about that too. But I'm really curious to hear how that mindset shapes the work that you're doing today at Majestic Care. Gregg Fuller (15:12): Again, I think it's about impact and it's how can you get involved with your staff, with your residents, and make it not the staff and the residents. It's about unifying that. And I think by having impactful education, having impactful decision making, having impactful outcomes that you celebrate, such as the deficiency free, and impactful failures that you can learn from. And I think those pieces of learning all of this compassion through time, my highs and lows through time, I think kind of bringing that to Majestic and then now as senior can share that with other facilities as well and kind of be impactful, especially with new people that we bring on board. I was meeting today, talking with someone who's been with the company for a month and just getting their story and letting them know about what my story is here. And I've been here for six years, just sharing the journey that we all can be on together. Chelsey Gheyara (16:00): Absolutely. That's beautiful. Can you share a moment from your leadership that really stuck with you? It might be a mentor story or from a resident or maybe a care team member that shaped how you approach creating better experiences for both our residents and our care team members. Gregg Fuller (16:15): In this facility, I can think of countless things that have impacted me, but I can think back to a young lady that, again, she wouldn't take her medicine. She wouldn't participate in activities. She wanted to sit in a room all because she had PTSD and it hadn't been addressed. And so again, getting involved with those people, building those trust pieces with those people, it made me realize at that moment those little things matter that we may not know. And she had no family. We didn't know her story. So you had to dig into that. But again, consistency, going down, making it a safe space, having those safe conversations truly made me realize that sometimes people don't share that story and you got to dig into people when they don't even want you to, helps you on a broader scale, get more invested in the world that you're around on a daily basis. Paul Pruitt (17:01): Gregg, what's interesting is as you talk through your journey a lot about the personal stories. So again, so if we apply it into healthcare, we in healthcare don't set up our structure to get to the stories. Correct. We set them up to check boxes. Our nurses, I think about our nurses, because again, that's what they want to know is the story so they can take care of. So when you look at that, do you see the same thing or do you see like, how could we do it better to get the story? Gregg Fuller (17:31): And I think bringing into the subject matter of AI is really a piece because yes, I've been through paper charting to electronic charting to check the boxes to 32 drop down boxes. And it is, it's a challenge every day to find out what are those redundancies in documentation that aren't necessary. (17:50): And in my ability, we may not run super clinical as far as like trachs and heavy dialysis, but documented behaviors is exhausting. It's a lot of work. And so to get the surveyors, the information they need to see we're taking care of people, it is a balance. And I think that the AI piece is going to bring hopefully a lot more summary to our table that we can work off of versus digging through charts forever and ever. So I think that's probably the biggest change I see coming, but our big piece is what can you do while you're doing that? I have residents that park at our nurses station now, not because we park them, they want to interact. And so whether nurse is charting or whether to pass the meds, they may follow them and it gives that, again, environment is what it's all about. (18:31): You're doing your job. My office, it's mandatory in my building all open door policy. My office is a hub. And so every manager, if they have two residents or three residents that visit them a day, that's two or three people that are busy, that may be two or three that have less behaviors that lead to less medication, which downsizes your medication pass, downsizes your documentation. And again, if they're busy, it's a silly saying, but we always say to our building, busy beavers don't bite. So if they're busy and they're having a good time, everybody's great. Everybody's getting along. It's a very harmonious place. So by not addressing those little fires, we're creating more documentation. We're creating more work that is probably unnecessary if we just dealt with the person and Paul Pruitt (19:10): Find. Yeah. It's just amazing when I look at, again, same thing went through back in the day when I was a therapist, SOAP notes or anybody remembers SOAP notes, so subjective, objective assessment and plan. So we would have to write SOAP notes. Chelsey Gheyara (19:26): The SBAR. Yes. I was like, is that like the SBAR? I don't know why I offeredly Paul Pruitt (19:30): Leaned into it. Literally, so when I went through my PTA program, you had to learn how to write a SOAP note, which would then tell the whole clinical story (19:38): Of your treatment plan. So what did Chelsea tell me during the treatment? That's subjective. What did she say? Objectives, all my clinical findings, my test, all of those things. My assessment is pulling those two things together to my assessment, and then what am I going to do in the future? So going from that, writing two page soap notes to check boxes, then you lose an element. Every time you move one step further, you lose an element because now you're just checking boxes. So you're losing some of that clinical piece. So again, to me, where we need to find a balance of like, how do we go back to the basics to tell someone's story, to know if they have PTSD so that you can really address it so you're not doing polypharmacy. Because as I do is, especially in the population you're taking care of, is as soon as someone has a bad day, do we get one another pill and it's, wait a minute, again, if I have a bad day, you're going to give me another pill? Gregg Fuller (20:35): And that's where the AI comes in. I think that speeds all that piece up to really read through 300 pages of documentation, give you a summary to where you can then have that person Paul Pruitt (20:44): Interaction. Correct. Yeah. When I think about our relationship with PointClickCare and what we're really striving for and what we've signed with them is we want to embrace all of it and we want to bring that AIT, but we want to be at the table with them. So when they're designing things that we're actually at the table with them to say, "Well, this isn't going to work or this is what we need." And I can tell you our chief nursing officer, you would've thought we gave him a million dollars recently came to my office because he got to be on the phone with people that are designing certain tools with assessments, falls assessment, but they were listening to him and they were like, "Wait, but Eric, wouldn't you want to know this? " He goes, "No, I don't. That's just another box for a nurse to check that. (21:27): We don't need that. " So what I'm excited about to what you're saying is those journeys hopefully will remove the white noise for the nurses so they can get to the true core of what they want to do is get to really know the patient's story versus just checking another box to say, "I'm checking it because I was told to and I don't want Gregg to come back and say, Why aren't you checking your boxes? Gregg Fuller (21:47): And I can say too, I know Majestic invested high on the AI, on the marketing side too. And I can tell you from my standpoint, I don't have going through with some bedsides because all of my residents have to have a bedside just due to circumstances and that AI piece that you guys have invested in that made it so much faster for me to get a good synopsis. So I'm doing a bedside, I'm not reading 300 pages. I'm doing a bedside with what I already know. I'm going to get to the bottom of that resident to make sure they have the best first 72 hours that they can have versus guessing. Paul Pruitt (22:15): And that's the critical piece. So again, that's where we want all of it to start coming together. And again, I know PCC or PointClickCare, the system we're investing in and we're developing with PCC or what they're doing is it'll trigger you and say, maybe you should start at room 108 because the resident room 108 is starting to have issues because AI is starting to pull, maybe it was their vitals from first shift, maybe it was a note that the nurse wrote, maybe this would have go down to 108 first because now you can prevent maybe, again, preventative. (22:45): So now instead of having a patient go out to the hospital, now you're caught up with all this paperwork, you can say, I'm going to call the physician, maybe I just need to have a med change or maybe I just need to do this and this and prevent a hospital readmission, which is not great care for our residents and then you can start your day. So again, that's what we're looking for. And I know Eric, another element he's pushing out and then are you part of the test pilot with PointClickCare? Yep. So I know one of them is chart advisor. So again, as that starts coming in and starts to really look at using AI to say, if you document one word in the progress note, it automatically will trigger and say, "Did you do an incident report? Did you do this? Did you do this? (23:23): Did you do this? " So again, nurses aren't looking to leave your building just because they don't want to do it. They have a lot to think about. It is a lot. Because if I can interact more with the residents, I'm going to have a better day and they're going to have a better day. Chelsey Gheyara (23:37): Absolutely. Gregg, this is the question I am most excited to ask and I know all of our listeners are going to be excited to hear the answer. The moment they've been waiting for, Gregg, you've had two deficiency free surveys. How did you do that? Gregg Fuller (23:51): It's a daily process. It's not being survey ready in the window. It's being survey ready every day. And again, I can tell you through transitions of time in the last 23 years, said that's impossible and that doesn't make sense. And of course that's the cliche that everyone has ever said, but it's truly true. And again, as we're going through PointClickCare, I read the 24 hour port every day. It's every day survey could walk in. And if you treat your building like every day survey could walk in, you're always survey ready. And again, too, it's really setting the expectation for the management. We can't have a sloppy kitchen Tuesday through Friday in June because our survey's not till December. It's setting the expectation of I'm not going to allow my residents to have a dirty kitchen as the administrator, so we're not having a dirty kitchen. (24:35): And so that's the expectation every single day. And if we don't meet those expectations, then how can I support you? What is the roadblock from keeping us from being successful? And I think that's probably been the biggest, even changing myself over the last three or four years is really asking myself, what am I willing to accept and what's the expectation? And if I'm accepting lesser of an expectation, then I'm going to get lesser. No one's going to work down to a bar. You want them to work up to that next level of bar. And so my team, I have multiple managers who, my dietary manager is a great example. He tells the story all the time that he couldn't stand me for the first six months that he worked there because I was always in his kitchen. He's like, "Why is this guy riding my rear end every single day?" And he now has had three deficiency free kitchens since he's been there. (25:20): And he tells all the staff he may be tough, but there's a reason. And now his kitchen's clean every day. It's never a problem. Again, they walked in on Sunday the last three years, no deficiencies in our kitchen. Paul Pruitt (25:31): Wow. Gregg Fuller (25:31): Again, I think it's just setting consistency and it's so much easier to maintain than it is to rebuild. Paul Pruitt (25:37): You're not just saying, "Hey, we're going to be state ready." You're just saying, "No, we're going to set a bar of excellence because it's the right thing to do. " So I commend you because you're setting a standard, not because of the state told you, because you said that's the right thing to do to have a clean kitchen. My residents aren't going to eat from a dirty kitchen. Gregg Fuller (25:54): And we don't have food problems. We don't have weight loss. We don't have pressure. And like I said, that's probably the biggest challenge that you see is that one, those little bitty things can add up quick. Correct. And then that's the expectation I have for my other facilities as well, is again, just be consistent. Set, what'd you expect? Chelsey Gheyara (26:10): What do you think your care team members have learned through not only being deficiency free, but I'm sure they've been at other companies, they've had other journeys before they got to Majestic Care. What do you think they've learned throughout this deficiency free survey process? Gregg Fuller (26:27): Expectations. I have them holding each other accountable now. I don't even have to say certain things. I can go be at another facility, help on out. And my staff's managing expectations that have already set. And I think that they just know the why. They learn to have the why and they've tasted now the outcomes of the why. I'm very big on education with my staff. There's no reason, there's nothing to hide. They might as well know why we're doing what we do, why the kitchen needs to be cleaned and why that cell phone needs to be put away or why a certain care procedure needs to happen. And I think they are smarter, wiser staff and friends and family throughout healthcare as well. And it's a big bragging right for them to teach them, their siblings and stuff, how things are going, as well as just to be able to brag. (27:11): And so I think they've learned to have a lot of self-worth and some careers that aren't always the most glorious. We don't get a lot of praise sometimes from our residents, they're particular, but I think they've learned that they can impact someone and they get rewarded for it. And again, not financial, just mental health themselves. They feel better when they go home knowing they've impacted somebody. Paul Pruitt (27:33): Yeah. Chelsey Gheyara (27:33): Absolutely. Gregg, we all know things don't always go according to plan. Can you share a time when you tried to implement a new system or initiative and it didn't quite work out as expected? What did you learn from that? Gregg Fuller (27:46): Oh my gosh, countless failures as an administrator 23 years that we could spend three hours just on that. I would say probably my third building, it's a rural building. I came from the city world thinking I'm going to come in and give these small town people how it's going to be, not realizing that every single one of them were connected through cousins and spouses and neighbors who I was the outcast. And so I think sometimes we come in wanting to make our culture the building and not always respecting the other culture that's already existed in the building. So I think for me, that was probably my biggest fall on my face, trying to implementing expectations without really understanding their why. Like I said, I was the guy from the outside. And so instead of embedding myself and learning from them and understanding what they're coming from, why they do what they do, I tried to come in and just revamp the entire facility unnecessarily. (28:39): Honestly, the building wasn't in shambles by any means, but again, from a culture standpoint, just implementing something that the staff doesn't need or want was probably one of my bigger failures. And then being able to step back, I was there four years, later become ED of the year at that same building. And again, we had great retention. We ended up growing census. So once I humbled myself a bit as a young ED and then realized that where we were going, both of us, my culture and their culture blended together and we made, like I said, even a better place than what it was prior. Chelsey Gheyara (29:10): That's awesome. I love that you said that yours and theirs blended that they accepted you were the black sheep, the outcast, and they finally opened their arms and accepted you and- Gregg Fuller (29:20): It took a while. Chelsey Gheyara (29:20): That's awesome. Kudos to you for being self-aware of that because that takes a lot to be like, "Okay, fine. I'm going to lay my ego if I will." Because sometimes it is our ego, right? We're like, "We know more. We know that. No, it's their home." Gregg Fuller (29:34): And that was my biggest advice for my AIT is when you get to a building, the first 30 days is listening. If you don't understand who you're working with and their why and what's going on with them, then how are you leading them? You don't even know why you're teaching. Again, always there's expectations right when you walk in, but in general, you need to absorb in that first 30 days of asking questions. I said, "If they're not telling you you're annoying them by asking questions, then you're not asking enough questions." I I said, because they're going to ask you, why are you asking so many questions? Because I don't know. I don't know you. I don't know your systems. I don't know your building. Teach me. And that's a big culture blender right there. Paul Pruitt (30:10): To know the why, know who people are and ask them questions. You're right.That's where it starts. Gregg Fuller (30:16): And their perception may be wrong, but to them it's and that's where you have to break down that. And EDs and offices they don't run buildings. Paul Pruitt (30:23): And again, the other thing I want to reflect on is I give you a lot of kudos. Again, an ED reading the 24 hour report, knowing what's happening in your building, because I've also worked with administrators say, "You know what? I'm not clinical." Guess what? You don't have to be clinical. Gregg Fuller (30:37): But that's the strongest piece. I'm not a clinical either, a CNA. But the greatest point is goes back to my original ask and make them explain it to you. Educate yourself. Correct. I'm smarter today because of countless nurses in my Paul Pruitt (30:47): Life. Right. But to your point, it's even better not to be a nurse because Gregg Fuller (30:51): It Paul Pruitt (30:52): Gives you a free pass. I'm not a nurse. So explain it to me because I have no idea why we're doing this. Gregg Fuller (30:58): And there's things that to this day I still know. I still ask just to make them, again, feel validated to that. It helped me understand their version of it too. Paul Pruitt (31:05): Correct. Gregg Fuller (31:06): It's huge. It's easier to remove the fire starting or debris in the first place than it is to put out the fire. Paul Pruitt (31:13): Correct. Gregg Fuller (31:13): So if you just don't ever let it start. And I think my staff does an amazing job at being proactive with some of the most challenging residents by knowing them. They know that if she says this today, she may have a UTI. There may be something going on there that is different. And if you don't know your residents, you're not going to catch that. And then it never turns into a behavior. It never turns into a fire that now we have to put out that the states come in and investigate that now requires more medicine. We stopped it before it ever happened. And my staff's great with that. Chelsey Gheyara (31:41): Gregg, on a more personal note, is there a recent story, whether it's from a resident or a care team member that reminded you why focusing on the human experience is so essential in your everyday work? Gregg Fuller (31:54): I have a care team member now that I don't want to go into too much detail on this because I don't want to make it obvious who it is, but they're going through some challenges that I wasn't even aware of. And I had asked them to come to work to complete something. They're more of a non-scheduled that varies every day. And the person said, "Well, I'll be there, but it's going to take me a little bit." And I'm like, "Okay, that's no problem." And this person stated they're living at the rescue mission and then they caught me off guard. It's not normal. That's not what you would normally hear from a reason why it's going to take a delay to come in and help with something. And I think that sometimes we see people and we interact with them and we don't always understand what they're going through. (32:31): And so that accountability piece balanced out with the compassion piece, we all have stuff. This person, you'd never know. You never know that they're going through some life challenges. And this person had had some challenges with some interactions with a staff member. And sometimes again, you had a bad day, it does affect you. And I think it was a very humbling piece for me to know that God's working behind the scenes in people's lives to get them into a place that I'm providing opportunities because this person had some failures at some other jobs and is doing fabulous for us. It's a beautiful thing to see that we can work that. This person now has an apartment. They now have a means of transportation. They now are very successful. I just talked with them about some potential future opportunities that may be outside the company, but better long term for where they want to get to. (33:19): And if we're just a passage for that, that's phenomenal. Why not be a part of their story long term? So I think that's been pretty impactful for me to understand that there still are people out there who are trying to move up that consistency, move up that ladder of success. And this person, again, huge ... They probably don't even know it, but huge inspiration to me. And that person allowed me to share some of that story with some of my staff. And it's been impactful for them too. It's very humbling to understand that the world isn't always peachy for everybody. You don't always have a place to go home to every day. And this person never calls in, shows up to work every day, does the best job possible, has their heart in the right place for a reason. Chelsey Gheyara (34:01): Wow. Paul Pruitt (34:02): It's amazing. Chelsey Gheyara (34:03): That was very heartwarming, but I need some Kleenexes over here. Paul Pruitt (34:06): I think if you want a culture where you say leave it at the door, then again, then you shouldn't be shocked with the negative outcomes of your company. Right. I think it should be, don't leave it at the door, bring it in with you. Share it with whomever you feel safe with and let them know. And again, some things people should be able to, we can help with or we can help give you. Sometimes we can't, but just even be that open door to share because that's heavy. That's very heavy for someone to have to carry that on in their journey, not to be able to tell it to anybody, but show up and everybody that wants, "Did you get this done? Did you get that box checked? Did you come in happy? Oh, you shouldn't have had a bad day." I mean, that's not fair. Gregg Fuller (34:47): And this person, again, with the transportation challenges, the staff wanted to be negative because I could have, as administrator, not listened to the story and be like, "You're tardy to what we need done." And not had the why, not had this person's why they couldn't be there timely. And again, to see from six months ago to where we are today, it's a big inspiration, like I said, to see that you can help people. You can really be a part of just by having an employee, just by listening, just by being there. And I think that flexibility has led to consistency. We were able to take in six months, $200,000 a month in agency and eliminate it, but it's gained. Those people who got that deficiency free are there today because we worked with them through their life and their challenges too. Paul Pruitt (35:29): And a lot of our care team members are seeing the moms. Being a dad, I can't imagine having to make a choice between my kids being home alone or work. Okay, I need this to pay this, but my kids are too young and if anything happened to them because of this, I would be mortified. So again, kudos to you guys recognizing how do we meet them where they're at and how do we ... And again, that goes back to policies are to guide us and help give us direction, but there has to be some strategic decisions on, okay, how do we do this and make a leadership decision? Because again, if you ever have to go in front of somebody about, yeah, in that case, I can tell you exactly why I made the decision. And again, if there's a negative outcome, let it be. (36:18): But if the positive outcome is my residents got the great care and a care team member got what they needed, we'll just have to take the deficiency or we'll have to take the hit because again, I would hope we would support somebody through that journey. Chelsey Gheyara (36:30): Yeah, absolutely. Gregg, looking ahead after you've had these two deficiency free surveys in all your 20 plus years of experience, looking back in those moments that were hard, right? In those beginning years when you were at Purdue, you were a CNA, in those moments, what were some of the times that built into your excellence today? What were those defining moments of excellence? Gregg Fuller (36:55): Two weeks into my very first building, I don't know where she's at now, but Kathy Brown was my nurse consultant and she informed me that we had five restraints and that we were going to be relieving some duties of a nurse that was a big builder of this is a real world now. So I think that's a key piece that I've carried with me because she taught me a lot going back to what we discussed earlier is that I think that was an opportunity again for leadership growth and for clinical growth. Going back to my situation I mentioned with the culture situation, like understanding that I can be a chameleon in those cultures. And so through all those different experiences of a CCRC to an inner city facility, to a rural facility, a mom and pop facility that we discussed, those different cultures have formed inside me into different perspectives that help me to relate with all those people. (37:44): I can relate with someone who had more of an inner city upbringing to someone who grew up on a farm, to someone who grew up, again, financially challenged, or someone who grew up in a much more fiscal, healthy situation. So I think just through those years, those roadblocks of falling down on your face, thinking you'd put trust in someone. And I can remember back, I had trust in a manager that said, "This is 100% ready to go. We're there and resulted in a citation because that hadn't been touched." So I think through those different challenges, it's helped me be more consistent and to be deficiency free, yes, it's excellent. We still have issues, we still have growth opportunities, but it's allowed me to take those cultural differences plus the clinical training and roadblocks I've had and blend them out into my other facilities as well as my staff. Chelsey Gheyara (38:31): If you could offer one piece of advice to other leaders in long-term care about integrating empathy into their systems and technology, what would it be? Gregg Fuller (38:41): There's always time to listen. There's always time to read that report. There's always time to step back and just have a moment. I think sometimes we make self-excuses. It's very easy for us to look up and say, "I have two reports to do. I got to get this email sent out. Two residents that are out my door have an upset family that I got to deal with and two CNAs that called in. " And sometimes all that is a lot, but you still have time. We still in 24 hours that you can make the time and that five minutes today will give you two hours tomorrow. And I think sometimes we get caught so much up in the day to day, that preventative piece, and when I say preventative, reading the 24 hour report is preventative. Talking to Mary CNA so that she's here tomorrow because she's going through something is preventative. Paul Pruitt (39:29): Correct. Gregg Fuller (39:29): Educating that department head today, even though you're slammed and you don't have time and you don't want to listen to why they didn't do their job, but you can take that dime, close the door and have a one-on-one is going to give you two less deficiencies six months from now. So I think at the end of the day, and that's why I told the AI team like, "You will always have time for what you make important and making important stuff or making things that are so minuscule today will give you huge impacts tomorrow because then you're not chasing and putting out fires that you left burning today." And so unfortunately, I think that again, we as administration, DDs, DONs, managers, we make excuses for that. I think society's taught us to do that. You're taught to run at 100 miles per hour and sometimes you're missing it. (40:12): That's the old edge of take your time. But I think the biggest one, just stop, just take five minutes because that five minutes is really two hours later. Paul Pruitt (40:19): So true. So do you want to fix it now or do you want to fix it with the 2567, which we all know writing out the 2567, doing your audits, doing your education, that's a lot of labor if I could have just fixed it at the beginning. So again, I think that's so true is taking that time. And I remember as a young administrator is finding the balance because there were times where time was where I needed and there were times I didn't leave the building until seven, but I had to get these things done, but I wanted to make sure that I followed up on these, whether call a family member back, whether it was follow back up with Chelsea on the floor because I told her I'd come back and follow up with her, whatever that was, but making that time. And again, over time, it will slow down. Gregg Fuller (41:07): It may take three to six months. Correct. That year and a half, two years later, you're now sitting with two deficiency free services because you took the time to break that system down, listen to a few people and really understand what's going on in your building. Paul Pruitt (41:19): Would you agree, Gregg, from your leadership and your time in the industry, I was talking to an ED today at the session you guys had and he's newer as an ED in Kentucky in one of our states. And we were talking and I said, if you're walking into a building that challenges and has a lot of opportunities, it probably takes a good three years. Oh, for sure. Plan on about three years of just a lot of just days where you just want to look and say, "What in the world is this ever going to change?" It will, but it's going to take three years of a lot of investment, a lot of time, but it will get there. Would you agree? Gregg Fuller (41:56): Yeah. I always tell, like I told my AIT at the time, it's 30 days to listen, it's six months to make an impact, it's a year to make a difference and that's the momentum. And then that year to get to excellence is three. I agree with you 100%. You really need to just take those steps because you're not going to get there. And I tell every new director of nursing and even new management that's outside of healthcare, it's going to take you six months to understand healthcare, let alone your actual job. It just takes time. And unfortunately, instant results don't exist. Chelsey Gheyara (42:25): Gregg, what does excellence mean to you? Gregg Fuller (42:28): Happy residents and happy staff. At the end of the day, if you do those two things, everything else works out. Your clinical's good, surveys are good. I don't think it's any secret formula. There's excellence is when everybody goes home and they're feeling great and your residents are cared for despite even speed bumps. I think that's what it comes down to because financial, it'll fix itself if your residents and your staff are happy. Census fixes itself if your residents are staff and staff are happy. So I think just to get invested in the people that live and work there every day, the rest of it's again, easy. Chelsey Gheyara (43:04): Thanks for listening to Hearts of Excellence. To learn more about becoming a care team member or how we can support your loved ones, visit majesticcare.com and don't forget to follow and share because every story deserves to be heard.