Which school of thought prepares post-acute providers for future success?

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Aug 10th 2015

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Featured | News

Leaving the LTC100, you could almost feel the ground starting to shake – and you can really feel it.
It is scary for most of us mere mortals who do not have a crystal ball to consider questions like: What is the real rate of change? How much risk can you tolerate? How does operational fatigue play into it all? And how do you get your team on the same page anymore while continuing to focus on core fundamentals that get harder daily, new mental modes required to assess the future, and the cultural implications on all of your stakeholders who just need to provide great care to the more complicated residents, 24/7?
Personally, I could see Anita M. McGahan’s framework of Industry Cycles of Change in many sidebar conversations, even if they did not know they were using it!
There are really too many conferences with spins on same themes, so many talking heads everywhere around us that could operate a lemonade stand, and the plethora of online healthcare futurist bloggers telling us we are all screwed in the end, that we should give up and go into medical tourism.
I ask myself often, ‘how many futurists can you trust without just giving up and throwing in your towel (or in my place, the keys), anyway?’
There seem to be only four distinct schools of thought circling around post-acute providers that I know intimately with no clear, absolute boundaries between them.
Heck, with leadership turnover at many shops, hospital C-suites changing rapidly, and REITs getting scared of future rent collectibility in many tired and dated centers, I always say just pick one that you believe in your heart and go with it.
The schools of thought I run into often…

School 1 – When we do the basics of quality, post-acute services will be chased by everyone so keep it simple, be a late adopter and in the end they need you anyway. Keep solid surveys, keep your team on fundamentals, squeeze your last liquidity left in the core business of fee-for-service and the other vertical healthcare providers will help pay you to convert later?
School 2 – We must be the first to embrace the new healthcare policy, new customer mindsets, and related technologies. Go ahead and grab the ‘halo effect’ and brand equity, because they all need to find innovative providers. During that vetting period, your team can learn things like rapid prototype options and innovation frameworks, and by trying many versions, you will be the first to figure it out. You know your core business is declining daily, so why wait? Recreate like the Blue Ocean framework taught us.
School 3 – What the heck is going on? Heightened regulatory scrutiny, closing networks, hundreds of new middlemen taking pounds of flesh soon, growing staffing challenges, just to name a few. These demands are getting insane and too risky too swallow. The provider has very little upside left – get the heck out of dodge and let one of these futurists or competitors who do not believe it will change buy us because the good days are over. Half of my close peer friends are thinking this way as we speak.
School 4 – Our best days are ahead of us. Just ‘Andy Dufresne’ it, like Shawshank Redemption, because with digital paperless, EMR, hand-held technology, value-based alignment, gain sharing, more transparency, and lower costs, we are going to win big anyway!!! We will be ahead of surveyors finally, see customer activity virtually, and that old way was misaligned anyway. So let’s get on with it and finally make some real hay in a more aspiring way – because when it finally turns, it will be beautiful.

Here, where we are at the Revolution today, we try to live School of Thought #2, but every time we stumble big time, we revert back to School of Thought #1. But School of Thought #4 will make all of the pain turn to joy someday if we can just see the mountaintop.
There are so many mixed signals from external forces that make it challenging to get everyone on the same page, so over-communicate if time permits and don’t ever give up because they all need us even if they act like they don’t. We are still the most inexpensive service that no one ever wants, but many really need like never before.

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Losing a Great One is Never Easy!

Prior to COVID, I think we all felt like we spent more time with work, work partners and peers than our own families. Was it good or bad? For me, I worked with some of the most talented people in the country, so I loved it.  And obviously I love my family too! I had the blessing to work with a friend, brother, Savant, Mensa member, and so much more for nearly a decade and a half – Stephen Stocksdale. To say he was talented with an amazing range is honestly a great understatement in a world full of the opposite. Stephen did so much intellectually, professionally, and personally that for the first three years of working with him, I assumed it “all could not be true”. But time and time again I learned the opposite was true.  He served our mission-based organization in every role (field leader, controller, administrator, VP, strategy, consultant, start-ups, etc.) and whatever else we asked of him. Despite having more professional success himself, he just wanted to help us grow in all ways. 

One day 5 ½ years ago, Stephen was diagnosed with terminal cancer, and we grieved with him as you would expect. But he was a determined guy and decided to not just learn all he could about cancer, but to master it. He decided there had to be a path he could carve out for himself that no doctor had considered, or he would locate new research that would help him beat it.  With a scientific mind and unparalleled IQ, he found a clinical trial he was approved to get in. This trial’s treatment regimen was so potent, and Stephen was the only one that survived. He learned about transfusions, blood structures, and cancer interventions. Cancer kicked his ass often, but he always beat it back up and won again!

We cheered, prayed, and cried often over the past years, but learned three great lessons from Stephen that we all cherish today:

“Be a Lifelong Learner” because we can always master new things and age is just a number, but lifelong learners never get old. Stephen mastered EMT services, police work, cancer research, hospital administration, heart transplant programs, high level statistical methods, travel, long term care, teaching, and many other degrees, certifications, and accomplishments over 65 years, so let’s all keep Learning and keep growing! 
“Never Give Up” because we grow everyone around us in our struggles and sufferings in ways that impact everyone around us and Stephen knew that and wanted us to get stronger, be more grateful and relearn presence, which we all did!  When he came back home, he rarely missed a day at the office and taught all of us new things daily up until the moment he passed last week.
“GOD IS SO REAL” Stephen had historical expertise on religions, studied theological premises, and had a metaphysical outlook, but in this battle, he felt like he met the Lord and had to share it with all of us. He knew he beat something that is nearly unbeatable, and he wanted time to share his story, his walk, and his private time with the Lord. He watched prayer groups with people he barely knew praying 24/7 that he receives a miracle, and he did receive one that he could share with all of us.

Our organization is going through a very painful time as a mid-size nursing home organization that has stakeholders who worked under unbelievable stress and pressure for so long and had to endure seeing some of our residents pass away. We have lost half of our team, and we are still trying to rebuild stronger and better.  I think after serving through the pandemic for 2 ½ years and struggling with how to bring it all back together in this changing workplace and overworked healthcare system, and after suffering so much pulsating unknowns for so long, it was Stephen who gave us the best reason to not look back. He taught us to enjoy the struggle as something that can deepen us all and stay prayerful that God is with us during times like these. We need to rebuild and have new passion as learners, which Stephen demonstrated everyday making our lift just a little easier. And lastly, when you beat cancer four times and die from something else, how could we ever give up? It’s time for us to just “STOCKSDALE IT” and grow by learning, fighting harder and believing in our purpose! 

Stephen’s office will remain untouched for now because when he left work on Monday with his ambitious assignments on his wall, we never knew we would not see him again. However, we can certainly feel his presence and we are all better people for his amazing lessons that he taught us until his last hour! 

Celebrating A Legacy Of A Mentor, Doug Hornsby

This past week we celebrated the ultimate legacy leader at the Revolution. Doug Hornsby, who mentored me and many others at Signature Healthcare, is transitioning from our CEO of Silver Angels to the next chapter of his life. Doug will no longer be my day-to-day partner after 24 years with the organization. Over a decade ago, Doug’s move from Champion Administrator to our fearless leader of Silver Angels might be the best story in East Tennessee by anyone’s standards. Doug took a fledgling start-up and made it into an excellent Medicaid waiver home care company that is the largest in the State with over 1,000 stakeholders and nearly 1,000 customers. One of the best examples of going from a clunky start-up to a powerful movement is when the leader keeps the mission front and center for everyone to rally around.

Personally, Doug and I have stayed very close for the past two decades, sharing our highest highs and lowest lows, and I consider him one of my closest friends on the planet. We pray together, try to vacation together with our families, and ride the healthcare roller coaster together. We have constantly challenged each other to stay faithful to our callings and give wise advice to each other in times of uncertainty because of the deep trust we have earned. Enough about Our history. Let’s get to Doug’s.

The core of his being is a lifelong commitment to serving brothers and sisters within his community as a man of Christ. Previously, he found the time to start and develop a fantastic ‘non for profit’ women’s crisis center in his hometown in rural Tennessee that is still changing lives daily with its expanded service offerings. However, Doug is now ready to start a new chapter by founding his following ‘non for private’ calling, an addiction center and addiction program around his service area needed in these trying times. He will launch later this summer.

Doug Hornsby is the very rare individual who, when you think of all the things he mastered, contributed to, or help build, it seems like a Forest Gump remake. When I first met Doug, he was the former president of our healthcare organization, and we hit it off on day one. I remember walking through his office, waiting for him to meet with me, and looking at all of his plaques, memorable pictures, and rare mementos on his office walls with slight envy. Doug was a small town Alabama boy with a distaste for traditional academics but a voracious passion for leadership and service to his community and his teammates.

The ten leadership lessons that we can all learn from Doug Hornsby that deeply impacted me are:

Be very generous because it is the key to true happiness. Doug has given back and has provided for so many people along his spiritual walk that he made me realize joy does come from giving, not receiving.
You can have many chapters in your book if you can trust the Lord, but the key is to let one door close, or you will never see what was coming your way. Doug has been everything once.
Family is much more powerful when we see it as a call to open our arms as wide as possible to let others join us because we know we are all deeply connected, and family is not a ‘bloodline’ or a generic link. It is something much bigger.
Mastery of forgiveness may be our biggest challenge, but we can truly love others like never before if we can get there. Doug taught me forgiveness in my darkest hours.
Stop keeping score all the time! No one cares like you think they do. Let it all go, and learn to cheer for everyone around you!
Only be passionate about things that truly matter! Doug loved every SEC team that ever won a football championship which seemed almost sac-religious, and I asked him why and he said, “I like winners, and everyone needs to win some time.”
Be a lifelong learner, and you will never age! Doug continued to share new literature with me and kept going deeper within himself when many were already winding down!
Every advanced hiring tool we can use to assess talent is essential today but always hire for HEART first and foremost! Doug gave so many leaders today a shot without requiring the perfect prior experience or best-in-class credentials, and usually, he was right!
Be a great friend and check on others often! Doug was always sending me motivational quotes or scriptures to check in with me in many trying times, and it made him be a friend that I have rarely had in my lifetime!
Be Humble! It’s the last place uncrowned! Doug had deep quiet competitiveness, but it was against himself, not others, and he learned early on there is no “I” in the word TEAM where he rarely accepted credit or wanted attention.

I was sad at his recent reception last week because I had powerful memories racing across my mind from years back as we told the room war stories about happier, hopeful, and transformative times that we shared. But then I had to remind myself of one of my favorite quotes by Groucho Marx – “don’t be sad it’s over, be glad it happened”! Doug, I am so glad it all happened! Thank you!

We will miss you Doug, but you will always be a big part of who we are at Signature HealthCARE!

Losing Your Brother During COVID-19

Sometimes you can’t even remember when normal was. What does “normal” even mean anymore? Since COVID-19 hit our country, our Signature team has fought PPE battles, COVID-19 testing access issues, funding uncertainty, Kentucky’s unfair allocation of Medicaid funds, thousands of COVID-19 positive residents to serve, staffing changes, and new regulations being issued daily by state and federal governments. But the hardest challenge has been the “No in-person visitation” mandate for six months, leaving many long-term residents feeling more alone than ever before. No one-on-one visits from the outside world: no family, no friends, no volunteers, no school children doing service hours and no direct religious clergy assistance, which to me has been the most devastating issue of them all!

Signature HealthCARE has a tough job taking care of some of our nation’s most vulnerable during these difficult times, but they make it happen because we have amazing frontline heroes who serve 11,000 “Ray Steiers” 24/7. Prior to the passing of my parents nearly a decade ago, at Signature HealthCARE like Ray, my brother lived at home with Mom and Dad for 25 years, locked in a time warp with little socialization outside immediate family. All of his great friends and girlfriend at the time of his medical event had to eventually move on, which we totally understood because his illness lasted so long, and he was not the same person, which we had to accept. Once our parents passed, Ray moved into a Signature HealthCARE facility where he thrived! It may shock you, but some of his best times since childhood all happened in a 120-bed facility where he found passion and purpose again. He thrived in that special community, run by rock stars. They gave him back the things he had lost decades ago: great friends, loving caregivers, a personal chef, daily socialization, access to ice cream, access to ‘stay vacations’ in the community, unlimited rock and roll, hall mates that loved him, constant hugs with affection, a thrilling gold medal from Signature’s Senior Olympics, and an amazing leadership team that made him a big part of their family at all times, so he never felt alone.
During COVID-19, our entire industry has been heavily impacted, which you already know, but the blow to the external world that surrounds and supports our communities and residents has been one of the hardest hits that has lasted too long. Ray lost day trips outside into the community because the world shut down, lost face-to-face visits from family and friends, lost direct contact with supportive volunteers, lost cool outdoor quality of life programming, and community events. Yes, technology can be great, but he lost all the hugs and embraces with medical personnel.
Over the past six months, Ray became very depressed, stopped eating and lost weight. He became more aggressive, dealt with many medication changes, and his favorite caregiver left the company. I think it was all too much. We Skyped and FaceTimed, but it was not nearly the same. In my last few encounters with him, Ray showed me he was already a very different person, which crushed me, and I knew I was losing him.
I know COVID-19 has changed so many things for all of us. It has been inescapable. And I want you to know, Ray always had an uphill battle with regular seizures, aggressive behaviors afterward, and some mental redundancy, but HE WAS HAPPY for years at Signature HealthCARE. I often asked him ‘Ray, do you want to go home? Back where we grew up?” And he would say, “Gosh, Joe, that was a nice offer, but I am home!” This always gave me peace of mind and an understanding that it takes an extended family and specialized expertise, that many of us do not possess, to have great healthcare.
When they called to say he passed in the middle of the night, I finally got to see him. He was already gone so there were no goodbyes and sitting next to his already deceased body, I just cried because he died feeling alone in the end. Ray never had COVID-19, but I think some of it could have been very different without so much change and chaos circling around him, and the other 1.4 million long-term customers in our nation today. I don’t want to get political, but post-acute care residents, their families, and the heroes that serve them have taken the brunt of the COVID-19 devastation. It has emotionally crushed so many families, like mine, and pushed our caregivers to the brink of exhaustion, physically and mentally, with no end in sight.

Today, we all know Ray is in a better place. He had a challenging life that he chose to live with grace, joy, and kindness, but I hated how it all ended and wonder, did we do enough? At his funeral services, we celebrated him with great stories and watched his videos where he seemed happier than most of us who loved him, knowing he inspired us all!

In closing, we want to thank every Signature HealthCARE caregiver, Signature leader, and Ray’s favorite care partner Debra, who helped him along his journey. Knowing that all of you gave him parts of his life back that he lost a long time ago, and we didn’t think was possible to regain, we appreciate you more than words can say!

Finally in the Black Hole in Oakland County Stadium

Anyone who knows me will tell you I have been a crazy Raiders fan since the 3rd grade, my only football team during good times and bad. Being a left-handed quarterback in our neighborhood street football games, who else could I have loved except Kenny Stabler?

I have everything Raiders in my basement, I see them every chance I get, and bought one of the first personal seat licenses in the new Las Vegas stadium on the night they opened the lottery. The lady said, “you are our only Kentucky customer so far!” This might make me Kentucky’s biggest Raiders fan!

Back in the 1970’s, the Raiders were one of the best professional franchises in all of sports labeled by, “The Just Win Baby” and “Commitment to Excellence” – all part of the epic founder, Al Davis, folklore. Davis, the beatnik owner who was a mysterious football guru who never followed status quo and seemed to defy conventional wisdom year after year.

Honestly, at 8 years old, it was Stabler initially but then it was the colors– black and silver; the colorful coach, John Madden, storming the sidelines in short sleeve shirts in the snow, and it was the culture to just win at nearly all costs that had me never miss a game on TV forever. And their Monday Night Football winning percentage record was unmatched for decades.

As a young boy, having your team be led by a vocal owner you could almost touch, players perceived as a bunch of unlawful bandits wearing mat black and pushing boundaries the entire game, plus the craziest fans of all time dressed in pirate customs and face paint filling up your TV screen – how could you not like them?

Being a Raiders fan in the late 70’s and through late 80’s, were some of my best childhood memories any fan could ever experience. I cried myself to sleep after the Immaculate Reception against the Steel Curtain, danced in my basement after the first Super Bowl win against the Purple People Eaters. I watched second chance Plunkett shock the league with an epic performance in Super Bowl XV, drank at my first Super Bowl party when Allen slaughtered the Hogs and all the way through until the tragic injury to Bo Jackson that seemed to end our amazing run. It has never been the same since!

Al Davis became out of touch as he aged and had constant coaching changes demanded by him to win tomorrow. There was undisciplined football by rogue players, constant threats to move the team, and a weak organizational management team underneath the mercurial owner that seemed to taint the black and silver.

There were decades when opposing teams feared coming to town because they were going to witness the craziest home fans anywhere in the world. But the two-decade decline took a toll on the franchise and fans today just see a crazy fan base and don’t fear the Silver and Black as they once did. Outside of the Gruden, Gannon, Brown run to a blowout Super Bowl loss, it has been continuous tough times.

However, when you are a true fan of any team you love the bad times because it thins the fan base, tests the loyalty of the fringe fans, and makes you hold on to the amazing memories that defined your childhood.

For all of us who are part of Raider Nation, this year is still a sad one because it is the bitter end for our Oakland historic roots, so everyone is rushing to the Oakland-Alameda County Coliseum (that is sadly shared with the A’s) to cheer like never before because we move to glitzy Las Vegas next year.

A few weeks back, when I realized our GLI Glide Trip would take us out to San Francisco, Silicon Valley, and Wine Country, I had to sneak away one night because it was Monday Night Football, Opening Night, in Oakland verses the Denver Broncos, and it was time to enter the BLACK HOLE even if it was by myself because this is the END.

If you want to make your own pilgrimage, go to StubHub and pick the section called the BLACK HOLE. I found one ticket still for sale, row 7, near the end of the row and a childhood dream was finally coming true!

On this night we cheered from the parking lot while tailgating with chants, the whole way entering the gates, and never even sat down once as we played masterfully this night picking the Broncos apart with Derek Carr looking like a right-handed Kenny Stabler. Prior to this night, I watched the Raiders on TV for 45 years and was envious every time of the true fans covering my TV screen that created the BLACK AND SILVER culture, and I finally got the chance to be one of them.

You can definitely go alone but you will leave with dozens of new friends from all walks of life. I hugged and high-fived everybody I met in my section, becoming one of them. My old teenage envy turned into true joy because, finally, I was home on Monday Night Football and a childhood dream came true!

Vegas may be the greatest football stadium ever built, and I will be there whenever I can make it out there, but it will never be the Oakland Raiders County Coliseum BLACK HOLE ever again where the football grit, the renegades, the regular people dress up like it’s Halloween and cheer like it is life and death for four hours!

This is your last chance to see it, make the journey, be part of history, go alone if you must, but please go!

Celebrating David Jones

Dear Mr. Jones,

I wanted to thank you one more time for everything you did for me when we were in South Florida trying to discern where the Signature Revolution should relocate to – between Nashville, Orlando, and Louisville.

It was a hard decision for me and our entire organization and many did not reach out like I hoped but you definitely did. When you called me, each time telling me why Louisville would be the best place for Signature HealthCARE, you were right. Our talks about how we could do more here than any other city held true!

Your advice was invaluable to our final decision and all that has transpired since. In that relocation process you promised me that you would meet with me regularly to be my mentor, to help me grow as a person, and help Signature navigate the complicated healthcare landscape.

The mentoring sessions were the ‘best one-hour sessions’ I ever had with anyone. You always started each session with a discussion on how to lead with integrity and faith.

I remember when you pulled your own “personal Peter Drucker notes” to show me management principles to implement into the Revolution that you knew we needed. And we put them all to good use.

The other sessions where you would go into your archives and show me your market segmentation notes from yours and Wendall’s prior working sessions decades back, helped Signature greatly see other ways to operate the organization.

Every complicated question I ever asked you, I was secretly hoping one time I might stump you, but that never happened because you always had the perfect answer that sometimes I had to unpack later.

The private discussions where you gave me personal advice about life resonated often in my own challenges, but they always held true. You were never easy on me, which made me re-examine closely held beliefs either way, so I knew where I stood.

Thank you for sharing your life principles with me every time on “how to live a meaningful faith-led happy life.” They are the true foundation to our optimal state here while we serve others. They are sometimes challenging to live by, but they helped me greatly even in my darkest hour.

I think what I loved most was that we always closed each session with a prayer just to remind both of us who was really in charge anyway.

My admiration started a very long time ago. When I was a very young entrepreneur struggling to try to find my way, you were the gold standard to me and hundreds of others around our great city. We thank you for making us all think bigger than ourselves, which we all needed, or we would have never found the path.

Your great impact on me was just one small thing you did of the thousands and thousands of great deeds because you did so much for everyone that ever asked for your help. In my opinion, your generosity and humility are unmatched!

As the whole city grieves today, and I know my thank you note is just one of a million, we all want you and your family to know how grateful we all feel about your relationship with all of us.

Lastly, I needed to remember what you said often about everyone being more Jeffersonian and giving back to your community at all times. We can still see you and feel your presence everywhere we look.

Thank you, Mr. Jones, for teaching us all how to “pay it forward” and inspire all of us to try to be the best our version of ourselves!

Love you,

Joe Steier

Why we should celebrate Lee Iacocca this July 4th!

From the first time I saw a Ford Mustang I knew I found my car. I remember seeing it in my favorite movie scenes in “Bullet,” “Diamonds are Forever,” and “The Thomas Crown Affair” where I felt my first irrational urgency to someday get one. The emotional attachments for me were the sleek lines, the vibrant colors, and the convertible tops, but at my childhood home the link was something much bigger!

At Elmer Steier’s (my father) house it was about the American innovation behind it, led by Mr. Lee Iacocca, that made the car a dinner table topic at the Steier household. It was Mr. Iacocca who personally moved inside the Ford plant to create the iconic example of rapid engineering speed as a symbol of an American comeback at a time we needed to make a statement that inspired our conversations about that special car. Growing up as a son of an active labor union leader and former bricklayer who pushed BUY AMERICAN at an almost religious level like our Catholic roots, Mr. Iacocca was the first executive I remember being mentioned at the dinner table!

At this time, I remember that foreign-made cars were not allowed to be parked in our driveway no matter who was the driver, which tells you how much my Dad believed in American protectionism versus a global economy that we live in today.

After the first recession during the Carter administration, I remember the impact it had on our blue-collar neighborhood. My father became deeply concerned with the rise of foreign car companies coupled with the arrogance of the U.S. auto industry making inferior products and he often predicted a future downfall for the massive industry. Even as an active union organizer, he respected great leadership, knew organizations needed excellent management, and knew that sacred balance was needed between all vested parties to make anything a huge success!

Besides creating the famed Mustang, Mr. Iacocca turned around the entire Ford Motor Company and then also the Chrysler Company years later, which are staple reminders that we invented an auto industry that still thrives today, drives our Louisville economy, and a lot of our Kentucky regions are still dependent on the success of it.

At one time, I collected old Mustang rag tops before they were traded in for four crazy kids. I once ignorantly drove a new Mustang Cobra out of a dealership floor in 1995 as a moment of irrational immediate gratification inheriting a car payment that required two jobs. Equally important, I still have the Mustang bought on my 40th birthday as a gift that has now been successfully passed onto to my daughter who gets the history of this special car!

This being our July 4th holiday season, we should all take a moment and have a toast to Lee because it is a great example of a son of first-generation immigrant parents with Italian roots making a big splash in our American life in a tangible way. We can all still be touched by it as we sit at red lights and just watch, even though Mr. Iacocca passed away yesterday at age 94.

As we watch today with dismay what is happening along the Texas border that impacts all of us deeply regardless what side of the aisle you sit on, we know we must find a better solution than the one we have now.

In all of Lee Iacocca’s interviews, he talked about how much he loved the open arms of America that were provided to his parents at a time they had no place to turn and who later operated hot dog stands in Pennsylvania. He talked and rattled off other immigrant sons and daughters making a difference at the peak of his power because he knew what they all contributed to the United States that could never happen somewhere else.

After his amazing career and how his parents were embraced, Mr. Iacocca took his personal resources and leadership skills to restore the Statue of Liberty that was decaying to show the entire world that we are a collection of hard-working people with links to pioneering immigrants and anything is possible, only in AMERICA!