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Becker’s Healthcare Podcast
Rewiring Excellence and Solving Healthcare’s Staffing Crisis with Dan Collard
00:17:57
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- [00:00]
A
This is Scott Becker with the Becker's Healthcare podcast. I'm thrilled today to be joined by one of my favorite people in healthcare. We're joined today by Dan Collard. Dan is the co founder with Quint Studer of Healthcare Plus Solutions Group. And both of them have had just brilliant careers, also brilliant writers. And, Dan, talk to us a little bit. First of all, give us the background on Healthcare Plus Solutions Group, and then let's talk about the term rewiring, rewiring excellence, and a lot more. Dan?
- [00:36]
B
Yeah, thanks, Scott, as always. Thanks for having me. You know, Quint and I got back together a couple years ago, and what we really wanted to do this time is take a much more diagnostic view of the industry. You know, as we came in out of the pandemic, we knew forever the industry had been changed. And rather than think of the path of a one size fits all, we wanted to be much more diagnostic. So if you look at any of our work today, whether it's our writing, whether it's the assessments that we've designed, we sort of walk in the path of the physician, you know, diagnose before prescribe. And that's really how I'd sum it
- [01:12]
A
up today and talk about this term rewiring and where that came from and how you see it applied in healthcare leadership, because it makes so much sense, but talk to us intuitively. It sounds like it makes so much sense, but talk about rewiring and rewiring in healthcare.
- [01:28]
B
Yeah, you know, it clearly was a bit of a play on words from the old hardwiring era. The book Hardwiring Excellence was such a seminal body of work in the industry. And when you really think about it, the notion of rewiring is really the essence of great process improvement. Very few organizations today deploy the same processes that they would have 20 years ago. And yet in some cases, we tend to be so literal in our learning in our industry. And you take rounding on staff and rounding on patients, for example. Some folks, you know, because they read it in our work all those years ago, they're still doing it the same way or even some cases in a more complicated fashion. And so we wanted to sort of take the rocks out of the backpack for folks. We wanted to lighten the load. And so the premise around rewiring today is that if whatever you're doing is working, you know, stick with it. But if you're not getting the results that you wanted to get or the results you wanted to see, maybe this rewired approach, you know, sort of right Time, right place. And what Rewired really means is we're not throwing the baby out with the bathwater, but maybe some fine tuning or tweaking of the processes. And it's just been met with such, you know, wonderful reception for folks because it really does make the day easier.
- [02:57]
A
Well, and the concept of rewiring, making some pivots, make some changes, but keeping what's working right is such welcome advice because people, like when you come to people and say you have to change everything, they're just overwhelmed. And that's daunting. And almost nobody can do that. Even though it sounds good on its face. We're going to change everything. You need to incrementally rewire and take different pieces of it. You had written originally a book called Rewiring Excellence. It's now in a second edition. What's changed or been added when we think about rewiring?
- [03:33]
B
Yeah, the original book came not from out of our heads, but by spending the time in the field looking for these rewiring opportunities. And so when we wrote the original book, we made a promise to the readers. We promised that this would genuinely be a living, breathing body of work. And when we had enough to officially make it a second edition, now that, you know, you're in the publishing business too, you know you have to create x percent of new material to officially get a second or third edition. And so we've really kept our eyes open, we really kept our ears to the ground. And this living, breathing body of work, you. We wanted to keep our promise. So the new content really isn't our content. It's what we've learned from the folks in the trenches, which is where Quint and I have always, you know, it's where we've always enjoyed being. And, you know, earlier this year, you always wonder if the work that you're doing has an impact. You never want to believe your own press. And we got some really neat news earlier this year. American College of Healthcare Executives has an annual award that they call the James Hamilton Award, and it's essentially their book of the year. And we got some news earlier in January that Rewiring Second Edition is the recipient of the James Hamilton Annual Book Award by Ache. So when we're in Congress in Houston in a couple weeks, we'll have a chance to receive that award not on behalf of ourselves, but on behalf of all the folks that we continue to learn from in the field, which is really where the book came from.
- [05:10]
A
Well, one of the beauties of yourself and Quint is you're two of the most gracious people ever who are able to keep the ego at the door. So it really does feel very sincerely about others and the lessons you're learning in the field and what you're seeing from people and in the trenches. Take one moment, Dan, when we talk about rewiring and some of the newer thoughts that have come into the second edition. Do any examples or thoughts that come top of mind to you of things that particularly of our interest to you as you, as you look at this next edition and also just at as you've come back to this so fully this next time around with you and Quint, what are some of the new lessons you've or new observations?
- [05:52]
B
Yeah, you know, let's take the three top issues in healthcare today. Staffing, staffing and staffing. You know, as we think of workforce challenges in healthcare, there are very few organizations that have really cracked the code. And we often joke we get so good at talent selection because we're not so good at talent retention. So we have to always use the talent selection muscle because we don't tend to retain as well as we should. And so there are some really neat new things in the book about specific tools and tactics that are incredibly easy to deploy relative to retention. And so most organizations, Scott, you know, we'll take a look at less than one year turnover in the post acute world, sometimes even less than 90 day turnover here before they see the churn. So we wanted to bring forth a couple of really quick tips, a couple of nuggets that if you read the book, you could go back and do it tomorrow. And I'll give you a couple of examples. We have a colleague named Abby Spence who runs a skilled nursing facility over in Tennessee. And when Abby first came to one of our sessions and learned about this, she went back to her skilled nursing facility and her big pain point was less than 90 day turnover. So she deployed not all 10 of the tools, but just two of them. One of them was an element of what we call emotional onboarding. How do you begin to bring people into the organization emotionally, sometimes even before the first day that they're there? How do you invite them into the organization? The second's a really neat tool called the personal retention Tool plan. And it's sort of the perfect illustration of rewiring. You know, for years we've coached once you hire someone, it's very valuable to have a conversation with them at 30 days and then at 90 days. Well, the problem is in some organizations, they're not there for the 90th day. And so what if we could create a day one conversation so in the book and on our website you can get it for free Is is a really cool tool called the personal retention plan. And what it does is it takes the concept of retention and it completely personalizes it down to the individual. So if I have that conversation with you on day one, then for the next several months when we run into each other, when I'm rounding on you, I actually already know the answers to the test. I know what brought you here and I know what'll keep you here. Abby put those into play in July and by December when I had her on one of my podcasts, she had actually reduced her less than 90 day turnover through 37%. And of course we all know that's real money and its real impact on clinical outcomes as well.
- [08:41]
A
Oh, it's real, real money. It's real stress reduction. It's better continuity on a million levels. And tika, when you look at the under 90 turnover, a large percentage of that is at the sort of what is almost a transitory part of the workforce, which you don't want to be transitory, which you want to be more long term in part of the institution vers in and out and see if you could fix that. And I take it their stats on once somebody says for 90 days, 120s, 180 days, there's probably a much greater chance that they stay for two, three, four years. And your point on emotional engagement early is so important because if the engagement is you got your paycheck in two weeks but you didn't really connect with them, be at work, you didn't really feel at home at work then, then it's, it's, it's probably very hard for people to feel like this is an environment they could thrive in and be a part of and stay comfortable in while they're taken care of and they take it. That workforce that turns over that much has so many other stresses in life that trying to make it is get performance and trying to make people comfortable is so, so important to longevity in those positions.
- [09:48]
B
Yeah, there's a brand new piece of research that just came out that's very strong evidence that says basically as an employer you've got 44 days. The evidence in this body of research said people may were making up their mind as to whether or not this was a good decision to come work here in 44 days. And, and so that window of time to reduce the transitory nature of our workforce has narrowed even more. And, and so if we can just give leaders one or two things to do instead of bringing in a whole new change management effort for them to try to, you know, absorb and then put into their everyday work, when they've got all this other stuff going on, we just find that it's doable. And I was just talking with Abby the other day because we're always concerned about sustainability and it was kind of cute. She was just named the skilled nursing facility CEO of the year for her region. And a lot of it had to do with what she had done in meeting the workforce challenges. And she said her job. Now this is kind of neat when you think about it. Her job has gotten so much better because she's experiencing less churn in all of her team. And if you can do it in a post acute facility, you can just about do it anywhere.
- [11:08]
A
No, it's simply remarkable. And that's so important because right there, that one thought, hey, I better be really attentive those first 45 days. I can't let people float through because they'll have already made their decision after 45 days that this isn't the right fit for me. If they're not embraced, they don't feel comfortable, they don't feel it's a place they could thrive or at least live while they're taking care of the rest of their life and so forth. I love that this is your second edition of Rewiring. You and Quint have had tremendous success with this line of thinking. You've really built companies around it, quite frankly, because it's so, so important. What is so attractive to leaders about this concept? And I heard a lot of it when you started off, so I grasped why it's so popular. It makes so much sense, you know, when change management can be so tough sometimes, when. Why does this work so well and why hasn't it been so impactful? I mean, people, you know, you know this. You go throughout the country and people preach the gospel of Quint and Dan and what you folks have done. So talk about why this is so impactful and why this is so attractive to leaders.
- [12:12]
B
Well, I think it's just a truth. I feel health care leaders are genuinely more busy than they've ever been. They're busier than they've ever been in this industry. So anything new that we bring needs to be doable. And doable is a word that we've sort of also landed on. Because if it's not doable, folks just keep looking for the next shiny new object. Secondly, the Idea that we're not making large scale change in this body of work versus fine tuning, tweaking, you know, iterative change there. It just makes sense to leaders. So if you take the average leader today, whether they're clinical or non clinical, they've got all these headwinds coming at them and large changes can just seem daunting. I'm going to throw the towel in on day one. But if we can bring them things that are iterative, they're essentially, you know, how do you eat a cookie a bite at a time? We just find that the acceptance rate and then quite frankly the success rate
- [13:11]
A
follows like that, you know, and I love that it's something we talk about in technology all the time. If the user experience is easy, people are much more likely to use the technology and really optimize it. It's very similar to what you're talking about. If AIP can come to work and make a couple minor changes. Oh, I really got to focus on the first 45 days. I really got to have an early discussion on personal retention plan and that it's a priority. We want you to be here for the long run. We don't want you in the door. We want you over the long run and just make some. Not huge changes that are exhausting and daunting, but small changes that could have a big impact. That's what we're all looking for, isn't it? Small changes that could have a big impact that you could leverage significantly. You have a conference coming up on Rewiring Health Care, the Foundation to the Future. Tell us a bit about that.
- [14:02]
B
Well, you know, again, it's a message we've heard from the field. We've been asked by our partner organizations, folks that we've worked with over the course of time, when are you going to bring back your conference? Because you know, at the height of our previous work, we were doing about 15, 16 conferences a year and my gosh, you know what it's like to put conferences on. And what we always realized is it was less about them coming to see us on stage nearly as much as we had a they, they came to be around like minded, like hearted leaders all in the same room. Just the fact that you could, could sit next to somebody you'd never met before in your life and you were still pursuing the same, you know, line of success there. We were all looking to get better. So when folks asked us to bring our conferences back, we heard the same thing. They said we just want to be in the same room with people like us. And we also know that, you know, those kinds of dollars are tighter than ever. You know, the headwinds on the expense structure in healthcare means that discretionary spending comes under greater scrutiny than ever before. So as we've done with the new organization, we didn't want to let money get in the way. So we decided to not create a conference that would be a massive revenue stream, but create a conference that would, number one, be affordable. Number two, it's not just Dan and Quint on the stage, it's our entire team bringing our body of work to the stage there as well. And each segment of the conference has a little bit of that rewiring. We have a colleague, Regina Shoup, who we've known for years. Just, we just published her new book, Rewiring the Emergency Department. So when Regina's on stage a couple of times during the conference, she's going to talk about what's an emergency department need to look like in 2026. And so there will be not just the theory that we bring to the conference, but folks that come will be able to stick a couple of things in their hip pocket and take it back and use it the next day.
- [16:07]
A
Dan, it's remarkable what you do and how you do it. I, I'm always struck by the incredible sincerity and grace that you and Quint handle yourself with and your entire team, I should say it's really remarkable. I love this concept of rewiring excellence and, and I love the concept of, look, it's about, I, I, I use the word user experience and it's now so much because it's so important in the technology world, the health care with everything. But this idea of we're providing guidance that doesn't take a tremendous amount of work to start putting to use that people could use it. And then of course it builds on itself because people love that if they're seeing results, it's so much easier to keep on going and without it being daunted. Dan Coward. We love what you do. When is the conference? When is the first conference? The Wewiring Excellence Conference?
- [16:56]
B
Yeah, the conference is going to be April 28th and 29th. We put all of our thought into this. Number one, it's just a day and a half because a lot of times when it's a full two day conference, folks start cutting out to catch their flights, you know, towards the end of the day. So it's a day and a half. April 28th, 29th. It's also incredibly convenient. We're having it in Atlanta at one of the venues that's right there on the campus of the Atlanta airport. So you don't even have to grab an Uber or a car or anything. You come to the airport and you grab the shuttle like you're going to the rental car location. About halfway there is what they call the Gateway Conference center. And it's at the Atlanta Gateway Marriott.
- [17:34]
A
Phenomenal again, again. Dan Coward is with us today, one of the co founders of Healthcare Plus Solutions Group, also the author of Rewiring Excellence, now in its second edition. Dan, I'm so thankful for you joining us. It's always great to visit with you. You're the best. Thank you so much for joining us.
- [17:51]
B
Yeah, likewise, Scott. Thanks.