Ep. 14: Compensation - The ONLY Known Way to World-Class! (Pt. 2 of 4)
Creating the perfect company from the organizational experts MultiView Incorporated. This content is based on NBI's work with over 1,300 organizations extracting nine eighty nine data elements with nine twenty two cross calculations over twenty seven years on a monthly basis and then systematizing the operational success patterns of the ninetieth percentile. Our intent is to get beyond the brag and the boast and simply share insights from our experience without manipulation or coercion to sell anything except helpful ideas. These messages range from intimate recordings from the Awakened Forest to concerts, national conferences, and broadcasts.
Speaker 2:Again, to me, compensation is one of the most fascinating subjects really that there is, as it directly correlated to an understanding, again, of human behavior. And again, for those that say that accountability or empowerment compensation or performance systems even do not work, Normally, this comes from a lot of academics. And I don't have anything against academics and all that, but I just know that sometimes people aren't living in really the real world and sometimes they're just trying to sell a book or whatever. And all I know is that I've hired three, a couple were heads of business at their college or university and I put them in charge of hospice because I've hired a lot of people to run hospices and, you know, over the years. And all I know is there's a big difference between theorizing how to run a country.
Speaker 2:It's a third wave information society, and we're do it like this and, you know, it's a big difference between that and and actually spilling blood. Getting rid of that employee that's been with you for twenty six years or wiping out that whole division. Those are the decisions that have to be made. Often brutal ones or things that just have to be done. But so the point is, so a person could just find a way to justify not doing it, but yet the evidence is all around us that, again, there's a directional correctness.
Speaker 2:The human animal, I'm not going to go into that too much. Again, it's just more of kind of the reality thing and there was a lot more of that in some of the other programs like people development. We really kind of go into what we are and how we learn and all that. Even being logical about this, let's just apply logic to to this idea. What is the number one cost in in running a hospice or a home care entity?
Speaker 2:Labor. Well and that involves payroll. So why would you not address it? I mean, 60 to 65% of organizations' costs come from there. Okay.
Speaker 2:The fact that people get paid, behave the way they're paid. And virtually all high performing organizations use financial compensation to get, the behaviors and the performance that that they want. So, yeah, that's just the the facts. Okay. If it's okay, let's go ahead and take a five minute break.
Speaker 2:And, actually, let's make it, four minutes and fifty eight seconds, not to be anal retentive. And, oh, by the way, is hyphenated? And we'll get into more of this. Welcome back, everybody. And just so we know, I don't know exactly when we'll wrap up.
Speaker 2:Again, kind of the booking on this is 06:00, but we may be done before that. Like I said, when you get into details, wanna make sure I I cover it, you know, adequately. And also, was gonna say as the vaccine gets out there more, we will be having more things live and and because sometimes there's just no substitute, you know, for that. So let's look at the relationship for the modern organization between revenue and expense. Okay?
Speaker 2:And then your hymnal again is on page 31. A typical organization is structured like this. You have your expenses, but then you have fluctuations of revenue or patient volume in the case of a hospice or or a home health. And so it goes up and down. So when census is high, we're making money.
Speaker 2:When census is low, we're losing money. And because expenses are not fluctuating with revenue. Now I'll just say this. If someone says we're making money because census is up or we're losing money because census is down, that takes no talent to do. No talent.
Speaker 2:Just like if your financial guy says, Well, the stock market's up. You're making money. Well, the stock market's down. You're losing money. You know, fire his ass because you want someone that's making money in whatever direction you're going in if you can.
Speaker 2:Okay. Compare it with this other graph where you have the fluctuations of patient volume or revenue going up and down And could you structure your expenses to go up and down in relation so that when census is high, you're making 12% profit. That's what we suggest in the model. And when census is low, you're making 12% profit. Could you do that?
Speaker 2:Well, of course you could. Of course you could. And because when you really analyze a hospice or a home care organization, again, 60 to 65% of costs are labor. Can they be structured like that? Certainly.
Speaker 2:Patient related are, you know, 16 to 18 or so. So those automatically go up and down. And then you have all these right there, you're you're around 80%. And then you can structure all other or many other contracts around that because people want your business, and you can say, hey, can you work with me like this? And you'll be surprised, how many costs, maybe 90%, you can get like this, and you can go, well, Andrew, you know, you have fixed and variable and all that.
Speaker 2:The point is there's lot lots of costs that you can make much more variable. And and costs are largely structural. That is they can be designed. So you can design your company, And your payroll is your your big one. Okay.
Speaker 2:And, you know, the question is if I if I was doing this, I would say, does this work? Okay. We've already indicated, just with all these hospices where it's worked for, does performance based compensation work? Well, again, at my very first hospice, I saw the hospice ad. I answered it and Deborah approached me because we were having some issues with productivity and documentation.
Speaker 2:Same stuff we have today. Said, Andrew, you used to, work for a compensation company because I did like 38 companies comp systems before I ever, came to hospice. And she says, yes. I did, Deborah. Well, I need one.
Speaker 2:We need and I said, well, I I've never did a hospice. I I don't know how to well, I need one in two weeks. Well, anyway, I just went to work, and and that time, I was very much into activity based costing system because that's one thing about MultiView. We can we can get to your costs by diagnosis, by lung cancer, by patient type, by referral source. We can give you all these advanced cost views.
Speaker 2:Most hospices aren't interested in that, but we can get you that stuff. But that led me I knew how to do that really well and I'd done because we'd done it with, you know, factories and textile mills and country clubs and I thought, well, how can I do a hospice? And the point is you can only do what you know at a time. Nothing else could be expected of someone. So I designed an activity based compensation system, like an ABC system.
Speaker 2:So basically, all clinicians, you know, depending on their discipline, get x amount for doing a visit. They get x amount of money for coming to meetings and it's completely based on the amount of activity. And so we just got rid of hourly where we could. We didn't put our aids on this kind of system or on a per visit system and all that. And that's the way we rolled.
Speaker 2:And what happened? We had a 100% increase in productivity for all disciplines, again, except for our spiritual people because we just had two that said, man, I can't reconcile this. And then two that said, again, I'll take your words if you don't want them. You know, and so only a 50%. And then we had all kinds of other, I'll say, unanticipated consequences which you'll get with any comp system that you put in.
Speaker 2:I mean, for example, our documentation, of course, went to perfect. Perfect meaning, again, the standards of the organization because we needed it in on time. It needed to be legible. It needed to be show show this. And because before people were stockpiling their their their notes and all that and we weren't getting it.
Speaker 2:You couldn't read it and just all these issues. And I burnt a good number or a few, I should say, two home health nurses early on. You've got to be able to do that where people actually feel the sting if they're not doing the standards. And suddenly that word gets all around, hey, they're serious about this. And, so we had a 100% increase in productivity.
Speaker 2:Our documentation, again, went to standard. And then we, for example, we had lines of people outside of admissions. Hover as we used to call them because they'd say, hey, do you have any new patients? I could really use one or two more. Now, how many hospices does that happen?
Speaker 2:Think about the way they're paid. They only want a new patient. Or in this system, I mean, they wanted IDT time shrank. People, they put away, you know, sometimes an IDT can be the cure for insomnia, right? And people actually put away their Cosmo or Bill, in your case, Field and Stream, and they really focused on what they you know, what do I really need to know about this patient to have an interdisciplinary thing?
Speaker 2:And so you had all all these things. And anyway and then I was asked because it worked so well, I was asked to speak at NHPCO. This is the first time. Again, I'm just a snot nosed kid in the hospice as ever asked to speak. And so I prepared my little presentation and I got there and explained it and people hated it.
Speaker 2:I mean, people would heck start heckling, like and that's where I kinda I mean, I felt like like Satan, you know, like, you know, like, this is this guy is destroying the holiness of the hospice movement. So, if you wonder why I wear black, just know that I have issues. But that's what your peer group will do to you. And then there are a few hospices that I remember a great big for profit said, Man, we want to know more. So, they put it in and had just tremendous success.
Speaker 2:You know, just by what mimicking the same pattern. And by the way, I'm not gonna tell you to do it like that. We're not gonna use an activity based approach, but that one works. There are multiple ways. We're gonna go through a certain way, but it's not like you can't do some things a little different.
Speaker 2:In fact, everybody's gonna do it a little bit different. But if you do use what we're recommending here, you will avoid a lot of potholes and indigestion. Not that there's tremendous amounts anyway, but most of it's just fear. And once you go, oh, this isn't gonna be so bad, and you get past that point, then it's like, well, why didn't we do this like ten years ago? So, there is that.
Speaker 2:So, we want to create this natural self regulating system of mutual performance where all parts of the organization, if we're designing this thing, where all the parts from your clinical operations, this is the way they work and this is how they're supported by IT and HR and finance and all these pieces will work together with a well conceived compensation system. Okay. And just to go through a few other things, I'll hit this pretty quickly, just quick payoffs, and then we're going to get into rollout. Why not pay people well, first of all? When here we are in the hospice world and all the benchmarking and measurement and Medicare, everybody said there's craploads of money, Craploads of money, but yet there are a lot of organizations that have poverty mentality.
Speaker 2:Oh, we can't make it. Oh, community help us out. They're, you know, we're kinda in Pooresville. And and that's just not true. It's just it's down to management and managing well.
Speaker 2:So why not just manage well and pay people well? And and I'll I'll say this several times. Again, the formula is less people paid well. The higher your quality goes, less people you need. And it means you can do this pay people, spread it around.
Speaker 2:Okay. And the point is people are doing it all over the place, you know, and and doing well. Okay. If your company is winning, why not share the gains? Okay.
Speaker 2:If you achieve this. And also people want a piece of a winning organization. It helps really bind people together. And most people want to make more than they currently make when you really get down to it. There's there's a feeling of progress there.
Speaker 2:And, that that's that's the truth. Obsessively talented people. Talented people tend to be motivated and, you know, they want to advance. Okay. The other thing about a comp and just a few other, payoffs, and let's go to page, 36, is of this type of compensation system is that there's an increase in confidence.
Speaker 2:Okay, when people, when every paycheck informs them of whether they're doing the standards or not doing the standards and they realize they can do the standards, every day with confidence and delight people. I'll just say this, especially when people know they're well trained and all that. There's a confidence that surges in people that I am well trained and I am rewarded for this. And in fact, I'm willing to bet on myself. I'm willing to bet on my hospice that I work for or home care organization.
Speaker 2:I'm willing to bet on that. And I don't need just some flat salary or hourly rate to make that happen. I'm I like having some control. So if my kid needs braces, I can do something about it. Or if I want to slack off a little bit and make a little less, that's an option I have.
Speaker 2:But I realize that if I want more, I've got to put more wood in the snow. I can't just say, Hey, you know, like the person with an empty sow is like, give me heat and wonder why it's not working. Because that's the way the world works. Again, it's a meritocracy. You gotta put in the wood.
Speaker 2:You gotta go out and get the worm. And that's a just system. Okay. So, confidence is one of the things that is built by the system. And what do we know about confidence?
Speaker 2:Unconfident people provide unconfident care. And because you can only give what you have. So you want to build build confidence, and the compensation system does a great job of doing that. You also wanna use the compensation system to smoke out people that lack confidence. I remember at one hospice, I mean, I watched a gal just just blow up in front of me, you know.
Speaker 2:It's like, you gotta be kidding me that I'm gonna I think it's a volunteer coordinator. You know? You gotta be kidding me that I'm gonna be paid for, like, how many volunteer hours you're producing? Yeah. Oh, man.
Speaker 2:It I really have to get out and do it. Right. I'm glad you had that revelation. Again, we want people that want to bet on themselves and the organization. And people want a fair system.
Speaker 2:Right? Okay. And I'll just say this. It's better to have less people that are talented than more people that are mediocre. And too many organizations will settle with for mediocre people and they say, well, we can't attract good people.
Speaker 2:Well, it's kind of this vicious cycle. You know, we can't pay them. We can't get good people. We're not attract you know, whereas if you start to dedicate yourself to quality, you need less people and that money is there. And it's just easier to manage less people than more.
Speaker 2:And by the way, managing talented people because they own their lives, because they understand accountability, because they understand personal ownership and aren't going to play the victim card and live in a world of excuse, they are easier to manage. All this stuff works together. So the formula, again, less people paid well. Okay, here's an important point and we'll hit this later on as well when we're going through some of the details of the mechanics of the system on page 41. Your clinical leader or clinical managers have to be one of your primary focuses.
Speaker 2:Right now, probably a lot of you are defaulting to thinking about frontline clinicians in the comp system. That's just a natural thing. I'm not Okay. But that is not where your primary concern is. Your primary concern is really your clinical managers or clinical leaders.
Speaker 2:Why? Because they're the replicators. Because, again, 70% of the development, 70% of the morale, 70% of the retention is gonna come from that relationship of the manager and the employee. That's the and so you can't afford to lose talented clinical managers. Or if you get a bad one, they're gonna replicate bad or whatever they become, lazy.
Speaker 2:I mean, a slow leader is gonna be a have a slow team. A speedy leader is gonna have a speedy team. It's just a sloppy leader is gonna have a sloppy Okay. So that that replication, that so that's one of the primary things you don't want to lose sight of. Certainly, we want to be thinking about our frontline clinicians, but we definitely want to focus on that.
Speaker 2:And through the compensation system, we can remove four of the major downers or negative aspects of managing. You and without having the compensation system, it comes down to hard ass, big boots, kick people in place, make sure people are doing their job, very unattractive. But when the compensation system or your systems, including your financial system and your EMR are sensitized to detect the deviations from your standards, suddenly you can remove from the job description of the clinical manager or clinic leader the need for them to monitor documentation. They don't have to do that anymore. The system's doing it for me and informs me if someone's out.
Speaker 2:I don't have to monitor productivity. The system does it. Or do annual reviews because if people weren't, you know, maybe you have to do it for Jayco but it's more like, hey, attaboy attagirl because you're doing the standards. You're doing the job because if you weren't, the system would have fired you. So even the need to fire people can be handled by the system.
Speaker 2:So we're removing the negative aspects of the job to free up time for people to do the first duty, the first duty of a manager which is to teach and coach. Let me do a ride along. And, of course, everyone gets at least one ride along every sixty days. Do you think any you don't want to say anything on the sixty day ride along? Because some hospices, they just I I just when I say that, they just go, woah.
Speaker 2:Whereas we we just think it's a matter of course because I know at some hospices, they're lucky if they get one a year.
Speaker 3:If if that and when you when you walk into a hospice that's not, let's call it dysfunctional, they are out there. One in sixty days, that's the goal. When everything's clicking, one in sixty days. But when you walk into a seriously dysfunctional hospice, they're going to need a little bit more than that. Had one talk to me just last week.
Speaker 3:I was with one last week and the clinical manager told me how many ride alongs she'd done in January. I said, how did that go? And she paused and she looked at me said, enlightening.
Speaker 2:Well, that's that's probably an enlightened person.
Speaker 3:Yes.
Speaker 2:Yes. You know, especially because, again, it's how you look at it. Okay. And that so anyway, so this is a big thing. So we wanna definitely keep in mind that clinical managers were designing the comp systems.
Speaker 2:This is kind of a big thing. 42, you wanna bring your people as close to revenue as possible in all situations, you know, and some positions frankly are just easier to do like that. Like, you know, marketing people. You you know, what kind of sales they have. Of course, in hospice, there's all kinds of regulations, and you have to do kind of fancy smancy here.
Speaker 2:We'll talk about that later too. But it's bad business not to have, not to have your people have skin in the game and to roll the dice with other people's chips. I always think of of the investor that's, you know, they take your money and it's like, whoop, didn't mean to lose it there. Didn't mean to put it in the horse farm or get that stock. And that's the way most of them are.
Speaker 2:If they lose your money, that's your response because they weren't betting their money. And so, there's a lack of accountability. I've had situations with investors where I make them sign a contract where they have to have their investments in the same thing as me. And so, if I lose, they're bleeding out. That's accountability.
Speaker 2:So, anyway, we want to personalize profit and all that. And also recognizing that the compensation system is key in our ability to attract talent or attract people and retain them over the long rung. We want renters rather than or owners rather than renters. Okay. Okay.
Speaker 2:Just a few other, quick things. No matter just recognizing this. No matter how well you pay people, they will leave if they don't feel their work is important. And that's especially true in hospice work. People deeply want to believe that their work has meaning and is significant.
Speaker 2:People would rather have a crappy job working for a great manager than a great job working for a crappy manager. I mean, I'll just tell I mean, this people have illusions or some just disillusional thinking and and those last two slides really kinda hit that because sometimes great pay is not gonna make a great worker. And all I know is I've worked with this statement. I I was I had this one hospice that every month was paying me just this great amount of money, and they were doing the model, and it took them from insolvency basically to to just rock star financials and quality and all that. And then they started not to do the model.
Speaker 2:They kind of got interested in another direction and it all started to go like this. But they still liked having me around or in the letterhead or whatever just because of whatever, but they weren't doing it and I recognized that and I basically quit because at a certain point, if you're not really doing the model the way we used to or we're going to do this other thing, then I don't really want to be associated. And you'll find that with a lot of people, especially relatively talented people. They just want to be aligned with something that's excellent and where they feel like they're contributing despite how much money you're paying them. And you wanna create a lifestyle, you know, for for your people.
Speaker 2:Okay. The loss of talented people, this has to do with retention, is the number one destroyer of value. So you wanna take care of your people. The other thing here is just to recognize that the compensation system must teach. That is every paycheck that we get says whether I'm doing my job or I'm not doing my job.
Speaker 2:So that means it can go either up, but it also can go the other way that would inform, the employee without the need for a manager to have to point it out that they're, you know, not doing their job. Anyway, there in fact, again, if we're really doing the model, the model is what? You don't as a hospice or a home care organization, we don't want you to see yourself as a quote provider of care. You're a teaching organization first and foremost, guiding people through an experience which we are most familiar with. Not enabling or disabling people, you know, by, hey, making them dependent upon us, but actually making them the caregiver or the facility able to take care of that patient immediately without a presence of hospice staff.
Speaker 2:That's what hospice was designed to do. Hospice was never designed where we do the care. And this is something that's been lost as we've gotten more stiff and professional and we just have gotten these ridiculous ideas. It was never designed. We are there to help others or the caregivers provide the care.
Speaker 2:And we get into that when we talk about the perfect visit and all that. So we're not paying you to do the care. This is what you want to say to clinicians. We're paying you to teach caregivers how to provide the care. Okay.
Speaker 2:A couple other things. No matter how much you pay a poor worker, it will not make a poor worker a good worker. Okay. Here's another one. When you pay people too much or overcompensate, most often they won't they won't even appreciate it, and you'll actually damage them.
Speaker 2:If you pay people too much for for what they're doing, you'll actually hurt them. Okay. Undeserved compensation destroys a company in many ways from wasted resources to demotivation of the motivated. Because and the underlying thing is the person goes, oh, they're paying me all this and I'm not really worth it. Oh, there's a sense of guilt that's building up within me.
Speaker 2:Oh, it's eating up my soul. Undeserved. Okay. Let's get into the overview. By the way, there's a bunch more, of the philosophical explanation behind the composition you can go through on your own.
Speaker 2:I'm not going to go through it, how much is enough and stuff, but it is pretty good stuff. So let's go to page 70. This is basically the overview of the system. So now we're starting to get into some of the mechanics and including the rollout and all that. Okay.
Speaker 2:What you're trying to achieve with the compensation system, I think, three primary things. First of all, you want to create a condition or environment, work environment, where people can self regulate. So self regulation because you want the system that continually teaches employees how to self regulate. So they will need very little supervision to do 100% of the standards of the organization on a day to day basis. That's what you're going for.
Speaker 2:Makes sense. I mean, just imagine an organization where people are just automatically self regulating without being having to be told what to do or looked over. Okay. So that's one of the things we want out of the system. Next, we we we want ownership rather than a renter attitude.
Speaker 2:You want employees to come into the building, and if they notice some trash, they actually pick it up rather than just walk on paths and say, well, someone else will get it. And, when people are linked in the compensation system, they they start to look at it like that. Like, oh, that might cause us to have less patience or, oh, if that happens out in the community, we need to do something about that. Okay. Through the compensation system, you also want, again, accountability, which is linked to ownership here.
Speaker 2:You want the system that does the accountability for the manager, just making it easier. Not that there won't be some discussion or, hey, let me help you. I I noticed that you had a nonstandard. Do you need help with your documentation? That's what you want, that helpful attitude because the person already knows about it.
Speaker 2:And that's a great relief. Again, right there. And the fourth thing you want I said three, but there's actually four. You wanna keep in mind you wanna focus on that clinical manager or that clinical leader as we've said because of that 70% multiplier factor. You cannot build a world class hospice unless you have rock star clinical leaders.
Speaker 2:Can't be done. When we are building the Baldrige winning one, that was one thing that, I mean, Norman Porter pointed out and and I just he says, we're not gonna get there unless we have this world class clinical managers. We've got to focus on that and that's part of the recipe. That's part of the model. That's what you where your focus goes.
Speaker 2:Okay. So let's take a look at at at this this overview, and you're on page 71, and now we're starting to get into some of that kind of deep deep detail in sequence. The first thing in developing a comp system, you want to establish standards because standards are key to everything. You've got to have something to base the compensation. So you establish the standards of the organization.
Speaker 2:We recommend as few as standards as you can, maybe even only five standards with primary focus on perfect visits with perfect documentation. This would also have your telehealth and all that in there too, but if you focus on that one standard and doing that well, it will cure virtually all quality and financial woes just with that one standard. And that's one thing about Molded View. Our concepts or directions are usually fairly simple. We spend a lot of time going through the explanation because, again, people need to have a deep philosophical or just a deep understanding of what's behind it or these things go away.
Speaker 2:Why are we doing this? Okay. We recommend in establishing these standards is to default to NDI's suggested standards when in doubt and move quickly without committees. Okay. That that that number one right there is probably got people scratching their head because people will form committees and you'll get people that are not experienced in things, and they will come up with all kinds of things that have already been done normally that don't work or don't work well.
Speaker 2:The committee is often just, it's a form of constipation where everybody surrenders their position and neuters out all the important nutrients and ingredients until there's no value left because everyone's making concessions to make everyone happy rather than someone that says, hey, I have been to The Orient like Marco Polo and oh, no, you haven't. So you get your standards in place, but focus have to focus on perfect visits with perfect documentation. Again, perfect equals to the standards of the organization. And, the other thing that's important to highlight in this first step is move quickly. You with compensation, it is not something that you can dilly dally around with.
Speaker 2:You're gonna fry people. If word on the street or in the grapevine is they're gonna be changing the comp system happens. Okay. Put yourself in the patient chair here. Only this will be the employee chair.
Speaker 2:People start to worry. They're gonna be grabbing for my nut. I mean, I don't wanna mean it like that, but, yeah, they're gonna be, you know, this this can impact me. And most people will default to negative because that's just the way most people like, you know, they're bombarded with negative news. They just kind of default there.
Speaker 2:Oh, this could hurt me. So fear and you'll start to lose perfectly good people just from not moving quickly. Okay. So it's step one. Step two, copy and imitate the compensation methodologies that have already worked with other hospices and home care entities.
Speaker 2:Just mimic. And, again, we can tell you what those are. Question here. Would you consider the clinical director part of the clinical manager team? Oh, yeah.
Speaker 2:Yeah. Definitely. And thank you for those questions. I mean, I like to feel them. Again, that's the one thing about when we're face to face I love.
Speaker 2:Now, people are just excessively being paid for very low standards. I'm just gonna tell you right now, that is the worst situations that we've ever gotten into. There's one hospice that we went to. They had a sense of about 400, not doing well at all. And people were being just paid outrageous sums for doing nothing.
Speaker 2:And I'll just say in those situations, it's it's it's it's gonna be hard because, I mean, they're getting this. Now you expect me to actually work? Can you get your head on? You're gonna ask me to work. I gotta actually do my job to get my pay now.
Speaker 2:You know? And those are rough things. Okay. Four, introduce Superpay or your branded system. We use the term Superpay because it brands it.
Speaker 2:You know? And hospices use it. You can rip off anything of multi but you wanna brand it BluePay or whatever logo your hospice has. Introduce your your system to management and solicit input or comments. Okay.
Speaker 2:So you, you know, you you you you know, you figure out what the methodologies that people are using. You introduce it to your management team because you want their input. And, you know, basically, you've got to sell it to them. If there's any I'll just say this. If there's any key people I know I've to get on board, I'll work with them before the meeting so that when I introduce it, they're already, Yeah, this is going be great.
Speaker 2:And that tends to swing the rest of the group. Okay. But the point is you want buy in. And again, that's why you want to go. It's already worked for other organizations.
Speaker 2:Okay. And I'll just say this. Be very careful not to remove the standards bonus when we're talking about the PACE system. The one thing you don't want to remove any rate is the standard bonus, because that's where at least 75% of the value of your comp system is gonna come from, that 5%, that we talked about before with the additive or the subtractive approach. Also, you wanna avoid, low standards.
Speaker 2:Because I'll just say this, you get people getting a paycheck that is standard to low standards, they'll get hooked on it like heroin. And then you try to raise the standards later on, you're looking at big hill. So when in doubt, on the side of pushing people too hard or having too high a standards. That's good policy because it's easier to loosen up later on rather than tighten up later on. Okay.
Speaker 2:Five. Work with key influencers to get buy in with respect to clinicians and managers. Show key staff what they are currently making and what they would be making with the new system, making it easy to contract the difference. You want to get people beyond fear. So basically, if I have a manager that I need on board or a key clinician, You work with them before the meeting.
Speaker 2:Say, Hey, here's what you're making now. Now, if we had this system in place, this is what you'd be making. And for a clinical manager, okay, now you're making 75, but you could be making a 140,000 or more. Woah. Really?
Speaker 2:That's like life changing. Or if it's a nurse, you're making this, and you're making 10 or $15 more in this system just by doing what you're already doing. Or maybe with this little improvement here with the documentation or whatever. But there's something about talking about it kind of in the abstract and then showing that contrast. Okay.
Speaker 2:When I put the systems in at Winston Salem with the home health and the hospice, I mean, is exactly the way I went about it to get By the way, I've never had any problem putting in a comp system. You know, this is how you do it, and especially if they trust you and they know that you're not a liar and you're just a generally good person concerned with them. And, you know, if a mistake happens, you're gonna go fix it. You know? But here's where you are now.
Speaker 2:Here's where you would be. Most people like that. K. Six. Okay.
Speaker 2:Then introduce Superpay, your branded system, to all staff. So after you have your managers on board, then let's introduce it to everybody. But, again, before that, you've already worked with your key influencers. This sequence is is is pretty key to really having a smooth rollout. And solicit comments, but because because and, yeah, I think you have to genuinely be open to people's comments.
Speaker 2:They may have just a great idea, but you also have to make sure that you're not like violating, I mean, it's kind of that fine line of here's what MBI is saying prescribing, and sometimes people will innocently take out some of the superpower pieces like saying, oh yeah, we don't need the standards bonus, or we don't need all service failures reported to the CEO, or giving clinical managers the ability to override service failures or complaints. Whereas, we don't give any such discretion. It just goes right through the system, because otherwise, all of those moves weaken accountability. And what you're gonna notice out of committees and groups and many solicitations is that the human tendency is to avoid accountability. And so most of the suggestions or many of them will be, to avoid that.
Speaker 2:Well, it doesn't seem fair or, you know, maybe this. And and you end up with with a really probably paying a lot more money in your compensation system for a subpar result. Not that it wouldn't be better than what you're getting now as far as quality and all that. Were you gonna say something, Bill?
Speaker 3:I just had a thought based on what you're saying. You know, as we implement, accountability and compensation systems into hospice and and and home care organizations, Occasionally we'll run into a blocker. In fact, it's not unusual to run into a blocker. But the far more lethal problem that we see are the leadership groups that gather together much like a committee that want to water it all down so that it works for what they're doing now, so that we get to throw out bonuses to everyone and no one has to change behaviors. Whereas if we institute the system and let the system roll without people having the ability to override this, that, and everything else, it seems to roll in so much faster and smoother, and we right the ship a whole lot faster.
Speaker 2:Yes. Yes. Again, avoiding potholes and mud holes. Okay. Seven.
Speaker 2:Immediately and without delay. We're back to speed. You pilot the compensation system with a winner. That is a team that that's already winning or, you know, would be doing the standards. So you pilot the system with a clinical team that would already be winning if super pay were in place.
Speaker 2:Okay. So basically, you look at all your directors, you know, I mean, all your clinical managers, and normally, you'll find somebody that's doing a really pretty good job or what have you. And you say, Okay, we're gonna pilot that. You make that known, because what is their likelihood of success? It's huge.
Speaker 2:One of the mega hospices that just got swallowed up in a merger, I was out there working with them on theirs and, of course, you know, the suggestion, Well, let's do this down in Dallas or with this small team or this team that's not doing well or, you know, all these things. And I said, No, no. Pilot with someone that's already winning. Because if you pilot with one of your bad managers that's a loser already that probably shouldn't even be here, that's gonna sink this whole thing. You wanna keep the momentum.
Speaker 2:But you, you know, the key here is speed because, again, you don't want people once this gets out, you don't want people worrying, so you need to move pretty swiftly. But we'll only pilot for maybe a month or two, not more than that. I mean, I mean, certainly. And I remember one we did and the manager was gonna make about 4 or $5,000 a month more. And then what are all the other managers doing for all the other sites?
Speaker 2:Can I be a pilot too? Can I be a pilot too? And it but then your weenies the conversation is just such a giveaway. When you talk about smoking out people that lack confidence and the people that go white, you know, those are the people who are really uncertain about their ability and skills. So it's quite telling.
Speaker 2:So immediately without delay, pilot with a winner. Okay. You also immediately start training staff in the standards using System seven. We're not going go through System seven. That's for other presentations and you can go on the website.
Speaker 2:If you don't understand a term I've used or it seems a little esoteric, just like some of this manual later on. I'm not going through all of this. You can reference it on our website, But we use System seven specifically so that there is no possibility of a knowledge deficit or somebody not knowing a standard. We don't want anybody to say, I didn't know that. So that's why we use, system seven.
Speaker 2:And it's better than sig Six Sigma. Why? Because it's system seven. It's one better. Anyway, Nine.
Speaker 2:Okay. All employees sign an accountability contract. And and this is something we developed, where where people know exactly what they're signing up for, that there's no question. And and we'll go through that a little bit here. But especially in places that are highly regulated, like in California, there's all these wage and hour laws that you have to, or or New York, Uniontown, what have you, that you really have to comply and watch out.
Speaker 2:And this covers so much of the legal aspect because it actually is a legal contract that basically says, This is when I'm to be, paid and this is how it works and I'm totally willing to do this, without I'm under no duress or anything like that. I want to do this. And it's a very powerful document. 10. You work with individual staff as needed to increase their confidence.
Speaker 2:You know, again, this is just, you know, you're in the process of implementing it and really any clinical managers or whoever's best at even presenting it. If there's folks that you know that you want to keep, get that out there and work with them if they're nervous. On the other hand, the folks that you want to leave, I mean, and that's the thing is, people think that everyone's gonna leave, and they don't. And a lot of times even the people you want to leave don't leave. But eventually, the system will will will will get them out.
Speaker 2:Okay. 11, modify as needed. And because once you get, let's say, what we suggest that you do, you you you mimic these these practices and behaviors. Well, then after you've gained some experience, well, then start making some modifications, but again, you wanna start out as as good as you can. And as you gain experience, you say, well, if we just did this.
Speaker 2:And I'll just say this. Comp systems you're always working on. And why would you not take that attitude towards compensation? That this is something we're always going to be working on. We're always going to be trying some different things with our comp systems because we want to be the best payer.
Speaker 2:We want to be the most fair and this is where most of our costs are and all our results come from it. So, would we not work on this continually or be thinking about it? Okay. So, there is really the overview, really, of implementation. Again, the most important position to focus on with your compensation system, again, is that clinical manager or clinical leader.
Speaker 2:And here I'm on on page 75, by the way. Again, because again 70% of employees' development, morale, retention will come from that relationship that employee has with that position. So that's why we again, you can never get to world class if you don't have rock stars as clinical managers in a home care or hospice situation. And so like this is an example of an org chart. I always like to put God and life, the big boss on top, but this is an org chart I I put out for a big, kind of Wall Street hospice group.
Speaker 2:But at the top of the org chart is the boss, patients and families. That's who we were serving. That's who we have to please. They'll write every check we'll ever receive, and they'll discharge us if they're unhappy. Then you have your clinicians.
Speaker 2:But here is where you focus. That that's where the strength of the organization is built in this layer, the clinical manager. Okay. I would like to take another quick little break. Let's go to page, 78.
Speaker 2:And, again, we're gonna be skipping the kind of the middle part. I'm gonna be hit a hit a couple points, and then we're gonna get into the methodologies here. But, when we reconvene, I wanna talk about getting getting past, the fear barrier and some points on the rollout, on page 78. So let's go ahead and take a quick break. Alright.
Speaker 2:Okay. Welcome back. Again, we're gonna be talking about getting past the fear barrier and the importance of the rollout. And let me just show you what one world class hospice that does magic, what they put together. And some of the formatting might be a little weird from one computer to another, but let's go ahead and play that.
Speaker 4:Let's explain this exciting new super pay structure. Each employee will be given four buckets. The first bucket is what we call their base pay. Base pay is your guaranteed annual salary if you're full time or hourly rate if you're part time. This base pay will be paid out on a bimonthly basis.
Speaker 4:The next three buckets of pay options are dependent on two major standards. We consider this the gate of safety, quality, and accountability. A gate swings on small hinges but can have significant results. These two standards are gifts, service failures, and perfect visit, which includes documentation. Any employee who fails to adhere to the gift standard or the perfect visit standard will not be eligible to dip into any of the following three buckets of pay potential for that pay period.
Speaker 4:If they correct these standard failures by the next pay cycle, they are eligible to participate on the following pay cycle. Bucket number one, standards bonus pay. This bonus adds up to about 5% of the base salary. If all five Heart and Home standards have been followed, an employee will be able to be paid this standard's bonus pay for that pay cycle. We expect all employees to receive this standard bonus pay every pay cycle.
Speaker 4:Bucket number two, individual clinical pay. This bonus is a reward for clinicians who have great efficiency and productivity performances. Heart and Home would like to compensate those clinicians for doing more than the minimum expectation within a forty hour week. For example, a nurse's expected visit range is 13 to 16 patients served in a two week period of time. This is very sustainable for any full time nurse within a forty hour work week.
Speaker 4:In this example, a nurse would receive bonus incentives for each patient served at 16 or above without a cap. Bucket number three, team pay. Heart and Home would like to install a three opportunity to receive rewards for team efficiency and productivity. If the team is financially profitable, the company would then like to bonus each team member of that office a percentage of the profits for that month. Heart and Home wants to be an employer of choice and share with its employees in the success of the company.
Speaker 4:We wanna promote good profits and eliminate bad profits. Superpay will hold employees accountable and greatly reward those who choose to stay within the quality standards set by the company.
Speaker 2:Alright. That gave you a good flavor. It's funny even now as I look at it, we've evolved some different things. Like now, like the team pay really is manager pay because we just want to juice up so that the clinical managers are making more and things, but still, but you get an idea. And also it's just good to see what other hospices are doing that are extremely successful and all that, but based on so many of the principles that we're we're talking about here.
Speaker 1:We hope you are having the best day of your life. If you need something further, just visit one of the Multiview Incorporated websites or contact us through social media. Smoke signals, carrier pigeons, telepathy have not proven reliable. All calls are answered within three rings by a competent real person. Thank you for listening.
