The Courage to Lead: A Blueprint for Healthcare Excellence

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Quotes:

*Please note this transcript is not edited

 

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Yep, hey? I'm just.

 

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Cooper Linton: I missed that before.

 

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Ken Segel - Value Capture (he/him/his): welcome everybody welcome to another episode of habitual excellence. I'm ken, Siegel. I'm the CEO of value, capture, capture, value, capture, and host of the podcast I'm excited. For this episode.

 

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Ken Segel - Value Capture (he/him/his): because we have a distinguished and a repeat guest. Today, he is a cooper. Linton

 

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Ken Segel - Value Capture (he/him/his): Cooper is the Associate, vice President and Chief retention officer for Duke health.

 

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Ken Segel - Value Capture (he/him/his): their home care and Hospice division, which he leads.

 

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Ken Segel - Value Capture (he/him/his): Cooper welcome to the Podcast.

 

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Cooper Linton: Thanks, Ken, I appreciate it. I I hope we have every employee here in our chief retention officer. We share that title all throughout the organization.

 

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Ken Segel - Value Capture (he/him/his): I we're I wanna hear about that in a minute, for sure. A little bit more about that, and I think some of the results you'll get you're getting will will help us understand why? Why, you hold that title and and others are emulating as well. I said, welcome to the podcast but I should say, welcome back to the podcast

 

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Ken Segel - Value Capture (he/him/his): and I think today, we wanted to have you back because for number of reasons one. You and your team

 

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Ken Segel - Value Capture (he/him/his): really are fully committed to a habitual excellence journey and building a world class operating system to get the results. You

 

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Ken Segel - Value Capture (he/him/his): felt your community, your patience, your team deserved.

 

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Ken Segel - Value Capture (he/him/his): and you have created better and better win. Win win results over time

 

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Ken Segel - Value Capture (he/him/his): when we had yon, and and originally, in about 2021. It was pretty exciting what you were starting to put together.

 

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Ken Segel - Value Capture (he/him/his): And when we checked in with you next you were achieving some retention numbers that coming out of Covid that were absolutely astounding. And things have gotten better on the people in the results front since. And that's all that's that's enough reason to have you on. But I think another reason is.

 

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Ken Segel - Value Capture (he/him/his): we always appreciate how much you think about the learnings

 

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Ken Segel - Value Capture (he/him/his): for yourself as a leader, and we've gotten a lot of feedback that other leaders find that you know to be very helpful to hear and listen to and

 

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Ken Segel - Value Capture (he/him/his): benefit from your humility. But sort of insight. And some of that comes because you're you're actually

 

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Ken Segel - Value Capture (he/him/his): quite great with a story which the audience, if they haven't heard the previous ones, is about to discover, is my bet. So

 

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Ken Segel - Value Capture (he/him/his): so we're we're really pleased to have you.

 

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Cooper Linton: It's great to be back, and I appreciate you having me back.

 

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Ken Segel - Value Capture (he/him/his): All right. So today we're going to get into. Actually, it's interesting. We're going to catch people up on the results. We're going to talk a little bit about

 

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Ken Segel - Value Capture (he/him/his): we're gonna remind people of the work that's led to those results. So they know you know the what led to the outcomes. And you know the latest learnings which which I think are really interesting. And then we're gonna talk about.

 

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Ken Segel - Value Capture (he/him/his): Why, if this sort of enduring habitual excellence

 

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Ken Segel - Value Capture (he/him/his): approach produces such great, real, sustainable results over time. Why, it's the one

 

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Ken Segel - Value Capture (he/him/his): so so rarely chosen versus, you know. Shorter term attempts that are generally frustrating for leaders. So we wanna sort of get into that territory and see what we can learn and invite

 

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Ken Segel - Value Capture (he/him/his): people who listen to the podcast to join us with their thoughts. So

 

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Ken Segel - Value Capture (he/him/his): with that is predicate. We're gonna turn this over to you and you know, will you? Will you, bring us up fresh on the results your your team is achieving, and and some of the work that's led to it.

 

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Cooper Linton: Well, thanks, Ken, I think the last time we we met to look at some results, our results had been done in a in kind of a model cell, if you will, which had been our home health program. And

 

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Cooper Linton: you know, Janet Burgess, for some of y'all who know her in in the industry have also heard her at catalysis. She's

 

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Cooper Linton: in my mind, absolute Rock star, home health. But

 

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Cooper Linton: she knows the business, but she's deeply committed to her people.

 

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Cooper Linton: One of the things we were struggling with as an organization not unlike the larger industry

 

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Cooper Linton: is our turnover's too high.

 

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Cooper Linton: and we lose this institutional knowledge. We lose the experience we lose our ability to handle increasingly complex patients because we don't get to build upon.

 

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Cooper Linton: The the experience of our staff, we keep turning them over, or, as I say, we keep training great people to go work at our competitors. And so how do we quit? How do we quit acting as the

 

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Cooper Linton: the proving ground for our competitors

 

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Cooper Linton: and start really keeping great talent. So we we got focused in home health where we had very high turnover. We had over 70%. Our end turnover annualized and got that number down to below 20 in a hurry. And then from that model cell concept. We said, We, we really.

 

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Cooper Linton: we've got to expand this. So we took it into hospice and we took it into home infusion, and though, in the larger entity.

 

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Cooper Linton: and began to see significant improvements in that. But we didn't want to limit it just to nursing. I mean.

 

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Cooper Linton: everybody here

 

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Cooper Linton: is valuable, and people say, well, different jobs are valued differently.

 

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Cooper Linton: Find the least valued financially person in your organization. Let them not show up for a week and reconsider their value. I mean

 

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Cooper Linton: it it it changes your mind right when the trash can start overflowing, or the grass isn't cut, or something like that, you you suddenly revalue that person. We want everybody sticking around

 

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Cooper Linton: everybody here is part of the same mission. And so we took that model cell, took it out to our our larger

 

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Cooper Linton: entity, and

 

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Cooper Linton: I'll be happy to share some of those retention results, because it's now taken a while for that to happen. There's no light switch, you know. It's implement this. And 30 days later, presto, Bingo! You have! Everything's great.

 

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Cooper Linton: So I'll I'll try and do a quick share, but I'll also I'll lay the groundwork for this. We also just did a what we call culture pulse here at Duke, which is really these employees survey right. It's is where we survey our staff to say, how do you feel about it? And because we've used the same tool now for a number of years.

 

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Cooper Linton: though we use an abbreviated version during Covid, because nobody had the bandwidth to fill out

 

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Cooper Linton: a long survey that just wasn't.

 

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Ken Segel - Value Capture (he/him/his): Yeah.

 

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Cooper Linton: Wasn't sensitive to what healthcare folks were going through at the time.

 

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Cooper Linton: but you can see that that we've now used the same instrument 5 times, and it's interesting to see how that data shot aligns up. Let me see if I can

 

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Cooper Linton: manage to share. You know, it's always a

 

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Cooper Linton: when there's a guy from public school like me. I'm doing the best I can here.

 

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Cooper Linton: So

 

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Cooper Linton: and you see that screen there, ken.

 

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Ken Segel - Value Capture (he/him/his): Yes, yes, indeed, Cooper, we can. We can see it,

 

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Ken Segel - Value Capture (he/him/his): you know, with the

 

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Ken Segel - Value Capture (he/him/his): with the slide sorter on the left. But.

 

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Cooper Linton: Does it still show up when I hit to the

 

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Ken Segel - Value Capture (he/him/his): Perfect. You're in charge right now. Yup.

 

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Cooper Linton: More gooder, all right.

 

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Ken Segel - Value Capture (he/him/his): More better.

 

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Cooper Linton: So here's what we saw in our in our culture pulse. And I just the highlighted area. The circled area on the right is the most recent survey data, and you can go all the way back to 2017.

 

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Cooper Linton: You can see during the the Covid and immediately post Covid era, our survey results declined, and in 2020 we we really did. Almost. We asked that for a very abbreviated survey. But you can see that

 

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Cooper Linton: in this oval on the right hand side

 

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Cooper Linton: almost everything went up, and the one that went down is always is a bit of an anomaly to me, since people. Sense of belonging went up, their sense of teamwork went up, their sense of empowerment went up. So I'm a little a little baffled by the one that went down. But I'll take. I'll take one out of that whole green list. But I don't want us to forget why we're focused. We still need to look and understand that better, that over 80% of our staff responded to this.

 

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Cooper Linton: This engagement to me is

 

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Cooper Linton: the one of the most scary things you know, if people are unhappy and telling you at least there's engagement, I get really nervous when there's a lack of engagement.

 

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Cooper Linton: and we had better than 4 and 5 of our staff members

 

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Cooper Linton: fill this out. It gives us confidence

 

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Cooper Linton: and the data.

 

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Cooper Linton: But when we start drilling into this it's easy to look at this and go. Okay, great. We're in the good

 

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Cooper Linton: and overall. That's probably true. But when we dig into spots we find that everybody doesn't have the same experience. And so we have to maintain vigilance.

 

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Ken Segel - Value Capture (he/him/his): Yeah.

 

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Cooper Linton: You know, we need to look at an area that has 5 employees the same way. We looked at the entire entity

 

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Cooper Linton: 3 years ago.

 

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Cooper Linton: We just can't back up. And so

 

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Cooper Linton: when you said, Well, that, how does that relate to overall turnover? So this was

 

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Cooper Linton: from July of 23 through May of 24, and that's the overall staff turnover, as you can see, it was higher during covid the the great resignation, as many people called it. But we're actually down in our in. Our turbulence is even below where we started pre covid. And in our industry this is actually

 

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Cooper Linton: pretty remarkable 30 plus percent turnover is not unusual. And then in certain categories, 50 and 60, and that that's absolutely industry destroying those kind of numbers. But if you look to the left, we had numbers in that category not long ago, and it was really damaging us.

 

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Cooper Linton: damaging our cultures.

 

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Cooper Linton: damaging our clinical outcomes. And so, not surprisingly with this, our clinical outcomes have improved

 

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Cooper Linton: as well. If we flip over and and take a look at nursing

 

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Cooper Linton: and I will say that there's it's not always apples to apples. If you're working in lower acuity, home-based care sometimes these numbers are lower for those that are not familiar with this Duke University.

 

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Cooper Linton: who we get the majority of our volumes from, is the highest acuity hospital in the State of North Carolina.

 

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Cooper Linton: So this is a very high acuity. Home health Hospice and home infusion program.

 

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Cooper Linton: incredibly short lengths of stay in hospice. And so what we've seen here is much great, a greater reduction or significant reduction in turnover

 

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Cooper Linton: terminations and a lot of that came as we spread that model cell into hospice and home infusion and said, Okay, we had some wins in home health, but we we can't let there only be one place that's a great place to work. We've got to let this.

 

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Cooper Linton: We've got to make sense out of this elsewhere. So our hospice numbers improve dramatically.

 

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Cooper Linton: and our home infusion numbers have improved dramatically, both

 

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Cooper Linton: in high turnover roles like pharmacy text, but also among nurses and aids and social workers, and those sorts of things

 

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Cooper Linton: so.

 

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Ken Segel - Value Capture (he/him/his): Super. Yeah, go ahead. I don't know.

 

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Cooper Linton: No, I look like you. You had a thought, and I'm always interested in yours.

 

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Ken Segel - Value Capture (he/him/his): Well, a thought that'll lead to a question just really on the

 

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Ken Segel - Value Capture (he/him/his): Could you describe

 

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Ken Segel - Value Capture (he/him/his): the work you've used? The word model cell and those familiar with process excellence, etc, will recognize that.

 

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Ken Segel - Value Capture (he/him/his): But what did you guys actually do, you know, just described at a high level to really change the course of those curves. You know. What? How did you? How did you create a great operating system.

 

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Cooper Linton: So the model cell that started. I think that what

 

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Cooper Linton: wasn't home health is one of the hardest things for us, because we thought we understood the problem

 

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Cooper Linton: and we jumped from, okay, we, we understand the problem which we didn't.

 

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Cooper Linton: And because we didn't understand the problem, we immediately made some assumptions about the solution, which were, by the way, pretty much all wrong.

 

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Cooper Linton: And that's a painful lesson.

 

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Cooper Linton: But we brought our frontline staff in, and we began to map the workout.

 

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Cooper Linton: Yeah, because they kept saying, Well, we're overworked. We're overworked. We're overworked, and

 

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Cooper Linton: a everybody's working crazy in this industry. We understand it. But when we began to truly map the workflows literally going down the walls, I'm pointing that wall. Wasn't this one much bigger? This wall wouldn't held it.

 

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Cooper Linton: We map the workflow that our staff was being asked to complete.

 

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Cooper Linton: just to admit a patient and treat them.

 

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Cooper Linton: And it was ridiculous.

 

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Cooper Linton: and once we began to understand

 

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Cooper Linton: how hard we had made doing the work. Not, I mean, the work's hard into itself, but we shouldn't make doing it hard.

 

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Cooper Linton: We had made this really hard.

 

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Cooper Linton: and that's up. There's a moment of self reflection in yourself as a leader where you go back.

 

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Cooper Linton: This does not feel good.

 

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Cooper Linton: And we've subjected people to this, and we had our frontline staff involved in this clearly guiding us through it, because.

 

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Cooper Linton: honestly, I didn't understand the workflow. I thought I did, but I but I didn't. I was wrong.

 

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Cooper Linton: I found out I was wrong a lot, by the way, it's turned into a trim

 

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Cooper Linton: and so we we took that and began to reinvest

 

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Cooper Linton: into changing the work for home health.

 

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Cooper Linton: Then we did the same sorts of things in home health, I mean in home infusion and hospice. But the work was really different, because the work between home infusion and home and and home based care and hospice and running an inpatient hospice. Facility don't have that much in common.

 

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Cooper Linton: So we began to understand what their pain points were.

 

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Cooper Linton: And it ultimately comes down to culture. You know, we if we can create a culture.

 

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Cooper Linton: then we build capacity. If we are able to build that capacity, then we can deliver quality.

 

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Cooper Linton: And it's in that order.

 

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Cooper Linton: Because our culture was such that we were ignoring the pain of our frontline staff.

 

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Cooper Linton: and we were turning them over. We never built capacity and without capacity we never had quality.

 

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Cooper Linton: and so it it really followed that cadence.

 

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Ken Segel - Value Capture (he/him/his): And that really changed. How you guys led every day you change your management system to be much more in touch with the actual flow of work, of the people who are providing value for patients.

 

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Cooper Linton: Well working with you guys right at the beginning of Covid hit, put in. You know, we started the huddles, but we also then work with Mike Radkey also on on your team, who

 

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Cooper Linton: walked us through some deeper dives into how to handle rapid cycle improvement, how to run sprints, how to change the way we thought about

 

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Cooper Linton: holding ourselves accountable to making progress. And what we found is that, in spite of being wrong a lot of times. If our staff see us authentically trying to move forward, even if we experimented, fail.

 

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Cooper Linton: And they they believe in what we're trying to do, they're part of it.

 

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Cooper Linton: They'll forgive the failure as long as they believe we're moving forward, and that we're going to execute change on their behalf.

 

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Cooper Linton: And so their Grace has allowed us over the last several years

 

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Cooper Linton: to make the kind of improvements that bring numbers from 70% turnover down to under 20, or as an organization have a, you know, a 13% and change turnover rate.

 

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Cooper Linton: they've stuck with us. In fact, we just did our career service awards where we recognize people at key milestones. We did that yesterday here.

 

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Cooper Linton: and we've never had more people at the 5 year milestone than this year. It was the. It was actually fairly long career service award ceremony was great, supposed to be long. If we do it right.

 

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Cooper Linton: there's always there makes

 

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Cooper Linton: yeah.

 

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Ken Segel - Value Capture (he/him/his): Making the chief retention officer look good. That's great.

 

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Cooper Linton: Well, they're all doing. I mean, every member of the leadership team. This idea that they're going to bring in one guy to do this or one lady to do this

 

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Cooper Linton: is a lost cause.

 

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Cooper Linton: the the, the, the model, the process that we've adopted and through our work with you guys is an all. In. In fact, everybody takes turns

 

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Cooper Linton: running our senior huddles because everybody knows how, and it's part of our organizational resilience.

 

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Ken Segel - Value Capture (he/him/his): And you started to share

 

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Ken Segel - Value Capture (he/him/his): some of those core lessons that you've had with us, and that it can't. It's not just the leader. The leader is the catalyst, but everybody's got to buy in. And

 

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Ken Segel - Value Capture (he/him/his): you're really eloquent about that. What you know. Do you want to expand on that and and maybe share some of the other lessons that have deepened for you in these last many months. As you accelerate the work.

 

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Cooper Linton: So there's this we we've learned. A number of one is that we have to walk in the door

 

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Cooper Linton: as humble learners.

 

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Cooper Linton: I mean, I'm I've been working in home-based care for a long time, but it's not the same industry I went to work in. In fact, it has very little resemblance to the one I work in today.

 

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Cooper Linton: we're always having to learn.

 

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Cooper Linton: But if we can walk in as people who are trying to learn learn what our staff are experiencing as opposed to tell them how to do it better.

 

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Cooper Linton: then

 

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Cooper Linton: they are so responsive to our efforts to help them.

 

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Cooper Linton: because they genuinely believe that we're there to help them succeed.

 

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Cooper Linton: you know. I'll I'll point out. I want to point out this one of the numbers we put up there from the culture pulse was around. Safety.

 

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Cooper Linton: Safety in our industry is terrible.

 

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Cooper Linton: and I, and that nobody wants to talk about it. I want to call it the way it is. It's flipping atrocious.

 

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Cooper Linton: and I get it. We're going into uncontrolled environments. I totally understand.

 

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Ken Segel - Value Capture (he/him/his): Yeah.

 

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Cooper Linton: Get it.

 

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Cooper Linton: but we still have an obligation to the people going in, and if you can't, if you're not safe in the delivery of the care. There's no way you can deliver safe care. I mean, there, there's an order of the operation. So we got very focused on safety issues

 

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Cooper Linton: very focus, like it is part of the 1st 30 min of orientation for all employees when they 1st come to work here.

 

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Cooper Linton: we put in some additional technologies to support them. But fundamentally, we said, we will trust your judgment, and you can remove yourself from any situation at any time, under any circumstance, that you don't believe you're safe, and you will never be Monday morning, quarterback, or second guest, and when we start off orientation that way people's eyes will fit in their head.

 

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Cooper Linton: They've not heard this before.

 

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Cooper Linton: And so, while our industry has a terrible safety record.

 

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Cooper Linton: we have a great one.

 

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Cooper Linton: because our people know when there's something unsafe. I'm fully supported in leaving this environment. We will figure out a way to deliver safe care if it's at all possible.

 

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Ken Segel - Value Capture (he/him/his): To put.

 

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Cooper Linton: Lord Sacrificial, and they heard that.

 

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Cooper Linton: and even and I mean our safety

 

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Cooper Linton: scores beat the health systems.

 

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Cooper Linton: If you look at it across the industry. Ours should be terrible.

 

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Cooper Linton: but it's our our staff have bought into it. Our leaders have bought into it. Our visiting employees have bought into it.

 

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Cooper Linton: We had the Executive Vice President from the health system come to the front door one day, and his badge didn't say home care and Hospice on it.

 

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Cooper Linton: and they couldn't get in, and he.

 

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Cooper Linton: buzz! Buzzed in, and receptionist asked him who it was, and he told us he came in. She said, I'm going to need you to sign in. That's our standard process. And he said, I'm the executive Vice President, she said, that's great. You can write that next to your name when you sign in.

 

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Cooper Linton: That's no offense. But

 

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Cooper Linton: if your badge doesn't open that door, you sign in, and so it's the safety. And he was very gracious about it, just to be clear.

 

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Ken Segel - Value Capture (he/him/his): I love how you use the term order of operation. And you guys, really, you all really did

 

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Ken Segel - Value Capture (he/him/his): leverage. The power of safety is kind of a precondition to get started and begin to produce that belief and tie everything together. And it's it's great to hear how that's become fundamental to the culture and not surprising. Usually places that have sort of results being tied together like this have have safety as that kind of anchor.

 

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Cooper Linton: It was funny is that was a new concept to me when you guys introduced it, actually.

 

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Cooper Linton: And I was not initially, I didn't initially buy him okay, and not to not. I don't mean to be disrespectful. But I, when I 1st heard this, is like this, is not where I'd start, I don't think.

 

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Cooper Linton: And and I remember you telling a story about alcoa and the challenges that they had and the safety issues. And they got behind that. And

 

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Cooper Linton: and I realized, well, there actually is a corollary there between

 

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Cooper Linton: we we don't make aluminum, but

 

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Cooper Linton: the safety issues, particularly in home based care, and it made me step back. I was like, well, genuinely, who hears not

 

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Cooper Linton: supportive of safety.

 

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Cooper Linton: Right? That's

 

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Cooper Linton: I mean, if if you're not in agreement that we're we're we don't want to hurt anybody, and we're going to follow all the rules. If you can't get behind that, you probably shouldn't be here.

 

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Ken Segel - Value Capture (he/him/his): I will.

 

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Ken Segel - Value Capture (he/him/his): you know, and how you talked about people's lives light up when they realize you kind of mean it. Which was great.

 

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Ken Segel - Value Capture (he/him/his): so so great to hear.

 

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Ken Segel - Value Capture (he/him/his): you've you've used

 

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Ken Segel - Value Capture (he/him/his): you. You've said this work is kind of different, that it's not a hey 1995 in a few months, and your problems fixed, it has a different kind of rhythm and logic to it. Can you can you sort of expound on some of those learnings, and and how you think of it now.

 

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Cooper Linton: Yeah, I I'd be happy to. But I'll tell you I I'm a little. I feel sometimes a little bit of conflict with what I feel like people want.

 

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Cooper Linton: And I'll say, people I count myself in there. I want

 

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Cooper Linton: I want there to be an easy solution.

 

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Cooper Linton: and what I found is that we makes. We started with safety and safety, allowed us

 

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Cooper Linton: to look at.

 

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Cooper Linton: How do we respect people's time and respecting people's time caused us to look into the depth of the work, understanding the work made us realize how many opportunities for error. In fact, it was remarkable that anything went right.

 

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Cooper Linton: I mean it was. Sometimes you look at a mapped out process, you go. How in the world did anything go right? And it was because everybody was working frantically to correct the errors in the process.

 

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Cooper Linton: and that went home exhausted, but because the process never improved, they had to come back tomorrow and be heroic again.

 

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Cooper Linton: And so, and then we call that burnout like, somehow or another, they just lacked the necessary resilience when in reality we abused the psychic health of these people for years until they decided that for their own self-preservation they'd leave, which is awful. It's a terrible indictment.

 

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Cooper Linton: But we worked on that. And then that allowed us to keep retention and retention allowed us to build clinical excellence and experience over time, and that caused more people to want to come here.

 

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Cooper Linton: and then we were able to accept more patients which improved our financial health. And it becomes this

 

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Cooper Linton: cycle of of improvement that continues. But it doesn't happen

 

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Cooper Linton: in 30, 60, or 90 days. It's not a give me your 6 month plan.

 

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Cooper Linton: and that's the hard part is that I mean, if you look at this. This is over.

 

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Cooper Linton: This is over a span of 4 and a half years.

 

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Cooper Linton: 5 years. Actually.

 

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Cooper Linton: yeah, it's 5 years

 

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Cooper Linton: to get to this point. And most of us don't want that. I don't want to go to the gym and eat right for 4 years. I want to take Wagovi.

 

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Cooper Linton: you know, and and I'm not on it, as you can tell.

 

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Cooper Linton: But there's

 

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Cooper Linton: we want these kind of

 

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Cooper Linton: rapid solutions. If we hire this person.

 

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Cooper Linton: yeah, they will come in and change the culture as opposed to. We've got a group of leaders that have got to sit down and evaluate our effectiveness

 

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Cooper Linton: and deal deal with our own painful truths and decide if we're going to lead differently.

 

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Ken Segel - Value Capture (he/him/his): Yeah.

 

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Ken Segel - Value Capture (he/him/his): Well, you know, let's let's let's continue to go there. But and, by the way, I love how you sort of describe quite physically and logically together.

 

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Ken Segel - Value Capture (he/him/his): the sort of virtuous cycle that starts to build, of results, piling on Toms on top of results, and sort of all the dimensions that matter, cause they're tied together, the people, the process, the outcomes.

 

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Ken Segel - Value Capture (he/him/his): the patient satisfaction. And

 

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Ken Segel - Value Capture (he/him/his): I know you've talked about it before, as

 

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Ken Segel - Value Capture (he/him/his): you know you, the the the batch of results that you get that are the glimmer of tying it together after 6 months become the down payment for the next level, and they're the down payment for the next level and the next level. And pretty soon you went back in 4 years.

 

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Ken Segel - Value Capture (he/him/his): Here you are.

 

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Ken Segel - Value Capture (he/him/his): You describe. We're going to get to the learnings of why, you know, we don't want to go to the gym and things like that, and try to think a little bit more critically as leaders in a minute. But

 

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Ken Segel - Value Capture (he/him/his): you've you've talked about

 

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Ken Segel - Value Capture (he/him/his): odd.

 

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Ken Segel - Value Capture (he/him/his): I had a thought there. Oh, so that Cooper go and and we'll I'll clean this up a little bit. But Cooper, talk a little bit about the work not being glamorous. It doesn't have a lot of sizzle.

 

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Cooper Linton: Oh, it's pretty anti, Sis, I mean, you know, if you if you think about

 

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Cooper Linton: it.

 

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Cooper Linton: it is the.

 

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Cooper Linton: It's the honorably. It's the honorable mundane. Okay.

 

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Cooper Linton: it's getting the little things right like, did we let? Did we handle someone coming through the front door

 

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Cooper Linton: correctly? So how big a deal is it? Well, depends on who it was coming through the front door.

 

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Cooper Linton: Some mistakes were small, some are big.

 

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Cooper Linton: but there's a grind to it. We do.

 

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Cooper Linton: Our. The cadence of our work is built around hopes. We start with

 

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Cooper Linton: the most important thing, like most a lot of organizations do with front line.

 

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Cooper Linton: But we often, as organizations, think that as our lead as leaders, we're here to solve the problems.

 

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Cooper Linton: What we have found over time is that when tier. One runs correctly with our frontline staff run tier 2, which is our frontline managers.

 

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Cooper Linton: When that's run correctly.

 

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Cooper Linton: 95% or better

 

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Cooper Linton: of everything that needs to be solved is solved there.

 

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Cooper Linton: but we do it the same way every day.

 

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Cooper Linton: and there's nothing new and exciting about it. In fact.

 

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Cooper Linton: there's a little bit of a grind at times. Yeah, it was.

 

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Cooper Linton: But what we have found is that

 

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Cooper Linton: there's a cadence. We run it the same way every time

 

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Cooper Linton: we understand our business better.

 

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Cooper Linton: In in fact, we used to run director meetings or leadership meetings, whatever you want to call them. Different places, call them different things.

 

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Cooper Linton: executive team meetings, whatever.

 

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Cooper Linton: What we found is when we ran tier 1, 2, and 3 correctly.

 

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Cooper Linton: we eliminated 80% of what we needed to meet on as a leadership team because it was being dealt with in in real time.

 

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Cooper Linton: And then we decided to follow a very similar cadence

 

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Cooper Linton: for our executive team meetings and break those into 15 min meetings held a couple of times a week up to 3 times a week, though very often, I mean, today's lasted 6 min.

 

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Cooper Linton: So.

 

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Cooper Linton: and we were done. In fact, we repurposed that meeting to something that came out of tier 3 that needed attention.

 

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Cooper Linton: and by 11 o'clock. Everybody was done

 

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Cooper Linton: with with those meetings, and we were off to then to the execution phase.

 

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Cooper Linton: So it was. It's rapid cycle, but it's not

 

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Cooper Linton: cool and sexy, and there's no whizbang solution. There's not a ton of Powerpoint slides.

 

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Cooper Linton: There's a set of huddle boards that all feed from one day to the next. And so.

 

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Cooper Linton: if we need to know what happened in home health on March second of 2022,

 

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Cooper Linton: we know.

 

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Cooper Linton: But it's usually resolved by noon on March second 2022. It doesn't carry forward, and 2 weeks later we meet about it.

 

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Ken Segel - Value Capture (he/him/his): Super. Thanks for that. And you know there's another sort of seeming paradox. I want to explore a little bit.

 

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Ken Segel - Value Capture (he/him/his): And that is that this does build over time you've talked about. It's not the 1,995, and you're done in 3 months.

 

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Ken Segel - Value Capture (he/him/his): On the other hand, once you get it rolling, you can make things

 

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Ken Segel - Value Capture (he/him/his): enduring. Solutions

 

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Ken Segel - Value Capture (he/him/his): happen quite quickly.

 

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Ken Segel - Value Capture (he/him/his): And you, you have a lot of examples of the sort of ability to do these structured sprints.

 

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Ken Segel - Value Capture (he/him/his): building on the day-to-day, solving things at the level, they should be solved and picked up

 

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Ken Segel - Value Capture (he/him/his): to actually accomplish things at a much more enduring and fast rate than

 

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Ken Segel - Value Capture (he/him/his): sort of more conventional approaches. So I don't know if there's anything you want to share with the group I want. Yeah.

 

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Cooper Linton: With the structures there the 1st few times we did. It's kind of like 1st times we did huddle. It was awkward, clunky. We got more wrong than we got right.

 

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Cooper Linton: When you got through one you felt like y'all to celebrate cause you finally made it through one correctly. Then you realize over time. This is actually very simple. It's very predictable. But it becomes well in line with the name of the

 

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Cooper Linton: podcast. It's becomes habitually excellent. I mean gets

 

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Cooper Linton: through repetition.

 

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Cooper Linton: The same was true when we started doing sprints. We worked with Mike on that, and 1st time we started running sprints and 14 day cycles, and you can run them in other ones. We have run them in other ones, but that does seem to be kind of a

 

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Cooper Linton: a workable cadence for us.

 

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Cooper Linton: It was clunky, and it was awkward, and the process of making sure we were on task was clunky and awkward, and we weren't quite sure who to assign to make sure we were being self accountable. I'll I'll give you an example. We not long ago rolled out a new Emr, and we had some substantial challenges

 

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Cooper Linton: with that em on.

 

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Cooper Linton: And it's not a terrible product. But we had problems with the implementation. And so we.

 

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Cooper Linton: what we found is we had key problems that that came out of, and we prioritize them all. We prioritize them all, starting with safety with the very 1st one we don't. It's not like we use a different

 

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Cooper Linton: decision tree

 

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Cooper Linton: every time we have a different problem.

 

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Cooper Linton: Part of what allows us to be faster is we have. We know what our decision tree is going to be, and we hang the problem on this existing model.

 

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Cooper Linton: We don't have to discover a new way to handle it. We knew what our priorities were going to be.

 

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Cooper Linton: and we knew what a model we would use, which is a 14 day sprint, and we were able to get more done in the 1st 3 weeks of that than we had done in the previous 9 weeks.

 

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Cooper Linton: Flailing and frustrating people and sending them home, and I was laughing with you earlier. They ever nobody went straight home. They all want to go to the ABC. Store first, st and not quite. Some of them made it home safely, but we we made sure that

 

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Cooper Linton: we followed this 14 day sprint, and we were able to move through this quickly, and we're still in some of those sprints. By the way, they're not all resolved.

 

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Cooper Linton: But sprint one becomes Sprint 2, and there's an accountability for getting it done, and then we meet to say, Where's our progress?

 

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Cooper Linton: But we kind of have the same solution to every one of these, not the same solution. We have the same process for solving them

 

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Cooper Linton: when we run into issues, whether it's something as big as an emr implementation, or if it's something as simple as

 

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Cooper Linton: elevated issues of social disruption near our inpatient facility.

 

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Cooper Linton: What's the 1st thing we're going to focus on

 

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Cooper Linton: safety

 

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Cooper Linton: containment of of harm? Those sorts of things, and we moved quickly.

 

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Ken Segel - Value Capture (he/him/his): It's that capability build that allows you to be agile and innovative and effective problem solvers. And you know, we

 

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Ken Segel - Value Capture (he/him/his): you know, you like other leaders on the podcast who listen or have appeared

 

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Ken Segel - Value Capture (he/him/his): sort of recognize that in a fast-changing world it's sort of the most essential.

 

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Ken Segel - Value Capture (he/him/his): one of the most essential capabilities. Leaders can create right and the way.

 

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Cooper Linton: Well, I actually.

 

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Cooper Linton: when we recognize that when we're slow, we are perpetuating harm.

 

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Cooper Linton: If we think about it, it's not well, what's the financial implication. Let's not worry about that at the moment.

 

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Cooper Linton: What is the

 

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Cooper Linton: what is the harm? Implication

 

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Cooper Linton: for our people, for our staff.

 

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Cooper Linton: And then what does that translate into as far as our ability to execute the mission

 

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Cooper Linton: that immediately justifies? Whatever it is we have to do to resolve it, because if we get that right we will stop the financial harm. The financial harm is a

 

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Cooper Linton: is a is a quantifiable consequence, but it's never the problem.

 

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Cooper Linton: It's just how we measure the problem. Sometimes I think.

 

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Ken Segel - Value Capture (he/him/his): Yeah, no, I appreciate it. And, by the way, for listeners that don't know the financial metrics that have been coming off this stuff are very, very impressive in terms of creating greater opportunity for the health system and

 

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Ken Segel - Value Capture (he/him/his): Cooper's own division. So

 

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Cooper Linton: We've had. We've had good results on that, and that we. We have an unusually modeled financial model for our home health program, where the I often laugh and say, we're the pressure relief valve

 

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Cooper Linton: for the highest acuity hospital in the in the health, in in the State. Not that when they need other pressure leaf valves besides us. But that's our job is to to decompress hospitals and do guns

 

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Cooper Linton: problem.

 

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Ken Segel - Value Capture (he/him/his): Yeah. Yeah. So anyway, super impressive and great to explore all that, including what seems to be slower, but in fact creates the possibility for faster and success, faster, success more sustained and more rapid and more agile.

 

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Ken Segel - Value Capture (he/him/his): So, Cooper, let's let's go back now for this

 

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Ken Segel - Value Capture (he/him/his): for this section of the podcast and talk a little bit more about this paradigm error

 

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Ken Segel - Value Capture (he/him/his): of what gets in our way as leaders. And we all do it

 

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Ken Segel - Value Capture (he/him/his): of choosing this enduring build approach versus the quick, the seemingly quick plug and play.

 

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Ken Segel - Value Capture (he/him/his): You've done a lot of thinking about it. You use the metaphor of the gym. Talk to us more about what's in your mind and that. And we want our listeners really thinking about that and helping us think through. Because I think if we can make a contribution here, we can do a lot of good.

 

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Cooper Linton: So let me give a disclaimer. I'm not anti technology in fact, what I think, we're using AI to to to transcribe this

 

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Cooper Linton: those podcasts.

 

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Ken Segel - Value Capture (he/him/his): Absolutely.

 

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Cooper Linton: we embrace technology, but

 

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Cooper Linton: it can't. It becomes a tool. It's not a solution.

 

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Cooper Linton: there seems to be this fascination with

 

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Cooper Linton: whether it's a consultant or a new

 

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Cooper Linton: bought, or it is a

 

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Cooper Linton: new software package that's gonna accelerate your revenue cycle. Or if you farm out your stuff to me. I'll make sure that you don't have any clinical outcome issues associated with your coding. There's a solution. Everybody's got a solution to plug in, and some of those are valuable.

 

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Cooper Linton: I'm not going to suggest we don't outsource stuff.

 

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Cooper Linton: but we seem to want really fast solutions that are externally generated.

 

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Cooper Linton: So we have a problem whether it's

 

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Cooper Linton: you know, we're we're seeing challenges in our financial outcomes, or we're seeing issues in our clinical outcomes or our staff are leaving.

 

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Cooper Linton: We've got compliance, challenge, pick something, and there's always this desire to have or doesn't. It seems to be an a pervasive desire to have an external group

 

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Cooper Linton: or gadget in some form. Come in and get plugged in, and that's our solution.

 

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Cooper Linton: I I picked for home health several years ago. The 1st solution that was thrown out is, we need a new Amr that'll stop our turnover.

 

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Cooper Linton: Our turnover went down with the exact same Emr.

 

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Cooper Linton: We needed to change the workflows. Now we have since changed Emrs, but not because of turnover.

 

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Cooper Linton: but because it was an evolution in the needs of the organization.

 

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Cooper Linton: We don't need to have an external solution that comes in. And and I've I've laughingly said he was Plugin. We we call it plug and play well, it it doesn't plug in very neatly, and it doesn't play very well

 

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Cooper Linton: most of this, and we struggle with it.

 

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Cooper Linton: and we continue to fall prey to to go to a national conference, and there will be an entire exhibit hall full of people with booths ready to sell you a solution to fit for your organization.

 

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Cooper Linton: and some of them may be helpful, but they will never fix the internal problem.

 

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Ken Segel - Value Capture (he/him/his): So some of the some of it is the the sort of sales pressure right? That's out there everywhere. But but what else? What else contributes to it. What? What is it in the life cycle of organizations that sort of sets us up for

 

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Ken Segel - Value Capture (he/him/his): grabbing? For.

 

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Ken Segel - Value Capture (he/him/his): you know something to plug in versus.

 

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Cooper Linton: One, it's speed of response. So if somebody else can come in and we can do it, their other. And I'm going to say this, and I don't know that a lot of leaders are going to love it.

 

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Cooper Linton: It removes some the need for some courage.

 

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Cooper Linton: If we put the if we hire an outside company, and this doesn't work.

 

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Cooper Linton: we can blame that outside company.

 

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Ken Segel - Value Capture (he/him/his): Kimmel.

 

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Cooper Linton: If we say that our fundamental problem is one of internal performance.

 

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Cooper Linton: and we need to reflect on how we function as a leadership team to support our staff and our mission.

 

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Cooper Linton: and it becomes a high level of ownership.

 

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Cooper Linton: We get to own the successes, but we also have to own

 

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Cooper Linton: the failures we have to own. When we underperform, we have to own when we drop the ball.

 

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Cooper Linton: and it by always bringing somebody else in.

 

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Cooper Linton: It gives us, some

 

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Cooper Linton: professional, maybe psychic insulation.

 

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Ken Segel - Value Capture (he/him/his): Huh!

 

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Cooper Linton: From really

 

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Cooper Linton: owning these problems. But I think it also erodes the trust of our people

 

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Cooper Linton: because they see us doing it.

 

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Cooper Linton: And I think it's

 

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Cooper Linton: think people see through the veil.

 

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Cooper Linton: I I'm not suggesting that we shouldn't embrace AI, or that you shouldn't outsource your

 

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Cooper Linton: insurance verifications. Whatever it is, I'm not trying to make the point that there's no value in and looking at ways to be more efficient and bringing in outside partners.

 

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Cooper Linton: But it can't become

 

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Cooper Linton: a surrogate or a replacement

 

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Cooper Linton: for us, owning our issues and solving our problems and addressing our processes. And if we've addressed those processes and we realize there's a gap.

 

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Cooper Linton: then fill that gap, and it could be an outside party that does it.

 

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Cooper Linton: But we got to do the homework inside first, st

 

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Cooper Linton: and not just looking for the new shiny Gizmo to come fix it for us.

 

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Ken Segel - Value Capture (he/him/his): Yeah, yeah.

 

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Ken Segel - Value Capture (he/him/his): Cooper, one of the things you said to me is, you've reminded me that in normal times, when things are going along, okay, change is hard and it's hard to get the gumption up to do it.

 

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Ken Segel - Value Capture (he/him/his): And then we react differently when we're under pressure. So tell me, tell me a little bit about the role pressure plays in these kinds of decisions

 

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Ken Segel - Value Capture (he/him/his): and sort of yeah.

 

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Cooper Linton: We're using the word pressure, and I'm and not to offend anybody's. Listen. But I think one of the biggest problems we have is is the F. Word 4 letter f word at work, and we get his fear.

 

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Ken Segel - Value Capture (he/him/his): And.

 

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Cooper Linton: We get. We don't want to call it fear. We call it pressure. We call it organizational stress, or whatever. But individually we have a fear that we're gonna fail.

 

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Cooper Linton: or we have a fear that we're not going to perform fast enough, or we have a fear of

 

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Cooper Linton: pick one. Everybody's got their own lens, through which they process their anxiety right?

 

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Cooper Linton: How do we

 

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Cooper Linton: back up from that some.

 

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Cooper Linton: and try and reframe it in a sense of objectivity

 

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Cooper Linton: and say, I'm going to take ownership of that fear, and actually, by bringing it internal.

 

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Cooper Linton: we can front that more authentically than

 

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Cooper Linton: externally trying to solve it.

 

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Cooper Linton: and if you get it to for one person to do it as a leader is probably not gonna work.

 

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Cooper Linton: In my opinion it has to become the organizational culture

 

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Cooper Linton: for us to sit down as a group and remove the fear, so that as a group we can hold each other accountable.

 

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Cooper Linton: all right or the other way around. I sat with a leader yesterday who was beating themselves up for something they hadn't done wrong.

 

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Cooper Linton: And I said, I think you gotta liberate yourself from this.

 

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Cooper Linton: You didn't drop the ball.

 

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Cooper Linton: You didn't get the outcome you wanted, but you didn't

 

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Cooper Linton: fail anybody, and there's a difference.

 

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Cooper Linton: you know. Either extreme can be unhealthy.

 

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Cooper Linton: but I do think we've got to internalize it and get away from the the fear of things.

 

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Cooper Linton: Part of that is what's the organizational culture that each one of us works in?

 

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Cooper Linton: Yeah.

 

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Cooper Linton: is it the old ge mentality? We're 10% gotta go every year.

 

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Cooper Linton: what does that do? Ultimately.

 

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Ken Segel - Value Capture (he/him/his): Right? Yeah, absolutely. And you know, and I I it's very powerful to hear you talk about that. And I think of

 

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Ken Segel - Value Capture (he/him/his): all the times we hear folks at the director level at the Vice President level

 

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Ken Segel - Value Capture (he/him/his): voicing exactly what you said. Don't the leaders realize that bringing in XY firm to do this study, and.

 

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Ken Segel - Value Capture (he/him/his): you know, share X with the board is

 

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Ken Segel - Value Capture (he/him/his): is is it's stuff we've actually already looked at and have better data than they think they do, etc.

 

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Ken Segel - Value Capture (he/him/his): And you know, when can we sit down together to solve the real challenges that we have, you know, in a more connected manner, and so to hear that you recognize

 

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Ken Segel - Value Capture (he/him/his): that phenomenon is is great, and then to help us think about where it comes from. You know that leaders have fear, too. In fact, you know that that's what generates a lot of the energy in there, and a lot of organizations a lot of the time.

 

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Ken Segel - Value Capture (he/him/his): and to help us think about that compassionately.

 

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Ken Segel - Value Capture (he/him/his): so that we can

 

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Ken Segel - Value Capture (he/him/his): help leaders

 

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Ken Segel - Value Capture (he/him/his): catch ourselves collectively. As you said, it's about us individually, but it's also about collectively.

 

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Ken Segel - Value Capture (he/him/his): and maybe start to experiment with a deeper path.

 

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Ken Segel - Value Capture (he/him/his): You know, it's really I. Really, we really appreciate hearing you start to move us in those directions.

 

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Cooper Linton: Well, i i i appreciate you saying I think we all need to be just reflective, and

 

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Cooper Linton: I'll be honest. I don't want to work any place where I'm afraid.

 

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Cooper Linton: But if that's the case, who else wants to? I mean, I've I've never heard anybody say I'd like to work in a really fearful environment where I feel intimidated and devalued. I've never heard anybody say that. And so.

 

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Cooper Linton: if we think about it from that perspective, how does it change

 

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Cooper Linton: what we want to create for everybody that we're around

 

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Cooper Linton: our peer group. I mean.

 

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Cooper Linton: yeah. Anyway, I.

 

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Ken Segel - Value Capture (he/him/his): Yeah.

 

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Cooper Linton: There was an easy answer. But I don't think any of this is easy that works hard, Kim.

 

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Ken Segel - Value Capture (he/him/his): Turns out.

 

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Ken Segel - Value Capture (he/him/his): turns out right. But it it is hard, but it it's it's it's great, too, right? Cause it. It puts you in touch with people in a deeper way. It's easy to look at yourself in the mirror.

 

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Ken Segel - Value Capture (he/him/his): You know. Sometimes it's hard, and then and then a lot of times, but in the long term you can feel pretty good about it. So.

 

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Cooper Linton: Well, you get a team that starts performing highly together, and trusts each other enough to be vulnerable and room together.

 

436

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Cooper Linton: And what you have

 

437

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Cooper Linton: is this engine

 

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Cooper Linton: that's becomes incredibly powerful.

 

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Cooper Linton: Yeah, incredibly self-sustain.

 

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Ken Segel - Value Capture (he/him/his): Well, it's you know.

 

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Ken Segel - Value Capture (he/him/his): it's great to hear about the engine you built and the sustainment it's getting, and that it's continuous, and that it's become agile and fast and producing great results across the board.

 

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Ken Segel - Value Capture (he/him/his): Cooper are there, you know, and we really appreciate you appearing with us again today. What you know. Are there any other thoughts you have for peers or for the field, you know, home help, home care, and hospice or healthcare more broadly, you'd like to share at the stage before we sign off and ask our audience to pitch in with us.

 

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Cooper Linton: No, actually, I think that is the thing. I I don't. I think this should be an ongoing learning experiment for all of us.

 

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Cooper Linton: and if we took this this learning experiment outside of

 

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Cooper Linton: one home-based care, entity, one academic health system.

 

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Cooper Linton: and were to replicate this across.

 

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Cooper Linton: not just home-based care, but elsewhere but home-based care we can at least share some things that are common.

 

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Cooper Linton: What would happen?

 

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Cooper Linton: I mean, what if we raise the bar for the whole industry as opposed to comparing ourselves to numbers in the industry that we know are bad to well, we're better than the bad.

 

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Cooper Linton: What if we collectively

 

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Cooper Linton: lifted that

 

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Cooper Linton: we could improve care for people at home, literally across the country.

 

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Ken Segel - Value Capture (he/him/his): Awesome.

 

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Ken Segel - Value Capture (he/him/his): awesome, and that's always been your vision. And for those that don't know, Cooper is a very prominent voice and leader and example in the in that industry which is such a you know we haven't said it, but such an important part of healthcare, and and maybe under song and

 

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Ken Segel - Value Capture (he/him/his): but heroic, and and those of us that have had the chance to touch it either professionally or in our own personal lives, know it. So

 

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Ken Segel - Value Capture (he/him/his): you know we we tip our hat to you as a leader, and we tip our hat to your entire team and workforce for what you do for all of us.

 

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Ken Segel - Value Capture (he/him/his): and I and I for leaders who are who are listening, you know. Again, I think Cooper has given us a big gift of opening up this last part of the conversation to how we make these kind of decisions, and how we can maybe

 

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Ken Segel - Value Capture (he/him/his): train ourselves up collectively to to to do it differently, and beyond that, to share in a in a way that's very powerful, and can change the industry, home care and hospice and beyond. So so we invite you to do that. Cooper is not a not a hard man to find on Linkedin or otherwise, or via the Duke Home Health

 

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Ken Segel - Value Capture (he/him/his): website. We have lots of resources, including previous appearances. By by Cooper and his team

 

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Ken Segel - Value Capture (he/him/his): in different formats on our website at valuecapture. llc.com.

 

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Ken Segel - Value Capture (he/him/his): I'm on Linkedin, you know. Join the conversation. Share your thoughts on this. We'd love to hear from you. And

 

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Ken Segel - Value Capture (he/him/his): Cooper is sitting there waiting to help build the movement further, and and home health and hospice as are we all so

 

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Ken Segel - Value Capture (he/him/his): you know. Thank you for listening today. Give us a like on your favorite podcast platform, if you haven't subscribed already, do so.

 

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Ken Segel - Value Capture (he/him/his): and most importantly, of all, again become part of the conversation. Cooper, thank you for joining us today.

 

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Cooper Linton: Thanks for having me.