Agents of Change

Profitability hinges on ensuring accountability across all operations


The cost of doing business is on the rise, creating tighter profit margins and underscoring the need for organizational accountability. For agency leaders trying to shore up losses top to bottom, tightening the belt can seem like the quest for an elusive Holy Grail, a road fraught with misunderstandings, entrenched habits, and distrust for change. Is there a path to staff buy-in?


A large white board on the wall behind Lisa Brochey's desk captures the agency's vitals in a one-dimensional version of an ICU monitor, its colored marker lists and categories displaying the heart of the home health agency, the daily rhythm and pulse.

Scheduling. LUPAs. NOAs. All the major functions are there.

It's Brochey's first month on her latest job as an interim manager for SimiTree, and she's outlining opportunities, looking for where and how she can create initiatives. More importantly, she's looking for where she can build trust.

This is a tricky time in Brochey's interim engagement. She spends three to 8 months – maybe longer, in some cases – working with an agency's management, sometimes in the role of fixer but more often as a guide, helping teams identify and implement solutions. She needs an agency team to trust her. She needs to show them how and why change matters. And she needs to do it right out of the gate.

“When we go in for interim purposes, we're not just keeping the seat warm," Brochey said. “We're part of the team from Day 1, helping get people from Point A to Point B, working with them on initiatives that will quickly make a measurable difference."

Brochey calls those measurable projects “early wins," and believes they are essential to team-building, trust, and team buy-in. Wins infuse a team with a sense of progress and purpose, she said, sparking enthusiasm for greater achievement.

“We generally see an overall turnaround at about the 8-week mark, but it's the results from those very early wins that really start to set things in motion," Brochey said. “And affirmation that we're on the right track tends to happen a few weeks before that. It's different for every agency, but somewhere around the 6-week point we begin to hear, ‘Oh, I see what you're saying.' That's when it gets exciting."

It's the buy-in moment, Brochey said. New ways of thinking and new procedures suddenly feel like less of a burden to the staff because the reasons for them are becoming clear. Change is about to happen faster, with less resistance.

VBP and The Great Resignation

The buy-in moment Brochey describes is what agencies are looking for, across all operations, to ensure greater accountability. In an age dubbed The Great Resignation due to a national worker shortage and a continuing exodus of employees, filling agency positions has become especially tricky. Agencies don't just need warm bodies in every position; they need warm bodies who “get" it and want to help shore up thinning margins.

Preparation for next year's first Value-Based Purchasing performance year is upping the ante, Brochey said.

“VBP is forcing our hand. We really must have accountability to achieve some our biggest initiatives right now: timely initiation of care, visit management, case conferencing. Agencies can't afford not to have accountability and buy-in."

How does an agency make certain its staff connects the dots between key performance indicators, patient outcomes and agency profitability?

Creating a culture of accountability

“Ensuring accountability really is more of an art than a science," said Laura Wilson, SimiTree's Director of Clinical Consulting. “At agencies where it's done well, accountability becomes an intrinsic part of the workplace culture."

SimiTree consultants say three hallmarks of a culture of accountability include:

  • Communication. Finances, including the budget, are openly discussed. Goals are communicated. Team members are aware of accountability both setbacks and achievements, as well as ongoing efforts to solve problems. They are invited to contribute ideas and solutions.
  • Context. Context is provided to address emotions and values, and deepen staff understanding of why these goals matter, inspiring accountability to make the goals happen.
  • Positive reinforcement. When progress is made, wins are acknowledged and celebrated. “You want the team to be interested, involved and excited," Brochey added. “We all want to be part of a winning team – and when we are, we want to keep on winning. We become highly interested in what we're doing that's making a difference and how we can do more of it."

With the right messaging, everyone can be on track to become an MVP, SimiTree consultants say.

Communication, context connect the dots

SimiTree Financial Consulting Director Erin Masterson believes accountability begins at the top – in the board room, in a seat shared by finance and clinical operations.

“Clinical and finance have to fully support each other and operate in tandem," Masterson said. Respect and support flow more easily when goals are rooted in common ground, Masterson said.

She recommends agencies focus on framing initiatives with both financial and clinical context, offering a LUPA as an example. Medicare imposes a Low Utilization Payment Adjustment, or LUPA, when the number of visits made by an agency does not meet Medicare's thresholds for patients receiving certain types of care. A LUPA can make a significant difference in an agency's reimbursement for a patient.

“Agencies have to make certain that everyone understands how a LUPA works, and that one visit can mean the difference between $500 and $2,000 for that patient," Masterson said. “But you can't just frame it in financial terms. You have to frame it in terms that are meaningful to all the people hearing it. Caregivers may not care so much about $1,500 until you make them see what $1,500 means in terms of being able to deliver care to patients. Caregivers are more likely to care about and respond to patient advocacy than to a $1,500 payment difference.

“It's true what they say – with no money, there's no mission."

Tools and training for better communication

Communication is the building block for sustainable and positive change, SimiTree consultants say. Brochey calls it “the golden thread" of accountability, uniting all agency operations in progress toward financial goals.

“At many agencies, information is guarded like Ft. Knox," Wilson said. “People don't know how many admissions the agency is doing each week. Or discharges. You wonder how they're scheduling. Is any thought going into it? When you provide information, you are empowering your team to improve outcomes and overall agency performance."

“And this applies agencywide, to everyone from the back office to the clinicians in the field," Masterson added. “Everyone needs to be empowered."

Wilson and Masterson recommend metrics be made easily accessible to all employees via dashboard, email - or a simple whiteboard like the one Brochey uses.

SimiTree consultants also recommend agencies provide team members with training to discuss accountability with those who answer to them.

“The most uncomfortable part of the job for most of us is to hold others accountable," Brochey said. “And we can't expect people to just know how to do that. It's a learned technique."

Providing coaching sessions with opportunities for role play can reap huge rewards in productivity as well as accountability, Brochey said.

The hobgoblin of accountability

Consistency can be the hobgoblin of agency management; on busier days, it plays hide and seek in a backlog of tasks and paperwork.

“Obviously, time management plays a huge role in accountability," Brochey said. “It's easy to spend too much time in the weeds, focusing too much on tasks instead of follow-up."

She recommends busy managers look for extra time in the portion of their day devoted to meetings.

“In a COVID world, everyone's always on a call," Brochey said. “But do we really need to be? Look for duplication in calls and work on eliminating it. Can someone else take that call for you? Can you cut the length of a call? Why not make the standard meeting length at your agency 30 minutes instead of an hour? Look for where you can gain lost time during your day and take it back."

A COVID-19 lesson

Brochey likes to hold aloft the COVID-19 public health crisis as a beacon of hope for agencies looking to make difficult changes.

“Even though it has been so challenging, COVID showed us that as an industry we can step up and do what we need to do," she said. “If we can see our patients remotely, there is no way we can't tackle some of these other issues.

“Give them the information and the coaching they need, then show them the wins and empower them to become the leaders you need."

SimiTree can help

SimiTree offers the full clinical, financial, and operational resources and expertise your agency needs to become stronger and healthier overall. Some of the ways we can help in your agency's quest for accountability include:

  • Operational assessments to identify your agency's weaknesses and develop a plan for shoring up efficiency and profitability.
  • Interim management services to ensure peak performance during times of transition.
  • Leadership development services to help empower your team for stronger performance, direction, and management.
  • Technological project management to help your agency create a dashboard for tracking accountability.

Use the form below to contact us today and let's start the conversation about what we can do for your organization.

Contact Us

Let's work together to improve the health of your organization. At SimiTree, we balance financial expertise and clinical excellence to help our clients grow. How can we help you? Call us at 866.839.5471 or complete the form below.