Mastering Growth in Home Care: Systems, Leadership & KPIs

Simone 00:00:00 Welcome to The Flychain Reaction, a podcast designed to empower healthcare providers like you to master the business side of running a practice. Each episode sparks a chain reaction, where actionable insights on financial management, operational efficiency, and growth strategies build upon each other, creating a powerful ripple effect to help your organization thrive. With Flychain's financial expertise and insights from industry leaders, we'll dive into everything you need to ignite success. Join us, and let the Flychain Reaction spark growth in your healthcare business.

Ethan 00:00:41 Hi, and welcome to another episode of The Flychain Reaction, where we speak with healthcare experts and let them share their stories with us and the entire Flychain community. While at Flychain, you know, we're really focused on the numbers. Behind every number, there is a person and a journey, and we encourage our guests to really share that journey with us. And provide some tactical advice based on their experiences. And it's my pleasure to bring Emily Isbell onto The Flychain Reaction here. Emily, how are you doing?

Emily 00:01:20 I am doing wonderful. It's a beautiful day. So I'm enjoying the beautiful day.

Ethan 00:01:26 Yeah, well, we're super excited to chat today. I didn't want to give too much of an introduction for you and steal your thunder. But we'd love to just learn a little bit more about yourself, your experiences, you know, what kind of brings us to the conversation today. And with that, we can kind of dive into some additional questions here, but yeah, tell us a little bit more about Emily and all the things that you're up to.

Emily 00:01:49 Yeah, sure. If I can, I'd love to kind of start with my journey in home care and just speaking to how I ended up here at this point in my life. So, I think it's always surprising for people to know that I actually started off as a caregiver while I was in college. And if it hadn't been for that part-time job to help pay my rent, I wouldn't be here today. I had a completely different trajectory. I was planning to do... be a clinical therapist and focus in that direction. And almost... I was in my junior year. So, really had no reason to change paths.

Emily 00:02:26 But saw an advertisement to be a caregiver, was shocked you could be paid to do something I thought you would do only voluntarily, and had done voluntarily. And yeah, as soon as I joined the company, I decided to change my degree. I actually spoke to an advisor at the school, and they... honestly they mocked me. It wasn't that blunt, but they were quick to say, and how long have you been working there? And I'm probably saying three weeks or something like that. And she goes, so, you're still in the honeymoon phase. And so, yeah, and I hadn't heard that term before that. And I went back and Googled it. And I was like, okay, maybe, but I don't think so. And here I am, it's been, gosh, that was 2007. So many, many years that I'm still riding that honeymoon phase today.

Ethan 00:03:18 Yeah, totally. And I know like, maybe when you got through the honeymoon phase, talk to us a little bit about sort of that initial part of your journey. What you were up to back then, and we'll switch gears into some of the, I think, more recent things you're doing. But we always love to kind of meet our guests and hear that journey because at the end of the day, our customers are people. And I think it's really helpful to relate to some of those shared desires, shared mission, anything on that front. Yeah.

Emily 00:03:50 Yeah. So, thankfully, I worked with an owner that was very attuned to seeing my potential, I suppose and actually took me under his wing and mentored me. And so when I changed my degree, I also kind of worked with him in a mentorship way. Fast forward to in 2012, we took over a location in Tennessee that I was going to be the face of. That I was going to run and operate. And I was only 20... whatever the math would be, 25 maybe. And the people that worked there when we acquired the business were definitely twice my age. And, you know, I had to overcome that challenge, but ended up doing that. And being able to apply the principles that I'd learned at the first location to that second location, put in systems and procedures that allowed us to scale.

Emily 00:07:00 But what I've realized now is that I wasn't a very good manager. And that goes back to these systems piece that I've referenced. I had systems and procedures in place, but they hinged on me. Like me being able to put my seal of approval on it, or have some sort of influence still within the system. And so that burnout stage where I was about to call it quits, I realized I've got to let go of being such a key part. And a manager understands how to create systems and then manage those systems, not necessarily manage, yes, the people. But it's more about trusting that process and having processes in place.

Emily 00:07:42 And so I learned back then, or what I've learned in hindsight, is that I was really good at leading people and having people that were advocates and wanted to do right by seniors and our mission and all that. But I wasn't really good at managing them and making sure they met the expectations of the role, without me having to be right there next to them to do that.

Ethan 00:08:00 Sure. Sure. Yeah, it's kind of funny. I, you know, we're building Flychain here. A lot of what you said resonates with me despite building a very different type of company. But it's like delegation. And how do you kind of trust something that you've probably been doing with a laser focus that, you know, you sign your name on that document or whatever, that email. And feel like, you know, it's gone through that. Talk to us a little bit about like some of those managerial aspects, like leadership. And it's kind of interesting, you said that leadership and management are two different things. And you like looked at yourself in the mirror and kind of realized, on the management side wasn't like scalable, maybe is maybe the right way to say it.

Ethan 00:08:43 And so talk to us a little bit about some of those maybe systems that you've put in place or have had success implementing in other organizations that really enable you to, not be hands-off by any stretch of the imagination, but enable you to actually trust the process, as you like to say. Because I love that. I'm a Philadelphia sports fan, and that's a big slogan there for the 76ers. Trust the process. So, talk to us a little bit more about the process.

Emily 00:09:10 Yeah, so I think... Unfortunately, there's not a silver-bullet process. And so I had to look at everything that was causing me to be a bottleneck. Or why did I have to answer a question about X or Y or Z? And so, there's different examples. One was, we were having turnover in our HR department. The person responsible for hiring and retaining caregivers and managing those processes, we were having turnover there. And so, not only had we had turnover, but then we had put somebody in place that wasn't equipped. She had been a wonderful home ec teacher in our life. And so I was excited for her to be a great trainer for caregivers. But just because you can train and teach people doesn't mean you can do the other pieces of the job.

Emily 00:09:55 And so I was holding on to someone that I didn't need to hold on to. So this isn't really an easy direct line to what you just said about process. That was one thing that was holding me back, was the reality that I didn't have somebody equipped to then do the role that I needed. And so that was one thing. There were people challenges that we had to work out. And I'll never forget when I talked to her, and she had been a caregiver that was promoted. And I told her that we would need to move her back to being a caregiver. Like that was a very... I avoided that conversation.

Ethan 00:10:28 Yeah. Difficult conversation, for sure.

Emily 00:10:31 And it was part of my burning issues that I was having... a desire to want to burn out, or why I was burning out. But anyway, when I did it, she just looked at me and she just said, I fully trust you on that. And so I couldn't believe that. I mean, I just debooted her, but she stayed a caregiver until, who knows, she may still be a caregiver today, which is wonderful. But I think that was the side of leadership outweighing management, right? And recognizing. And so finally I married the two and realized, as the management piece of this has to change. And that my leadership, thankfully, the credits I had built as a leader helped guide through that. So that was one example.

Emily 00:11:10 But back to processes. Then from there, I needed to find and hire someone who could deliver on processes, who thought in a systematic way. We really looked at, like, the business... pulling it from my brain and putting it on paper. And I think a common thing that people do is they get excited. They have a honeymoon phase maybe over a system update in their office or something specific they want to implement. And so they create a checklist or a structure and then SOP. And it goes somewhere into the cloud, and it never comes back again. Or it's used for three days, and then it never comes back again. So, what I learned was really to make sure that it looked, and what I was about to say a second ago was, what we leaned into was like an assembly line process.

Emily 00:12:01 So, looking at, you know, from the time an applicant inquires to the time they're interviewed, that there is truly this streamlined checklist. Have to do it, or have to acknowledge why you didn't process. That there's still human aspects that can cause mistakes. I'm not going to deny that, but theoretically, you can't get to here without doing this first. And what happens also with people is they create checklists outside of letting it just disappear or, you know, the honeymoon phase goes away. They also create checklists and don't keep it timely. So, for example, the state requires you to do TB skin tests. Well, then they update you and say, you don't have to anymore. And so the checklist still says it, and your team has to acknowledge it. And if you have too many of those things that aren't applicable anymore, the ones that matter are going to start being less -- they're going to have N/A across everything. Because they're not going to take it as truth of like, I have to do this in order to get to this.

Emily 00:12:58 And so, that's kind of a digression. But a little bit of a thing that I found, you know, when I went to clean up processes, and why that particular person wasn't a good fit was because some of it was her for sure. There's no denying that there were skill sets that weren't there. But on top of that, I didn't make it that easy for her because I needed her to think independently and not follow the checklist or to ask me. And so that's where processes can come into play. So yeah, I think checklist, I kind of harp on that too much, but I am old-fashioned in thinking there should be a checklist for many important processes in the business. Because it really can streamline it and make sure that people know step one, two, and three.

Emily 00:13:47 And then the last thing I'll say is certain ones, we would actually... you had to initial because they were just so important. Not to say the others weren't, but like, I don't have a really good example. But some that we had to initial because it was just such a crucial piece to standard audits or state certification and things of that nature.

Ethan 00:14:10 Yeah, just to kind of like, double-click on some of the things that you said there. Because we're operating in a universe where people are pretty much everything, right? Like you know, your staff, whether it's the caregivers or more on that operational administrative side. When you're thinking about hiring on that side of the fence, that operational side. This is something we get asked all the time, and I don't have a good answer for it, which is, what are the kind of characteristics that you're looking for? Is it someone that has to have a very specific understanding of home care, or is it someone that is much more... And obviously it's great if you kind of get the combination, but that's not always the case. And maybe it's someone that's very process-oriented and can take, you know, instruction. Is that, you know, kind of the most important thing when you're thinking about hiring for those operational roles? And I know you mentioned part of this is you as Emily training and kind of creating buy-in to that new process. Or is it better to maybe hire someone that had an operational role in at another home care agency?

Ethan 00:15:16 Because we kind of see sometimes that that's a really net positive, but sometimes it can be almost like you're butting heads because you're now trying to inherit another business's processes that might not jive with the way that you want to run your organization. So how do you kind of weigh those things as you're thinking about hiring someone that you can then delegate, you know, some of those mission-critical processes to? What are those sorts of characteristics, or also maybe like not just the positive characteristics, but what are some red flags when you're thinking about hiring someone that can prevent a bad hire from joining your team? Because I think the opportunity cost of making a bad hire and then having to try... and constantly try and educate them, new processes, it oftentimes can be a waste of time. Can be a drag and ultimately maybe not work out. So, any advice to our customers or community there?

Emily 00:16:13 I'm glad you asked this. I could honestly speak for hours about this because I'm pretty passionate about it. So, one thing, keep in mind my story. I started off as a caregiver, and I had an owner who invested in me as a mentor. And so I am passionate about growing people from within. And I mentioned a story at the beginning of this of a caregiver who didn't work out. But you said, also that some of that relationship and how it was handled, can also be very amicable and healthy. I think a lot of people are afraid to promote from within because then, if they do and it doesn't work out, they lose a good caregiver. And so on a sidebar, I will say a good caregivers don't always make the best staff members and bad caregivers don't necessarily make a bad staff member. It's fascinating. And so you got to look at why are they considered a bad caregiver. But I can circle back to that in a second, but I want to stick with what you're saying.

Emily 00:17:09 So, I am... When it comes to hiring somebody with experience at a different home care operator, I am very hesitant. I'm going to be much more harsh in my judgments and my interview style. I'm really going to double down on asking a lot of questions to really try to get to their character. And I want to know everybody's character overall in general. I always say hire character, not skill. It does... there are perks to some skill. Like, somebody who doesn't know how to utilize Microsoft Word or anything like that, that might be a baseline you need to have. I'm not trying to exaggerate that too much, but character is a big part. And specifically, I think you said someone that follows instructions, I think was your words or something like that. I often say, find out if they are coachable. Are they someone who will listen to feedback without a lot of offense? We're all kind of human, and it can hurt our feelings. But are they willing to hear that, take a moment, maybe take a deep breath, and then improve upon whatever the feedback was?

Emily 00:18:22 And how do you find that out in an interview? That's kind of tough, but I think the best way to do that is what I call competency-based interview questions. Or you might have heard of behavioral-based, it's the same concept. And that's where you ask questions with scenarios and things like can you tell me about a time where you were asked to execute on a process, but you didn't agree with the process? How did you handle that? And so that would be a really great open-ended, see where they take it.

Emily 00:18:52 And they might tell you, well, I refused to do that. And when they found out, they talked to me about it and I told them why I didn't think it was okay. Well, that's one person's answer. Another person's answer might be, when the process asked me to do that, I immediately sought out my supervisor for a one-on-one meeting to talk about voice my concerns. And see if there may be a better way to go about this. And together, we actually adjusted the process because she agreed with my feedback and we made it better. So, one is ignoring and not willing to work with or try to address and the other one is trying to be collaborative, right? And so both of them probably felt confident in their answers because that's how they show up to situations. So, I love those kind of behavioral based questions. I can tell you have a thought. So, I'm going to give the mic to you.

Ethan 00:19:41 Yeah. Yeah. I actually... It's kind of going back to what you said around that, the HR, you know, individual that ultimately didn't work out. But one thing, maybe bring it to sort of the Flychain perspective. We're always interested in like margin and how to improve profitability and things. And I always like to really highlight how perhaps making that wrong hire can have not just a single problem that can be solved by replacing that person but like, was there a trickle down effect of that person not doing the right thing? 'Cause I think viewing these decisions, hiring decisions, the right operational person, the right HR person. They shouldn't like, at least from our lens, maybe shouldn't be made in a vacuum because there can be a pretty big opportunity cost there of not just replacing that person.

Ethan 00:20:32 But if they're not doing the recruiting and the onboarding and the training the right way... did that like, you know, that hire that didn't work out. Did that have a ripple effect into that caregiver universe? And you could talk a little bit more about that just to really hammer home that point that like, putting the right kind of people in place that delegate and then kind of own that specific workflow or, you know, job description -- whatever you want to call it, can actually be significantly more important than you ever realized day one. So, yeah, if you could talk to that point a little bit more, I think that'd be really helpful to really reinforce the notion of like one hire, it's not just one hire. It could actually impact the entire organization or a very big fragile portion of your organization.

Emily 00:21:17 Yeah, it definitely can have a compounding effect. And I think you nailed it on some of those, like caregiver hire numbers. Then, if you can't hire the caregivers you need, you also can't say yes to clients who need care and then clients who need additional care. So existing clients are now unhappy. So, there's definitely that ripple effect. It also affects the administrative staff, and that the client effect and caregiver effect are huge, right? Revenues are important for keeping the lights on. But the, like intangible is you have other staff picking up the slack.

Emily 00:21:51 And for us in that example, on call was really impacted. Because the same thing that was happening in her skill sets of not knowing how to handle or think independently on certain things, and where she was quote unquote bothering me during the day. And I was realizing, oh my gosh, this is... I'm too, and I need to do better checklists and processes. And she's not exactly the right fit. She was doing that when she was on call, too, right? And so she's calling everybody who's supposed to be off, and then they're not having time off, and they're frustrated. And she's, in this case, a wonderful person. I think, honestly, that's also a challenge in home care is we attract wonderful people. And then we're like, but she's so nice. I feel bad. And it's like, yeah, but this niceness is not working for the overall good.

Emily 00:22:39 That's where I talk about in my book about sympathy versus empathy. Like, sympathy is, she's so nice. I don't want to hurt her feelings, I'll work around it. Empathy, in other words, though, is recognizing and being able to have that hard conversation and having empathy for the effect it's having. Even on her, right? She doesn't feel confident in her role if she's having to call everybody. And I think that also using that person as an example. Like that's why she's like, I trust you, 'cause she had that thought herself too, right? Some of those thoughts. But yeah, anyway.

Ethan 00:23:13 Yeah, no. I love that little, like, sidebar anecdote there. To get a little tactile, because you've got a lot of experience under your belt and a few different capacities. But one thing that we really like to always ask our guests. Again, given our sort of purview here from the Flychain lens. You obviously have like systems and checklists in place. And the important of process so things don't slip through the cracks. One question I'd have is, for agencies looking to grow, given you've kind of gone through this a few different times in your personal and professional journey. For agencies that are actually looking to grow maybe in the beginning or maybe hit like a stagnation point, are there specific KPIs or things that you want to, to really track within your organization that you see as being mission critical? And do those change over time, perhaps?

Ethan 00:24:06 Maybe things that you pay close attention to day one, as you're growing and scaling and hitting certain revenue thresholds. Like, are there specific KPIs that you saw that by tracking these, it really moved the needle in accomplishing better prudent growth or better margins, or maybe it's staff attrition? There's a million different levers we could chat through. But were there any sort of mission-critical KPIs that you would recommend anybody that's running a home care agency to really monitor closely to make sure that things are going the right way? And if they're going the wrong way, you now have an ability to track that and course correct. So if you could talk about any of those, I think that would be really helpful to the audience.

Emily 00:24:45 Absolutely! Yeah. So I think what I like to hone in on this is not "I will get to specifics and home care." But I think what is a missing piece is also the structure and management to bring that work up again, the management of KPIs and metrics. So, and I say KPIs and metrics on purpose. The way that I define it, me, and if you Google this, who knows what Google says, but for us and what we teach is there are metrics and there are KPIs and a KPI can be a metric, but a metric's not necessarily a KPI. So what does that mean?

Emily 00:25:22 Metrics tend to tell the overall business health. It is good information to have. It's knowledge you need and it's helpful to give -- paint the full picture. KPIs to me, the breakdown of that word, it's Key Performance Indicator. So I like to look at it as an indicator of performance and so I take that further. What can the person perform to do and influence that number? That's kind of the way I think of it.

Emily 00:25:48 And so number one, I think there should be a KPI for individuals, a minimal number like two to three, maybe five, depending on level of your business. And maybe if you've grown to a larger organization, that's a managerial level with many people under you, you can have more than maybe five, but in general, three to five is a good amount. And so KPIs need to have a goal, like an expectation. I'm going to achieve 90% plus conversion rate of consultations to clients. That would be an example. The KPI is... the topic is conversion of consult to client. And then the percentage 90% or plus is the goal. So that's one thing. That is not one of the ones I actually wrote down to kind of share today. So I'll give you some more in a second. That's one part of the structure.

Emily 00:26:46 The second part of the structure that's really important is the management piece of it -- again, a lot of home care owners are good leaders. I think I have similar stories to me that people enjoy working with them or passionate about what the mission is and believe in what they're doing. They don't focus in on management as well as they need to to be able to scale and grow. And so the management piece of KPIs and metrics is making sure there's a weekly check-in on results to goal in terms of your KPIs as well as maybe some certain metrics you want on a weekly basis. But we really focused on KPIs weekly and then on weekly basis doing a monthly one-on-one with your team, one-on-one, face-to-face, not weekly. That's a common thing that I see homecare owners doing and 24/7 home care business doesn't have time for weekly one-on-ones. It should be really a weekly team meeting to go over your results to goal for KPIs and then a monthly one-on-one where you then do dedicate some time for that person to have space to talk about their challenges and things they're overcoming to achieve their KPIs.

Emily 00:27:53 So the structure of that -- but then one more piece of that structure is having them report out what they're going to do differently if they're not meeting their goal, like an owning their responsibility as a staff member of if they're supposed to hire a certain number of caregivers a week, what are they doing this week to improve on their results from last week if they didn't meet their goal?

Emily 00:28:12 Okay, so now to answer your question about KPIs and I guarantee you, if you asked me in a month, I'll tell you different ones. But today, I will always say this one, I'll say, hours is something that you've got to pay attention to. And I will... I have been shocked, and if somebody listening, this is you, I'm sorry to call you out or make you feel seen in this moment. But I've been shocked by clients of hours who don't know how to know what they're projected to serve in terms of hours of service. And to me, that's your purchase orders, right? If you were a factory or selling a product and you need to know that, and then you need to know, 'is it going up or down?' And you need to be responding according to that proactively.

Emily 00:29:01 I had a client that, it was unfortunate because... honestly, I learned in this process to do better job as a consultant. She was so excited about how much they were growing. And she was telling me this, we had multiple calls a week over the course of an entire month and we're working on our other projects. And I would do a check-in and ask, well, "how's it going in terms of growth?" "Oh, it's great. We, you know, three consults yesterday and the day before, and it's just been great." She unfortunately didn't have a pulse on her hours and so she was bringing in 12 hour a week clients, but she had lost like two or three 24/7 clients. In her brain wasn't a... her skill set wasn't to do math that way, that quickly and I'm not a big math person either, I'll be honest. I can study numbers and figure it out, but I don't think as quickly as some do.

Emily 00:29:50 And so we get to the end of the month and she thought she had been growing the whole month, looking at her projected hours truly on the schedule. So having a goal for your hours so that you can, which is your revenue growth over month over month, but then also having a pulse on it and actually evaluating what is projected in, on the books at the time.

Ethan 00:30:12 Yeah, just to distill that a little bit more. So I understand it and the listeners do too. It's really about like in that example, like that owner was probably feel' like they were, they were crushing it, right? They closed all these new clients, right? But it's sort of like what is the understanding the value of that client? Obviously, we value our clients the same no matter what, but there's a business sort of valuation you want to do. And it's almost like if you want to use the baseball analogy, it's like she was just hitting signals every single day and which feels really good, but doesn't always mean that you're hitting home runs where you're going to have those, you know, longer duration or you know, more hours associated with each of those customers.

Ethan 00:31:53 So, that's really what we're talking about here is really understanding like sort of the time commitment and in turn revenue opportunity of said you know, patient that you're going to be caring for. I just wanted to make sure that that's what we're talking about.

Emily 00:31:06 100%. And you can look in your system, most systems have it to see what's scheduled on the books. It is... whether you've put--- the right thing to do is sign up clients within your parameters of what you want to do for as a business leader. But then you also need to have a pulse on recognizing, "oh, but that didn't replace the client that we lost on hospice last week." So, how do you respond to the network in terms of marketing and sales? What do you need to do differently to replace--- replenish that loss and have a healthy perspective on your businesses' overall health?

Emily 00:31:44 So, I don't think that, I won't say that's a very common--- it's common enough, though. So I think if you are not looking at what you're projected to to have, that's a number one metric. And then you can create a KPI, meaning a goal of certain number of hours per month or per week or whatever your measuring period is to have for your office and for yourself as a business owner.

Emily 00:32:08 So another couple, I'll just throw some at you, just to give you even more. I think a common one that I think is powerful and can sustain a business even if sales is not going well for a period of time, if there's a dry spell, whatever that might be, that is to do internal sales and so having a record of increasing hours with clients and recognizing clients are ageing and so they likely need more care over time. Now it's not a matter of growing them in a greedy way or saying, "you know what, let's come 24/7, even though you only need morning breakfast and medications." That's not what I'm saying. But having a pulse on it and recognizing and having a KPI around it just to drive you towards asking better questions of existing clients.

Ethan 00:33:03 That makes sense. It's like, "hey, you've got the relationship, what more can we be doing in here to help meet the needs that you have, whether you might realize it at this exact moment in time?" And so it's almost, I don't want to call it "customer stickiness". That's something we think about here at Flychain, but it's really just being able to be that voice and leaning more in on meeting them where they are in delivering services that can help them, you know, get through whatever rough patch they're going through.

Emily 00:33:32 The stickiness, I know that concept outside of home care, but technically all senior care clients, when they come to us as a home care provider, should be very sticky because they want to say "home". And so it's our job to ensure that we create that environment for them, whether that's increasing hours or making recommendations on adaptable devices and referring them to partners of ours who can help them stay home with other services in addition to ours. So yeah, 100% focusing on your existing clients and I like putting a KPI to it because --- it's the concept of what gets measured gets managed. If you're not, if you're not measuring it, you're not actually checking in on how are we doing in terms of increasing our clients' existing hours, then you're not going to think of it because you're going to deal with a no call no show, a callout, a caregiver who took their boyfriend to work, all these things that happen in the day and the life of home care operators.

Emily 00:34:32 Another thing that I think is a common thing and then I'll turn the mic back to you, but it is two other caregiver focused ones. I think we often look at how many caregivers we hired or how many we lost and I think that needs to be paid attention to. And it can be a KPI just by the way, like a metric can be a KPI that maybe started out as a metric 'cause you realize you can focus in differently on it. But we found that we started focusing on "caregivers paid", not "caregivers hired versus lost" and like, what's the net gain of that? It was net gain of "caregivers paid" because if we hired 10 and we lost one, but nine of those people didn't actually work, we didn't gain anything. They might have, and why did they not work? Was it because of us or was it because they weren't good hires? So "caregivers paid" a net gain of that, like over time truly shows growth with your caregiver pool.

Emily 00:35:28 And then the other thing on that same note is caregiver optimization. We would measure the desired hours they had preferred hours they wanted. Did they want 40 hours a week? Did they want 20? Whatever their desire was compared to what they actually are getting. And we would put a KPI to that to set a certain percentage of our overall caregiver pool having a certain percentage of optimization and try to make sure we're always paying attention to that. So--- **\[crosstalk\]**

Ethan 00:35:56 Awesome. No, yeah, no, that's fantastic. This is a bit of a curveball question, but I always like to ask it. So, there's this other podcast that is pretty famous called "How I Built This" and it's like, talks to you know, founders, entrepreneurs that have built super successful companies. But personally, and I think a lot of people at Flychain feel that you actually learn a lot more about what not to do by learning about mistakes and so this is the segment where it's how I botched this, if you will. So instead of "How I Built This", "How I Botched This" and was there anything that, you know, maybe you've done historically that you can look back and say, "I made the wrong decision here, I made like a really bad move here and here was the outcome, but then here is how I maybe corrected that."\ \ 00:36:41 Ethan: And again, like this is out of nowhere, I realized that, but at least from our lens and running Flychain and working with our customers, I think we learned so much by seeing, you know, admittedly the mistakes that people make and looking out for those from our lens. But we're not coming from that sort caregiver lens and so anything that you could maybe chat through on that front that, you know, you've made a grave error -- maybe not grave errors, probably, let's not go too crazy here, but any issues that you, you know, maybe self-inflicted wounds that you now, hindsight being 20/20, would have done things differently.

Emily 00:37:19 Yeah. So I've actually given a whole presentation on this. So I'll try to give you the CliffsNote version. So one of our acquisitions that we did, they were contiguous territories and we decided to combine the team and make it like one big office, theoretically. And we felt like that was going... that was against what we had done historically, but we were like, "this is a different. This is new territory," because they all are together in the same... they're within an hour and a half drive end-to-end. So this should work.

Emily 00:37:54 And what that allowed was the business was able to save money. I will tell you that that was a motive. It was a recognition that somebody who we need in one office, we only needed like a 0.6 FTE, not a full FTE and so to combine it, then that made more sense because then this office only needed a 0.2. and so it worked. On paper, it looked beautiful. That's one. Then two, we also were able to offer opportunities of promotion. So because we went from three different teams to then a larger team, we could create larger opportunities of departmental leadership. And so---**\[crosstalk\]**

Ethan 00:38:37 Yeah, like, like bigger, **\[crosstalk\] \[inaudible\]** structure. Yeah, okay. **\[crosstalk\]**

Emily 00:38:41 And we were like, also, then we'll have the best people doing these that are skilled in this doing that and doing that and we kept with our processes. So the reality is we grew the business, in a year's time, we grew it by about 9, 10%, I think. The problem is that wasn't our history. We had always grown a lot better and higher than that year over year. And so we did grow and on paper, it looked good. The reality is we were miserable. There's many horror stories within that. Like I said, I gave a whole presentation on this, but one of the examples is my mom came to visit on a Friday. I lived at Nashville's part of the area.

Emily 00:39:20 And so she's asleep on the caregiver training bed because I'm there 'til midnight and with the team handling things because it's just such a big organization. And it wasn't wise what we were doing. It's what we were figuring out. And so there's a picture of her next to a dummy mannequin that the caregiver is training with asleep, snoring. Anyway, that we can make light of it, but in reality, that was a very unfortunate situation to face and kind of...

Emily 00:39:51 So a year goes by and I made the decision to unwind it, which then also meant demoting. But not like because of their fault, but just basically reorganization is what it was. And so what I will say to that is we scaled to seven locations and we kept them all after learning that lesson separate. Two separate teams and what I've learned is to call that, my team member, Matt, taught me it's the Subway model.

Emily 00:40:18 It's the idea that there's a Subway here and a Subway there. But because of that, you can actually provide better service to these people coming to that location because you don't have the line being too long and you actually get more business. There's all kinds of reasons for Subway to do it, but it's similar in home care. So, I would recommend to follow that model to the point of even satellite offices within an existing territory versus trying to combine a lot because overhead it looks better and it financially looks like better earnings and profit. But in reality and execution, you're bottlenecking yourself from growth and optimizing that trading that market.

Ethan 00:40:59 That's fascinating and I feel, you know we hear that from a lot of our especially, like smaller customers that might candidly get acquired by like a private equity group and they combine things and it creates\... It's almost like you said, like the best laid plans on paper often look really good, but in practice, you know, the spreadsheet doesn't always add up in the same way. 'Cause at the end of the day, we're dealing with people, not numbers, as we say. Very cool.

Ethan 00:41:28 Well, I do want to just maybe end on one final question here, would be, you kind of mentioned like burnout that you had and that's something we hear time and time again, whether that's the owners, the administrators, the caregivers themselves. You've given a lot of insights so far in this conversation around like perhaps ways to combat that, but given what you're doing now, tell us a little bit more about 24/7. Like, when someone is feeling overwhelmed in that current job, like how do you kind of work with that organization to say, "you know, it's totally normal that you're feeling this way, but there's a light at the end of the tunnel if you do X, Y, Z". So, you know, I think that is something that we hear time and time again, running a home care agency feels like this ever evolving, like amoeba, if you will.

Ethan 00:42:16 That's why you're saying KPIs might change in a month and we realized that there's no silver bullet answer to any of these hard questions. Do you have any kind of advice and also definitely want to highlight some of the work that you're doing at 24/7 to really help those folks that might feel things aren't going as well, as you know they think they were supposed to go or they're hitting like maybe a plateau or they're having a really material growing pains? Maybe just talk a little bit more about the work that you do at 24/7 to really help those folks that need it and might be afraid to ask for the help, but the whole goal here is to really make them feel that they're not alone in this. Because we see it time and time again, that a lot of these same issues do continuously kind of present themselves.

Emily 00:43:03 Yeah, I'd love to. So I think to answer your question aside from us, my advice here would be that you look at your business, you truly take some time -- which I know what I'm saying. And like, I feel like I have the street cred to say I do know what I'm saying. Take time to do this. When in home care, it feels like there's not enough time in the day and I get that. But I would force it upon yourself to -- and not even necessarily a weekend, like I think you need mental health time for yourself to have a true weekend. Rest can recharge you.

Emily 00:43:37 But I would take a couple of days yourself to strategize your business and like think about if... do what I do with clients, what would you do if you were to acquire this business today? If you were to walk in, you didn't have any history except what the previous owner, which happens to be you, told you about your business and what would you do differently and spend two days developing an action plan that responds to that. And so that ties to what we do with clients.

Emily 00:44:06 So one of our consulting services -- we have a variety of services, but one of our consulting services is we take people through a Cumulus Strategy and that Cumulus Strategy takes people... we learn about their business and then I actually asked that question, "what would I do if I were to acquire this business"? So that was our background. Scaling to seven was acquiring existing locations, knowing what was scalable and could be copy and pasted into a location, but then also knowing what can't be because of State Regulations that are different between states, that are market differences between rural and metro and all kinds of different factors and marrying that. What you can copy and paste versus what can't be and marrying that and finding the right action plan for the business. So we work with clients to learn their business so we can do that just like I did for turnarounds in my background.

Emily 00:44:58 But you could do this for yourself like you could really just take that quiet time. Go to a library so that you're not at your office and it's just a different environment and you can sit quietly and just really think about, "if I were to acquire this business and", you know, put a mirror out \[inaudible\] being a little sillier, but like look at yourself and learn from that person, "what about this business is not great versus what is good"? And really evaluate what you would do differently if you were to... you were a new owner starting fresh. And I don't mean like starting over from scratch. You have these existing staff, you have these existing problems and you are the new owner who took over.

Emily 00:45:35 So, I would, if that's something... if you're at a plateau because you can't seem to get past a certain dollar amount, hour amount of service, if you're at a plateau because you feel like you can't scale past the staff, like they still need you too much and you're pushing that burnout like I was, that's something we can help you with is our... to really dive deep and through our Cumulus Strategy approach.

Emily 00:45:57 The other thing that really I have found, that honestly it surprised me, is the number of people -- because my story I've shared with you in the beginning, my story is that I would say I was a good leader, that my staff would say I was a good leader. But in hindsight, I wasn't a good manager. I didn't have good systems in places and process in place that excluded me. And that's what management is, is they can work without that oversight, direct oversight. And then also just that check-in process of managing the systems.

Emily 00:46:35 So what I learned through my burnout process is how to be both and I've tried to teach that and some of my clients, perfect students, but other ones will just directly say, "I just don't think I'm ever going to be able to do that". And it's what I'm talking about is that structure piece of making sure you have regular monthly one-on-ones, having weekly check-ins on KPIs and numbers. I've even had an owner who early on said, "I don't want to schedule this meeting because I may not want to go to work that day". Like because that's the entrepreneur journey, right? But they didn't have the size to be--- have a general manager or operational leader and you're not going to get to that size if you don't do this first.

Emily 00:47:17 And so I have been surprised by that. And so I... what I'm excited about that we offer to try to combat that is our Powerhouse Peers for administrative staff. And so what that is, is we work with clients to... we say, "let us be the manager so you can be the leader". And it comes from... full story and so we are going to manage the KPIs that they're responsible for on a weekly and a monthly basis. And the reason it's under our Powerhouse Peer service line is because they also will join a network of other schedulers or other salespeople, depending on the position, we focus in those core cohorts and they get to know other people, non-competing, not somebody in their same territory, to learn how are they optimizing caregivers or how are they getting caregivers to accept last minute shifts or how are they getting referral providers to send discharged patients their way.

Emily 00:48:10 So we do the managing, like I've said, but we also offer that Powerhouse Peers Network to further amplify their resources and help them. And so those are two services that can really help if you know you're not able, that's not your strength, nor, or you just -- matter of fact, I had a consultation yesterday, she goes, "that's not me, I don't want to do it and based on what you said, that's what my team deserves, and I want to give that to them". And so that's what we're going to do for her office. And so, anyway, those are the two options. It's either figure out your... an action plan for your business or it could be both or invest in some sort of management support to make sure your team feels invested in and has some structure in making sure they work towards the KPIs and goals in the business.

Ethan 00:49:02 I love it. Emily, I know we're close to time here. I do want to give a little option here for you to plug your book, like we're very excited about it as well here. Tell us a little bit more about that, where they can find it, when it's... like anything that you want to share there, 'cause I would encourage folks that are interested in launching a new home care agency, scaling one, getting into the space, what have you, to pick that up. But yeah, any insight on that would be awesome and then we'll wrap up.

Emily 00:49:30 Yeah, yeah! So the book is basically available anywhere you can buy a book, so Amazon, Barnes & Noble. It's called the 24/7 Solution: Proven Strategies for Home Care Business Leaders. You can also go to our website, which is www.247solutions.co and learn more about our services and definitely encourage people to subscribe to our Twosday Takeaways, which is spelled T-W-O-S-D-A-Y, which means it's a play on words. Two takeaways will be provided to you every Tuesday that can help improve your businesses' operations.

Ethan 00:50:06 I love it! Well, Emily, thank you so much for joining us today and spending some time to tell us about your journey and all the things you've learned. And yeah, we'll let you go on that, but appreciate the time again.

Emily 00:50:19 Perfect.

Ethan 00:50:20 All right. Take care, Emily.

Emily 00:50:22 Thank you.

Simone 00:50:23 Thanks for tuning in to the Flychain Reaction. If you'd like to keep the conversation going, feel free to contact us at <info@flychain.us> or schedule a demo through our website at [www.flychain.us](http://www.flychain.us). See you next time!