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A Model of Multifacility Management

October 1, 2006
by root
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One administrator describes the benefits of corporate "macromanagement" by Kevin R. McMahon
BY KEVIN R. McMAHON A model of multifacility management
A grateful administrator describes the business approaches that allowed a facility in transition to emerge and shine Within weeks of meeting and starting work for Provider Services, Inc., I knew there was something different about this company's philosophy and approach to operating nursing homes. In the Provider Services model, the facility administrator is the linchpin and the focal point for all that flows between the corporate office and the facility. Those who work in the corporate office treat administrators with a strong measure of dignity and respect-the facility administrators are the ones who are empowered to make operational decisions supported by the corporate office.

Administrators who work for Provider Services are typical long-term care professionals: They come from a variety of backgrounds-but almost to a man/woman, they have experienced working for organizations that view micromanagement as a mandate from the hand of God himself. In Provider Services they have found a company that truly believes in unshackling administrators and permitting them to do their jobs as conditions in their facilities dictate.

This has created in this multifacility chain a culture of measured risk taking and independent action that has allowed Provider Services to grow. It has also created a culture of loyalty and appreciation between facility staff and the corporate office that I have never before experienced in my career as an administrator.

The Little Picture
A facility administrator has the day-to-day headache of keeping a wide variety of publics happy and satisfied. This involves paying endless attention to many varied and minute details. This "little picture" management of a facility is required to give nursing home residents a positive and life-enriching experience. Provider Services' approach is to free administrators to focus on the "little picture" items that ultimately spell operational success.

Administrators in the Provider Services system are given wide latitude to act as de facto owners/operators within their sphere of control. This sphere of control is condensed and focused on areas that administrators can realistically control and that will have a demonstrable impact, both on their success and that of the overall operation. These areas include:

Census. Many companies are built around the concept of marketing specialists and consultants planning and, in some cases, executing facility marketing plans. Too often these specialists do not fully understand the facility that they are marketing in terms of its operational environment. It has also been my experience that these marketing specialists/consultants have graduate-level degrees in "blame-gaming" operational personnel when their genius-inspired marketing plans don't produce a correspondingly healthy census number.

Provider Services believes that the administrator, along with facility staff, is best suited to develop and execute marketing plans. The company's creed is that no one knows the local market better than those who live and work in that particular community. The company's approach is to provide each facility with a sufficient number of marketing dollars and then get out of the way and let the facility do what it thinks best. Provider Services also provides regular reporting mechanisms so that facilities know exactly how they are doing with respect to budgeted census (totals and level-of-care mix).

Controllable fiscal realities. Many companies believe in absolute full disclosure when it comes to reporting corporate financial performance to facility administrators. This would include such items as revenues, uncontrollable expense line items, and operating margins. While this may make sense in theory, in the practical world of long-term care administration, the uncontrollable can overwhelm all but the most hopelessly optimistic or downright delusional administrators.

Provider Services believes that administrators should focus on controllable items on the financial side of the operation. The thinking goes that an hour of concerted attention by an administrator focusing on a controllable expense item that is out of budget will beat eight hours of worry about how to get the natural gas bill down to the level it was five years ago (or some other such uncontrollable financial situation). A key focus: Facility administrators regularly and dutifully monitor and respond to labor expenditures.

Leadership. From a corporate leadership standpoint, Provider Services has a decidedly low-key approach to the facilities that it operates. By contrast, I once worked for an owner who loved playing the "large-and-in-charge" role to the hilt whenever he made one of his regular, beautifully choreographed triumphal visits to his overawed facility. Provider Services, on the other hand, supports the administrator from a distance and behind a thick velvet curtain (metaphorically speaking). Administrators are encouraged to step forward as the people in charge, as the officials who are ultimately responsible for the good things that happen. (And when bad things happen, as they inevitably do, Provider Services does not point fingers or second-guess, but rather focuses on fixing the problem.) This low-key approach not only allows administrators and department directors to be in charge of their areas, but to be perceived as such by residents, families, and staff.

The Big Picture
The corporate office takes on the burden of making the "big picture" of facility operations work. For example:

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