Organizational Design – An Overlooked Secret Weapon in Home-Based Care

 In Podcasts, Preparing for the Future

For home-based care providers, some choices or changes come easier than others. Hiring decisions, process and protocol development and updates, and even the creation of new service offerings can be made with the applied effort of a small and focused leadership team. That doesn’t mean it’s a walk in the park, but there are definitely areas where it’s easier to be nimble.

The Things We Take for Granted

The tougher areas can sometimes feel so set in stone that they may seem almost invisible. Concepts like reporting relationships, areas of ownership at the leadership level, and operational practice can be taken as “givens” within an agency. It’s like thinking about air – it’s so omnipresent that we don’t even think about it day to day.

But taking a step back and looking at these invisible factors is where Transcend often sees enormous potential. Thinking about hierarchies and portfolios within your agency has a huge impact on the results you get! We see this most often with how sales and admissions are designed – if there are imbalances in reporting relationships in these areas or splits in focus, we often find that lower conversion and admission rates, higher turnover and lower census tend to follow.


Organizational design map drawn on chalkboard


Admissions isn’t the only area, however. The patient and consumer experience is another one of those invisible portfolios that tend to shuffle along on autopilot. To be fair, QAPI teams at home-based care organizations do critical and amazing work at focusing in on quality scores and metrics. These initiatives can tend to focus on specifically what’s being measured by the government – the types of metrics that will be published on Care Compare. But what about the critical elements of how we interact with patients that don’t show up as a part of a star rating?

Organizational Design Is Hiding in Plain Sight

In our most recent podcast, we sat down with Chad Ghastin, vice president of consumer experience for VNS Health in New York City. Chad shared with us some of the ways that VNS is thinking about how to design amazing customer experiences for home-based care and population health that extend outside of standard patient outcome measurements.

How Chad talked about his team’s role was fascinating – it extended far beyond the quality team and wove itself into almost all aspects of life at VNS. Some of the key takeaways from that conversation were:

  • A Holistic Consumer Focus. VNS Health prioritizes understanding and serving a diverse consumer base, including patients, caregivers, family members and health plan members. They think of the consumer experience from many different points of view.
  • Autonomous Consumer Experience Team. Operating independently under the chief experience officer, the consumer experience team ensures focused attention on consumer needs across all business lines. They are specifically not a subfunction of the QAPI team, though they do work closely with that department on a range of projects.
  • Comprehensive Journey Mapping. VNS Health conducts thorough consumer journey mapping, utilizing internal interviews, qualitative and quantitative research, and direct client feedback to refine service delivery and drive positive outcomes. They seek ways to truly understand the entire relationship they have with a patient over time.
  • Alignment with Value-Based Care. With a strong emphasis on patient satisfaction and clinical excellence, VNS Health positions itself to meet the evolving demands of payers and regulators, upholding values of empathy, integrity and agility. Customer experience plays a huge role in how they set themselves apart when competing for contracts and taking on risk.
  • De-Implementation. It’s easy to add five minutes of work to a documentation workflow. It’s much harder to simplify and take five minutes away. Chad’s team focuses on constantly examining what processes and protocols may no longer be needed – giving clinicians the time to develop deeper personal relationships.

Having a consumer experience team is akin to having your own agency ombudsmen – a group of passionate and dedicated individuals tasked with asking “why” about every choice the organization makes through the lens of the patient. It’s a team of individuals who can analyze what’s working and what isn’t and even start thinking about larger questions, like the organizational design of the agency itself.

If you need someone to ask “why” at your agency, Transcend can help. Consider taking our Mini-GRO™ Assessment or learning more about our full GRO Assessment. We also offer support for strategic planning and a host of other services that can help your home-based care organization not only meet your goals, but Transcend them.

Reach out to us at to start a conversation about the superpowers you may have hidden in plain sight.

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