At Transcend, when working with hospice and home-based care organizations, we often find a leadership team willing to invest significant time understanding why growth has stalled. They’ve hired us to map processes, interview staff and examine performance data. Often, we uncover an underlying issue that shows up in organizations across the country:
The problem isn’t sales or admissions alone. More often, it’s what happens between sales and admissions.
Referral ownership is unclear, information is bottlenecked in email chains, and in some cases, teams optimize for their own priorities or success metrics instead of the organization’s larger combined goals. Small disconnects compound into delayed admissions, frustrated referral sources and missed opportunities to serve patients.
Once leaders see those issues clearly, they typically take the right next steps. They establish governance and create efficient meeting structures. They bring the right people together to review performance and solve problems.
That’s where many organizations expect things to get better permanently.
Unfortunately, that’s not usually how it works.
Governance Is a Starting Point, Not a Solution
Governance helps. It gives leaders a place to surface issues, create accountability, and keep the right conversations from getting lost in the day-to-day.
But governance alone doesn’t sustain performance.
We’ve all seen it – organizations launch daily huddles, weekly reviews and monthly operating meetings only to find themselves having the exact same conversations six months later.
Not because the meetings were bad, but because meetings alone don’t solve problems – the people owning/running them do.
The organizations that sustain momentum are the ones that turn governance into operating habits.
Keep Looking for Friction
A common mistake is treating root-cause analysis like a finish line, when the reality is that growth barriers evolve.
Referral source changes. Staffing changes. Market pressure changes. New leaders come in with different expectations. What was true 12 months ago may not be true today.
Strong operators keep looking for barriers. They don’t assume they have all the answers or that a process is forever fixed simply because they completed a project or implemented a recommendation.
These are not complicated questions, but they are critical for continuous improvement:
- Where are referrals stalling this month?
- What is frustrating referral sources right now?
- Which steps in the process create unnecessary delays?
- What are we hearing from frontline staff that leadership may be missing?
The moment an organization believes it has “solved” admissions is often the moment performance begins slipping again, old habits return, or a nimble competitor finds an opening.
Create Shared Ownership of Results
If sales is only accountable for referrals and admissions is only accountable for conversion, the organization is managing pieces of the process instead of the outcome.
The organizations that perform best create shared visibility into the full path from referral to start of care and share responsibility for perfecting it.
Everyone should be able to answer the same question: What has to happen for an eligible patient to receive care as quickly as possible?
When teams rally around that outcome, conversations become more productive.
Instead of:
- “Admissions is slowing us down.”
- “Sales promised something we can’t deliver.”
You start hearing:
- “How do we remove this obstacle?”
- “What can we improve together?”
- “What is preventing this referral from moving forward?”
That’s where you begin to see true alignment of two separate but interdependent teams working toward a shared goal.
Focus Less on Reporting and More on Learning
Many organizations have plenty of data. The greater challenge is building the habit of learning from it.
The purpose of reviewing metrics isn’t solely to explain what happened last month. It’s to improve the next month. The strongest leadership teams use performance reviews to honestly and objectively identify patterns, test solutions, and determine what they’re going to do differently moving forward.
The dashboard should be the beginning of the conversation, not the final answer.
Your Managers Are the Flywheel
If I had to name one factor that determines whether improvement lasts, it would be the strength and grit of the organization’s mid-level leaders: directors, managers, team leads, intake supervisors, admissions leaders. These are the people who reinforce expectations every day. They’re the ones coaching staff, resolving issues, overcoming barriers, escalating concerns, and ensuring that processes are carried out the way leadership intended.
Yet many organizations spend much more time talking about frontline staff performance or executive strategy than supporting the people in the middle, and that can be an operational blind spot.
When managers are equipped, aligned and empowered, the flywheel keeps turning. When they’re not, even the best governance structure can break down.
Sustainable Growth Is Usually Boring
Boring is probably not what most leaders want to hear.
We like breakthrough strategies. We like transformational initiatives. We like shiny objects and the next big thing!
Yet, sustainability comes from doing the fundamentals consistently, from maintaining accountability after the excitement of an improvement project has faded, and from leaders continuing to ask questions, challenge assumptions, and remove barriers long after the root-cause analysis is complete.
The organizations that sustain growth are not necessarily the ones with the best strategy. Most often, they are the ones disciplined enough to keep the sales and admissions flywheel turning after everyone else has moved on to the next priority.
Need a partner in sustaining the sales-admissions flywheel? Transcend experts can help identify operational barriers and ways to overcome them through the GRO™ Assessment.
