Talking Ops: Why Focused Execution Drives Better Hospice Growth

Chris Smith (0:00 - 0:15)
You need to be able to play to your strengths and there has to be a really symbiotic relationship between your marketing leaders as well as operations at clinical to make sure that you can provide the service level that's needed to continually grow the business.

Tony Kudner (0:18 - 2:22)
Welcome to the Transcending Home Care podcast. I am your host and Chief Strategy Officer here at Transcend, Tony Kudner, and we've got a good one for you today. There's a quote that I use a lot that I forget who to attribute it to, but it says, politics is the slow boring of hard boards.

And I think about that a lot when it comes to home-based care operations, because there is no easy fix. I think a lot of people reach out to consultants like Transcend or they go to conferences looking for the silver bullet. Operations has no silver bullet. It has no weakness that can, you can just apply one stroke of the pen and solve problems. It's complicated. It's people, it's inertia, it's processes and protocol and refining and being relentless in a search for constant optimization. Choose your metaphor. It's like the football game of inches kind of thing. And so, it's something worth having a conversation about.

How do we look at operations and understand all that complexity, but make meaningful progress in our work and in growth operations and admissions that usually means a focus on improving some of the KPIs, you know, key progress indicators, but, but when you have too many of them, or when people aren't aligned, it can be real easy to feel stuck. And so, there's somebody who I have known and worked with and admired as a world-class operator for gosh, better part of 10 years at this point. Again, I'm mining the former network of Seasons Hospice and Accent Care mafia that's out there, but it's my pleasure to welcome Chris Smith to the podcast.

Chris, how are you doing today?

Chris Smith (2:23 - 2:31)
Tony, I appreciate the opportunity to talk a little bit about operations and how unsexy it is, but how impactful it can be overall.

Tony Kudner (2:32 - 2:42)
Absolutely. So Chris, you're the CEO of Affinity Hospice. Can you talk to us a little bit about Affinity and maybe the journey that brought you there?

Chris Smith (2:42 - 3:25)
Yeah, absolutely. So very blessed to be the CEO for Affinity Hospice. I have been here now for probably two, two and a half months.

So very fresh in the journey in this seat, but very passionate about what we do, how we do it, and being able to be really accessed for those that are looking for the perfect end of life journey. And so blessed to be a part of this role. As you know, Tony was with Seasons Hospice for a better part of 10 years, lived in the operations role and have been in the operations role for about a decade now and, and really love being able to bring strategy, operations, clinical marketing all together for success of any organization that I’ve been a part of.

Tony Kudner (3:27 - 4:19)
So Chris, it sounds like you're just peeling back the layers of the onion at Affinity, but I saw your head nodding as I was kind of doing some of the intro here. And, you know, one of the things that we really see can be a barrier to sustainable hospice growth that's invisible is just these art and science of operations. You know, in a lot of programs, we see that there's not a huge structured approach. It's maybe office by office, maybe there's not the right series of meetings to inspect some of the data, right? Like what maybe you and I used to call a MOR or monthly operating review. Can you talk about your time leading operations work and how, you know, what you viewed as some of the key strategies to move the needle towards growth and quality and compliance?

Chris Smith (4:20 - 6:12)
Yeah, happy to. So, I think what I might say might be interesting for some, and they may not necessarily agree with it off the bat. However, I'll say understanding the marketing plan and being a seat at the table to understand how you're going to market; where you're going to market; where your clients, patients, referral sources are going to be really is the driver.

And having a symbiotic relationship with your sales team, with your marketing team to understand where and what they're going to be doing, what type of patient dynamic, demographic, geography is so key and so important, because if you aren't aligned on what your overall sales strategy or marketing strategy is, you're never going to be able to operationalize it. So, all of the hires that you need to make, you need to make sure that are aligned with that particular marketing plan, the geography that you're covering, the patient type that you're covering. So for me, it always starts out with who are we? One, as an organization, but two, where are we and what type of patients are we serving? What type of patients do we want to serve? Because you can't be all things to all people.

You need to be able to play to your strengths. And there has to be a really symbiotic relationship between your marketing leaders and as well as operations and clinical to make sure that you can provide the service level that's needed to continually grow the business. So I think honestly, Tony, that's the first question that I ask is, you know, where are we? What does it look like? Is this a patient demographic that we want to be able to serve? Is it the geography that we can serve? If not, how do we get there? And I think asking the question is very important at that fact of what can we do today and what can we do tomorrow and how do we get to tomorrow to be able to actualize that operational result. So that's the way I think of it, Tony. I want to start very first from the marketing plan. And the second question is how do we operationalize that?

Tony Kudner (6:15 - 7:10)
Yeah. That's another thing we see with a lot of our clients, right? Another thing we see with a lot of our clients that we've brought on, and I think you're doing it at Affinity, and I certainly know you did it at Seasons and Accent Care, is having the growth team and the marketing team present their plan for growth to the clinical team to get that alignment, right? Both, so clinical can say, yes, we can support that. We have staff capacity in that geographic area, or we can handle that acuity, whatever the case may be. But also to put them on record as saying, I'm going to support this plan, right? I'm not going to start telling my marketing team, no, we can't do white gloves at Christmas, SNF, you know, well, you committed to that. So we have to have an open and honest conversation about that. I think that alignment is crucial and it's very obvious when it's not there.

Chris Smith (7:11 - 7:50)
Yes. And what I would say is you can't be all things to all people. And so figuring out how good you can be and where you can be good, I think is very, very important. Having tough conversations of we can operationalize or can't operationalize certain things really makes sense. And you have to have those robust conversations between sales, marketing and clinical to really understand how do you drive the overall organization forward? And I mean that at the site level, the region level and obviously at the national level too.

So, I think you're right on with that. If there's not that communication and symbiotic relationship between those kind of three pillars, you're never going to see the growth that you really want it to see.

Tony Kudner (7:51 - 8:38)
So we've talked about the fact that alignment is important, the nitty gritty of how that alignment, how we come by it and how it gets executed on. You're an acolyte of a Covey adjacent style called the four disciplines of execution, which I have read, my colleague Courtney has also read, and we are seeing success at your suggestion, quite candidly, with a couple of programs is, is this style of sort of the wildly important goal, the wig, but can you talk to us about how you've implemented the 4DX model and what you feel like some of the achievements are that you've seen in terms of its implementation in hospice operations and growth?

Chris Smith (8:38 - 11:56)
Yeah, happy to. Big proponent of The 4 Disciplines of Execution. It's a really good framework of being able to understand what they affectionately call the whirlwind. But I think a majority of us would know as the firefighter, the dumpster fire that happens on a daily basis that we have to deal with.

But not only that, what are your overall strategic goals? You know, we talked about communication. If you think at the site level, region level or national level, you should only have two, three, four things that are going to move the needle in the organization. And unfortunately, all of us can look back on a week and go, I'm not sure I worked on those two, three, four things, which are the most important things. I think the daily firefight really got in the way. So four disciplines of execution really kind of sets the framework with rocks or wildly important goals for you to be able to get a grants alignment with your site, region, you know, organization to really try to reduce the squirrel mentality with good ideas and continually add new things in, but really focus in on what those most important things are to be able to move the needle.

Secondly, with that, Tony, I think the majority of us focus in on lagging indicators, what referrals are coming in, what admissions are coming in, how do we, or what is a retention metric, or what is a CAHPS measure metric? Those are all things that are a result of activity that happens before. And I think many of us really focus in on what that lagging indicator is rather than focusing in on the leading indicator is what activity needs to happen to be able to drive that overall execution and the number in the right direction, whatever that number may be.

So really focusing in on the day-to-day activity that needs to happen, how many meetings do you need to have? How many calls or contacts do you need to be at to drive a referral? It really, I think, makes it very succinct on what you need to do every single day to be able to get the result, whether that's a monthly result, a quarterly result, or an annual result.

And so, I think that's one of the biggest ways that organizations can drive things forward is thinking about what is a leading indicator that I need to do daily or weekly to be able to drive the outcome that we need it. We've done it in a whole host of ways, or I guess I've done it in my career in a whole host of ways. I've been blessed to be a leader of biz dev teams, which is great. We talked about stops and contacts. So where are they going? How many people are they talking to? Are they in the right mix? The right referral sources, whether it be ALF, SNF, physician, hospital, to be able to drive a particular outcome. We've done it in financial metrics, looking at the levers in hospice specifically with pharmacy, DME, staffing, all of those to be able to get quality financials at the end of the month.

And even our teams did it with CAHPS scores. And I mean, those that are in hospice today have probably thought about HOPE and how they execute HOPE and the leading indicators that they need to make sure happen on a weekly basis to be able to meet the HOPE standards as we move forward. I think it happens an awful lot, but we really, at least in my world, have transitioned the thought from lagging indicators, what is this going to look like at the end of the month or the end of the week into how do we drive the behavior day in and day out to be able to get those results?

Tony Kudner (11:58 - 13:01)
Hugely helpful. And you mentioned the dumpster fire. I like that better than the way they put it in the book, which is the whirlwind, but that concept, 80% of your week is spoken for.

By 8 a.m. on Monday, 80% of your week is just the day-to-day stuff of running a business. How do you maximize that 20%? You get one day a week to focus on the larger strategic things, and you can't focus on all of them.

So that's what appealed to me about 4DX is what are the biggest levers? And as you said, what are the ways we can tell that they're going to affect what the ultimate goal should be? It seems so simple, but when you're in it day-to-day, I mean, you can blink, and it's already, we're recording this on a Thursday. My week is 70% over at this point. Have I achieved anything that I've wanted to, to hit 2026 running? Maybe. I don't know that I could document it for you, but it's a really helpful framework in that regard.

Chris Smith (13:01 - 13:37)
Well, the one thing I'll call attention to is we've really transitioned into scheduling the meetings on the most important things and scheduling everything else around it. It's a 
non-negotiable. We've got to be able to meet, see where progress is, to drive accountability to myself, through myself, through the overall organization. As you get into it, it's really important for teams to say, okay, I've got to have an update on the WIGs (Wildly Important Goals) on the most important things. So schedule those meetings, get them on the book, make them recurring, and make them non-negotiable. And I think you'll see an awful lot of result if you just do that.

Tony Kudner (13:38 - 13:44)
Yep. What day of the week, Chris, do you usually schedule some of those four disciplines meetings?

Chris Smith (13:44 - 14:46)
Well, we've got ELT meetings that we talk about them very briefly to give team updates on Monday mornings. And then I have generally speaking more specific, when I'll say divisional meetings on where they are with their WIGs and scoreboarding and those types of things. It is not easy when you first implement this, there's a lot of manualness that's associated with it, but the more that you can get automated, you can really have concise conversations pretty quickly once you're talking about automation.

So I don't want to make sound super simple. Usually that first month or two is a big list with understanding what the leading indicators are, and then usually trying to find manual ways to be able to track those. You know, we're just now, I've been here a couple of months, and we're just now getting a lot of this stuff automated and still probably 30 days away from it.

But I had a boss one time that really said, don't let, I guess, how did he phrase it? He said, don't let precision get in the way of progress or perfection get in the way of progress. And so it's, you know, start the lift and then get better as you go down the line.

Tony Kudner (14:48 - 15:14)
Great. So Chris, just one final question here. We're both doing this in between calls.

I think we're both a little time limited. What are some of the big changes that you've seen in growth strategies in post-acute or hospice specifically, and how have they affected how you're leading Affinity? How's the market changed from 10, 12 years ago when you really started getting into this work?

Chris Smith (15:15 - 17:05)
Yeah, it used to be, you know, try to be all things to all people and be able to take all patients. It was a lot of hospital-centric type of referral sourced activity. There wasn't, you know, you think about the utilization of hospice has only grown 2, 3, 4, 5% over the last seven or eight years. So people are starting to think about it differently. But if you remember, Tony, it was super interesting, you know, CARES is moving upstream today and more into the community. Payers have gotten more sophisticated in how they're approaching things. You're thinking about ACOs, regulatory compliance and expectations are tighter than they really ever have been. And honestly, the best part for me is families are more informed. They kind of know what hospice is. They're asking a lot of questions. And so, I think right now we really think about right patient, right time, right setting. And, you know, we're looking at data-driven targeting, understanding who and what our referral source is, matching it to our marketing plan so we can operationalize it.

A lot more clinical education. It's not more general education now, it's clinical education. So how can we support our hospice consultants when they're out in the community to better talk about the services that we can provide? Nothing can ever supplant kind of tight alignment between sales clinical and operations. That all needs to be a very symbiotic relationship and so a huge focus for us. And probably lastly, elevating the family experience.

You know, it's all about the perfect end-of-life experience for not only the patient, but the family as well. And so really focusing in on, you know, what that overall experience is and how it translates through the organization. So, overall, it's value, quality and integrity-driven model, Tony. If you think about it in that kind of short, concise statement, that's who and what we want to be as an organization.

Tony Kudner (17:07 - 18:03)
Yep. Definitely tracks.

So Chris, I can't thank you enough for your time. I feel like we're probably going to have a part two at some point to dive a little bit deeper into these. I will close as I have been recently at our CEO's suggestion with a pet peeve.

This week's pet peeve for me is if I don't know you and you're trying to do cold call outreach to me, sending me an unsolicited calendar appointment to try to get time on my schedule. Blocked. Blocked immediately. Reported to Microsoft. You are spam. Don't do that.

Offer me value and I will definitely engage with you. But if you just send me a cold call calendar invite to my email address, no time for that, son. We're all too busy.

Chris, thanks so much. Best of luck in the new role. And thank you so much for sharing your experience with our listeners.

It's really great to catch up with you, man.

Chris Smith (18:03 - 18:04)
Thanks, Tony. It was great to see you again.