What Chipotle can teach long-term care

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Tim Mullaney
Tim Mullaney

I love Chipotle. What makes the burrito purveyor so great? There's the fresh guacamole and the chips kissed with just the right amount of salt, the varieties of delectable salsa, the sizzle and scent of chicken and steak on the grill. But the real secret to Chipotle's success might be how it grooms and retains its managers — it's an approach long-term care leaders might do well to study.

The basic principle is simple and time-honored: Promote from within. In practice — as described by Max Nisen in a recent article for Quartz — there's a bit more to it than that. But given that the idea is to pick strong managers from the ranks of entry-level staff, step No. 1 in the Chipotle system is to hire these frontline restaurant workers with great care.

Smart hiring of nursing assistants and other entry-level workers is a theme increasingly sounded in long-term care. Carol Scott, field operations manager for Advancing Excellence in America's Nursing Homes, addressed the issue recently. “Are you breathing?” is the main question that too many homes ask candidates, Scott joked during a presentation at the American College of Health Care Administrators annual meeting in Las Vegas. Her point was serious, though. While the need for staff often is urgent, just hiring a warm body is “short-sighted,” she said, citing statistics about the high costs of turnover. The good news is that more facilities are “figuring this out,” she said.

However, reducing turnover is only one benefit of smart hiring. The other is that strong hires have the potential to climb the ladder to more senior positions, bringing with them knowledge of the organization's culture and business practices and an enhanced ability to relate to more junior colleagues. This is one reason that great administrators often come up through the facility's rank-and-file. Here's the thing that Chipotle has come to realize: Picking the person with the greatest potential means that you have to judge a person's character more than their skill set.

“We look for people who possess certain qualities that you can't teach,” Chipotle co-CEO Monty Moran told Nisen. “You can teach somebody … how to hold a knife and prep ingredients, or even to run a restaurant.”

Chipotle has devised a list of 13 characteristics that every hire should possess. You can read the whole list in the Quartz article. Hiring managers in long-term care could create similar lists of their own, and it seems to me that they might want to include many of the Chipotle traits — such as “conscientious,” “honest” and “curious.”

Once a Chipotle restaurant has workers with great potential on the payroll, the company's robust mentoring system is designed to help the strongest performers work their way up. Scott asked the ACHCA audience about mentoring programs in their facilities, and a few people said they have one in place. However, most hands did not go up. Not only are official mentorship programs too rare in long-term care, the typical management approach discourages even informal mentorships from flourishing, said attendee Adam T. Ashpes, president and CEO of Sigma Healthcare Management and a former administrator.

In most facilities, if an aide has little communication with mid-level managers or administrators, that's considered a good thing, Ashpes said. In his experience, most interactions with management are punitive or unpleasant, occurring because an aide has done something wrong or because there's an issue to address. This is a self-perpetuating problem, he said, because oftentimes a facility's mid-level managers — be it nurse managers, dietary or housekeeping — achieved their position by themselves having few interactions with their superiors. So they know how to show up on time and execute their jobs, but they often don't know the “art of management,” either through formal training or through example, according to Ashpes. Therefore, they manage in the “hierarchical” style that they are familiar with.

This does a disservice to aides who could benefit from more proactive guidance, Ashpes noted. “You can't manage everybody in the same way,” he said.

Chipotle has tackled mentorship by using what is probably the greatest possible incentive: payment. The chain is “unique among fast food restaurants in that it ties pay and promotion to how well you mentor people, rather than store sales,” Nisen wrote.

This innovation came because Chipotle did a little root-cause analysis. It asked what its best-performing locations had in common. The answer was a manager who had risen through the ranks. And so the company embarked on an ambitious improvement project to empower as many crew members as possible to become managers. This has led to a structure of eight positions, starting with crew member and culminating in team director, and a reward system in which people in higher positions are given bonuses when junior members of their team earn promotions. As you can imagine, this has fostered active, ongoing communication.

Of course, most long-term care facilities can't rain down money or stocks on their best mentors as Chipotle does, and a mom-and-pop facility can't promote a great administrator to regional supervisor. However, even modest incentives could prove effective. For a CNA struggling to make ends meet, a one-time bonus and some extra paid days off could make a big difference. Furthermore, a facility that implements a mentorship program might find substantial extra cash in its coffers to pay these bonuses, due to reduced turnover. One facility that did a “full-court press” on culture change — including staff retention initiatives — added $1 million to its bottom line after the first year, Advancing Excellence Executive Director Doug Pace told the crowd at ACHCA.

Believe it or not, the government also might help operators move toward the Chipotle model. Federal dollars might soon be available for operators to create an “advanced nurse aide” position, thanks to a bill introduced in the House and Senate last week. If the bill passes (admittedly a big “if” in these days of political gridlock), it seems this program would help in creating a stronger management ladder in long-term care.

Chipotle executives say their management philosophy is driving the company's amazing growth and strong financial performance. But they acknowledge that it still is a work in progress. Right now, about 40% of stores are overseen by a manager at the high “restaurateur” level. The goal is to bring this to 100%. In the meantime, co-CEO Moran said, there is a palpable difference when you walk into a Chipotle managed by someone with restaurateur potential:

“I walk into a Chipotle and the first thing I do is take notes on how I feel. Is it fun, is it upbeat, is there camaraderie, is there pride? Enthusiasm? Is the place clean, does it sound and smell good? … Do the customers seem happy? How does it feel? And if it doesn't feel excellent, then I know it's probably not going to become a restaurateur restaurant.”

Substitute “nursing home” for “Chipotle” and I bet that sounds familiar. The real question is, what is the long-term care equivalent of a Chipotle “restaurateur?” The answer could lead to many more nursing homes that feel — and are — excellent.

Daily Editors' Notes

McKnight's Daily Editors' Notes features commentary on the latest in long-term care news and issues. Entries are written by Editorial Director John O'Connor, Editor James M. Berklan, Senior Editor Elizabeth Newman and Staff Writer Marty Stempniak.