In a variation on the idea that you have to give up power to gain strength, regional skilled care provider Guardian Healthcare is actively working to decentralize its operations.

In doing so, Guardian’s leaders hope to see specific facilities better serve referral sources, increase their capabilities and improve patient care. Operators around the country are keeping an eye on the move, which is about six months underway.

“It’s really the desire to break down those barriers that are sometimes created inadvertently by a centralized model,” said Michael Herald, president and CEO of Guardian Healthcare 

Founded in 1995, Guardian has grown to 35 skilled nursing communities in Pennsylvania and West Virginia. Overall, it has more than 3,800 skilled nursing personal care and independent living units, as well as an in-house pharmacy that serves people inside and beyond the company’s patient base.

“We are one of the largest providers in Pennsylvania. We tend to have sites that are within a close radius of each other. Sometimes it’s 10 miles, sometimes it’s 20 or 30 miles,” Herald told McKnight’s Long-Term Care News. “When you have a large, centralized model, we saw that sometimes our sites weren’t collaborating, communicating and working together as effectively as possible. This approach is really meant to be a strategy to help us to work more effectively with our referral sources. It also helps us to ultimately provide better care at higher levels of acuity care to meet all of the varying needs of residents within these communities.”

A big challenge in devising the new operational structure was creating clear expectations and ways to route information.

“It’s really making sure that we all understood what accountability would look like for this type of model, what our expectations were for our site leaders and for our regional team members, who support those sites,” Herald explained. “It’s really being ready to clearly communicate those expectations and setting that level of accountability, really focusing in on communicating to our sites that a lot of their preconceptions or prior thought processes and ways of doing things could be set aside as we focus on collaborating together.”

Empower local leaders

Better empowerment of site leaders is a major goal. That has meant creating procedures and operational and clinical policies within a common framework. Regional support teams are currently being fine-tuned to mentor leaders and help them make their own decisions.

Herald said he thinks his company’s moves will allow sites that focus more on short-term residents to do a better job with them, and likewise for those who may have a larger long-term population.

“This is really meant to be a way for those sites, those two sites in particular, to be communicating and collaborating and focusing on how they can ultimately process the referral that they might both get. That’s really how we see this sort of playing out in terms of that collaboration and making sure that our sites see it’s not necessarily about their individual outcomes, but it’s about the clusters’ outcomes.”

The model should prove beneficial for referral partners and payer partners, Herald feels. It also should increase overall operational efficiency.

“Our organization over the last year has made a tremendous investment in technology. We’ve developed a really effective referral management platform. It’s an SAS-based system that we rely upon to help process all of our referrals and ultimately convert our admissions.”

Special considerations for the 3,400-strong company workforce include making sure there is a dedicated clinician for each of their designated regions and also focusing heavily on personal development.

“That could include putting them on career paths within their site to help them grow and develop into ultimately a site CEO or a path where they might want to get some multi-site management experience,” Herald explained. “Now we’re focused on working with our existing leaders to develop a talent pipeline of site leaders for the future to ultimately bring them into the organization. We’re looking for leaders who really embrace our vision and the culture that we’re attempting to create of leadership and workforce development.”

Partnering with local colleges and universities in Pennsylvania and West Virginia to build more educational tracks for healthcare administration and leadership has been a standing strategy for Guardian. Slippery Rock University is perhaps the best example of a school partner.

“Our HR team is really committed to building out that professional development program and creating those opportunities for additional education,” Herald said.

A leap of faith

He acknowledged that taking up this model requires a leap of faith and trust.

“An organization has to be ready to let their leaders make mistakes along the way,” Herald observed. “They have to do it, within certain bounds. It can’t jeopardize anyone’s health or safety in the process, but as long as it doesn’t do that, as long as it’s not illegal, unethical, immoral or puts someone in harm’s way. One of the things that we’ve worked really hard to talk to our leaders about is that under this model you have to be given that ability to try something new. 

“Try a different approach, even if it’s not the way you might traditionally do things and know you’re going to make mistakes along the way. And that’s OK because we have subject matter experts and we have operational clinical leaders who are there to support you, help you identify the ways in which, you know, your approach maybe didn’t work as best as we had hoped and ultimately to get us back on track.”

In that vein, lessons learned by one cluster might be transferable to others so successes can be replicated.

Implementation of the new model may take as long as a year total. The Guardian leadership team hopes to start seeing solid results by the fall of this year. By that time, it should start to be clear whether key metrics from the referral and hiring processes are improved, and whether staff retention rates rise.

Herald recommended that any organization interested in possibly creating such a model first speak with its site leaders. Changes could be the perfect tonic and a catalyst as the nation emerges from its pandemic hangover.

While still a work in progress, the decentralized model has already met with success and been embraced by staff, the company CEO noted. The enthusiasm has been contagious, from senior executives down through regional and local leadership, and ultimately front line employees, Herald said.

 “They’re really focused on helping to make this strategy work,” he said. “I think it’s because of the fact that we’re all focused on really creating a team atmosphere and making sure that we have a team-centered approach to the way that these clusters of sites will approach their operations. So people seem excited about that. They’re engaged around it, frankly more so than I think we had even anticipated.”