00;00;01;14 – 00;00;12;17

Jeff Howell

Welcome to Home Health 360, a podcast presented by AlayaCare. I’m your host, Jeff Howell, and this is the show about learning from the best in home health care from around the globe.

00;00;14;01 – 00;00;41;28

Erin Vallier

Welcome to another episode of the Home Health 360 podcast, where we speak to home care professionals from around the globe. I’m your guest host, Erin Vallier, U.S. director of sales for AlayaCare Software. And today I am joined by an amazing human, Ian Gordon, to talk about making jobs harder to increase job satisfaction. Yeah, you heard me right. Making jobs harder.

00;00;42;11 – 00;01;05;17

Erin Vallier

Now, I know some of you raised your eyebrows to that, but stay with us here. Ian is uniquely qualified to speak to us today, and I promise you will be completely enthralled with what he has to say. He has worked for over 30 years in a variety of roles in the U.S. health care system, from CPA to operations to tech and strategy area at national Payors.

00;01;05;26 – 00;01;41;03

Erin Vallier

A third party administrator, a home health and hospice provider, and a variety of suppliers to both payors and providers. Ian has spent the majority of his career driving consumer provider and employee experience improvements and improving administrative efficiency in his roles as chief operations officer at Blue Cross Blue Shield, North Carolina Senior Vice President of Health Plan Operations at Arrangements Blue Cross Blue Shield and President of Administrative Operations at Elara.

00;01;41;03 – 00;02;01;27

Erin Vallier

Caring for almost ten years. He has been involved in the health care Executive group and is currently serving on the board where he holds the role of Treasurer. Now, there’s a lot more to his resume, but those are just the highlights to get to interested in what he has to say. Welcome to the show, Ian.

00;02;02;24 – 00;02;04;06

Ian Gordon

Thanks, Erin. Happy to be here.

00;02;04;17 – 00;02;26;13

Erin Vallier

I’m super excited about this conversation. I think our audience is probably super excited to hear about this crazy topic, making jobs harder and expecting employees to be satisfied with their jobs. Sounds like a complete oxymoron. Can you please explain to us what you’re thinking here?

00;02;27;13 – 00;03;02;29

Ian Gordon

Sure. So employees, especially the frontline employees, they’re operationally oriented employees and they’re first line managers, just to name a few. They spend an inordinate amount of their time and their workday engaged in and performing highly repetitive tasks. And they often don’t require them to operate at the top of their license. So they’re not overly satisfying tasks and they’re not what they principally are engaged to do, in many cases, deliver care to patients.

00;03;03;21 – 00;03;18;15

Ian Gordon

And so what I’m saying is that they’re not being challenged. They’re not required to solve complex problems and or to be creative. It’s too many of them. It’s just a distraction from really what they want to do.

00;03;19;10 – 00;03;37;17

Erin Vallier

Boring working below their intelligence level. Okay. So that does help explain why these employees might be less satisfied or engaged with their jobs, but why it is making their jobs harder. Change that. Because if you make my life harder, I’m not going to like you at all.

00;03;38;27 – 00;04;01;29

Ian Gordon

Now, that makes total sense. And I think I need to clarify. When I say harder jobs, I’m not referring to asking people to carry a heavier load. I’m not asking for people to do more of the same thing or to do more of the same thing faster, more things on top of anything that they’re already doing, because clearly that would just satisfy employees.

00;04;01;29 – 00;04;23;00

Ian Gordon

Just as you said, please give me more of what I don’t already enjoy doing. And of course, they’d be less engaged in their job because that’s not what they want to do. And then the pressures that come with that, they probably end up delivering worse quality and a higher likelihood that they would decide to leave an organization. So it’s not creating a more challenging work environment either.

00;04;23;12 – 00;04;30;11

Ian Gordon

It’s working to, of course, have the best work environment you can, and it’s definitely not creating an up and out culture.

00;04;31;02 – 00;04;36;11

Erin Vallier

Gotcha. So if that’s not what you’re talking about, what is it that you’re talking about?

00;04;37;28 – 00;04;59;29

Ian Gordon

So what I’m talking about is eliminate those repetitive, mundane tasks and asking employees to work on the more complex value adding activities. And for them to be more collaborative and giving them the chance to be more collaborative and more creative in their problem solving.

00;05;01;06 – 00;05;23;14

Erin Vallier

It’s interesting. I understand what you’re saying, but somebody still has to do those, as you put it, the more mundane, repetitive tasks. I call them the five or $10 tasks. So who are you suggesting do these things? Are you advocating that we outsource all of these tasks and jobs and send them offshore?

00;05;24;05 – 00;05;53;07

Ian Gordon

It’s certainly an option and something that many companies have either tried or actually done in search of really a cost savings, a labor arbitrage. And it’s motivation was totally around cost and not around improving employee job satisfaction or the level of employee engagement. And contrary to what people had hoped would happen, it didn’t even have a positive impact on customer satisfaction either.

00;05;53;23 – 00;06;25;08

Ian Gordon

Outsourcing isn’t a strategy or contributing strategy to creating a better culture. Engagement play satisfies action or employee loyalty. In fact, it’s just the opposite. Every place that I’ve seen outsourcing occur, it generally sows fear and distrust in management leadership overall in the company. And people really spend a lot of their time then wondering when is the next shoe going to drop?

00;06;25;17 – 00;06;28;08

Ian Gordon

When is my job going to get outsourced?

00;06;28;22 – 00;06;47;22

Erin Vallier

That makes sense. And you just referred to companies wanting to save money, and that seems to come in cycles. And I think most health care companies right now are keenly focused on reducing costs right now. So if outsourcing isn’t the answer, what is the answer?

00;06;49;09 – 00;07;22;04

Ian Gordon

Erin, the answer’s technology. More specifically, it’s about the automation of those mundane, those what you referred to as five in $10 activities, those repetitive tasks. Doing that will free up the employees to work on the real much more value added activities that have the greatest impact, frankly, on the customers. It’s the ones that folks can get up in the morning and go to work knowing they’re making a difference.

00;07;22;17 – 00;08;12;02

Ian Gordon

Employees want to do a good job. Employees want to come to work every day knowing they’re doing meaningful work and making a difference and eliminating through technology those administrative, repetitive tasks is one way to really drive down costs and improve employee satisfaction because we’ve made their jobs harder. You’ll probably always need employees to do some of those tasks because everything can’t be automated to 100% level, but it becomes the exceptions, the fallouts that people focus on, which again allows them to be creative and do problem solving and continually improve the value of the technology and the effectiveness of the technology.

00;08;13;01 – 00;08;43;12

Ian Gordon

But as you’re driving those administrative tasks, the mundane tasks, our people become more engaged, more satisfied, and more of them the process of improving and eliminating those tasks. And I think what that will then do is you end up with those engaged, loyal employees, which frankly, in my mind is a sustainable competitive advantage that most companies don’t have today.

00;08;43;29 – 00;09;19;00

Ian Gordon

And with that, you can see a direct correlation with customer satisfaction and growth. And what happens is as you grow, you’re able to actually hire additional employees to focus on delivering the creative problem solving solutions that are focused on customers. And that enables you to pay for the process of going through and eliminating, through technology, those repetitive administrative tasks.

00;09;19;16 – 00;09;48;09

Erin Vallier

You are speaking my language right now. I love the premise of creating more meaningful work for people and leveraging technology to do that. I know you must be aware that like your declared war on repetitive tasks this year, so this topic is on point and there’s a lot to dig into here. I’m assuming that by all of these efficiencies that one might be able to pay their employees more.

00;09;48;09 – 00;10;05;28

Erin Vallier

And you started this response by talking about technology and automation. I’m thinking like an owner here that sounds like it’s going to cost a lot of money and be completely contrary to the corporate goal of reducing expenses and increasing EBIDTA.

00;10;07;02 – 00;10;34;01

Ian Gordon

Yeah. So I first have to say that I love the concept of declaring war on repetitive tasks, and I think I enlisted in that army a long time ago because of the impact it ultimately has on employees and your customers, where you spend too much time on that. And then of course, the economic ex of it. And so your challenge or your question to me is one that comes all the time.

00;10;34;02 – 00;11;03;25

Ian Gordon

Any time you’re asking people to, quote unquote, invest in technology to eliminate something, they’re looking for the return on investment they’re looking for. So I don’t have the money to do this. My real response to almost everybody I’ve talked to about this is you don’t have the money not to do this. There’s an old saying, Isn’t it funny that we don’t have the time or the money to do it right?

00;11;04;21 – 00;11;27;11

Ian Gordon

But we have to find the time and the money to do it twice. I’m not suggesting that all these repetitive tasks are being done twice. What I’m saying is we’ve got to find the money and the time to eliminate them so we can spend our money on the right things and there might be an initial investment to start the automation activities.

00;11;27;23 – 00;11;58;06

Ian Gordon

The cost of doing that has declined so much over the years. When you look at the new solutions from a technology perspective that are either embedded in core systems, core operating systems, or the introduction of robotics. So RPA or LOW-CODE, no code solutions. It takes the heavy reliance off of big Bang investments and spends and puts them into a much more incremental process.

00;11;59;01 – 00;12;33;01

Ian Gordon

On top of that, it’s not about automating your bad processes. It’s actually taking the time to do value mapping and to improve your current processes. Find out what those repetitive tasks are and then automate them in the most effective way that you can. And so there’s absolute money to be saved in stopping doing things and automating things. And I think that in the end, it’s also how you choose to make these changes.

00;12;33;16 – 00;13;18;18

Ian Gordon

Back in the day, there were a lot of massive re-engineering projects, and I’m not suggesting that. What I’m suggesting is that you start small and it’s the incremental changes and the successes that start to deliver additional engagement drive up satisfaction and start saving costs quickly and in a relatively short period of time. I often find that the strategy of incremental change can reduce materially or even create a situation where you’re self-funding these types of initiatives so the cost can be zero or close to zero if you do them right.

00;13;20;04 – 00;13;49;04

Erin Vallier

That’s awesome. I really like that you highlighted that there are new tools out there. It’s not quite as scary to get into the automation business these days because there are super easy to use low tech, low code solutions, and I imagine that implementing things over a period of time rather than just ripping the Band-Aid and changing everything, it’s going to have a better rate of adoption for your employees as well.

00;13;49;06 – 00;13;55;22

Erin Vallier

I love that perspective. Do you have any other thoughts on the financial implications of the Make Work Harder strategy?

00;13;56;28 – 00;14;30;14

Ian Gordon

I do. You mentioned I was a CPA once. I actually refer to myself as a recovering CPA. And so I do have a few more things around the savings or the financials. First of all, by improving employee satisfaction, employee engagement, you’re able to significantly reduce the costs and the time you spend recruiting, hiring and training employees. And I often refer to the strategy that many companies employ as a leaky bucket strategy.

00;14;30;27 – 00;14;57;14

Ian Gordon

It’s just hoping that you can pour enough new employees into the bucket so you stay ahead of the employees leaking out, choosing to leave your organization. It’s almost like a sieve. And so the money is being spent, unfortunately in the wrong place. And it would be much better not spent there by helping employees again, making their jobs harder so they’re more satisfied.

00;14;57;26 – 00;15;04;09

Ian Gordon

You can reduce significantly your costs of recruiting, hiring, training for sure.

00;15;05;05 – 00;15;08;18

Erin Vallier

Okay. That’s the one. That’s the first thing. What about the uninitiated?

00;15;09;08 – 00;15;42;05

Ian Gordon

So a second is one that people don’t often look at because they’re driving towards how are you reducing my costs? And the second one I would talk about is actually increasing revenue. It’s not always intuitive and it may not always be relevant. But in health care and in the services industry, more satisfied and engaged employees and the continuity of employees engaged with your customers has a direct correlation with customer satisfaction.

00;15;42;11 – 00;16;17;26

Ian Gordon

And there’s a direct correlation between satisfied customers who tend to stay with you and also become your best advertisement, which ultimately leads to increased revenue. The third one, and it’s another one that’s often overlooked, is the health and the well-being of the employees and the related health care and worker’s comp costs. Caregivers and home health aides are three times more likely to struggle with anxiety and depression than the U.S. population.

00;16;19;19 – 00;17;02;19

Ian Gordon

And recent surveys that I was reading the other day. 27% of the caregivers or home health aides reported having some ailment related to just pain or general pain. 18% specifically to back pain and 13% having existing. That translates in, of course, to additional health care costs. Certainly worker’s comp and also people being less productive. And absenteeism, which then can translate into missed revenue opportunities, poor service to customers specifically in the home health space.

00;17;02;19 – 00;17;30;00

Ian Gordon

When you’re looking at home health aides, the number of times and changes in people who show up at someone’s house. I was reading an article and the other day that said one woman specifically was complaining and her family was complaining how in a six month period of time she had seven different workers show up, which puts a burden on the family and certainly does not improve a company’s market reputation.

00;17;30;11 – 00;17;54;07

Ian Gordon

So those three places, obviously immediate cost savings, then you have a revenue opportunity and then the health and well-being and the costs related to that from just a pure medical expense in a worker’s comp expense situation are three things to factor into any ROI when you’re trying to automate the more repetitive tasks.

00;17;55;15 – 00;18;19;10

Erin Vallier

And that sounds amazing. And if I’m an agency owner listening to this, you’ve just told me I’m saving money on recruiting and retention. I’m making more money and my employees are going to be healthier. So that’s going to cost me less money. And absenteeism and health care costs. That sounds too good to be true. Have you actually seen this work in practice?

00;18;20;02 – 00;18;47;23

Ian Gordon

I have. In my last role at a multistate home health agency. We did exactly what I’m suggesting. We looked at what it took to perform the referral intake and management process, which is a highly repetitive, highly manual process. It was 100% manual, and I was told by many of the industry veterans that nobody automates the referral process and it can’t be done.

00;18;48;19 – 00;19;15;21

Ian Gordon

Which was a great challenge of which I appreciated all their naysaying. And so what we did is we engaged in a program of process review and value mapping. We sat with employees, we observed them. I even personally recorded their activities on my phone and frankly, just wanted to be sick because of all the challenges that we created for them and the difficulties finding the information that they needed to do what they needed to do.

00;19;16;13 – 00;19;42;20

Ian Gordon

What we were able to do is drive the codification of the required process roles and embarked on a process of automating as many of the repetitive tasks as we could. We did it incrementally. And in doing so, we were not only able to automate a portion, in fact, we went after initially 30% of the referrals that came in through a portal.

00;19;43;08 – 00;20;08;04

Ian Gordon

And at the time of my departure, we were at about 50% of those referrals being what I referred to as auto adjudicated. And one of the great values there was things that used to take over 30 minutes to handle. We were able to accomplish in under 2 minutes in an automated fashion, and that had an impact on revenue.

00;20;08;23 – 00;20;34;04

Ian Gordon

It had an impact on employee satisfaction. It had an impact on cost. And so it was a reduction in cost and improvement and employee satisfaction in an increase in revenue. And that’s how the ROI was built and achieved. And on top of that, because we had to drive through consistency of process. And as I mentioned earlier, there’s always manual processes that remain.

00;20;34;22 – 00;20;53;23

Ian Gordon

The portion that wasn’t addressed. We were able to create tools and simpler processes for the people doing the work, so they didn’t get hollered at every day. The quality of their work improved and they were much more satisfied with their jobs and were working on the harder tasks.

00;20;54;16 – 00;21;19;02

Erin Vallier

What an incredible success story here. That’s awesome. It sounds like you have a lot of relevant experience to help agencies get started evaluating their workflows and identifying some of those mundane five and ten tasks that they can automate. What advice would you give agency owners listening to this podcast who would like to initiate this kind of project?

00;21;20;17 – 00;21;45;13

Ian Gordon

So first and foremost, it’s to sit with the employees for each step of the end to end process and really watch what they do. Transaction by transaction. And I think it’s really valuable to have some folks who are not alcohol industry veterans, people who have preconceived notions and mental maps of what and why things happen the way they do.

00;21;45;26 – 00;22;09;19

Ian Gordon

So in my case, I was what I would refer to as pretty ignorant to the process. And as I said, I was appalled by how difficult it was. But I wasn’t wed to what had to happen. I wasn’t encumbered by everybody else’s reality. So bringing somebody like that in to do the sitting with people transaction by transaction I think is very helpful.

00;22;10;16 – 00;22;35;08

Ian Gordon

And that sometimes is going to mean you’re going to pick an unusual suspect because the usual suspect would be someone who’s come from another agency or someone who’s done this their whole life. So I’d suggest you pick a really inquisitive, detail, process oriented person, regardless of whether or not they truly understand the industry as well as the veterans do.

00;22;36;08 – 00;23;03;22

Ian Gordon

You’ve got to ask lots of questions as to why they’re doing what they’re doing and what changes they would like to see made. So I think it’s really important to engage the people who do the work because frankly, they’re the smartest people there. They understand what needs to happen, what their challenges are, and they know their frustrations. And they are so eager to tell you about them as long as they truly believe you’re going to do something about it.

00;23;04;12 – 00;23;28;14

Ian Gordon

So that’s the other thing. You can’t go into this half committed. You’ve got to go all in to make the changes. As you understand, the value of each step become simpler to figure out which steps need to go away, which steps are so repetitive and need to be automated, where you need to build roles that you can automate with.

00;23;28;14 – 00;23;51;25

Ian Gordon

Either you’re low-code no code or use RPA to automate. And I would just say, be aggressive. Again, don’t be encumbered by what everybody tells you can and can’t do. There’s lots of opportunity out there. You just have to be willing to do it in small chunks. So if it doesn’t work, you move on to the next piece.

00;23;53;10 – 00;24;14;15

Erin Vallier

Gotcha. So bring in an unusual suspect with an unbiased opinion. You can look at the process for what it is, not for how the industry expert will look at it, because this is the way we’ve always done it and we have to do it this way. And a fresh set of eyes be super inquisitive about each step of the process.

00;24;15;00 – 00;24;24;29

Erin Vallier

Fully committed to making the change and aggressive about proving people wrong when they tell you can’t do it. That’s the take away that I misstep there.

00;24;25;18 – 00;24;46;16

Ian Gordon

There’s one more Ian ism, as I referred to him that I didn’t share, which is you need to be unreasonable, but make sure that the people know what needs to happen. Don’t let it be stupid. So you need to really push the envelope and people will start to get behind that. So I tell folks, I’m going to be unreasonable, but your job is to make sure I’m not stupid.

00;24;47;04 – 00;25;10;25

Erin Vallier

I like it. I like that Ian ism. And I think we could probably talk about this topic for hours. There’s so many different use cases that we could dive into, but I know we are approaching our time. I just want to thank you so much for sharing your wisdom with us today. I really do love your perspective on making jobs harder to make them more enjoyable.

00;25;11;13 – 00;25;21;04

Erin Vallier

Now I have a question. If our listeners have follow up questions about implementing some of the stuff that we’ve talked about today or anything else, how can you be reached?

00;25;22;12 – 00;25;40;06

Ian Gordon

Sure. So they can, of course. Erin, come to you through the podcast and we you can get us connected and be part of that or they can come directly to me at Ian at Next Step Advisory services dot com and I’ll be happy to engage in conversation.

00;25;40;26 – 00;25;51;13

Erin Vallier

Wonderful. Ian at next step advisory services dot com. Got it. Again thank you so much for coming on the show. It’s been such a pleasure speaking with you today.

00;25;52;00 – 00;25;53;19

Ian Gordon

It’s my pleasure. Thanks for inviting me.

00;25;55;09 – 00;26;24;17

Jeff Howell

Home Health 360 is presented by AlayaCare. First off, we want to thank our amazing guests and listeners. To get more episodes. You can go to alayacare.com/homehealth360 that spell home health 360 or search Home Health 360 on any of your favorite podcasting platforms. The easiest way to stay up to date on our new shows is to subscribe on Apple Podcasts, Spotify or wherever you get your podcasts.

00;26;25;04 – 00;26;42;04

Jeff Howell

We also have a newsletter you can sign up for on alayacare.com/homehealth360 to get alerts for new shows and more valuable content from AlayaCare right into your inbox. Thanks for listening and we’ll see you next time.