Outmaneuvering Chaos Through Performance Management

In our typical candid manner, Dr. Mike Strouse, Ivo Ivanov, and Lauren Vohland dive into the systems behind success in care services. From zeroing in on medication error rates to designing personalized health dashboards and embracing tech-driven remote care, this conversation reveals how performance metrics and system design fuel real outcomes. Discover why good systems—not JUST good people—are essential in an industry plagued by turnover, and how culture, accountability, and unconventional thinking create measurable impact. 

What you’ll hear about:

• Why individualized care still needs standardized systems
• Why agencies fear change—and how to move forward anyway
• What Yellowstone, Uber, and behavioral analytics all have in common

Whether you're leading a care organization, managing a team, or just love learning how great systems empower great people, this episode is your roadmap to rethinking performance in the care services sector.

Links & References:

• The Showrunner
• The Four Sixes
• Landman
• 1923

Transcript

Ivo Ivanov (00:00:08):

Hello and welcome. It is Fedora Friday at Good Life University and that means that we are ready for another exciting episode of the Quest for the Good Life with Dr. Mike Strouse, your host. And we have a guest today. Again, it's our fabulous senior executive, Lauren Vohland. And I'm excited about today, you guys. I was thinking about something while I was thinking about GoodLife.

Dr. Mike Strouse (00:00:40):

Wait, wait. About Ivo. You forgot the co-host. With

Ivo Ivanov (00:00:43):

The co-host. With

Dr. Mike Strouse (00:00:45):

The co-host. So at least finish

Ivo Ivanov (00:00:48):

The introduction. Good point. I'm also with you sound engineering, fun. Engineering, co-hosting Ivo even Off is with you as well. And the last few episodes were very, very interesting. And while I was listening to them, something came to me. It was, believe it or not, it was Taylor Sheridan, the showrunner.

Dr. Mike Strouse (00:01:17):

So I've been watching everything. I'm watching Landman now.

Ivo Ivanov (00:01:21):

Oh it is. Oh my gosh. Outstanding. Outstanding.

Dr. Mike Strouse (00:01:24):

This

Ivo Ivanov (00:01:24):

Person has nailed it.

Ivo Ivanov (00:01:26):

Yes,

Lauren Vohland (00:01:26):

Billy Bob. I didn't know how much I liked Billy Bob Thornton until I watched that.

Ivo Ivanov (00:01:31):

He's incredible. But why did, this got me thinking about good life? First of all, Taylor Sheridan reminds me of Mike Strouse. In many ways, this man is juggling.

Dr. Mike Strouse (00:01:43):

I too am a two pack a day smoker or something…

Ivo Ivanov (00:01:46):

In many ways the the juggling of many projects is something that you have mastered the multitasking skill that is so hard for many people. And Taylor Sheridan, he is running six shows at the same time. The mayor of Kingstown, Landman, 1823, Yellowstone. Now another one, the four sixes and

Dr. Mike Strouse (00:02:19):

Oh, has that happening yet?

Ivo Ivanov (00:02:21):

No, but it's in production. He is writing it and directing it as we speak and shooting it in Texas.

Dr. Mike Strouse (00:02:26):

I don't know. The world knows the four sixes, but other than King Ranch, the four sixes, there's a couple of others. But it's just this legendary,

Ivo Ivanov (00:02:37):

Legendary,

Dr. Mike Strouse (00:02:37):

Legendary ranch.

Ivo Ivanov (00:02:40):

And you know about it because you've been involved with horses almost your entire life. And isn't that the biggest ranch in the country? Maybe in the world?

Dr. Mike Strouse (00:02:50):

I think it's in the world,

Ivo Ivanov (00:02:51):

Yeah.

Dr. Mike Strouse (00:02:51):

Well, yeah, it could be. And there are people who may own more land but contiguous and there's so much of it. I'll tell you something, the four sixes, if you love horses, it is so cool that they have a lines of horses and how they raise them on the ranch and they're just incredible.

Ivo Ivanov (00:03:20):

Yeah, it is absolutely amazing. And every show that this man writes is… you are very entertained, right? You're very entertained on the surface, but you also, it will get you thinking about stuff. I was trying to analyze his most recent shows, like 1923 I'm watching right now. Lioness. Incredible, incredible, incredible Landman. Absolutely spectacular. So there's a couple of things that I found parallels with GoodLife. First of all, of these shows, ultimately are really about efficiency of a certain man or industry. The Yellowstone Ranch, the Landman, it's about really, it's about achieving success and you can't achieve success without having ways to measure success or failure. And it is quite illuminating watching his characters, Billy Bob Thornton, going through seemingly chaotic process, but ultimately finding the right people, always hiring the right people. The same with Kevin Costner's character in Yellowstone. It's about casting the right personnel and then holding them accountable for each success or failure. And that is the only way of achieving success in an otherwise very unforgiving world. And then there's something happened in this last episode of 1923 that got me thinking about Mike. And in this case it was the villain. Not that you are a villain, Mike.

Dr. Mike Strouse (00:05:13):

No, I'm okay with that.

Ivo Ivanov (00:05:13):

You are our hero.

Dr. Mike Strouse (00:05:14):

I have a Black fedora.

Ivo Ivanov (00:05:16):

You are our protagonist here at GoodLife. But there was an antagonist in 1923 who is a villain, but he's brilliant. He was walking around in Montana, walking, driving around on an archaic vehicle/car from 100 years ago and he made the driver stop.

Dr. Mike Strouse (00:05:38):

I remember this scene. I loved it. He was talking about I know what you're talking about.

Ivo Ivanov (00:05:43):

Yeah, yeah. But it reminded me of you so much.

Dr. Mike Strouse (00:05:46):

Yeah, no, it was just like I saw that and I was like, he is a villain. He is incredibly easy on the eyes to hate.

Ivo Ivanov (00:05:56):

Yes,

Dr. Mike Strouse (00:05:57):

You just want to not like him,

Ivo Ivanov (00:05:59):

But he's brilliant. But

Dr. Mike Strouse (00:06:00):

He's brilliant. You can tell that. And he's got vision,

Ivo Ivanov (00:06:03):

Visionary,

Dr. Mike Strouse (00:06:05):

And that's cool that you'd say that, but I love that he stopped. He said, what are these guys doing? And I went talk to 'em and they were skiing,

Ivo Ivanov (00:06:14):

They were Norwegian immigrants for skiers

Dr. Mike Strouse (00:06:19):

Down this hill was like, what are you doing? Can anybody do? He asked all these, can anybody do it? And could you teach me how to do it? He didn't want to learn. You could teach somebody like him how to do it. Because what he saw was

Ivo Ivanov (00:06:34):

Opportunity.

Dr. Mike Strouse (00:06:35):

An opportunity. People will pay for this

Ivo Ivanov (00:06:40):

To experience escape from everyday life, euphoria, exhilaration. He looked at a couple of Norwegian guys sliding down on two flat pieces of lumber, two

Dr. Mike Strouse (00:06:54):

Sticks.

Ivo Ivanov (00:06:57):

And when his passenger, he said, those are idiots. What are they doing?

Dr. Mike Strouse (00:07:04):

He said something point, you are like this too. There is a desire of people to sort of within the range of acceptability, they want to have the thrills and have danger in their lives and stuff like that. And he saw this is it. It's got that experience that he was like that people could have

Ivo Ivanov (00:07:29):

100 years ago. He looked at these people going down the hill and when other people saw people wasting their time, he foresaw the desire for work-life balance in the he did. And a gold mine, potentially a

Dr. Mike Strouse (00:07:50):

Crummy guy that wanted to offer GoodLife, not because he cared about the Good Life, he just cared about money, but he saw it.

Ivo Ivanov (00:07:59):

Yes. And that's in a way what you do as well, Mike, you are a visionary. When other people see empty space or a barren mountain, you see an opportunity and you seize this opportunity. And I think it's very important for the success of this organization for GoodLife and any organization I believe. And also the other parallel I made between Yellowstone, Landman, all these shows was the level of accountability that the protagonists demand from their employees. So I feel like it's a good opportunity for us to talk about this

Dr. Mike Strouse (00:08:42):

Is, and it may be a good segue into the discussion today, if we ever get to it and we might not, it's very possible that we won't. But even on the way back from a trip I was traveling with Megan Todd, I was telling Lauren that there are two people who I travel with periodically, Megan and Lauren, who are exhausting, just exhausting. I mean, I can be stuck with either one of these guys for hours. Cause I like to drive, I

Lauren Vohland (00:09:14):

Think it was a seven hour drive…

Dr. Mike Strouse (00:09:16):

It was a seven hour drive and I was going, I mean we just talk and talk and talk but we were talking, interesting enough, Megan and I were talking about but she was talking about a problem of ethics and people were sort of, a couple people that she'd worked with were kind of almost following the rules so much while other people weren't. And that got us into this discussion of Landman because the idea behind it is you got this pristine sort of industry of oil at the top level. They're in their wood oiled conference rooms with the great views and they're talking about this and they're talking about that very properly. And they're working on typical business stuff, but they hire this guy that gets everything done.

Ivo Ivanov (00:10:44):

Done

Dr. Mike Strouse (00:10:46):

And they don't quite get involved with how he does it. And it is like a messy, the oil business is a messy business working with very sort of people that are dubiously ethical and they have to have somebody that sort gets it done. And that's Billy Bob Thornton. And he sort of follows the rules and sort of doesn’t, but he gets it all done. 

Ivo Ivanov (00:11:21):

He's Unconventional, its an interesting lesson. Sometimes you've got to be unconventional to resolve a messy problem.

Dr. Mike Strouse (00:11:27):

You don't have to be unethical, but you do have to be unconventional. You've got to figure out what to do and work backwards from (I always talk about working backwards from the goal). That's just how I live my life.

(00:11:39):

But anyway, that writer, he is frigging amazing.

Ivo Ivanov (00:11:48):

He's outstanding. And this theme is kind of a connective tissue between all of his shows. Mayor of Kingstown is the same way.

Dr. Mike Strouse (00:11:55):

I've never watched that.

Ivo Ivanov (00:11:56):

Yeah, it is different. Completely different industry. But again, it's a serious problem and there's the right people for it.

(00:12:06):

I Feel like at GoodLife, one of our biggest assets is the talent, finding the right person.

Dr. Mike Strouse (00:12:16):

That's true, that's true. And putting people towards their passion. But kind of the discussion today, it is definitely that. But there's another side to it and that is sort of the models and the systems and the processes. And that's what we were talking about, why that people will, I mean, I never want our core talent to change, but over 40 years they have.

Ivo Ivanov (00:12:47):

Of course

Dr. Mike Strouse (00:12:48):

We have good tenure. But when you have incredible talent, you like to keep 'em in the box, but they're not going to stay there. I mean, I can talk to you about a managed care company that has a lot of people from good life in it because they were coveted.

Ivo Ivanov (00:13:09):

Yes, that's right.

Dr. Mike Strouse (00:13:11):

And there are a lot of people, I take my other people who have worked, I can go backwards over the 40 years. And I can tell you there's some people who have been leading all parts of our industry, not GoodLife. So at some point in time people move on or they move up or they become something. And you just got to be proud of that. But what you're left with is systems. The last thing you really want is, and you are in the basketball world, you can hire a new coach, you got a new system.

Ivo Ivanov (00:13:51):

That's true. Yeah. 

Dr. Mike Strouse (00:13:52):

You’ve got a new system. In our world with turnover being what it is in our industry, if you rely on just the people that you hire, you're going to have a new system every day. And you're never going to achieve what you really want to achieve. You’ve got to have a good system that evolves continuously & improves good model services systems. And if you remember, we talked with Dr. Flo DiGenarro Reed last session, her forte and my history is in the development of module systems and key processes. That's what she does. She's an OBM Master, and she's developed these tools and processes for GoodLife. But there are other people, Holly, other people who do it. We met yesterday with Heather [Kessler], the nurse who's got to do a podcast.

Lauren Vohland (00:14:54):

She's our director of nursing and then Nicole Kanaman, Ph.D. So we have several leaders within our organization who are fantastic at system design. So not only are they talented within their field, but they have that ability to design a system. So in the IDD field, within just nationally, there is a ton of turnover. And so they have the brilliance to create these systems that factor in turnover. So it allows for turnover, but maintains systems through it. And I think if we relied on each new person or a good system on a person, it leads to chaos. And there's enough chaos when you're working with humans and working through health concerns and behavioral concerns, that even with a really good system design, there's chaos that still exists within it. So that a really good system design allows you to look upstream and manage, really have good structure in place to manage all of those other things. So like, certain things within Heather's design that she created, really as long, everybody who's,

Dr. Mike Strouse (00:16:07):

Which was breathtaking when I looked at her work

Lauren Vohland (00:16:08):

Yeah

Lauren Vohland (00:16:09):

So everybody works within the system. If someone's not working within the system or there's an error, it gets flagged for her. So there's three nurses who support hundreds of people with complex health. How many? Many 306 to be exact, but yeah, at the moment.

Dr. Mike Strouse (00:16:25):

So with complex needs, I mean we've closed state institutions and stuff, so we're serving people with a range of really medically complex needs. Three nurses are doing that. And I would have to say over 90% of their work is remote.

Lauren Vohland (00:16:42):

And so to give an example, we're passing over 1.5 million medications a year. We've got, I don't know, what's

Dr. Mike Strouse (00:16:51):

Our error rate going?

Lauren Vohland (00:16:53):

It's like 0.000... point, yeah 0.0001% or something on 

Dr. Mike Strouse (00:17:01):

It's Just outlandishly low.

(00:17:02):

That's unprecedented.

(00:17:03):

I Don't think there's a historic comparison in my time and Heather is responsible. But there's some elements in this. It's kind of important today, this is kind of where I'm evolving myself. I'm a behavioral analyst. I keep saying that, but it's the most important thing to me. I always work backwards from the goal, but at the end of the day, you got to have a scale that you step on, that you measure your performance. So when you say something like medication error, that's a scale that you step on. That doesn't lie. You have error rates for medication and it is what it is. It doesn't have excuses. I always love Weight Watchers. When I was going to Weight Watchers years ago, I'd go there and I'd step on the scale. I didn't get to control what it said. There was one scale at Weight Watchers, Ivo, that was off. And I don't usually try to find that damn thing, but that was the only thing I could do was maybe a pound. It wasn't much, but I wanted that one so bad. But there's a scale for this stuff.

Lauren Vohland (00:18:27):

Well, so, to have that low of an error rate is because you have a good system design. So we have over 300 people, 300 employees within the agency

Dr. Mike Strouse (00:18:35):

How many medications?

Lauren Vohland (00:18:37):

So we have over 300 employees within the agency who are administering over 1.5 million medications a year. And to have a low error rate like that is because of a really good system design that manages on an hourly basis, on a daily basis, on a weekly basis, monthly basis. And so as long as things are working and, you know, the nursing department with three people can't look at every single med administration. So they're using technology. We're a very tech…

Ivo Ivanov (00:19:06):

Oriented

Lauren Vohland (00:19:06):

Oriented agency. So they're using,

Dr. Mike Strouse (00:19:09):

highly distributed too, which is a challenge. I mean, you're looking at people that's all over Kansas, all over.

Lauren Vohland (00:19:15):

Oh yeah. We are...

Dr. Mike Strouse (00:19:16):

Are hundreds of homes.

Lauren Vohland (00:19:19):

And so they designed a system that relies on tech. And so as long as people are following the system, then it doesn't raise to the level, the system doesn't boot it out for the nursing department to focus on it. But so if there's outliers, whether that's an error on administration or we can even track it to, if there's an outlier on someone's health. So they had an individual who their blood pressure was out of range for a significant period of time. And so “significant” depends on that individual person. So they were able to take that information, work with that person's specialist and identify what the issue was. So on a good system, make sure that everybody's following the system and it can identify when someone's not. But then it can also identify if there's issues that need to be addressed. And in this situation, it's health concerns which are really important. And so based on these systems, they've been able to have all 300 people administering medication with absolute reliability. And then the most important part of that reliability is the fact that the people we serve depend on that medicine to be healthy. And so we're seeing really positive outcomes as a result of really consistent medication administration. 

Dr. Mike Strouse (00:20:39):

So as an example though, there were other metrics that was in that beautiful ones that I would never have thought of and that's why I love—you cultivate this sort of culture of accountability. But then you've got these leaders like Heather

(00:20:56):

That gets it and she understands that the first thing that she has to do is get her dashboard out there of accountability. So she knows if her systems are working. But the one that I thought was unique, guys, was she looks at individual profiles of health, individual profiles of health, meaning that what is healthy for you and what's healthy for me and what's out of range for you and out of range for me are different things. Because I don't know if you guys know this, but I'm older than her. I'm a little older than her. So my range is different of things. But other people, they may have seizure disorders, they may have other kinds of medical complications. So what's normal for, and by the way in IDD in general, I mean I can talk to you about psychotropics, what is “normal” for people is different. So the idea that she came up with a metric of out of profile I thought was brilliant.

Lauren Vohland (00:22:10):

Yeah. So the other really brilliant thing of this is going back to turnover. And so first she instituted all these systems and how do we get people to comply? And so she's working with over 300 people who are interacting with this system on a daily basis, but then you have to factor in turnover. So within a whole year you're getting hundreds of people who are engaging in this system. And so she had to develop strategies. And I will tell you from the moment that someone steps foot on GoodLife property, they are getting educated on how to work within this system, the importance of working with this system and how to be successful. She really outlined clear expectations, the accountability of it, and then an intervention strategy if they're not either doing it, whether that's they get distracted by other things going on in the home or whether it's a lack of education. So every step of the way she had to get buy-in from all of these employees and she has to maintain that buy-in. There's never a point where she can just step back and say, I did my training. I've got people doing what they're supposed to do. That is an everyday thing. And that will maintain as long as we're supporting people is you have to continuously get them educated. 

Dr. Mike Strouse (00:23:32):

So a nurse goes out of the three and, nurse goes in, they're going into and, Ivo, this is kind of like what you were talking about. They're going into a system. Bill Self of the Jayhawks has a System.

(00:23:45):

He might get different players, but they're going to and they bring their own talent to it. And he may make some adjustments to the system based upon that to a degree, but he still has got his system.

Ivo Ivanov (00:23:56):

Yes. And I love the basketball analogy really, it got me thinking, why are there certain basketball teams, franchises that are always successful? Boston Celtics and Los Angeles Lakers are always successful between them. They have almost half of the titles in the National Basketball Association. Well, there's post Celtics culture and there's Los Angeles Lakers. Culture within this culture is a system. Then there's lean protocols, expectations, performance management. When you enter this franchise, when you are a player in this franchise, you become part of that culture and the expectations are different. Failure is unacceptable. If you don't fit the culture, you'll be replaced. If you don't fit Yellowstone Ranch, you'll be replaced. There is a culture, and those are the successful industries, successful organizations that have that culture, that system is built in. And there's strategies, protocols. But the one variable that's the most unstable is the human variable, right? In this equation. So when this variable enters the system, it has to be instantly educated on what the strategies or the expectations are, what the accountabilities and what the culture is.

Dr. Mike Strouse (00:25:21):

So I want to go in on that, but as successful as Heather has been, she's been marvelously successful. I don't want us to diminish the fact that she's doing that in an agency. And our world, as we've talked about, is high turnover on the care industry, but there's a whole other side of the elephant of GoodLife that does nothing but work on staffing stability. So it is like, okay, great, you got a great system here, but don't look at that system without the context of also knowing there's this other group over here that knows that without staff stability, even Heather's system will fail. So you now got this other group that's working on Shared Living strategies, Neighborhood Network strategies, different types of live in, live by live near strategies and front half back half, three day work week strategies and all these other things with other metrics and other dashboards that are designed to make it so that Heather's work has a chance

(00:26:31):

This dragon we're wrestling, and that's what Wolf used to call it, he called it dragon wrestling has all different sides. And in order to be successful, every one of them has to focus on their part. Heather's system is what I talked about. I was most excited of all the metrics is her “out of profile” measure because it was an individualized approach to health that was put into a system. And therein is the problem with IDD services completely. Everywhere I go and every aspect of it. And it specifically evolves around technology. How would Heather's system work if every client got to pick their eMAR?

Lauren Vohland (00:28:00):

It would be chaos.

Dr. Mike Strouse (00:28:02):

It'd be utter chaos.

Lauren Vohland (00:28:04):

And I don't think they could...

Dr. Mike Strouse (00:28:05):

It wouldn't be scalable, it wouldn't be deliverable, it would be nothing but chaos. If each individual got to pick their own eMAR because that's their choice, then all of a sudden we couldn't achieve any of those results. It would be utter chaos. And it seems so logical to everybody. So well, of course you can't have everybody pick their own eMAR.

Lauren Vohland (00:28:31):

300 different strategies.

Dr. Mike Strouse (00:28:33):

You can't have every employee pick their own payroll system or have a CRM that every customer got to pick their own CRM. I mean, it is just ridiculous to think that that could actually happen. Yet we are approaching technology with people, enabling technology, where everybody picks their own thing as if there was no relationship to anything. And then we now are serving 400 people where everybody does that. And we think that that's scalable. And of course it isn't. You can deliver individualized services through systems. You can't really do it unless there is one [system]. And we have understood that with Uber individualized transportation, when and how and where people want: system. We do payroll services and deliver individualized pay strategies to it. The software is all configurable and all competitive. You're giving an agency a platform to do that stuff, but somehow we think that we can do individualized support for people and not have a system. And it is the chaos that that has caused.

Lauren Vohland (00:30:25):

And probably lack of utilization and lack of quality outcomes. So I think at the end of the day, I think two examples that most people would understand would be med administration. The individuals expect to receive their medication at high integrity because that's important to their health. Their doctor expects that employee expects to be paid on time and expects to be paid correctly. So the outcome is what is so important there. And those are created through those systems that the agency has developed and designed so that we can meet those expectations by utilizing those systems in a system wide approach. But then also, like you said…

Dr. Mike Strouse (00:31:11):

But You can personalize it.

Lauren Vohland (00:31:12):

You can personalize it.

Dr. Mike Strouse (00:31:13):

Because the software, if it's well designed, allows the personalization of the system. But it's still a system. It's still a platform, it's still a thing. You know what I mean?

Lauren Vohland (00:31:23):

Well, and I think for me, I use Uber. I don't necessarily want to know all the things that go on behind the scenes with Uber for them to make that system design work. I don't want to be responsible for the hiring of drivers, for the making sure that the driver has insurance, all of those things. I like being able to rely that Uber has all of those systems figured out and I can sign up and I can get the ride when I need it. And I have transparency and accountability on the cost, on where I'm going, what driver I get to select. Those are what's important to me is the outcome. And I'm going to leave it up to Uber to figure out those system approaches to make it possible.

Dr. Mike Strouse (00:32:10):

Yeah. Remember when we started interviewing, we were in Arkansas and we were interviewing these individuals, I'm going to call it just individuals who really needed help. They self-direct.

Lauren Vohland (00:32:38):

Self-direct. Right.

Dr. Mike Strouse (00:32:39):

One of these guys, we'll call him Jim, just because that's not his name. Tell me about some of the stuff that, like, his experiences. He was self-directing in-home care.

Lauren Vohland (00:32:54):

He was authorized for 24 hours a day of in-home care and a really cool guy.

Dr. Mike Strouse (00:33:01):

How much was his services costing?

Lauren Vohland (00:33:04):

Oh, I would say probably $150,000 a year in just the direct.

Ivo Ivanov (00:33:12):

Wow. Wow.

Lauren Vohland (00:33:14):

Direct. So just direct support from staffing, supporting him with his daily living needs.

Dr. Mike Strouse (00:33:22):

Yeah, he had small challenges.

Lauren Vohland (00:33:23):

That wouldn't include other costs based on his health and whatnot. But that alone, I would estimate that would probably be it. But he, really cool guy, but authorized for 24 hours of care a day, but he was unhappy. He wasn't getting staff. There would be times of the day where staff just wouldn't show up. He didn't know where they would be. He wouldn't get any communication on why they weren't there or if they were going to come later,

Dr. Mike Strouse (00:33:51):

Two staff worked for two different agencies and they didn't get along. Remember that? Or there was uh, somebody quit and it could be a long period of time. And so he'd have to rely on his family members to come in and volunteer their time to fill in a gap. And he luckily had somebody, yeah,

Lauren Vohland (00:34:12):

Yeah. He was full physical support needs.

Dr. Mike Strouse (00:34:17):

He couldn't live on his own without this support.

Lauren Vohland (00:34:20):

And I think to me, I got the impression that he had to just settle for the things that he could get done in a day based on the labor that was showing up.

Dr. Mike Strouse (00:34:31):

And he was talking about, like, somebody didn't show up, so they had to send somebody that he had no idea about him and couldn't do a lot of things. That's what you meant. So they had to change the day because they couldn't do a third of the things he needed to have done to live a normal day. So that turbulence, the gaps, the people who didn't get along because they were coming from two different agencies and they didn't like each other.

Lauren Vohland (00:34:59):

“You were supposed to do that.” “No, you're supposed to do that.” Well, someone's got to do it!

Dr. Mike Strouse (00:35:03):

No, I'm not doing it. I mean just I said to everyone just amazed how articulate this guy was. He was such a cool guy. But also it was clear that not everybody could have done it. They didn't have the family to fill in the gaps. They didn't have the ability to articulate things as well as he did. And for all of those people, those guys had to trade living on their own for facility care because they didn't have all that support.

Dr. Mike Strouse (00:35:42):

Yeah, my point on that is, there was no system. There was none, no system other than trying to hire people and send them to a place. And that's where we kind of resolved. You approached each individual that you support individually, cool all for that, but you did it in an individual way that had no ability to be sustainable or scalable, and that's what you got for it.

(00:36:22):

Take that back to the Uber example where if one driver can't make it that day, their system does not crash. They share things but deliver individualized services. So there is a method to how Heather…you have a system, you have metrics, you have a scale that people step on that measures success, and you have a system of delivering it that is scalable, replicable. We talked a lot about some of these things with Flo, but one thing we stopped short on is Performance Management. And I want to talk a little bit about that because you manage a lot of people and I love your style. You are very coaching and your style you set and you have the one-on-ones where you look at what they're working on and you help people get there and you recognize that you got to work with this person differently than that person. I mean it takes years to figure those kinds of things out and you've done it amazingly, but as you're doing that, you develop these incredibly strong relationships with people and their personal stories, they had struggles with this or struggles with that, or even personal struggles. So what's so hard about GoodLife I think, and that we try to push through is you can easily end up changing the goalposts or the scale

(00:38:40):

Because of all these personal things. I give our Neighborhood Network as an example, I asked more than a few years ago, if you remember, for us to develop a Site Review. And this is how we learned too, and we hired one of our best people to do that. Well, they knew what we wanted. They knew some of the outcomes that we wanted to do and they knew the key processes. All I wanted 'em to do is to put an assessment together to know if a Neighborhood Network was performing at the level it should. I wanted to scale. I wanted the metrics. I felt like that was the first step. 

Lauren Vohland (00:39:25):

Wanted make sure we had designed the system. You wanted to make sure that across the Neighborhood Networks that we've started that they were all following the system design instead of it running different ways and not meeting the expectations.

Dr. Mike Strouse (00:39:39):

So what happened?

Lauren Vohland (00:39:41):

Well, I think emotions got involved. The daily challenges of what it looks like supporting people.

Dr. Mike Strouse (00:39:48):

If we measure that thing, I won't look that great. There was some of that.

Lauren Vohland (00:39:54):

I think it was one of those things where when you're in the trenches and you're in the weeds, you're like, this is my bigger problem, this is it. But then, so the Site Reviews got completely sidetracked and started focusing….

Dr. Mike Strouse (00:40:10):

The consultant a bit got absconded with

Lauren Vohland (00:40:13):

She did

Dr. Mike Strouse (00:40:14):

To help them improve the services so that when they stepped on the scale, they would be lighter,

Lauren Vohland (00:40:23):

But in the end it

Dr. Mike Strouse (00:40:24):

They didn't want to step on the scale. They didn't want to do the scale because they knew that they hadn't lost the weight yet!

Ivo Ivanov (00:40:30):

They hadn't lost any pounds.

Dr. Mike Strouse (00:40:32):

So why don't you help us with all the stuff that we're not doing so that when we step on the scale…and it's like this culture, they want to do well and that's amazing. That's a wonderful thing. But for almost a year they were working on these other things instead of the thing that I asked them to work on, which was: please do the Assessment. Because the whole idea was if you do the Assessment, then we'll know what to work on. It's not like, I think it was like we're not doing the assessment so that we can show how not good something is. We're doing the assessment to help them organize how they get better.

Ivo Ivanov (00:41:16):

Avoiding the scale doesn’t help.

Dr. Mike Strouse (00:41:17):

Here's 25 things we assess and here's the five important ones and here's how they all would come up to a score and all that kind of stuff is the site review that we end up developing and it gives you a method by which you can evolve and improve, right? Finally they did that.

Lauren Vohland (00:41:37):

Yeah. 

Dr. Mike Strouse (00:41:38):

Freaking amazing assessment by the way.

Lauren Vohland (00:41:39):

It's an amazing assessment and it really looks at each individual Neighborhood Network and determines really, we don't want programs that rely on one person who's really good at doing X. The system has to factor in turnover that this really good person could leave, but who's going to come in and replace them? And we don't want the program to be dependent on any one person. The program should be dependent on the design of the system. And so by creating this Neighborhood Network site review, we were able to measure where the programs stood up within this system design, but it also measured the outcome. So what's the stakeholder satisfaction? What other quality outcomes do we think are important?

Dr. Mike Strouse (00:42:32):

Which is the top level. I think what we're trying to get across, and we did, is look, there's six, seven, whatever things that are really top level, they're outcomes that you want to achieve. And then you have all the key processes and things you do that's supposed to make that happen, right?

Ivo Ivanov (00:42:49):

Yeah.

Dr. Mike Strouse (00:42:50):

Well, what happens if all of a sudden they're doing really, really well, but they're not doing some of these key processes? What does that mean?

Lauren Vohland (00:42:58):

It could impact the outcomes, which

Dr. Mike Strouse (00:43:00):

Well, I mean it could impact the model. It's like, wow, you're doing really, really well in this outcome, but you're not doing a couple of the key processes to do that. Maybe, what are you doing? I'm the kind of guy that if I have to change the model because we figure out something that can do it really well, I’m super happy to do that. But it could work a lot of different ways. Measure the outcomes, measure the key processes that you're doing, measure people's happiness and satisfaction with stuff. And if you've nailed it on a couple of areas and you're not doing some key processes, you might want to ask what are they doing that's getting those outcomes? Or maybe it's the other thing, the outcomes aren't there and you're not doing some of these key processes, maybe a little insight on how you prioritize what you work on, right?

Lauren Vohland (00:43:56):

Yeah. Yeah. And so I think that that's the whole purpose of it is to identify those areas of weakness, areas of need. And it's a very collaborative process. So it does consider the humans that are involved. So if they're struggling on a key process, why are they struggling? So it's not to hold people to say, oh, you're in trouble because you didn't do this, but what are the barriers to achieving this? Because this was something that we originally said was so important to this key process was so important to the entire system. And if we're struggling to do it, what are the barriers? And so that's really what that whole system is designed to do. And yeah, it's been really successful.

Dr. Mike Strouse (00:44:40):

And now that we have the scale that people step on, we now know when we can call something a “certified Neighborhood Network.” It's certified that it is doing all the key processes and achieving certain outcomes that we're proud of because there's a lot of people who want to do [a NN], they visited all the time from all over the country and they want to do a Neighborhood Network and they think, well, I can put in technology and I can do this, that and the other, and I've got it myself, a Neighborhood Network. And we know, no, you don't.

(00:45:21):

There's certain things that we embed in that program, and it is not just technology and it's not just an apartment and somebody living in it. There's more to it than that. So, now we have with the site review a way that we can help people know, here's what you got to do to have a Neighborhood Network. You can see it. You can see what key processes, what outcomes we achieve, and now you got to, and here's the process for how that's implemented. Now you have something that could be a key process. You go into other worlds, you see it. You say, okay, I once went to a Kentucky Fried Chicken that had something that I'd never seen before, and that was interesting. But Marriott, for example, is a flagship hotel. They have franchisees all over the world that do this.

(00:46:34):

But if they decide to change the special sauce, it's changed for everybody. And then the local team, who are leaders in their little respective companies, they're not able to change the scale. They agree to it.

(00:47:02):

May have a lot of input in it, but at the end of the day, the scale exists independent of them. So what the cool thing about that is from a management perspective, a Performance Management perspective, you are a coach for your team. You can't have the coach somebody come back to you and say, “Hey, I know that this is basketball that I know you keep score that whole score thing, but can we just not keep score?” You can't do that. So all of a sudden, if you have a really good scale, if you have really good outcomes, if you have a really good accountability process that's independent of the person doing it, now all of a sudden you have the ability to be their coach and you're not in charge of where the goalposts are.

Ivo Ivanov (00:47:57):

So having the right assessment inventory is crucial. If you don't have it, the entire system can be compromised. I was thinking how we have an intricate assessment tool and how it's helped us. It's also a motivational tool and it's also a data collection tool so people can improve their performance. And it's the same with Uber. Would Uber work without that feedback loop with the rating system? Probably not. It trades both the driver and the customer.

Dr. Mike Strouse (00:48:35):

I've never been on an Uber ride where I haven't looked at the number of rides and the satisfaction thing, I mean, there are so many elements of Uber that you need to think about. In fact, or \ how I'd like to see our Neighborhood Network or our safety net program for seniors, which will be discussed in future podcast, but they have amenities and benefits for the driver. The higher the ratings and the more rides they get, they go up to all the way to Diamond. And there's different classes of a rider based upon their historic performance. But the idea is you got to have people that are reinforced for doing it well. And so Uber is a absolute beautiful designed system that looks at both the person that's supported and the people that make that possible.

(00:50:10):

And they elevate both people's lives by having their goals lined up. They do things in ways that the taxi guys could never do. I mean, they basically give ownership of the services to the drivers. You can buy your own car and you get preferred routes. You get preferred areas based upon your historic performance. What you want to do in services is have a model that really works for people that supporting, but it's got to work for the people that are making that happen. And the more you do the one, the better you get from the other. And I think in IDD services, the whole approach on individualized support is super important, but how is that affecting and elevating also the lives, the people that make that possible. If you can't do that, you're going to get what you got. This is where the Shared Living program elevates both lives. The Professional Neighbor program and how we deliver community care elevates people's lives. With nurses, the idea that they can work remotely, not only help deliver on-demand care of nursing, but it elevates their lives. So without somebody focusing on the performance management, the labor side, the environmental context, Heather and her systems, which are cutting-edge would not would be so-so. You have all that.

Ivo Ivanov (00:52:19):

Yeah, engineering the right system is extremely important. Obviously. I was thinking about something you said in the beginning, Mike, how some management companies kind of poach our talent, and there is a little bit of turnover of high-level talent that leaves our organization, but the reason for this is because this organization provides the correct professional nutrients for people to grow, to elevate their skills, and when they leave, it's also helping us in recruiting new talent because they know this, they see it, they see an opportunity for career growth and evolution. So it is also important. Having all these components in place in the system also helps recruiting talent.

Dr. Mike Strouse (00:53:14):

Yeah can. it makes you sad for a little bit, but at the end of the day, you're very, I mean, sad, you have to do it again, but you're happy for people. You're legitimately happy for people. 

Lauren Vohland (00:53:30):

Well, and I can think of several who were here for decades, 20 years and left and are highly successful in these other positions or organizations that touch all Kansans with support needs. And so, to see them go from GoodLife and be really successful and impactful across the state or even the nation is really impressive. And it's awesome to be able to work with some of the best in the field and know that GoodLife is attracting people like that. But I think a lot of that comes from your leadership where you are pushing the envelope and we're always exploring ways to improve. We're always looking at different strategies and how to utilize different industries, and such as tech, software. What can we do to make things more possible so that we can achieve our outcomes?

Ivo Ivanov (00:54:26):

Yeah, you lose Billy Bob Thornton. You get Kevin Costner.

Dr. Mike Strouse (00:54:32):

Okay. But then you got to get a good script and you got to get, yeah, you need the four sixes. It's about the system, other things. But as happy as you are and grateful as you are about what you have, I can't help but say I want more!

(00:54:59):

And I want an agency to want more because you cannot improve anything unless you take the time to examine why it's not working and have a level of honesty about that. And sometimes we're so wanting to celebrate the successes. Look, I love success, but I always want more because more means better, right? You want to evolve. But I would just kind of say that some of the stuff that I'm perseverating on right now, today, is we work with places all across the country on staff stability and labor work. I'll go into an agency and I will look at it and say, “boy, the kinds of services that you deliver and your challenges are an exact match for what we have to offer you. We could change your life.” And we know there are people that we've worked with that's been true, but there are also agencies we work with who are, well, it's just not a good time. I'm sitting there going,

(00:56:21):

“No, it's a perfect time because right now you're in a bucket and we can help with that.” But there is this human nature part. I mean, I love human nature because as a behavior, it's so predictable. I know Lauren is years and years in working with horses. That's one thing that we've always had in common, and I don't want to say that that's why I originally hired her, but boy, I really liked that part of her because there's a couple of things about working with horses that mean a lot to me. Number one: is it's hard work. You have to work hard to have horses in performance areas trained to the highest levels of performance. There is nothing easy about it because you're working with an animal that is a flight animal. First of all, let's get to nature. My kind of ending comments.

(00:57:24):

There's nature and as a flight animal, their eyes are set over here. They can see all this stuff. Their ears are going back and forth like that. They're constantly radar focused on anything that's a threat to them, right? The reason a horse is so amazing is because when you do leg cues with a horse, it can be just the littlest bittiest thing that you can do. And in fact, my daughter was really good at this. She could go with her one horse, she could go bridleless, and it looked like she was just mind melding with this horse because nobody on the could see the cues that she was giving it, but she was giving it cues. But they're so attracted to very small things and that these very small things were allowing her to guide this horse to obstacles without a bridle. Really kind of cool to watch if you ever watch something like that. But my point on all of this is, is that there's human nature and the nature of horses, and you harness that. That's why round pens work, because they're always running away. We harness that running to get them to do whatever. My point in all of this was that when you're working with agencies that are struggling specifically when something that you can help them with, they get it. They understand this could change the game, but they stall in going from one step to the next because they have fear.

(00:59:09):

In this case, human nature is “I know we're changing stuff and I know it'll work, but I can't lose any. We're 30% vacancies. We just can't afford to lose anybody.” Well, you know what? You're only getting three people to apply a week to your agency, and we've just showed you this new system that’s going to get 10x that easily, 10x that number cause we’re changing the attractiveness of the schedules, pay and all this sort of stuff. But how do you help people move to new systems that really can change the world for them, but they're afraid of how they navigate through their system or their lack of a system in this case, and organize people to do that? Because they're afraid of change. Of change.

Ivo Ivanov (01:00:15):

Yeah. Fear of change, part of human nature. Well, show them the outcomes, right? That's the best way to do it.

Dr. Mike Strouse (01:00:20):

One of the ways. But you’ve got to make sure that you, and this is where I feel like we can do better. We've got to show them that there's a way of getting through it that doesn't have the impact that you're fearing, that actually has the opposite of that impact.

(01:00:40):

That's why in change management, you've got to work with somebody that can help you through that first iteration of change and be there with you through that whole process. So this goes back to my thing. The world is so fixated on training. I can go to give you a workshop and you're good to go, and we know that it couldn't be anything farther from the truth. To change you need help. To change and you need somebody that can kind of guide you through that first iteration of stuff.

Ivo Ivanov (01:01:16):

Well, this has been a great conversation. We want to thank our listeners for joining us today on our quest for the GoodLife and Wrestling Dragons with Dr. Mike Strouse and Lauren Vohland. Today's episode was produced by Megan Olafson and recorded at GoodLife University Studios. Sound editing and engineering were provided by me, Ivo, Ivanov. Engineering, and Reverse Engineering of every topic was provided by your host, Dr. Mike Strouse. We want to remind you that our inability to remain concise was completely deliberate. Please feel free to contact us, ask questions or voice an opinion by sending us an email at GoodLifeUpod@mygoodlife.org. Together, we thank you for listening and promise you that The Quest for the GoodLife will continue next week.