Priority Management CEO Rick Forscutt said that the one word to describe his skilled nursing operation would be empowerment since the company has decided to give local skilled nursing facility leadership more authority to make business decisions. Forscutt said this decision has led his company to get better results clinically, culturally, and financially, despite continued struggles with the staffing crisis.
The staffing shortages remain a concern, however. Ramifications from Covid on retention rates – even as retention has improved – are still being felt as the company continues to use more expensive forms of labor to maintain staff. Priority Management has had to hire a greater number of agency staff while paying overtime to a quarter of its own employees to staff facilities at adequate levels, Forscutt said.
Founded in 2006, Priority Management is the operator of skilled nursing facilities, assisted living, and long-term acute care hospitals in Louisiana and Texas. The company operates 26 facilities with 17 SNFs in Louisiana, and 9 SNFs in Texas.
The following transcript has been edited for length and clarity.
You mentioned Priority Management empowered facility leaders to make business decisions rather than having corporate making decisions for them. Could you give any examples of some of those facility-level decisions?
Well, one example might be when a corporation wants all of its 30 buildings to use a specific food vendor, pharmacy consultant, or patient supply vendor. We often think that if we negotiate and get the best price, everything must be going well in the field. However, upon closer investigation, we’ve found that those corporate contracts weren’t really working as intended in the field. But facility-level teams were hesitant to make changes because they didn’t have the authority to do so. So, we’ve empowered them to make vendor changes on their own without relying on a corporate-mandated vendor. This has allowed them to get better service, enhance patient care, and often save costs. So, that would be one great example of how we’re empowering leaders to make better business decisions at the facility level.
Would you use the same word to describe the year for the sector as a whole so far?
No, that was harder to think about because the word empowerment that I talked about is specific to some of the new structures we’re implementing as a company. But when I look at the industry as a whole, unfortunately, I couldn’t come up with just one word. It’s actually two words. I would say the words that best describe the sector as a whole are staffing shortage or staffing crisis. As you probably know from speaking with others, the new pandemic for our industry, now that we’ve moved past Covid, is the staffing crisis. That is the biggest challenge for all of us right now. So, I would say staffing shortage or staffing crisis are the words I would use to describe the sector as a whole.
Can I ask how your staffing levels are doing compared to a couple of years ago?
We heavily monitor hourly PPDs (patients per day) to ensure appropriate staffing based on acuity and facility layout. From an hourly PPD standpoint, we’re pretty much staying the same as we were pre-pandemic. However, what we’re seeing now is higher overtime percentages and much more extensive use of agency staff. This means that while we’re maintaining similar staffing ratios as before, we’re doing so at a much higher expense than ever before in our history. A significant portion of this is due to burning out our own employees. Pre-Covid, we aimed for about 3% nursing overtime, but now we’re seeing buildings with overtime percentages between 20% and 25% with our own staff. Additionally, the use of agency staff, which was once frowned upon, has become commonplace as a way to backfill open positions. So, while we’re managing to maintain staffing levels, it’s coming at a higher cost and with increased reliance on overtime and agency staff.
Have there been any recruitment or retention initiatives that have worked?
Yes, one notable success we’ve had, which also ties into retention efforts, occurred in May. We saw our lowest agency usage since before the pandemic as an organization. This gave me, as CEO, great hope that things were changing. One practice that has been successful in recruitment and retention and has helped reduce agency usage is getting our facility administrators more involved in the onboarding process. When a new hire candidate receives a text message or a phone call from an administrator instead of an HR supervisor or staffing coordinator, it grabs their attention. Similarly, having administrators actively participate in the interview process, personally interviewing candidates for various positions, allows the new hires to establish a relationship right from the beginning. For example, administrators reaching out via text to schedule interviews or even to express interest in meeting with candidates can make a significant difference in attracting talent to our industry, as a good relationship with a manager or administrator often leads to longer retention. In the past, we often considered onboarding and candidate responses as the responsibility of HR or staffing coordinators, but involving administrators more directly has proven to be more effective, especially during the staffing crisis.
What would you say is one key goal for the next half of the year?
One of the key goals I’ve been emphasizing with my team is the concept of “relationships before tasks.” I believe that prioritizing relationships over tasks will help us solve the staffing crisis. We’re learning that bonuses and pay increases alone are not fixing our staffing challenges. Especially in this post-Covid era, employees need to feel that we care about them personally and value and appreciate them more than ever before. So, the key goal for the next half of the year is to create a culture where staff members feel appreciated and valued, which will spread throughout the community where our skilled nursing facilities are located. This, in turn, will help attract more applicants to fill our staffing vacancies. So, the goal is to prioritize relationships over tasks, recognizing that positive relationships with managers and administrators lead to longer staff retention.
Is there one notable win or success story for Priority Management so far this year, what would it be?
Certainly, one notable win that I would like to share is related to our recruitment and retention efforts. In May, we achieved our lowest agency usage since before the pandemic, which was a significant achievement. One practice that has contributed to this success and has aided our recruitment and retention efforts is getting our facility administrators more involved in the onboarding process. When a new hire candidate receives a text message or a phone call from an administrator, it captures their attention and shows that we value them.
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