Saturday, February 16, 2013

Gentiva: Where M is for Mediocre


Your coworker spoke deep truth on changes in IDT at Generic Hospice.  I offer a bit of same (hopefully) in return regarding Gentiva.  I intersperse my lament with words from Gentiva CEO Tony Strange:

I can't say I was excited about the way Gentiva leaders decimated our hospice's clinical services. Over a period of months they instituted programs that eliminated every special, distinctive, unique thing we did for our patients. Gentiva corporate dismantled what made us the standard of excellence in our community.

"We have four pillars for growth. One, we continue to invest in our clinical delivery system... Two, continue to expand our referral base through investment in our sales organization...Three, realize Home Health/Hospice synergies (Positioning Gentiva to be a care transition company, to get patients into the most cost effective setting)…. Four, grow through strategic acquisitions (Positioning ourselves,looking to de-lever by paying down debt/growing earnings, look at opportunistic acquisitions)."--Tony Strange, Gentiva CEO at 2013 JP Morgan Healthcare Conference.

I saw earnings grow through employee turnover.  It bothered me that many of my peers worked long hours covering for two positions for months at a time and the company did nothing to thank them, much less reward them for their burdensome labor. They were salaried. There was no additional compensation. My peers worked the hours needed "to get the job done." It mattered not to the higher ups that one person was doing two jobs.  That bolstered EBDITA.

When someone does two jobs they can't do both well. When mistakes were made, as any competent leader could predict, management hammered them. Write ups, counselings, what's the matter with you, why can't you think, I'll teach you, now get back to work and stay until everything's done to my specific direction!   While it may have been couched in more socially appropriate wording, the message was clear.

"Home health and hospice offers a cost effective alternative to providing care for the aging demographic."--Tony Strange, Gentiva CEO 

Things weren't great, but I maintained my intrinsic motivation to help others do sacred work, that is until....

"We have a very strong density in Certificate of Need states, which creates a barrier to entry. We have a very strong presence in CON states."--Tony Strange, Gentiva CEO 

...they judged me.  I could expound on technical flaws regarding the annual performance evaluation, how it wasn't based on my job description, how it covered events after the evaluation period or how I was held accountable for things not within my control. Those bothered me, but something cut deeper.

Gentiva rammed a stake through my intrinsic desire to do good work, to be part of a team, to contribute to something greater, something sacred. I let their judgment pierce my heart.

I swore I wouldn't let in those corporate bastards. I promised to hold off their reliance on word-parsing lawyers, tight-fisted bean counters, and orange-tinted, white-toothed marketers. This troika set the corporate agenda which repeatedly unbalanced our site. Even with our hospice badly listing, I thought I could hold on, hang in there, even be a positive, counterbalancing force.

"Average aged of our patient is 79 years old. They have multiple co-morbid diagnoses and are on 10 or more medications."--Tony Strange, Gentiva CEO 

We used to deliver medications to the patient's home. The company instituted a new formulary which dropped many medications our patients used. Overtime was banned, needing corporate approval before a nurse or chaplain could stay over.

At first, staff ignored corporate directives. When a nurse asked to stay with a dying patient, the common answer, "No Overtime allowed." Nurses, given their professional oath, usually donated their time.

When corporate HR learned this, a pinhead essentially said, "That's not allowed. They can't work overtime without approval and they can't donate their time. Write 'em up. Who's doing it?"

No one answered.

Pinhead,"Warn them, if they do it again they'll be fired!"

"Investment highlights. Demographics are compelling. Our market grows by 10,000 people per day. Patients have skin in the game. We have a seasoned management team. Most of the team have been with me over a decade."--Tony Strange, Gentiva CEO 

This "management team" knows Home Health. They don't know jack squat about Hospice.

How did I allow this crappy company, with its over-reliance on control by extrinsic motivation, to wound my internal desire to make a difference? I struggled with how to move forward ever since I was labeled a "good, solid employee," nothing special.

Funny, the descriptions in the evaluation were highly complimentary. They noted the many outstanding things I'd accomplished. If those words were the only thing on the page, I'd have been content. No, the company had to collapse me into a summary rating (High, Medium or Low).

They ranked me M for mediocre, effectively damning me with faint praise. They collapsed a year's worth of hard work,where I'd done many things outside my job description, into one solitary letter of the alphabet. It seemed I was downgraded for not doing even more outside my job, despite putting in long hours, with great impact.

The evaluation came with nothing. I received no raise, no bonus, no gift card, no anniversary present, not even a cheap Chinese pen or crappy mouse pad embossed with the company logo.

I felt I gave my all. I didn't see how I could've worked harder or been more effective. I would've been happy to not had their judgment, pro or con.  That's not why I do the work.

Yet, they gave it and I made the mistake of listening.  Gentiva's judgment acted like an invasive cancer on my heart. It couldn't see a sliver of what I'd contributed, much less the whole. I had to remind my evaluator of the many things I'd done specifically to help them and our site, most of which were not in my job description. What the company couldn't see, it couldn't appreciate.

I did those things because I wanted to, not for recognition. So why is this bothering me so much now? Why would I expect an out of balance company to appreciate human respect and dignity? Maybe I don't want to become mediocre, like the company itself.

"Closed or sold about 59 locations... Took a lot of cost actions end of last year, took out additional regional/area costs, corporate back office costs... Home health continues to run very strong... Hospice has been challenged... Get after growth with sales initiatives, better trained sales people, more salespeople, more feet on the ground. Put a new leader in April in Hospice sales organization. No different than what we went through with home health two years ago. Looking forward to 2013 and getting hospice back on track." Eric Stusser, Gentiva CFO at 2013 JP Morgan Healthcare Conference

Addendum:  It's been two years and the second evaluation went much like the first.  While my co-workers say they've never had service this good, my boss focused on a handful of things I hadn't done.  It's sad when the annual evaluation requires a coat of armor to survive.  Toxic management is alive and unwell at Gentiva. 

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