Senior living organizations that are staying ahead of the curve today have a unique challenge: they not only have to serve a changing demographic, but they also have to adapt to a changing landscape for doing business.
That landscape comes with traditional considerations such as technology, but in the case of senior housing organizations, it also includes a shifting health care landscape, affordability concerns, and uncertainty around competing options that are emerging or have emerged to compete with traditional assisted living, independent living, skilled nursing and CCRC organizations. Looking back and looking forward—simultaneously—becomes a rising challenge in light of these factors.
But in spite of the challenges, some are managing to stay ahead of that curve and preparing for 2015 as well as 2030. Several are doing this by implementing management approaches under the concept of the “ambidextrous” organization.
The common definition of ambidextrous applies to people who can operate equally with their right hand and left hands, rather than having side that is stronger than the other as in a “lefty” or “righty.” Applied to business, The Harvard Business Review wrote about this concept in a 2004 edition:
“We discovered that some companies have actually been quite successful at both exploiting the present and exploring the future, and as we looked more deeply at them we found that they share important characteristics. In particular, they separate their new, exploratory units from their traditional, exploitative ones, allowing for different processes, structures, and cultures; at the same time, they maintain tight links across units at the senior executive level.”
An organization doesn’t have to escape its past, HBR wrote, to renew itself for the future.
The term applies broadly beyond senior living, but is based on several conditions: compelling strategic intent; common vision and values; leadership owns success of ambidexterity; separate but aligned organizational structures; and tension held only at the top of the organization.
One provider that has adopted the approach is Clark Retirement, a 107-year-old CCRC in Grand Rapids, Michigan.
“Roughly a year ago, we recognized that we have a long history and a strong component of people who live here,” says Brian Pangle, CEO of Clark Retirement. “When we look at Clark today, I know who we serve and how we serve them will not be relevant 5 and 10 years from now, and maybe even sooner than that.”
With an eye toward innovation, Clark sought the advice of industry consultant Ryan Frederick of Point Forward Solutions to develop its plan around becoming more “ambidextrous.” One important distinction Frederick notes in a recent white paper is between disruptive innovation and sustaining innovation.
“For Ambidextrous Organizations, pursuit of both sustaining innovation and disruptive innovation is important,” Frederick says. “Effective sustaining innovation helps increase the success of the organization’s exploitative business; disruptive innovative helps spawn exploratory businesses that may be pivotal for the organization’s future.
In addition, disruptive innovation can serve as an insurance policy when it’s controlled by the organization—effectively taking a proactive, or offensive approach, rather than a reactive one.
In the case of Clark, within a year of working toward ambidextrous principles, the organization has shifted its perspective. One example is its approach to post-acute and sub-acute care, says Pangle.
Of its 481-resident capacity, 111 are skilled nursing accommodations, with a quarter of those devoted to sub-acute care and short-term rehab. Here, the needs of today—largely rehab following joint replacement—may be different than the needs of tomorrow, given the growth in chronically ill seniors with dementia.
“We look at hospital partners they are saying these are people we care for in hospitals and need a different setting,” Pangle says.
Now, Clark has partnered with a local university’s nursing school to develop a dedicated education unit (DEU), and utilize its community as a classroom. The DEU approach makes Clark the first of its kind in the state of Michigan.
It’s also taking an evidence-based approach to its care model.
“If we didn’t change our rehab model and look at evidence-based changes that are necessary, we’d be out of business on the sub-acute rehab side,” Pangle says.
Likewise, Baltimore-based CCRC The Broadmead has also employed the ambidextrous concept to its organization, and is taking a slightly different, but similar approach to evidence-based research.
The community has partnered with Johns Hopkins Medical institution on an initiative that will study and analyze the community’s dementia care approach in order to work toward improved and dynamic care and a center of excellence that accommodates the needs of residents.
“We know we can’t do it in a silo,” says Broadmead CEO John Howl. “[We saw a] need to find academics in our market, a need for research and evidence based programs, then metrics and outcome measurements so we can prove what we are doing is making a differnces in the lives of those we are serving.”
Much of the ambidextrous approach starts at the top of the organization, with its leadership, and extends to its culture as well as its resident base.
“I’m a huge believer in culture,” Pangle says. “The culture of an organization is not something you can see, but you have to be able to feel it when you walk into a building. Underlying that culture are systems…. At Clark, every new staff member goes through person-centered living training. We have even rolled it out to residents and have asked them to participate in the training.”
Hiring of staff in ambidextrous organizations also considers that staff’s approach to the changing landscape in which they work.
“We will get the biggest bang for our buck as we reimagine a constantly evolving delivery,” Pangle says. “We were a sleepy, somewhat dormant, organization, and getting a 100-year-old organization to get the inertia to move forward is challenging.”
The Broadmead faced a similar challenge, as many longstanding organizations say adoption of technology that is in flux is a major issue operationally. CCRCs have historically not been very good at adapting to change, due to several factors including their size and scope, multiple service offerings and care types, and the fact they’re often associated with larger organizations that often maintain control on a larger scale.
“We didn’t have the competencies around the latest technology,” Howl says. “In our effort to do a strategic audit of the organization, we found in that area in particular we were well behind.”
Broadmead ultimately committed to a $3.5 million technology investment that has since been rolled out, spanning applications that are both safety- and communication-oriented.
Resident adoption of technology is an important element of keeping the organization on the cutting edge, as well.
“For the most part, for residents and family members it’s met with enthusiasm,” says Tom Grape, CEO of Benchmark Communities, a senior living organization based in Massachusetts. “Implementing certain technology is a change, but if you’re doing it for the right reasons, generally staff is supportive.”
Benchmark implemented wireless technology across its communities “earlier than most,” several years ago, and also rolled out a Benchmark Connections platform that spans email and Internet to residents and staff.
“People were thrilled,” Grape says. “We saw a much higher level of engagement and participation from residents, who were thrilled to be able to keep in touch with their kids and grandkids.”
But launching technology and expecting it to take care of itself does not necessarily align with success, providers say. Benchmark has changed its care packages several times to accommodate rising levels of acuity. It has added additional options as they have become available as a way to respond to trends as they are coming.
Ultimately, embracing change and working toward ambidexterity is benefiting organizations—one community at a time.
“From the time I have been in the industry, we have seen age and acuity creep up,” Grape says. “I have seen changing customer expectations, and adult children who are very demanding. None of those changes are going to stop. We have been having to adjust over time.”
Written by Elizabeth Ecker