The Management of Change

Are you ready to challenge the status quo in care services, staffing models, and organizational behavior? In this episode of The Quest for the GoodLife, Dr. Mike Strouse and co-host Ivo Ivanov take you on a deep dive into the science of change management, implementation strategies, and innovative solutions that redefine what's possible in disability services and beyond.

From behavioral analysis to workforce stability, Dr. Strouse reveals how GoodLife has pioneered groundbreaking models—leveraging technology, refining staffing structures, and pushing the boundaries of what traditional care looks like. Learn why standing still is not an option, why active listening and strategic delegation matter, and how the lessons of Netflix and Blockbuster apply to transforming human services.

If you’re passionate about change, leadership, and making a meaningful impact, this is the conversation for you. Tune in and discover why at GoodLife, Impossible is What We Do Best.

Listen now!

Links & References:

• The Family Teaching Model
• Herbert von Karajan
• The Royal Concertgebouw
• Implementation: Practice & Science Book

Transcript

Ivo Ivanov (00:00:07):

Hello, hello, hello, and welcome to the Quest for the GoodLife with Dr. Mike Strouse. This podcast is a production of GoodLife University. The conditions inside the studio is perfect. We have 72 degree F temperature. We've got south wind at zero miles per hour, and we are overcast as usual. I'm going to start with something unusual. First of all, listeners, what do you think is the most complicated thing in the universe? The most complex thing in universe? Is it the internet? Is it supercomputer? No. The most complicated thing in the universe weighs about three pounds and is inside your skull. The human brain, the human mind is the most complicated thing that we have discovered so far in the universe. You've got 100 billion nerve cells, you've got trillions of connections between them. There is a supercomputer working in Europe for 10 years now, trying to decipher the connectome, those connections between the nerve cells, and it has accomplished so far 1% of the human brain.

Ivo Ivanov (00:01:25):

So the human brain is very complicated. Consequently, humans are very complicated, and that got me thinking about the most complex systems in existence today. And naturally, I believe the most complex systems is not a server farm or anything else, but a congregation of humans, of human brains. And, you know as a coach, I try to manage 11 players, and I find it incredibly hard because the humans are unpredictable and you can try and harness some kind of strategy and system in operation that will control those unpredictable variables, but usually it's impossible. I think the best, maybe the most complicated thing nowadays is a symphony, a philharmonic, a classical orchestra, because there you have 100 humans who have to be perfect on any given night. You have 100 human beings on any given night, they might have issues, health issues, relationship crises, all kinds of unpredictable things.

Ivo Ivanov (00:02:53):

They might be homesick. And you have to find a way to exclude each one of these variables and make those 100 people be dedicated to one and the same goal and perform perfectly. So the best conductor I've ever seen personally, was Herbert von Karajan. Herbert von Karajan is considered maybe the greatest conductor of all time. He had a very interesting approach to managing this 100 person orchestra. He knew each musician personally, knew what their issues are, knew their problems. He had a connection with each one of them and managed the orchestra in an unbelievable way to a point where there was a sound of his orchestra that was deemed "The Karajan Sound." So it was fluid, it was perfect. The strings, the woodwinds, everything was working always in unison. And you could always tell in a recording if this was a Herbert von Karajan orchestra, but it took a herculean effort to control all of these variables.

Ivo Ivanov (00:04:12):

So, this long overture was because I want to ask you, Dr. Strouse, how did you manage to turn this organization into a philharmonic? How do you control all these variables? We are talking about decades, decades of managing a very complex system that features far more human beings than a classical orchestra, and you do it year after year after year. What is the secret sauce? What are the components that make this work so well? This is a very, very big organization. It takes a lot of effort to have a personal approach to each of the employees, to hire the right people, to avoid the turnover. That always compromises the sound eventually and the ultimate goal, how do you foster this positive environment? How do you manage to make everyone feel valuable? How do you delegate? When is it time to micromanage? When is it time to macro-manage? This company is unique because it is both a nonprofit but has also, an entrepreneurial spirit. So you have to do something very rare and balance your approach to a nonprofit mission while using entrepreneurial devices. So this is very interesting to me, and I believe it will be very interesting for our listeners. So please help me understand it.

Dr. Mike Strouse (00:06:02):

Well, Ivo, that's got to be the longest question anybody's ever asked me, number one. I'll start with that and I'll do what I normally do, which is break that down into some manageable chunks. Before I do though, I do think it's a good discussion topic, not because of how I do it necessarily, but I'll tell you. But because what we're about ready to do is to take a vision that I painted last time that we started to at least about a blue zone.

Ivo Ivanov (00:06:35):

That's right.

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

We talked about Blue Zones, we talked about a lot of things, but we talked about blue zones, which really was what I was wanting to get to because blue zones are what my vision is for a GoodLife. And we got to figure out how to do that and then deliver it in a wide scale, which is kind of what I think you're talking about. Because we as a society and GoodLife, we go after BHAGs, we go after big hairy, audacious goals, and we go after that vision of how do you change the world a bit? How do you make a difference? How do you push something forward that's never been done? How do you solve problems that's not been solved? I mean, that's what we live for. I mean, honest to goodness, that is exactly what we live for. I don't want anybody who listens to this podcast—that's why I read those poems; it was the only reason I shared them—was that, I don't want anybody to feel like they're not up to the challenge, what those poems were about. They were about doing things that might be considered a little impossible. And having people that maybe a little bit ordinary do that.

(00:07:57):

I like that. And I think that's what we're all doing. We're ordinary people. But you did say that we're comprised of a few brain cells, and it's pretty complicated. And I'll tell you, you're right, working with so many different people who have so many different backgrounds that I will say it every episode, but I am a behavioral analyst.

Ivo Ivanov (00:08:24):

That's right.

Dr. Mike Strouse (00:08:25):

And I'm a very certain brand of behavioral analyst. I'm an Organizational Behavioral analyst, and that brand is sort of the behavior of organizations, but within the context of that, it's people,

Ivo Ivanov (00:08:39):

That’s right.

Dr. Mike Strouse (00:08:40):

People and systems. That's what we do. All social problems are solved or are eventually solved by people and systems that they develop. I don't care if it's technology or whether it's how we approach problems, but it takes a combination of people and a strategy. And then once you have that, it's getting people to pull it off. And that last sentence is everything. How do you get people to pull it off? And that's pretty much the nut of what you asked.

Ivo Ivanov (00:09:20):

Yes.

Dr. Mike Strouse (00:09:20):

And I've been sort of trying to figure out how to talk about this anyway, but I grew up educationally at the University of Kansas Department of Applied Behavioral Science. That's where I learned to become an organizational behavioral analyst. They call it OBM or Organizational Behavioral Management. That's kind of

(00:09:45):

The profession that I kind of feel that I came from. But all those things were about organizational behavioral management for programs that serve people who had needs. So there's a not-for-profit part of that. And so all the education was about how do you do that? How do you come up with great ideas? How do you turn those great ideas into a strategy? How do you know if you achieve them or are making progress? And then how in the world do you get everybody to do their little part, whatever that is, and unison so that you don't go in circles.

Ivo Ivanov (00:10:31):

Yeah, yeah. I find it very interesting that you have a scientific approach to managing complex systems. But you also have a personal touch. You have a way of empowering people. I've seen you time and again in the last 20, 30 years that I've known you, collect people together and identify their strengths, and then you allow people to express the things that they're strong in and inspire them to be creative. You allow people to be creative, and you have a way of extracting the best that people can provide in a very personable way. So, I think that's very important. And I understand that there's many, many ways that you achieve what you do, but one of those things I believe is your personal approach to people.

Dr. Mike Strouse (00:11:33):

I think that there's something definitely too, that, again, even though I'm a behavioral analyst of organizations, you can't do that without being a knowledgeable a little bit about people. And I learned a lot from people that are pretty smart on that. So I've absorbed some of what they taught me. But I always tell you that sometimes there's common sense sayings that resonate. And you ever heard the saying, “you got to learn what makes people tick.”

Ivo Ivanov (00:12:06):

Yes.

Dr. Mike Strouse (00:12:07):

Right? I mean, little things like that. And I got to tell you, that really is it. It's like you got to take the time to understand what people think, what motivates them, make them feel important, those sorts of things. But I always said, if you know somebody well enough, you can make anything their idea. I hate to be that blunt about it, but you can because you just have to present things in a way that's logical to them.

(00:12:53):

And the best way to do it, is to present the problem to them that is logical and consider all the different options and solutions that might be out there and present it to them in a way that they're just logically going to think that there's a pathway to get there that is pretty much the pathway that you need somebody to go. And along the way, you sometimes find out that maybe they have a better pathway than you, and you’ve got to be really open to hearing that because a lot of times, they’re right. We help providers all across the country on workforce stability, for example. But every provider, even though they may have stability problems, is somewhat broken. There's always pieces of it that's unique that could be used to make what YOU do better. So you’ve got to always keep your eyes open for those sorts of things, Ivo. But yeah, I mean there is that, but the takeaway that I want people to have is that there is a science, even though yes, there are, it matters that you take the time to get to know people and that you take the time to treat them like they're absolutely essential, because they are, to your progress. But they’ve got to feel it, that they are.

And they got to know that they carry a special superpower. I have a really good friend that really has the superpower, and she always says, my superpower is connecting people that together are better than they are than apart. And she's totally right with that. It's a woman named Serena Lowe. She's really, really good at that. And she always takes the time to connect people that she thinks could together do something better than they could separately. And so she does that. I mean, everybody has a superpower. Remember that thing that I called Destiny, that poem that I called Destiny?

Ivo Ivanov (00:14:59):

Yes.

Dr. Mike Strouse (00:14:59):

It was about everybody having a purpose and being here to make a difference. And you've just got to make 'em feel that way. The art of it is they got to do it not just for themselves, but they got to do it for some joint purpose or a mission, a project, and you're Ivo involved in this because we need somebody to do this, and you're the one to do that. And they got to feel that. It gets exciting for them, and they really feel like they play a part in stuff. And so yeah, that's important, but it's also important to not just be making it up. You got to recruit a team that can actually bring the goods. And the truth is Ivo, sometimes people are in this industry and they're maybe not the right tool for the task. Right?

Ivo Ivanov (00:15:56):

Yeah.

Dr. Mike Strouse (00:15:57):

And sometimes the kindest thing to do is to either get them in a task that they can do or help them find their way to something they're really passionate about. I guarantee you, nothing happens without passion.

Ivo Ivanov (00:16:12):

Yeah. Such an interesting topic. This is, and you got me thinking back to the classical orchestra metaphor, and I have a friend who is the first violin, the concert meister in the greatest philharmonic in the world. It's the Amsterdam Orchestra, The Concertgebouw is the name of the orchestra. His name is Eschkenazy, Vesko Eschkenazy. And I talked to him about his orchestra and he said, what's interesting about our orchestra and why, 10 years in a row, we are the best orchestra in the world. We don't recruit the best musicians. We look all over the world and we recruit the right musicians that fit our sound, that fit our building and our understanding of music. So there are virtuoso violinists out there, but we don't want necessarily those guys. We want the ones that are perfect for our orchestra. And that's what you were talking about. And I was also thinking about that skill that people often reference: active listening. What is active listening? I think you described it. You just described it. You're not just listening to people and nodding your head and agreeing with them. You're actually listening to them and you are guiding them in the right direction, and you are rewarding them for their good ideas.

Ivo Ivanov (00:17:46):

You're steering them in the right direction. So active listening as you do.

Dr. Mike Strouse (00:17:49):

I think you got to also recognize your limitations, too. I mean, anybody that knows me knows that I'm also impatient and that I sometimes am so focused on a goal that I don't see what I'm nudging into occasionally. And so you've got to put people around you that compliment you. And frankly, some people around, I think is important, and I'm not the emperor but, the metaphor is to tell the emperor they're wearing no clothes.

Dr. Mike Strouse (00:18:26):

One of the key leadership characteristics I look for, I don't want somebody on the team that is, “you can't do that.,” number one. I would never want a person that just doesn't believe in the mission or just is sucking positive energy out of there. There are those people that do that, and it just is not for me. But at the same time, I want people that can have their own mind and not be afraid of questioning whether we should do X, Y, or Z until we decide to do something. And then once we decide to do it together, we got to be working on that thing. There's a time for questioning and a time for moving forward, and they're not the same time. You’ve got to move forward when you decide to move forward. But there is a time for questioning, and you’ve got to make time for that because that's all part of the respect, but it's also part of where good ideas come from. 

Ivo Ivanov (00:19:35):

Yeah. 

Dr. Mike Strouse (00:19:36):

Can I give an example of that?

Ivo Ivanov (00:19:37):

Yes, please.

Dr. Mike Strouse (00:19:37):

Well, for example, I'm always going to weave something about social services into this thing. That's kind of what we're about, right?

Ivo Ivanov (00:19:46):

That's the point.

Dr. Mike Strouse (00:19:46):

And we are going to be talking about neighborhoods and in-home care, the first thing I always do when I approach a problem is I look at some of the barriers to why it doesn't work the way it's supposed to work. I look at other industries and other ways people solve similar problems. And I try to look at a lot of things to get insight about things. So when I say the emperor's not wearing clothes, that metaphor, it's more like I want to study the problem before I come up with a solution. And I'll give you the example. In-home care. There's lots of problems with in-home care. In fact, what's ironic about in-home care is in-home care is necessary for some in-home support, whether it's technological or remote or in-person, help from people. People who have challenges need help to live with greater independence. They need help and support, right? That help needs to be delivered by people that are completely committed to that symphony. As Jim Sherman said, you got to be a durable dance partner, right?

Ivo Ivanov (00:21:06):

Yeah.

Dr. Mike Strouse (00:21:07):

They got to be focused on that. But when you look at in-home care, you see that it is turbulent, it is constant turnover. It has all kinds of challenges because a person who is new is working alone with somebody and they're new. How do you support somebody who is working by themselves and think of hundreds if not thousands of people that you're supporting with all these people? Cause that’s the system.

(00:21:42):

That's the system that we're talking about. Think about that system that supports hundreds and hundreds of people in their home by one person at a time who may be new, who may not know how to deal with a complex need, who may not have a relationship with somebody. I mean, there are lots of barriers to delivering the vision of a good life by helping people. There's lots of barriers. And when you look at how it's traditionally done, there's that word that I cannot sometimes stand, but how it's traditionally done, you have to study it because that's where you're going to find insight of what's wrong. And then you need to figure out, okay, fine, we've identified all the things that don't work. I mean, this is that Edison and the light bulb thing. I mean,

(00:22:35):

You look working on all the areas that have problems. Then you got to look at, okay, well how can you solve those problems? Well, so many people look in, they just look with blinders on that problem, trying to get insight on how to fix the problem that exists when they need to look at other ideas on how similar problems have been fixed by others or other industries or other places. Where does it work? How does it work? And then how can you take those ideas or something similar to that and adapt them over here? And that's kind of part of the science as a behavioral analyst is part of the science is looking at the barriers to in-home care. And once you understand them, you know what you need to fix. But I'll give you another side of this. Nobody wants to live in congregate care. You know, congregate care like,

Dr. Mike Strouse (00:23:39):

Assisted living and places like that.

Ivo Ivanov (00:23:41):

Yeah, Group homes.

Dr. Mike Strouse (00:23:42):

Group homes. You know what those are? And I say this affectionately because we have, as you know, ran them for years. Well, I got to thinking, what are those? And I got to thinking of the Netflix problem. I remember that story I always tell, but it is Blockbuster and Netflix. Well, Blockbuster was a place that, to all you young people out there, guys, is a place where you used to go to pick out a movie. If you can just imagine that, a store where you could pick out a movie. Well, we'd all go there, we'd pick out a movie, and we'd keep it too long. We'd be fined. And we'd turn it back in, and then we'd go there and pick out movies, again. It was a store you went to, to do that.

Ivo Ivanov (00:24:30):

Rewind the tape, remember all the VHS tapes, “Be Kind, Rewind.”

Dr. Mike Strouse (00:24:34):

Yeah. Well, anyway, then there came Netflix.

Ivo Ivanov (00:24:39):

Yes,

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

Netflix had a different mission. Their mission was they wanted to deliver the movie, without the store, directly to the person. They wanted to bypass the store, right? Well, it first started off, they'd mail it to you, and then you have to mail it back. And then they came up with technology where you could download it and do it, which took a year. You'd have to do it overnight and play it the next day or whatever. And then finally, it got to that point where they're actually delivering movies live on-demand anywhere anyhow,

Ivo Ivanov (00:25:08):

Original Programming.

Dr. Mike Strouse (00:25:09):

All the way YOU want to do it, all on demand.

Ivo Ivanov (00:25:12):

Yeah.

Dr. Mike Strouse (00:25:13):

I think that was their vision all along. Their vision all along was started off on how can I get this to the customer in the best way possible? And as technology came around, more became possible, right? Well, Netflix wasn't a blockbuster business plan with technology bolted on. Technology made possible what Netflix was able to do. And they completely bypassed the store, right?

Ivo Ivanov (00:25:46):

That's right.

Dr. Mike Strouse (00:25:47):

Amazon did the same thing with goods and services.

Ivo Ivanov (00:25:50):

Yes.

Dr. Mike Strouse (00:25:51):

I think Talkspace does it, bypasses the clinic and does it. So I got my insight lots of times not by looking at IDD, not by looking at in-home care, but recognizing that, okay, not only here are the problems of in-home care, but look at the other side of it. Why is it that living in your own home and receiving care in your home, which is what everybody wants, but it has all these problems and they end up living in congregate care. But why do they live in congregate care? Well, they live in congregate care because it overcomes a lot of the barriers of in-home care, just in a way they don't like it. And then I recognized that congregate care was just a store you send people to for care. That's all it is. All it is is a facility that organizes a space for care so you can deploy it better. That's what it is. So if you study the barriers for in-home care and then you study how it's otherwise done, that avoids those barriers. And then you look at some other industries on how they do it. By the time you're done, you not only know what's broken, you know why people have migrated to congregate care because it overcomes some of those barriers. They just don't like how it's done. But for many people, they have to trade what they want for what they need.

(00:27:35):

And in congregate care, they're trading the fact that they're not getting the kind of care they want for a different method of getting care that they don't really like, but they feel like they need it, complex needs and stuff like that. And then, okay, you understand that now, and now you’ve got to figure out a different solution. And you get some interesting insight to say, okay, well if a facility like assisted living or that is just a physical space where they've kind of organized care, it's a store of sorts that people go to for care. Is there any other places, any other examples, where they've sort of eliminated that? How do they do it? And you start looking at that and you start getting insight about an alternative. And to me, the alternative was a different method of deploying and delivering care leveraged by technology. But I got that not by me thinking, oh, it's technology. I got that by studying how other people approached similar problems.

Ivo Ivanov (00:28:50):

Yeah, yeah.

Dr. Mike Strouse (00:28:50):

There's a long-winded answer, but the idea behind all this discussion is there is a science and a process to become innovative. You're not really thinking outside of the box. You're looking at every frigging side of the box and you're going to look outside the box to see how other people do it, but you're getting insight from real things. It's not like you, I mean, very few people come up with ideas that are completely and utterly never been thought of. I would tell you some people think the neighborhood network was never thought of, but it has been. It was just done in different ways in different places. It's literally a virtual assisted living community.

Ivo Ivanov (00:29:36):

Yeah, yeah. No, it's a brilliant, brilliant comparison. I was, as you were talking about all the problems that Blockbuster presented, you go and you spend gas to get there, you get out of your home, you brave the elements, you flip through a million boxes to look for the right title, and you acquire a lot of germs while you do that.

Dr. Mike Strouse (00:30:06):

And what you really do in the old days is the best movies have the most boxes.

Ivo Ivanov (00:30:12):

Yes, that's right.

Dr. Mike Strouse (00:30:12):

So the first thing it is, you went to the ones that had the most boxes and

Ivo Ivanov (00:30:15):

You touch those

Dr. Mike Strouse (00:30:16):

And hopefully you got those, but usually you're late.

Ivo Ivanov (00:30:18):

And why not stream human services directly to a person's home?

Dr. Mike Strouse (00:30:24):

Yeah, why not?

Ivo Ivanov (00:30:25):

Yeah, why not

Dr. Mike Strouse (00:30:25):

Stream 'em?

Ivo Ivanov (00:30:26):

Stream 'em. Avoid the germs.

Dr. Mike Strouse (00:30:28):

Probably a good analogy.

Ivo Ivanov (00:30:29):

Yeah. No, it's a brilliant analogy.

Dr. Mike Strouse (00:30:33):

But all of that stuff, coming up with an idea isn't one person's job. It's a lot of people's job and it takes a lot of time and it just evolves as soon as you have the idea. It's like Netflix. Netflix didn't start off as streaming. It was an idea that bypasses started that just kept getting better as other things got better. But they learned along the way. They made adjustments, but they kind of had an idea where they were going, but they just kept making adjustments along the way. And I think that's that continuous improvement mentality. But the other thing I want to point out is: there's an old, well, there's a saying that a really important person that I knew used to say, and he says, “you do what you measure.” And that was all about performance management and stuff. But you do what you measure. And so many people are anecdotal about things.

Ivo Ivanov (00:31:41):

Yeah.

Dr. Mike Strouse (00:31:43):

And that's fine. There's nothing better than talking about, “yeah, I think it's getting better” or I think that or I, whatever. But at the end of the day, you've got to decide, what is the measuring stick for progress. And it's kind of like the old Weight Watchers saying, you need to know that you're going to have a weigh-in out there because if you know there's going to be a weigh-in and when it is and everybody's going to go on the same scale at that time to do the weigh-in, you can get a lot of effort out of people because they know there's an accountability piece. So it's not just about, it is about a great vision. It is about good goals. It is about strategy. It is about knowing people and having them feel like they play a part in stuff. But it's also about, there's a bit of accountability to it where we're all what I will call “evidence-based.”

Dr. Mike Strouse (00:32:46):

Right?

Ivo Ivanov (00:32:46):

Yes, yes. 

Dr. Mike Strouse (00:32:47):

Without evidence-based measures that are taken, there isn't much accountability and we're all just sitting here real proud of ourselves because we are able to give anecdotal stories about what we're doing instead of measuring. And I feel that way, absolutely, with the staff stability.

Ivo Ivanov (00:33:10):

Yes,

Dr. Mike Strouse (00:33:11):

Everybody who talks about staff stability, but people don't, you know they either don't measure it—And if I could say this, Ivo—they don't measure it, and I can give examples about that. But if we had greater understanding of staff stability and a more collaborative measurement system of it, we would be making, as a country, a lot more progress.

Ivo Ivanov (00:33:39):

What do you mean by saying we don't measure it, right?

Dr. Mike Strouse (00:33:43):

Well, I think I talked to you a little bit about this. It was about turnover and I was romanced by that for many years. It became the industry standard of measure. But the truth is, it's the number of people involved in care that is the single measure that matters. If I'm your caregiver in a home,

Ivo Ivanov (00:34:08):

Yes,

Dr. Mike Strouse (00:34:09):

And there's a lot of different means involved in your care, then that's a single measure of things either going better or worse.

Dr. Mike Strouse (00:34:21):

There's absolutely no doubt, the more different people involved in care, the worse the care…

Ivo Ivanov (00:34:25):

It diminishes the quality.

Dr. Mike Strouse (00:34:27):

Yeah. I mean, it's not like having less people involved in care guarantees you quality, but having too many people involved in care guarantees you won't have it.

Ivo Ivanov (00:34:35):

It's a guarantee.

Dr. Mike Strouse (00:34:36):

And so developing models and systems that can not only deliver care, but deliver care with the fewest different people you can, the best you can, and making sure at least the right care is delivered by people who have, you know, good skillset. But in-home care is a barrier. We talked about one of the biggest challenges is that every time there's a caregiver change, it's a hundred percent turnover. If only one person is serving you in your home, every time that person turns over, it's hundred percent turnover.

Ivo Ivanov (00:35:11):

Yeah, that's true.

Dr. Mike Strouse (00:35:14):

And there's nobody working along with him or her to teach him the trade if they're working alone. So it is a really important measure to minimize the number of people. It goes back to Dr. Sherman's, “A Durable Dance Partner.” It’s been a beacon for how we develop and deliver care. But I know that this is, we're moving a little bit from the original discussion, but I feel that how you approach a big problem and how you get everybody to behave together in concert, there are elements to that and the elements to that, outside of the personal relationships, which cannot be minimized. But there is a science to it that is important. When I work and help another agency implement processes to improve staff stability, we have very specific things that we teach, and we have a method to teach and help people do them so that they'll be successful. And that is the science of implementation is beyond any show that we can do. But I can tell you with technology, a lot of people sell technology for example, and end up in a bucket somewhere because they're not taught how to use it. And I'm not talking about how to actually use it, like how the software works. I'm talking about: how do they change their program because of what this technology made possible?

(00:37:02):

I mean, I was just talking to somebody today. We were doing some training on our technology, on our systems, and I said, you can take iLink in our systems and just bolt it onto your current systems. That'd be like bolting it on technology onto a Blockbuster business plan. It doesn't change anything. What happens is our technology makes you be able to differently deliver services. That's what it's about. But technology often isn't integrated. They don't help people integrate technology into new service approaches. They just sell 'em the technology and it doesn't really help them. And so that's what I'm saying. The science of what we do is we create models and services that are leveraged by technology for sure. And then we help people learn how to implement them. When I was doing training today, they wanted to learn about iLink technology and it was a two hour training and I didn't get to explain the technology for the first hour. And I think they were getting a little like, when are we getting to the pudding? But I wanted them to see how the technology could be used to change how they deliver services. And at the end, they completely got it and they understood that some places could sell technology and they end up with the technology, but they're not going to end up with anything that helps them if they don't know how to change the program to change what's possible. And the other side of it, the technology and the systems that you develop that has to be implemented, it has to be implemented in a way that's a pleasure for them to use.

Ivo Ivanov (00:38:57):

Yes. Do you remember when Netflix offered Blockbuster to buy their model? Do you remember that?

Dr. Mike Strouse (00:39:08):

Say that again.

Ivo Ivanov (00:39:09):

Netflix, in the beginning of the company, they went to Blockbuster headquarters and said, “Hey, do you want to buy us? Do you want to buy our plan, our motto?” And they laughed in their face and kicked them out. And just a few years later, Blockbuster was gone. And so I come from Europe. Europe's a little bit like Blockbuster. They're traditionalists and they're somewhat afraid of change, of drastic change. I feel people in Europe still love their newspapers and paper newspapers.

Dr. Mike Strouse (00:39:45):

My Father-in-law loves his newspapers. Yeah, I know.

Ivo Ivanov (00:39:48):

But I feel like you are built different because you have never been afraid to embrace change. In fact, I think you believe that that's the only way to manage an organization like this to constantly move forward and embrace change. We talked about your approach to solving problems in the first episode about reverse engineering a problem. We talked about it today as well. How taking a problem, approaching it academically, research, peer reviewed experience and analysis, careful analysis, taking the problem apart, one component at a time and solving it. But what's not academic is how daring you are when the time comes to really tackle a problem. You have always pushed the envelope. I feel like there's always been resistance, just like there was resistance initially to the Netflix model. A lot of people said, no, I like to go to the store, I like to look at the boxes.

(00:40:55):

I like this. And I like that there was resistance, there was traditionalism. And eventually Netflix step-by-step developed a new model. In the beginning, like you said, they were mailing you a DVD, but then at some point they came to the end of the, I guess to a cliff and it was, do we jump in? What do we do? And then they decided, no, we are going to stream directly to the homes and we are going to take the plunge and see what happens. They believed in their vision and eventually they overcame all the other companies and got to a point where they started original programming and started winning academy awards for their original movies and TV shows. And I feel like you did in a way the same thing. You pushed it and pushed and pushed the envelope and the traditional approach to care. And at some point you came to the edge and you said, “Hey, I'm not afraid to embrace technology, embrace progress and change because that's the only way to make the next step.” And you took the plunge and now we are delivering original programming, streaming our care directly to the homes and winning awards. So kudos for that.

Dr. Mike Strouse (00:42:19):

No, I mean, and it is really horribly, just a good start actually. I mean we have a very light blue zone. It's not a beautiful blue that I would like to see.

Ivo Ivanov (00:42:36):

Powder blue, it's powder blue.

Dr. Mike Strouse (00:42:38):

It’s Powder blue, but it will be, it's kind of blue.

Ivo Ivanov (00:42:41):

It's getting darker,

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

It's kind of Blue, but it's going to get that beautiful….

Ivo Ivanov (00:42:47):

Sky Blue.

Dr. Mike Strouse (00:42:48):

Yeah, it's going to get that beautiful blue someday, I think. And that's so motivating when you do that. But I'll tell you, I remember talking to some senior program providers about a different vision of care and why and what we're doing. I kind of get that same feeling that Netflix must have got when they went and pitched it to the Blockbuster. And what happened, because I was pitching it to some people and they were very successful at what they did. It is kind of like Blockbuster. They were the big dog when they were being pitched. They were the big dog. And that's how I felt like I'm pitching more ideas than real things, but it was starting to be a real thing. I was pitching it to some senior programs that did very traditional services and I kind of felt like they patted me on my head and sort of sent me away. But their response was, “you know, we're in the business of billable hours.” And it was very business discussion and I got it and I realized they were totally right. I'm proposing a system that actually delivers care much more affordably, but that's not how they made money at the time.

(00:44:27):

But I'm here to tell you that's how they're going to make money pretty soon because the world can't just simply own—you know, the customer doesn't want to pay for somebody sitting in the home waiting for a need. I mean anybody knows that the customer is paying for this stuff. Now sometimes it's the government customer, but still they expect more value on that. And what it taught me is that all the systems for payment, for services and for regulations and everything, they're made for what is currently possible. So the interesting thing in the care industry, when you make something that's better and beyond what's currently possible and you think this is going to be incredible, and then you go and you look and you find out, well it is, but you're going to have to go through all of this process change because all the things that are designed to perpetuate and regulate and perpetuate and make sure the care system is working is based upon what's currently possible.

Ivo Ivanov (00:45:47):

Yes.

Dr. Mike Strouse (00:45:47):

Not what WILL be possible. And so you're proposing things that's going to make people less money, not in the long run. And I think that that's kind of how Blockbuster probably felt with all of this. They have all these investments in stores and they have all this. They're making everybody else do all the work for them. The customers is the one driving out there and doing all this stuff. They just have to distribute their stuff there and that's all they got to do. And it is working until Netflix did what they did and then they went bankrupt like that. So you got to be thinking down the road and the real leaders in our country, I think they have to have a foot on the boat and one on the dock in a way, and they've got to be here and now. But they also have to know and understand where things are going. And the difference between those two places is change management. And when you're talking about working with places and they just, so many people are resistant. I will tell you, and people laugh about this in good life, I do not give people the option to stand still.

(00:47:10):

And it's something I feel very strongly about. If you have no goals, if you're not moving forward, then you're just in the wrong place.

Ivo Ivanov (00:47:19):

That is amazing because we are in an industry that's notorious for standing still and the status quo is rarely challenged. So it was very refreshing being part of this organization. I quickly realized what's going on to take listeners on a journey back in time. This organization started in 1977, we're going to celebrate 50 years, and when it started, it was a group of parents and scientists from the University of Kansas who decided that institutions are not the right place for their children. They said, we are going to make a change and we are going to put them in homes. Everybody said that's impossible.

Dr. Mike Strouse (00:48:09):

They did.

Ivo Ivanov (00:48:09): 

That's impossible. 

Dr. Mike Strouse (00:48:09): 

They did at the time. And in fact, we went and proposed our mission and before me was to serve people who previously had not been served in community settings whose only other choice was institutional. I mean that was literally its mission. It isn't now, but it was a good enough mission for us to close six of them. I can tell you that.

Ivo Ivanov (00:48:33):

Yes.

Dr. Mike Strouse (00:48:36):

But there was lots of resistance because there was so much investment in the seventies in institutional services.

Ivo Ivanov (00:48:43):

Oh gosh, there were Blockbusters everywhere 

Dr. Mike Strouse (00:48:45):

And they really believed that there was no other way to serve people. I mean in 1971 there were 200, a little over 200,000 people living in institutions.

Ivo Ivanov (00:48:54):

Yeah.

Dr. Mike Strouse (00:48:54):

I think it was closer to 20,000, so just think 200 to 20,000 today. But it is just amazing to me how resistant to change people are.

Ivo Ivanov (00:49:07):

Oh gosh, Resistance.

Dr. Mike Strouse (00:49:09):

I mean there were parent groups. There were a variety of different people whose whole whole life was to keep everything the way it was. It still is for some groups, but that is the problem. If your life is focused on keeping something the way it is, you are doomed. 

Dr. Mike Strouse (00:49:34):

You are doomed for innovation, you're doomed for getting better if your goal is preservation of what you are doing today,

Ivo Ivanov (00:49:44):

The status quo.

Dr. Mike Strouse (00:49:46):

as if that is the finest. That's just nothing I can be a part of.

Ivo Ivanov (00:49:51):

A part of.

Dr. Mike Strouse (00:49:52):

But I was a part of understanding because this is a really a very relevant discussion. I was very intrigued by why people felt that way. I worked with family group after family group who were wanting to preserve an institution that we were supposed to close, and I always asked them what was it that they LOVE about it? What is it about that? And it becomes, how can you give that to somebody differently?

Ivo Ivanov (00:50:28):

Like safety? Yeah.

Dr. Mike Strouse (00:50:30):

I mean the principles behind it were, to many people, very important principles.

Dr. Mike Strouse (00:50:39):

That's what I'm saying in that last analogy where I was saying, people migrate to those things even though they give up a real life because they feel like that's the only place that they can get what they need. They give up what they want for what they need, and that's what, that is my vision of old institutional service. But there were so many other baggages around the issues that were horribly not good that you couldn't get rid of because of its size and its culture and everything. But it is, it persists today, those things. But it's so much more fun to be part of an ever evolving system. The only thing that makes people uneasy is I'm okay if, I love things to evolve, but sometimes you’ve got to pivot and everybody thinks that you take what you’ve got and you make it better. But 20 years ago we did research, and maybe we can end with all of this, is that 20 years ago we did research and we looked at, it was all about staffing strategies. It's where we came up with the front half back half staffing approach and the three day work weeks and look at how that has more capacity for working. I mean, there's so many metrics that actually did improve, and again, that didn't come from me, that came from hospital industries and other industries that use that methodology of care. And we looked in how we could adapt those things. But what I always loved is we did that initial research and we were able to improve things. I don't know, 15% or more, which for the first work we did was pretty darn good.

(00:52:33):

Right? 15% more pay for the same payroll, 15% fewer staff. But there's a lot of things that we did there that really improved things that had not been improved before. And one of the most unique things was we actually had interventions to do things where everybody else was just doing correlational studies. We were actually developing procedures on how we were going to improve the workforce and trying 'em out, and we were making improvements. But here was the funny thing that while that was really important, we compared that, if you remember Ivo, to the Family Teaching Model and what then became the Shared Living model, which was a different service, a completely different service approach where we use live-ins and other types of strategies to improve care. Nothing we have ever been able to do with staffing models—we've improved it over the years—but nothing we've ever been able to do has made as many improvements as changing the entire service delivery system and doing something entirely different, which was the live-in, live-by, live-near approaches as opposed to shift staffing. I mean, the Shared Living model that we did, has about 3%-4% turnover a year since 1999 (annual turnover).

(00:53:56):

I mean, so my point is there's a time to just keep evolving something, but I think what makes people really antsy is if I had to abandon it, and do something else that I thought would work better, I'd be fine with that.

Ivo Ivanov (00:54:12):

Yeah.

Dr. Mike Strouse (00:54:13):

I personally would be fine with that.

Ivo Ivanov (00:54:15):

Yeah. You are respectful to people's opinions even when your goal ultimately is to change the status quo, and that's also part of the active listening. You are listening to the parents, you're listening to the guardians and advocates telling you what they liked about the previous model, and you try to take that opinion and incorporate it into the new model and give them a peace of mind, and that changed that tendency towards constant evolution has been part of this organization's DNA since the very beginning. We mentioned the 1977 and moving from institutions to group homes, then FTM, and

Dr. Mike Strouse (00:54:58):

They thought that that was earth shattering, then we went to something else. But I wanted to comment something: Those people, those family groups that we work with in institutional care, the scariest thing I ever did was I grabbed those people that were very, you know, clinging onto that so tightly after we had the discussion like why and what qualities would you expect to see in an alternative? I used them for evaluating the alternative, and it was scary because they kind of were filled with a bunch of dogma about how they thought it should be, but it turns out they converted. And converts are powerful people. They were pretty powerful and they attested it.

Ivo Ivanov (00:55:53):

They become your foundation, your base. 

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

Yeah. One of the institution we closed, which I think maybe one of the records, we closed about a 300 bed institution that had been in place for 135 years, in 14 months.

Ivo Ivanov (00:56:11):

Wow. That's just massive.

Dr. Mike Strouse (00:56:14):

14 months. And we retooled the family, or some of the families that were, I'll call them as part of the resistance into the board part of them, into about half of the board of some of the alternative programs.

Ivo Ivanov (00:56:33):

That's spectacular.

Dr. Mike Strouse (00:56:35):

Which was really pretty cool.

Ivo Ivanov (00:56:36):

I feel like every two or three years you hear the words, “this is impossible” and you move on. I feel like that was the same way with the family teaching motto, extended family teaching motto. I was working conventional hour shifts, eight hours at the time, and I was part of it and I saw it around me. People were saying, “this is impossible. We are never going to do this.” And it was a better model. It was the next step than the EFT (Extended Family Teaching model, also known as Shared Living). Then The Neighborhood Network was considered impossible. Then iLink was considered completely impossible. Rural opportunities, day services for people that enjoy rural environment, that had massive resistance. Do you remember the neighbors? It was so hard to create Midnight Farm and it seems like every few years you encounter this type of resistance, but you understand that the only way forward is through evolution. I've heard a phrase somewhere this week, I'm not going to say where because I don't want to get into it, but I think it's perfectly appropriate for you and this organization. The phrase I've heard was “a lot of people said it was impossible, but impossible is what we do best.” I think this is a perfect motto for you and for this organization, impossible is what we do best.

Dr. Mike Strouse (00:58:00):

I would love to do more of it. I'll say that, but I'll end this discussion by just saying that we have a lot of really important goals out there

(00:58:15):

And we need to be strategic in how we address 'em. We need to get everybody oaring in the right direction, and we need to make progress and measure it evidence-based project, and we need to follow the science of how we implement it because the truth of the matter is people clinging to the way they do things because it partially works and they're afraid because they're in this environment of instability. They're afraid of it getting worse, and that's the truth. Literally, I work all the way across the country with agencies that are struggling mightily, most of whom are struggling because of staff stability and the reason, the only they can see, I'll show them what we do and our processes and even the outcomes that we achieve and how we do that, and they can actually say, “yes, I see it. It could really work here. I really think it's great.” And then some of them won't do it because they're afraid that it could make things worse before even it got better. So part of change management is taking these complex, for them, even though I can say I've done this in a hundred programs and it's gotten pretty much the same result. I can go down to Arkansas and they say, yeah, but it's not in Arkansas

(01:00:00):

Or it's not in Iowa, or it's not different places. There's always like, there's a worry of that. And when you do something in a very sort of unstable environment, it is fearful because it's so hard that they don't want it to ever get worse. Like the first thing they'll say when we do this is, yeah, but what if the staff that we have don't like it? And some of them leave and I'll say, well, I probably don't think that's going to happen, but right now you have about three people applying a week to your services and. with the turbulence in that, you're losing more people than you're having. So here's your trajectory anyway. When we do this, this is what your pipeline's going to look like of new people coming in because their schedules are more attractive and the pay is more attractive, and here's how that's going to work. Part of change management is constantly putting out in front of people what the next step is and how it's going to work and breaking this complex chain down into that next step and being there with them. I mean, I have a whole book that's written by one of my idols. It's, it is called Implementation Practice and Science, and one of couple of my good friends, Dean Fixin and Karen Blasé,

Ivo Ivanov (01:01:23):

Authored the book,

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

But they're also one of the creators of the Teaching Family Model. This whole science of implementation came from their work at the University of Kansas, “798 Replications of the Teaching and Family Model” was I think the title of their article that they first did, if I remember right. But they wrote a whole book about how you implement major systems, how you bring scale to things, and there is a science to doing that. And the truth is we're not following it in how we scale our services as an industry, and I'm trying to help people understand a little bit more about how you do that, and then give them a system and implementation structure to help them solve a social problem like that.

Ivo Ivanov (01:02:23):

One of the things about managing change is that even the most wonderful and illuminating things like this podcast have to come to an end. So we have a lot to talk about next time. I want to remind our listeners that this was the quest for the GoodLife with Dr. Mike Strouse, the Herbert von Karajan of Human Services. Today's episode was produced by Megan Olafson and recorded at the GoodLife University studio. Sound editing and sound engineering were provided by me, your co-host with the most, Ivo Ivanov. Together we thank you for listening and promise you that the Quest for the GoodLife will continue next week. We want to emphasize to our listeners that our inability to remain concise is deliberate. Also, I want to remind you that impossible is what we do best. Please feel free to contact us, ask questions, or simply vent your frustration at www.mygoodlife.org.