Beyond Turnover's Temple of Doom

Is your workforce strategy stuck in the past? In this episode, Dr. Mike Strouse and co-host Ivo Ivanov dig into the hidden traps of traditional scheduling in the care industry. Through powerful analogies and data-driven insights, they explore how rigid five-day workweeks, fragmented part-time roles, and outdated scheduling models are driving workforce instability—and what you can do to fix it.

Listeners will learn:

• Why your “stayers” might be hurting your hiring pipeline
• The measurable impact of schedule design on recruitment and retention
• How to transform scheduling from a liability into an incentive
• Why a 3-day workweek might be your secret weapon for workforce sustainability

Whether you're a leader in healthcare, disability services, or just curious about human-centered operations, this episode offers fresh perspectives and practical frameworks to help you pivot with purpose.

Transcript

Ivo Ivanov (00:00:08):

Hello and welcome to the Quest for the Good Life with Dr. Mike Strouse. He is the president and CEO of Good Life Innovations. He's also an adventurer, an archeologist of best practices and an all around amazing man. I'm your co-host, Ivo Ivanov, and I wanted to start today with a little bit of a background story, I believe it or not, was involved in martial arts when I was in my teenage years and early twenties. My father is a legendary martial artist back in Bulgaria, and he's a multiple champion, judo champion, TaeKwonDo karate. He was the president of the Bulgarian TaeKwonDo Federation and a referee, and he got me. I had no choice. I had to do martial arts with this parent. So I got involved in TaeKwonDo and I quickly discovered that it was very torturous. Why? Because of the flexibility routine. So each practice started with half an hour of flexibility routine.

(00:01:36):

There was inquisition level stretching and stretching in directions that we are not used to stretch. So this continued even after all of us that were involved, started doing the splits in both directions. I thought once we are done with the splits, it's going to get easier. No flexibility is a skill that has to be maintained nonstop or you lose it. So the sport is such that it is scored differently. You are rewarded much more for strikes with the feet. So when you are in a competition and you land an up chuggy, which is a very popular kick in TaeKwonDo with your foot, this scores twice more than if you land the punch. And so the sport evolved in this direction that you had to be extremely flexible. But what my Korean master was telling me is that it is not for the scoring. This is not as important, he said as the other benefit of flexibility.

(00:02:53):

It was the fact that you stretch your ligaments and you condition your cartilage in a way that will help you in the future avoid catastrophic joint injuries. So as I moved away from TaeKwonDo, I was always in love with basketball, soccer and basketball team sports, and I maintained that flexibility routine. I kept at it because I wanted to play my favorite sport, soccer and basketball forever if possible. I fully recognize now that at my advanced age, I'm still able to play those sports on a regular basis because I maintain that skill and I go twice a week for this tortuous routine. I can still drop one of the splits. And I've been so close to very bad injuries playing basketball and soccer. And I believe in my heart that I avoided those catastrophic injuries because of my exceptional flexibility. So now I coach soccer as well. I coach high school for the last 16 years, and I put my players for these torture chamber and I make them work on their flexibility and they hate it, but I know they'll appreciate it in the future if you have not figured it out. Listeners, today, we're going to talk about flexibility

Dr. Mike Strouse (00:04:29):

Or maybe too much of it, maybe Ivo. That's

Ivo Ivanov (00:04:33):

Possible. Yeah. I feel like a lot of organizations, not just in our industry, and a lot of CEOs fail because they don't recognize the importance of flexibility and remaining rigid and stubborn in today's age of rapid change can be catastrophic, just as catastrophic as a joint injury and can handicap your organization. So you've always been different in that way. You've always looked forward and you were not afraid to be flexible, whether it's with technology or schedules or new formats of delivering care. You've always maintained high level of TaeKwonDo flexibility. So I feel like this is a good way to start this conversation.

Dr. Mike Strouse (00:05:30):

Yeah, it could be Ivo flexibility. I'm going to define it differently as a place. I hope so. Well, no, I don't mind the one that you gave. I'm just saying that there's different kinds of flexibility that we're actually going to talk about today. But the one I absolutely agree with you about is that old adage, if you want different results, you can't keep doing the same thing, the same thing over and over and you'll never get it. And the interesting thing today, if we ever can get on non-agent discussions, which I don't know that we'll, we're going to talk about our disappearing workforce and kind of the step one of it is I want people to understand why we're having so much trouble keeping it and our workforce is disappearing. And I don't need to have a podcast to tell you that in the care industry at least, and the independent living support industry is disappearing. And there's lots of reasons for it. But since Covid, there was a couple of supernovas that collided into each other. The first one obviously was covid was a supernova that immediately changed the nation's behavior and how it worked. And I'm not talking about the care industry here, evil or I'm talking about covid changed everybody's method of working and pushed. We all had remote possibilities before covid. We all had video conferencing and

(00:07:29):

Other things, but people didn't practice it. People didn't live it. When covid happened, the world pivoted to remote work. Every industry that could pivot to remote work did. And what happened as a result of that was a couple of things. I think the world is pivoting back a little bit, but it won't ever pivot back to pre covid levels. And that is that the world is working remotely. And it's because number one, the workforce, all workforces, not just ours, was disappearing a little bit hard challenges to attract, especially blue collar, lower paid care industries and other industries. But when that happened, everybody pivoted to remote work that could, and agencies found out, or companies of all sorts found out that if you could pivot, you could save money because you didn't have office infrastructure and you could start recruiting people from anywhere, Right?

Ivo Ivanov (00:08:49):

Yes

Dr. Mike Strouse (00:08:49):

So if you were in San Francisco and you could be remote, why the, would you hire anybody from San Francisco? It's too expensive. Let's hire 'em from Iowa.

Ivo Ivanov (00:08:59):

Good point,

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

Or Missouri or Kansas.

(00:09:03):

Let's go in places that are lower paid areas. And all of a sudden that was a big deal. And the second thing they learned is that employees liked it. Like right now today, I think 65% of everybody looking for a job, everybody looking for a job, wants remote work or hybrid work. That's what they want. And if you look in the care industry, 81% are female, 35 years of age, many are childbearing. 65% of that workforce, 65% are the sole income earners. So it's single women, many of whom have children. And when Covid hit, all of a sudden that was a group that disproportionately wanted to stay at home. And it used to be Ivo that our biggest competitor was other care programs, other was their competitor. Now, since Covid is not other caregivers, it is remote work. We're competing against employers that we can't even see. I was in Alaska up there doing some consulting, and the guy that drove the Uber back said he's moonlighting an Uber, but that his real job is in, I think he said Las Vegas. I go, what do you mean it's Las Vegas? He said, yeah, I am a remote worker for a business that's in Las Vegas.

(00:10:41):

It's like, okay, that's what you're facing right now. So our workforce is disappearing. It's always been unstable. It's always had 50% turnover minimum for 40 years. And then Covid came along and it's gotten much more challenging now. So when I was talking about the supernovas, I think there were three supernovas that struck each other. The first one was Covid, the second one was technology. Technology was advancing that allowed remote work. And the third one was high weightiness driven by retiring baby boomers. I think it's 10,000, 10,000 a day, one every eight seconds. The retired now that baby boomer hasn't quite flooded the caregiving workforce, they hit retirement, but they're starting to flood it. It's going to be a tsunami. So you have those three forces hitting each other and you're not going to have hardly anybody left. And we still behave the same way we did for 40 years. We're doing the same schedules, we're doing the same approaches. And when I go consult, I see the exact same problems because when people get in trouble, and then over time, the weird thing about the care industry, they've had 40 years, this sounds like Moses. They had 40 years of wandering out there in the wilderness

(00:12:23):

Trying to make ends meet. And for most they've gotten resistant because they've built up this sort of strength and expectation that it's just hard. It is just hard. So they just expect, well, I just got to keep shoveling. And they just keep engaging in the same behavior. But the problem is that may have been true for 40 years, But It's different now. I mean, Ivo, you know how technology is exploding and you know how the world is changing. And we saw the industrial revolution and how that happened. That's nothing compared to the technological revolution.

Ivo Ivanov (00:13:05):

Exponential. Yeah, it's rapid and it's happening in real time. We are witnessing history right now. I feel like things are changing and there's some kind of event horizon that we've reached and there's no going back.

Dr. Mike Strouse (00:13:19):

There isn't. And GoodLife is heavily in the industry, but I tell you, trying to keep up with it

Ivo Ivanov (00:13:30):

Is Challenging

Dr. Mike Strouse (00:13:30):

is impossible. It's impossible. And programming is changing. How you approach things are changing. We were talking earlier about how in the old days you'd go to somebody and they build a custom website and then all of a sudden you saw the Wix and the Squared. What is that? Squared spaces, I think Square, these widget based Websites Start happening and everything's already pre optimized, things like that. So the bottom line is custom programs can't keep up with that because they're not good. They're not good enough.

Ivo Ivanov (00:14:17):

Yeah.

Dr. Mike Strouse (00:14:18):

It's like trying to program against Amazon on, you're not going to keep up with it. You need to pivot. So that's where we are. That's the space we're in. We're not in the industrial revolution. We're in the technological revolution that hits full force, sort of a different level of need, care, those sort of things. And our podcast we have, and we will talk about technology and the role of that. I feel the care industry, generally, I does some of the same thing that has done for years and it is resistant and does not understand how to adopt and use technology as an industry.

Ivo Ivanov (00:15:03):

It's not flexible.

Dr. Mike Strouse (00:15:04):

It's not looking at other industries enough to do that. But today I want to talk about, frankly, I want to talk about schedules. Something simple or I mean a simple topic, but

Ivo Ivanov (00:15:20):

That's one of the most rigid things about our industry is this inability to change schedule.

Dr. Mike Strouse (00:15:26):

No, it's rigid in that. It's rigid in that they do are people engage in human behavior. There's, I'm trying to come up with the best word for this, but as a behavioral analyst, people tend to behave the same way when they face problems. And that's so true with schedules. And we have solutions for schedules that work. And sometimes it's challenging to get people to implement them or implement them with fidelity, not because it's hard to implement, because they're afraid mainly, or they just are worried about how it's going. Their workforce is going to react to something different. It's change management. There's just so many factors out there. But the bottom line is they get in this fix, don't, my behavioral word for it is they get into this fix where they'll always end up at the same outcome. They always end up with these barbecued, wonky schedules that make no sense when you go up 500 feet and look at them. But they get there the same way and they do the same thing. And then they kind of are, you're right, Ivo, they're locked into what they did 30 years ago and they kind of keep doing it.

(00:17:03):

And so today, in future podcasts, we'll talk about how do you fix it, but I kind of want to talk today about why are schedules wonky and how do they get there? And a little bit about why that's a problem. Because I want people to come away from this podcast kind of analyzing their own and shaking their hands. That's what happened. That's what we did. But that's kind of the discussion of today. I want to go through some of the things that cause us to end up where we are with schedules that don't work.

Ivo Ivanov (00:17:45):

Yeah

Dr. Mike Strouse (00:17:46):

Because if you understand that maybe you'll understand what you need to do differently. And so you'll be a little bit more open to some of the suggestions of change that actually work me. We're measure everything. And so the first thing I want to talk about Ivo is just that people don't have any metrics. So I would say one of the biggest problems is they haven't got a scale to step on to show them what kind of shape they're in. They don't have measures. It is all anecdotal. When I go and talk to agencies, sometimes they have great HRAS systems and they can tell you what their turnover is and their vacancy rates and the metrics. And I love agencies that at least know that. But the fact of the matter is even the agencies that even can tell you really good measures, they don't necessarily use them to gauge their interventions. And so what are always one of the things we always do, and we have workshops on this, we worked for probably 15 years, developing metrics for our workforce, metrics on the pipeline, metrics for stability, metrics for satisfaction, metrics for manager workload, things like that, that when you do an intervention, you expect that to make a difference

(00:19:31):

On what you measure is what you do. If you don't measure it, you're likely not going to do it. So one of the first lessons that I'm going to tell you is if you go, I've gone to agencies where they don't know where they are, and it's like any journey. If you don't know where you are, how are you going to go to where you want to be? Because you got to at least know where you are if you don't, and as you migrate and start your journey, are you making any progress or not? Or are you going to just keep going in 40 years of wondering the wilderness?

Ivo Ivanov (00:20:15):

Yeah, doing the same thing over and over, over

Dr. Mike Strouse (00:20:18):

And over And over again.

Ivo Ivanov (00:20:18):

It's like the temple of doom, Mike,

Dr. Mike Strouse (00:20:25):

This is going to sound like a doomy one, but trust me, there'll be future podcasts that talk about solutions. But there has to be kind of an accountability moment where you know where you are

Ivo Ivanov (00:20:41):

Well, you know...

Dr. Mike Strouse (00:20:42):

If you really know where you are, then you can agree that you need to change.

Ivo Ivanov (00:20:47):

Yes, yes. And clearly the industry is in a bad place in many ways. And I was thinking as you were describing all these problems of

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

I haven't got To 'em yet. I'm fixing to get to 'em.

Ivo Ivanov (00:21:03):

I know. But I was thinking about what are the things that attract someone to a job? What are the components that make you want to work something? So obviously you want to be part of a mission. Yes, you commit to the mission of your job and you believe in it, but also the compensation and also the scheduling.

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

It is

Ivo Ivanov (00:21:25):

Those things are, you always have a way of looking at the components that constitute a job and turning those components into incentives. How can I turn scheduling, which people just look at it as a work shift. How do you turn scheduling into an incentive? That is very, very interesting approach to this.

Dr. Mike Strouse (00:21:50):

Well, there's two types of scheduling needs I've seen across the country. One is what I call continuous care. That's where somebody needs care 24 7 or most of the day, and it's the same every day. They need somebody to support them. Maybe in the future we'll have robots that can work whenever you plug them in or you'll have other help. And we have help for that, but as like neighborhood network for fractional care. But the two types of things is either continuous care or what I call fractional care. And so when I work with agencies, you first have to look at all their scheduling needs and use your Harry Potter sorting hat and say, are we talking about continuous care scheduling issues like assisted living needs of continuous care, larger facilities need to, or people who have really complex needs need continuous care, or you're looking about trying to fill the gap in care, what I call fractional care. And both are problems. Continuous care consume a lot of staff. And fractional care on its own really has a high reliance on wonky, fractured schedules that are hard to fill. So those are the two types of scheduling problems. In fact, I was in Alaska ironically,

(00:23:33):

And they have a lot of fractional schedules there in their communities and they have care plans and which decide how many hours people need. And then they have scheduling strategy to try to fill them. We did an analysis there. They're averaging less than being able to fill 49% of their hours. So they are not able to fulfill by, they don't have the labor already to fill 51% of their hours. Now from an agency's perspective, they're losing 51% of the income from the person serves perspective. They're not getting even half of the services they're entitled to receive. It's enormously a problem. And what I found out, same thing's true in Arkansas, the same thing. It's a weird deal that it's about 50% when you're getting to fractional care. You're delivering 50% of the authorized hours, which is crazy. Continuous care, you're delivering more of the hours that you were supposed to do. But in continuous care, the belief is, the reality is that you can't have a care gap. So what happens there is you just work people to death or you work managers to death billing vacancies that they can't fill. And so the manager backfills that and they come up with all kinds of strange ways to fill and backfill that stuff. So those are the two types of schedules, continuous care and fractional care that we work with. And Ivo, I'm going to say this, where I disagree with flexibility

(00:25:26):

Is I'm a model guy. I believe if you're going to have something that's sustainable and replicable and scalable, you got to have a model that can be replicable and sustainable and grow. And there's some predictability, there's some standardization to models. But even those models have to have flexibility built in them. To a degree,

Ivo Ivanov (00:25:57):

Yes.

Dr. Mike Strouse (00:25:57):

But I'll tell you that's part of the human nature problem. One of the first things we're going to bring up in this whole problem is the stayers have a vote in determining their schedules and they have influence. The pipeline in the vacancies have no vote. So what always happens is, especially as the vacancies go up, so when I go to an agency and I see 20 or 30% vacancies, and that's pretty common. Now they are perseverating on the staters. Now don't get me wrong, this is a message that I don't care about the staters. I absolutely do. But if you're doing continuous care, continuous care models, and you have a 30%, 25% vacancy factor, and you have the stayers decide what the schedules are, it's always at the expense of the quality of schedules of the vacancies. And this happens time and time and time again that the people who stay have enormously more say over what their schedules are. But in the continuous care model, I don't know what those things are called, but it's those little puzzles. They're little squares where you have to move the letters around to spell stuff, and there's always a blank.

(00:27:32):

Well, anytime stayers change the schedule, it changes the schedule for the vacancies. And the more, if all the positions have, if you have one glass of water to give to all the positions, and we'll call this glass of water attractive schedules, the more attractive schedules you give to the stayers, it will directly change the attractiveness of the vacancies. Does that make sense?

Ivo Ivanov (00:28:07):

Yeah, it does.

Dr. Mike Strouse (00:28:09):

So I'll go to a large agency and we will, they'll talk to me while they got a 20% vacancy factor in their pipeline's dripping. The first thing I ask them is, can I see the opens? And by the way, some of 'em can't even give 'em to me, but give me the schedules of all the openings you're trying to fill. I want to see 'em. We lay those that have them. We'll lay 'em out on the table and you'll see them. And I go, wow, those don't look very good. So if you only have a few people applying a week to your schedules, usually it's because they're incredibly unattractive. And this goes to that. I mean, so rule number one is that your schedules, that you have all of them, every one of them, you need to try to make those as equally attractive as possible, which includes the open ones. Because if you have very few open schedules that have any level of attractiveness to them, you're not going to have any applicants.

Ivo Ivanov (00:29:32):

Yeah,

Dr. Mike Strouse (00:29:33):

That's number one. But human nature, I love that word because I'm a behavioralist human nature is you have this desire to please the people that stay for lots of reasons. They work hard, they're loyal, of course, all the things. But if that means that the open positions are unattractive, it's not going to help anybody include the stairs because they too won't, if you got too many openings, they won't be able to work their schedules either because they're going to have to fill all the other stuff.

Ivo Ivanov (00:30:16):

The water will be gone and everybody will be dehydrated.

Dr. Mike Strouse (00:30:20):

But it is human nature that you want to give people what they want. And what I see out there all the time, in fact, there's even consultants out there that basically, and there's industries out there that basically say we're how you work, what you want, McDonald's, some other industries. I've tried those things. And as long as you're not doing continuous care and you don't care about the number of people involved in care, that's an approach that can work, but not for continuous care. Because with continuous care, if you do an approach like that, there's a phenomena ebook called schedule migration. Schedule Migration is when all the schedules aren't of equal appeal. And so that means there's some schedules that are better than others. And so if there are, and let's say a good schedule opens up, what do you think the probability of that good schedule opening up is going to be filled from somebody from the outside or somebody from the inside?

Ivo Ivanov (00:31:32):

Inside? A

Dr. Mike Strouse (00:31:33):

Hundred percent of the time, a hundred percent of the time, the better schedules are filled by people who are in the site. It's called schedule migration.

Ivo Ivanov (00:31:40):

They migrate to the good schedule,

Dr. Mike Strouse (00:31:41):

They migrate to the good schedules. And then what happens is the open schedules are the ones that are the least appealing in the agency. So you go into market, let's call it going to market, recruiting people with beginning wages to fill the open schedules of the least appealing that you have. And if you want to know why your pipeline's dripping, that's number one. That's the most common thing is you have unequal schedules. Now, there's a way to make them equal there. You can do it by how they're designed and what you can't design to make them equal. You can do it by pay.

Ivo Ivanov (00:32:19):

Yes. But it's expensive to do it by pay increased compensation for undesirable schedules.

Dr. Mike Strouse (00:32:27):

It is, but I'll tell you this, you should do it by design first. Yes. But there still may be some that are better, but not perfect. All I can tell you is it's better to equate those very few by pay

(00:32:50):

Than it is to simply leave them the same as everybody else and them not being filled. And I have that. It goes to show is I've gone to agencies too, and I said, Hey, do you keep, I'm always going to talk about data. So do you keep data on the length of very specific schedules being open? Most people don't, but those that do, and there have been, but you can get anecdotal anecdotally that says, we've never filled that schedule. I mean, literally, or it's been six months and we haven't been able to fill that schedule or whatever. Well, let me say this. If you had a need for continuous care schedule for continuous care and developed, you decided, I'm just not going to schedule. I'm not going to include in my continuous care. I'm not going to do Saturday and Sunday. I'm not going to have a schedule for Saturday and Sunday. And I asked agencies, would you do that? Would you just not have schedules for Saturday and Sunday? And they said, well, that'd be stupid. No, I wouldn't do that. And I said, well, yeah, it would be, but that's kind of what you're doing because you have such lousy schedules for Saturday and Sunday that you haven't had anybody either apply or able to keep it.

(00:34:08):

So in essence, you've created a schedule for five days a week and you don't have a schedule for Saturday and Sunday. He said, well, we have schedules. And I said, no, you don't. They've never been filled. So if you can't fill 'em, they don't exist. And so that's the whole point is you got to have the schedule to design to be one that you can fill, and that's attractive. And there's only one measure of attractiveness, Ivo. And that's your pipeline.

Ivo Ivanov (00:34:38):

Yeah,

Dr. Mike Strouse (00:34:38):

It's not the current employees. The schedule of attractiveness for open schedules is the flow of the faucet.

Ivo Ivanov (00:34:47):

Yes. And a little bit of a teaser for our listeners in the future. We will tell you about this little magic that Dr. Straus has done to make weekend schedules incredibly attractive. So there is a way. There is a science to it.

Dr. Mike Strouse (00:35:07):

There is,

Ivo Ivanov (00:35:08):

But you'll find out probably in the future about

Dr. Mike Strouse (00:35:10):

That. In fact, I'll tease this. Our schedules often have for Saturday and Sunday, often have a waiting list.

Ivo Ivanov (00:35:17):

Yes, yes, exactly. And people

Dr. Mike Strouse (00:35:20):

Have a hard time with that one.

Ivo Ivanov (00:35:22):

Yeah. It's hard to believe. But you've done it and I've seen it firsthand.

Dr. Mike Strouse (00:35:26):

We're very proud of that. But we're not going to talk about that today. Today,

Ivo Ivanov (00:35:31):

Today. Yeah.

Dr. Mike Strouse (00:35:31):

So one of the things I want to tell you about is a schedule, schedule migration. That's a problem. The other area is too big a reliance on part-time. And the issue there is I'm going to talk about two things at once because they were so related to each other. Our love affair with a five day work week and our love affair with part-time nationally, we average 32% part-time in our industry. 32% of all the positions are part-time. And as home size gets smaller and home health, home services in-home services, it's much higher than that. Almost over 50% of the positions are part-time.

Ivo Ivanov (00:36:24):

Oh gosh.

Dr. Mike Strouse (00:36:27):

Basically excludes being able to support people who have complex needs with part-time. You end up pushing people to congregate care with part-time positions are open twice as long and twice as often. So part-time is never your friend. And one of the metrics that I rely on the most is a simple one. I'm going to digress, and I know that's odd in this podcast, but I'm going to digress for a minute and talk about a metric.

Ivo Ivanov (00:37:06):

Yeah.

Dr. Mike Strouse (00:37:07):

Did you know that the turnover goes down as vacancies go up? Really? That's kind of counterintuitive, doesn't it? Right. It is. Well, it took me a long time to figure that out, but here's what, and it only happens when the vacancies get to 20% or

Ivo Ivanov (00:37:34):

Higher. Very

Dr. Mike Strouse (00:37:35):

Interesting. I ran across a couple of agencies that kept decent data and they had 25% turnover. And he said, well, but Dr. Strouse, the blessing that we have is our turnover has gone down. Oh, really? I looked at it, and it turned out they were right. Their turnover was low, but their vacancies were up. And the other thing is the pipeline for new positions was dripping. What had happened is they absolutely designed the schedules for the stayers, and they were disproportionately five day work weeks, and they were disproportionately Monday through Friday, and they were relying on what they used to call a weekend warrior to recruit the weekends. Well, the people that were left in that agency after 25% vacancies were actually the long-term employees. They think about schedule, migration, everything went, and there was lots of pressure to keep the people who were there. So they were sort of catering to the stayers to the point where they ended up with all these weekend schedules that none of which were full. They were actually reliant on a lot of pool staffing that they had to come in and it was not a good place for them to be.

(00:39:16):

But here's the thing, when you have 25% openings, the early turnover of people, when you look at tenure in an agency, there are a high degree of 90 day or less people that constantly turn over. And then as you get into the people that's been there a year or two or three, that turnover is far less slower. Those people stay partly because they migrated to the best schedules. And so they had this high, it wasn't a lot of turnover at the 90 day, there was just nobody applying. So the 90 day people or less were just absent. And they had the people who had stayed longer, but were in the better positions. So their turnover was less, their pipeline was dripping, and they had a constant rate of vacancy. So the reason I'm telling you this story, this is why I do not like the measure of turnover. It's a bad metric. It is not a good metric. There's a much better metric that I prefer. And it is called the number of people involved in care. I mean, if you look at it from a client's perspective that you support, most important metric in the whole world is how many different people is involved in care. As a number of different people go up, the quality goes down,

Ivo Ivanov (00:40:46):

Care down, goes down, down.

Dr. Mike Strouse (00:40:47):

As the number of people goes down, the quality goes up, goes up. And by the way, a number of people involved in care are affected by turnover, vacancies, call offs, PTOs, everything that you do affects it, which means that you can work on so many different things to improve how you replace labor, how you assign people to work in homes, your scheduling strategy. Everything that you do affects that one number. It's like you step on the scale. You always know when you gain weight, there's only one number ahead of you. It's only one number.

(00:41:27):

It's weight. And that's kind of like how I feel about number of people involved is a single number that people need to keep their eyes on. I mean, we always have others, obviously pipeline, that kind of stuff. But anyway, as usual, I digress. But I wanted people to understand that you have to measure, and you can't get romance by saying, I'm in a bucket. I feel horrible. We have lots of challenges, but our turnovers less. I think part of the time what you measure is what you do and what you focus on. And I think that's not the right thing to focus on. So we talked about schedule migration. We talked about kind of catering to the stairs instead of listening to the vacancies. And if you listen to the vacancies, then you will understand part of your problem. When I say listen to the vacancy, I'm talking about another metric, and that is applications. If you don't measure the number of people who apply and the number of people who agree to take a job, if you don't measure the length of time a vacant position is open, If You don't listen to that data, then you're not going to fix the problem. Those are just incredibly important things to do change. And so I'm going to go into one other area here that I just kind of want to let people know because something they always do. And then I'm going to circle back to the five day work week, kind of my favorite interesting bit of data to talk about. But the other thing that people do is that they have, which it sounds so normal and so reasonable, the manager of the home or the program, they allow the manager of the homes that you're trying to provide care in to create the schedule. Now, doesn't that sound reasonable in a way?

Ivo Ivanov (00:43:46):

Yeah, In a way it does. The Manager knows

Dr. Mike Strouse (00:43:48):

It does. I would tell you, 90% of the agencies I go to, the managers of the home are given a ratios. Here's the ratios of care you need to deliver,

(00:43:58):

Which is often related to budget. You have, if there's seven days a week and 24 hours in a day, you could write little numbers in each one of those squares. You need two people here, and you need three people here. You need one person here, one person at night. So there's ratios that need to be present to deliver care, and then they say, create a schedule that works for you because your home's different than that home and so on and so forth. So create a schedule that works for you. Then realize that manager has relationships with the people that are working there and no relationships with the vacancies again. So if you let a manager create the schedules, can you imagine the pressure that's put on that manager to change them? I mean, if you're scheduling for a home, and I know you can change it and you got half of the home is vacant and you cannot imagine losing the other half, and they come to you and say, we want to work this schedule, what do you do? You change it and then all of a sudden the openings become completely unhirable and you're stuck. The other problem is they become highly eclectic.

(00:45:28):

And if they become highly eclectic or meaning they're very different.

Ivo Ivanov (00:45:33):

Different,

Dr. Mike Strouse (00:45:34):

That home schedules incredibly different than another home schedules, than another home schedules. Than another home schedules, right? And if that's true than what happens is that there's no way to think in advance of recruiting people to be ready to work in that home or replacement labor for that home. You can't have a system sitting on top of all these homes to replace it. So I'm a big fan of standardized schedules to a degree that have flexibility built into the models, schedule models so that you can plan ahead. So that's another area and want to focus on is that, and literally every program you go to, they have the managers develop the schedules of the home, and that's a reason why they end up being wonky. And then the openings get really fragmented. Sometimes they get almost unfillable. And then the accommodations that you make, what's really funny about this is you make all these changes for one person because you want to keep them, and then that person leaves, and then all these other schedules have been changed around them, and now you're starting from square one again. Does that make sense? Yeah. So those, again, it's human nature. People do it all the time, but it's why we keep doing the same thing over and over as we wonder the wilderness for 40 years. That's another thing.

(00:47:20):

So we talked about schedules being of equal appeal.

Ivo Ivanov (00:47:23):

Yes.

Dr. Mike Strouse (00:47:23):

We've talked about schedules being too reliant on part-time. We talked about schedules that are fragmented. Now I'm going to circle back to that five day work week. And one of the reasons for that is we, as you know, we have multiple schedule approaches. We don't have one, but we have go-to base schedules.

(00:47:51):

But go-to base schedule is a three day work week, and I'm going to talk to you why we do that when I'm not going to talk to you about how, but more the why and why we don't do a high reliance on five day work weeks. So a five day work week is most highly, is the highest correlation to increased part-time. And the reason a five day work week is a high correlation of part-time in continuous care models is because people traditionally, a long time ago, Ivo people wanted to work five days a week Monday through Friday, and I think there's even songs about working three shifts a day, 40 hours a week.

Ivo Ivanov (00:48:40):

Dolly Parton.

Dr. Mike Strouse (00:48:41):

Yeah, Dolly Parton had it. And so the five day work week is 40 hours a week, eight hours a day, and disproportionately skewed to working the weekdays and pushes a high reliance on part-time for the weekend. So one of the reasons I don't like a five day work week is associated with the highest level of schedule migration because it's hard to make five day workweeks equally appealing. Secondly, it's related to the highest reliance on part-time weekend labor of all schedules. It's related to the highest reliance on overtime. The Highest number of PTOs are used with five day work weeks of any. So there's all of these reasons, but here's the biggest a five day work week, you hire somebody to work 40 hours, right? In care, I always tell a CFO to go take all your five day workweek people and do an average of the number of hours. They actually work across six pay periods. Six. Guess what The average, I mean almost reliably is you're hired to work 40. How much do you actually work? Keep in mind, this includes the people who are heat seeking missiles to try to work overtime. People who call often people who work their schedule,

Ivo Ivanov (00:50:18):

I don't know,

Dr. Mike Strouse (00:50:18):

Average number is between 30 and 32 hours a week. So the reality is you hire them to work 40 and they're working 80% of the hours that you hire them to work. Now, there's reasons for that call offs, PTOs, all kinds of things. But the bottom line is, I call that hidden openings. You're Hiring 'em to work 40, they're working 30 or 32, they're working 80% of the scheduled hours, 80%.

Ivo Ivanov (00:50:55):

Wow.

Dr. Mike Strouse (00:50:55):

Guess about a three day work week. So in a three day work week, 12 hour workday, You're Hired to work 36 hours. Guess how many hours you actually average?

Ivo Ivanov (00:51:09):

Let's say 28

Dr. Mike Strouse (00:51:13):

Closer to 40. Wow.

Ivo Ivanov (00:51:16):

They work a little bit over the 36

Dr. Mike Strouse (00:51:18):

Hours. So a three day work week works 106% of their schedule. A five day work week works 80%.

Ivo Ivanov (00:51:29):

This is Fascinating.

Dr. Mike Strouse (00:51:32):

Without any, let's kind of talk about PTOs in that without any PTOs at all, just looking at a five day work week, you have two days off, two days times 52 weeks in a year is 104 days. 104 days.

Ivo Ivanov (00:51:49):

Yeah.

Dr. Mike Strouse (00:51:50):

I work with agencies that have really generous PTO policies where they give 30 days off a year or three weeks or something like that. I mean a fair number. So I'm going to be generous and add 30 days to that. So if you have 104 plus 30, that's 134 days off a year, right?

Ivo Ivanov (00:52:10):

Yeah.

Dr. Mike Strouse (00:52:11):

Well, a three day work week has 208 days off a year before you give any days. I had somebody tell me yesterday, the agency that implemented a service model that we helped them with, that their three day workforce has seven months off a year.

Ivo Ivanov (00:52:29):

Yeah, that's absolutely amazing.

Dr. Mike Strouse (00:52:31):

They have seven months off a year comparing those two. You don't need pt. I'm just telling you, you don't need PTOs to have life balance. You got seven months off a year. Now, there's other ways to give people days off without using PTOs. I'm not going to get into all the details.

Ivo Ivanov (00:52:54):

That's fine. Another time.

Dr. Mike Strouse (00:52:55):

That's for another day. Or people can always contact us when we do workshops on that with no charge for any of that stuff. But the point I'm making is a three day work week has a 40% greater capacity for working extra than a five day work week.

Ivo Ivanov (00:53:23):

It's not just that you get two weekends a week, which is amazing on its own, but you get them in a row.

Dr. Mike Strouse (00:53:31):

Well, actually, we always say you have three days in a row. And I mean, we always give people four days off a week.

Ivo Ivanov (00:53:37):

Yeah, yeah, yeah.

Dr. Mike Strouse (00:53:39):

We guarantee three days in a row.

Ivo Ivanov (00:53:40):

That's spectacular.

Dr. Mike Strouse (00:53:42):

I'd say half of them though are four days in a row.

Ivo Ivanov (00:53:45):

Unbelievable.

Dr. Mike Strouse (00:53:46):

And they're standardized, and I don't care if this is fractional care

(00:53:53):

Or continuous care, and everybody's going to raise their hand and say, well, how do you do that in fractional care if they only need two hours? How do work 12 hours? Well, that's where our neighborhood network and our neighborhood care strategies come into play, and we're not going to get into that either. We've talked a little bit about that already. But the point is having a higher reliance on the three day work week, and by the way, you know us, we're not talking about three days working Friday, Saturday, and Sunday. We're talking about making them equal. We assign one day to the front half of a work week where they work Sunday and either two days out of a Monday, Tuesday, Wednesday or Saturday and two days out of a Wednesday, Thursday, Friday, that makes them equal. That's why we call it the front half and the back half model is because we try to make those schedules as equal as possible. So you're looking at continuous care models, you're looking at front half back, half day and night, four squares that we feel is the model. Now, that's not the only staffing pattern we use, by the way. We layer other ones on top of it and use all other kinds, but I'd say 50% or more of our schedules, maybe 60% or three day work week. And using that general model of care, I gave you about 10% of that model. But the point we did that was because five day work weeks are associated with part-time

(00:55:30):

And part-time is bad. It has a higher number of, it has a higher number of people involved in care. So the three day workweek doesn't rely on part-time people working weekend. We divide that up equally. Three day workweeks can be equated so that there are equal value. They're equally appealing.

Ivo Ivanov (00:55:51):

Absolutely.

Dr. Mike Strouse (00:55:52):

In fact, the pipeline goes up about seven x.

Ivo Ivanov (00:55:57):

Wow.

Dr. Mike Strouse (00:55:58):

So listen to your pipeline.

Ivo Ivanov (00:56:00):

Wow. Imagine a swimming pool and the swimming pool is a five day work week. Now the water is your employees and the drain is the weekend. The closer you are to the drain, the faster the water spins around and this is part-time water. And the farther you are from the drain, the slower you're spinning. So you want to plug that drain and keep the water in. And the way to go is with a three day workweek.

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

It truly isn't the only one,

Ivo Ivanov (00:56:38):

But

Dr. Mike Strouse (00:56:39):

It is a part of the solution. We always talk about good life has five faucets running. And I think that's important because we have different staffing models that we use at the same time to maximize the flow of water. And again, we're not getting into that, but the three, three-day work week is one of the largest faucets that we have, and it is so clear that that has the greatest flow coming into the agency. It's interesting when we go and implement this in the agency, and I'll say this part of it, the number one fear that they have is that they're going to pivot to this and lose people. Because again, remember evo, all these people have migrated to these preferred schedules or what they call thought were preferred schedules, and then all of a sudden you're going to put in an equal schedule system in their agency, those three day work week. So the greatest fear is because this has been their fear for 40 years. I can't afford to lose one more employee, but they cannot think about the idea that, well, you lose 50% a year. Look at, I mean, if you want to look at turnover or look at turnover, you're losing all kinds of people.

(00:58:08):

That's not the question. The question really is why is your pipeline dripping? If you're having constant turnover obvious or people losing people, your pipeline should matter to you, right?

Ivo Ivanov (00:58:23):

Yes.

Dr. Mike Strouse (00:58:25):

Right. Unless you're happy, just kind of stagnating at 30% openings and having them backfilled by managers and pools. But if you want to get out of that rut, you're going to have to focus on the pipeline. So their fear is losing employees when the fear really should be. You're dripping frigging pipeline. And the other issue, when we implement this, we do it in such a way, and I'm not going to get into that. Literally, we hardly lose anybody because there's a lot of factors. I mean, your payroll costs go down 15%. There's so many factors that you use 15% less employees in this model because you have a less reliance on part-time. We are averaging about $2 and 50 cents more an hour for the same payroll that you had before in this model. So the new employees are getting more money that move to this model, and the existing employees get more money that move to this model because we can have more to spend. The point I'm getting at Ivo is that the fear they should have isn't the fear they have. The fear they have is they're going to lose employees. The fear they should have is I have nobody applying.

(00:59:46):

And the other fear is the reality is those employees that are working elsewhere that are not in the great little Monday through Friday positions are all going to move to this new model and it's going to disrupt the other homes. So there are fears to have in this, and that's why you work with an agency to help you through all of that and protect against all of that. But the reality is they fear the wrong things, which is how they ended up in the boat that they're in. They're listening to only one group of people, but they're not listening to their people that apply to the program.

Ivo Ivanov (01:00:30):

Human

Dr. Mike Strouse (01:00:30):

Nature,

Ivo Ivanov (01:00:31):

You have a way of addressing turnover and turning scheduling into an incentive as well and addressing compensation at the same time.

Dr. Mike Strouse (01:00:44):

Well, and I said that all the schedules have to be either equalized in appeal or equalized by pay.

Ivo Ivanov (01:00:53):

Yeah.

Dr. Mike Strouse (01:00:54):

Well, that is how, I'm not going to talk about how we do it, but that's how we actually do it. We do incentivize working on the weekends, but only when you work these three day schedules, you have one weekend day, and we always paid that particular day to be more than through the week. And we use a premium pay system that has another hour to explain, and we're not going to do that today. But we use that pay system because we want to make sure that the one day that they always work is the weekend, because that's when the managers don't want to work. That's when you have less supervision, that's when all the problems happen. And you need experienced people working those days. You don't need part-time people working those days. Imagine we've created a system right now today, over and over and over. We're the part-time people which are the least engaged, the least tenured, the most turbulent are working at the point in time that there is little or no supervision in those home or other experienced people working with them. And we think that's a good idea. More care concerns. The likelihood of somebody calling off is so high. The managers end up backfilling weekends. If I ask any manager the thing that they fear the most, it's going to be weekend work being called in to work weekends. That's

Ivo Ivanov (01:02:31):

What they, yeah. So you have the lowest skill employees working, the highest volatility of the schedule. Working the part of the schedule is the most dangerous.

Dr. Mike Strouse (01:02:41):

And they call that weekend warriors sometimes. I mean, they try to make the name good, but it isn't good.

Ivo Ivanov (01:02:47):

No,

Dr. Mike Strouse (01:02:49):

It is all part-time people and you end up if you try and there's this whole sort of human nature thing again that's like, well, I can't pay them more than my full-time staff will. And I go, why not? They're working at the hours that nobody else wants to work. That's silly. Offer the same pay to anybody and see if they take it and answer. They won't. So that's sort of another human nature thing. And we didn't talk also, I said, don't have the managers create the schedules. The other thing you don't want to have the managers doing is finding replacement staff half. And the reason for that is they all call the same people. I mean, what happens in the agency is you have 20 managers and they have openings on weekend. They're all calling the same people to get, I mean, a person might get 10 calls from different managers to try to work. And if one manager has some people on the side that they really have cultivated a relationship with, they won't share them with anybody else. They will never share them with anybody else. It's the biggest secret that they have.

(01:04:13):

So sometimes when they don't need 'em, they have extra capacity, but nobody's going to get it. So we never have managers find replacement staff. We have a workforce manager that coordinates all that because in fact, a large agency I was talking with the other day, evo, they said they have all the managers do it. And the overtime was outrageous because each manager doesn't know where the people they're asking to work, how many hours they've worked someplace else. So they're asking people that already have 40 hours to work. So there's no way to even manage overtime

(01:04:54):

For all of that stuff. There's no way to make sure it's equal. There's no way to make sure it's fair. And by the way, with managers having all these EC collective little wonky schedules that aren't standardized like a three day work week or those sorts of things, if they're not standardized, I'm going to give one of my last things that we always focus on. Most agencies wait until there's an opening in order to hire somebody. And there's reasons for that because every schedule is unique, so they don't know what to hire. So if you don't have any standardization in your schedules, then you have to wait until there's an opening so that you can hire it. Well, what happens is if you're waiting to hire, it's going to take you 30 to 50 days to advertise, hire, find, and train somebody. So you wait until you have an opening to begin that process. You're going to have a month to two months of effort before it's replaced with good life. We never wait to hire. We don't hire for any particular position or home. We hire three day work weeks on the front, half of the back, half of the week, day and night, four squares. They all work the same schedule. We hire them and we average nine and a half days from the application to when they're completed training.

Ivo Ivanov (01:06:36):

It's fascinating. We've identified a lot of problems with scheduling today. We talked about the importance of being open-minded and how stubborn commitment to traditional scheduling and lack of flexibility can be damaging not only to the service industry, to any industry and your TaeKwonDo career. This was

Dr. Mike Strouse (01:07:02):

Before you go, Ivo. I want to end by just saying one thing and I was saying, look, I just focus on how we got into this boat and some of the problems that kind of repeat themselves. Again, I just wanted to say, look, it's always important to look at the barriers.

Ivo Ivanov (01:07:20):

Yes,

Dr. Mike Strouse (01:07:20):

It's always important. Any behavioralists always looks at the barriers and what the problems are,

Ivo Ivanov (01:07:27):

Of course,

Dr. Mike Strouse (01:07:28):

And the challenges because that's the first step you need to do on how you develop fixes for it. So obviously in the future, we're going to talk about some of all of the fixes that we have with respect to that and there their measurable impact on stuff. I would just want people to understand that the things that I described today are the reason why we keep getting in the same boat and it's repeated itself across 40 years, and it truly is time to pull back. And if this is you, then you need to think about, okay, I can't keep behaving that

Ivo Ivanov (01:08:10):

Way. That way. Yeah.

Dr. Mike Strouse (01:08:11):

If you want different results,

Ivo Ivanov (01:08:12):

You are a behaviorist and you better than anyone know that the first step in any recovery problem is admitting you have a problem. Right. But there's hope. We will in the future. We will go deep into the mechanisms, into the logistics of how to actually address this problem. This was the quest for the good life with Dr. Mike Strouse, who is able to find the treasure even deep inside the turnovers Temple of Doom. Today's episode was produced by Megan Olafson and recorded at the GoodLife University Studios, sound editing and sound engineering were provided by me, your co-host with the co-most Ivo Ivanov. Together. We thank you for listening and promise you that the quest for the GoodLife will continue next week.