Revisit the Innovative Strategies of an Expert in Hiring & Retaining Staff
Lorraine Rice of TalentCare joins Paul to discuss the staffing shortage in PT and ABA and five principles for recruiting and retaining staff, from telling your story to onboarding and ongoing support.
Full transcript
Generated from the episode audio and lightly edited for readability.
Good afternoon and welcome to another episode of Paul Martin's Crucial Conversations. Today we are jumping into a brand new series and our series is on innovation and how innovation can help to solve some of the biggest challenges that we are seeing in ABA and physical therapy and the topic for today and we have brought the expert of all experts is how we can utilize innovation to find and retain professional as well as ancillary staff in both the physical therapy as well as the ABA industry. And we have on our show today someone who has experience in both of those industries.
And I'm so excited to introduce to you Lorraine Riche from Talentcare. Welcome, Lorraine. Hello, Paul. Thanks for having me. I appreciate that introduction. I don't know all deserved, but appreciate it nonetheless. Great to be here. Oh, I'm just getting started with your introduction, Lorraine. I want to I want to get our guests really excited to hear from her. And from you. So, look, Lorraine has extensive experience in both physical therapy and ABA, having spent time with Acorn Health as their chief experience officer, as well as with PT Solutions on the PT side as their chief operating officer and is currently the chief, you're chief in everything you do, Lorraine.
She's currently the chief growth officer with a company called Talentcare. And so again, real excited to jump in here today and find out again how innovation as well as some of the ways in which we can solve I believe the biggest challenge in these industries today and that is finding and retaining staff. Great. Well, glad to be here. Yeah. Thanks again for joining us, Lorraine. So let's start a little background from you Lorraine in terms of what do you think are some of the main causes of this significant supply and demand challenges that we have in both the physical therapy and the ABA industries today.
Yeah, I think you can really put it down to three things. And everyone probably knows and recognizes this every day especially in people serving people businesses. So the first is demographics. So we have an aging population that is requiring to stay active longer and live more meaningful lives longer and so that compounds the need. And then on the other side of the coin we have a lower talent pool. So the number of graduates, the number of people who are choosing health care, health services or people services is lower.
So there's something there. And then the third is we've all heard about it the exodus of people from healthcare and health services businesses. So those three things aging population the second a lower talent pool to access and then the third the exit of our current talent pool from choosing health services makes it a really tough environment to find the right people. Yeah, we got to write this ship and I'm hoping you're going to have some great suggestions on writing this chip ship because on the aging side and on the active aging side, I'm not sure that's going to ever diminish from where it is today.
And so, we got to get more professionals and we got to make this, I don't know, sexier or something. I know when I came out, I came out as a physical therapy, you know, had my had a master's in physical therapy, went off, first job, I was making probably more than just about all of the people that I had graduated college with and it doesn't seem to be that way anymore. So in terms of the supply and demand issue we have how has it impacted the financial performance of where you and I live which is the privately held companies in both the physical therapy and the ABA industry.
Well, I had a little chuckle on what you said earlier because I was a physical therapist, physiootherapist early in my career and I remember when I took my first job making $27,500 a year and I thought I'd made it. So, it's funny when you look back at the change. Well if you think about just the pure economics of service delivery in people serving people businesses your only asset in the business are the people and it's the only asset that appreciates over time and just like any other business you generate revenue by the services that you provide and those services needed to be provided by people.
And so when you can't get the people to deliver those services, then the business can't generate any revenue. Complicating that is when you have the opportunity to get great human capital. If they don't stay with you, then there's a cost associated with the investment you made on their training, the turnover, the churn in the organization. So, it's really two sides of the same coin. The first is your business can't be successful if you don't have people to deliver the service. We're not in manufacturing. You can't make the engine go faster or put more widgets in.
You need the right people in the right seat. And then the second thing is once you bring those people on, if they're not able to perform well at their position in terms of training and onboarding and they don't feel valued enough to stay with you, then you'll have a cost associated with the training and the turnover and then re-recruiting a new team member. So, Sure. Sure. And I know you're setting us up with some major league, you know, strategies to get through these challenges. As you look at the challenges, we'll talk a little bit more about the challenges.
Do you think there are distinct challenges on the PT side different and unique from the ABA side that we should, you know, separate here? And along with that is there a difference in ch are there different challenges professional versus support staff? Could could you tackle that just a little bit? Yeah. So I think there's similarities and there are differences. So the similarities of the challenges exist even in our own human DNA. So I think this is across any employment. At the end of the day, the similarities with the challenges are creating an environment where people can be successful, but also being able to sort of lean out and attract talent in a way that's sort of meaningful to them and meaningful to the business.
I think when you think about the ABA side of the business, the number one position to deliver services to a family that has a child or an adult or a senior with autism is the delivery through a registered behavioral tech or a behavioral tech. And if you think about where those individuals are, they're almost always early career. So for some it could be their first job. And so different than when you think about recruiting a physical therapist, an occupational therapist, a speech language pathologist or a BCBA, a board-certified behavior analyst.
They're far enough in the maturation of their career. They've spent several years training for their craft. So, it's not that there's a maturity, but there's an experience level that they know when to ask for help. They have their own tools and techniques to manage through something brand new versus the type of support network you need in an ABA environment where the registered behavior tech or behavior tech, this could be their first job. Sure. So, [clears throat] you know, when you're thinking about onboarding and supporting a professional who's had years versus an individual who's showing up for the first job for the first time, and often services [clears throat] in PT are provided in either a setting where there's other professionals around them, like a clinic or a hospital.
Some home care is done alone, but if you think about the large aspect of autism services, many are done in the home alone with a professional. That's that's a different set of support and a different sense of community that you must build and be very intentional about it. Yeah. And it seems like on the ABA side that, you know, the RBT and we don't want to align them with a PTA. But it seems like, you know, an RBT is incredibly valuable to that BCBA in the delivery of that care because they become the face of that care.
Which is similar on the PT side with the PTA in many states where a PTA can treat unsupervised. So, a and you hear more and more of companies struggling and fighting for those RBTs. Yeah, you rais a really interesting point. When you and I both graduated and became clinicians, we were responsible for ourselves, right? We didn't instantly become leaders of people. And the delivery of our services 90% of the time was done through our own individual treatment plan. If you think about the BCBA, RBT, BT dynamic, their the BCBA is a diagnostician and sets the plan of care and adjusts the plan of care, but 90% of the delivery of that care is done by the RBT.
Yeah. Yeah. So it's a different [clears throat] model and a different economic driver. Sure. Sure. And I hope for you physical therapy business owners out there and ABA businesses out there. I do think the cross of these two industries can be valuable for you. And if you have an ABA company, if you're a PT nearby and you can meet that owner, to talk to them about how they utilize their RBTs and on the other side, you know, how physical therapy companies are, you know, continuing this drive with acquisitions, etc., etc.
Think there's so many crossovers. And many companies now, especially physical therapy business that do pediatrics are adding ABA and on the ABA side, many ABA companies are adding physical therapy. So, I'm hoping these industries will continue to cross, especially for folks like Lorraine and I who now work in both of these industries. Yeah. Yeah. I totally agree. And I think we have to create an environment where we're talking about solving the crisis that we have in frontline work. We and we have to create it in a way where we're very solutionoriented and we're saying at the end of the day, what does it mean to create a great place for people to work and a great place for our clients or our patients to get care and then what do we need to intentionally build around that for that to be true?
I totally agree with you and instead of talking about our differences, we should talk about our similarities. So if I asked almost actually any business that relies on frontline work, talk to me about a time where finding the right people at the right time and keeping them that is beneficial to them in their career and you as a business has ever been a constraint to your growth. And I bet you everybody would raise their hand and say that's the case. So Lorraine, as you look at the PT industry and the ABA industry, it seems as though there are some similarities in the way in which care is delivered utilizing on the ABA side, the RBT.
And in the PT side, I would relate an RBT more closely to a PTA than to a physical therapy tech. So how can we how can we benefit from that? Well, I think the lessons that have been learned through the PT PTA relationship. So, there are some differences. Obviously, a PTA's training is much more extensive than an RBT's training. So, a lot of RBT training really just consists of sort of 40 hours of curriculum and then you're ready to go and it's on the job training.
A PTA through sort of college certification and others has allowed them to get a little bit more framework. But at the end of the day, I think the most important thing is that these lessons have been learned before and there are some similarities and some differences. You know, when you and I graduated from PT, we were responsible only for us and the delivery of our care associated with our treatment plan one-on-one. We spent 90% of the time with our patients or clients delivering those services. And then over time we learned that in order to extend our care, there were certain things that PTs needed to do at the top of their license that allowed space for a professional like a PTA to come in.
And so we were able to expand services more because you know if it was a manipulation we would do that as a PT and then the PTA in states where they can practice independently would carry out the other portion of the treatment plan. So I think two ways the BCBA RBT relationship BCBAS graduate already being leaders. So they do a lot of the diagnosis they set the plan of care and then the delivery of that care 90% of the delivery of that care is done with an RBT.
And so I think having more BCBAS talk to PTs about the transition of topoflic care. What does it mean to build a therapeutic relationship with the patient through the assistant or through the allied health practitioner? Those are really important things. And then remembering that maybe ask some PTAs, what was the best supervisory relationship that you had that allowed you to be successful? And BCBAS could maybe put together programmatically a way to support their RBTs early stage, late stage. Because they may not stay in the career forever, but if they have a really good impact while they're there and they can speak positively about being an RBT or a PTA, they're going to bring more people into the field.
I think we are on the front edge of a new conference where we can put together some PTS, PTAs, some BCBAS and some RBTs and a lot of good, you know, cross trainining can occur there. Well, I also think let's just tackle the issue about frontline work. So there's tons of honor in frontline work. So I think about home care, hospice care. You know, we constantly need to learn about how do the people who are on the front line all the time who from an hourly wage perspective are probably the lowest economic hourly wage on your whole organizational chart.
How do they how do we attract them? How do we help them feel meaningful work? How do we connect them to purpose? Because if we can solve the frontline work and make it an attractive place to be and it's really impactful I mean more impactful than a PT often that the PTA has than a BCBA than the RBT has. So I think it would be a great topic. And I think we should look at our similarities maybe go beyond healthcare and talk about people in restaurants who do frontline work like that's the business.
Yeah. I think I think it's start at the front line and come back to the executives. And I think some of some of these problems could potentially be solved. So, what do you believe that this is kind of the key question for today? I'm going to ask you to give us five I put up 10 five key principles for successful recruiting and retention. And that can relate to the AB and or physical therapy industries. And if there's any innovation we can throw in there, Lorraine, love to see what innovation innovative things are happening out there for you in talent care working with your clients.
Sure. So let's talk about retention begins at recruitment, right? So I'll it was hard for me to think about five as you said that. So I'll break it down into five things that would already be a way to build a talent ecosystem that retains people, attracts the right people. So, first you got to be able to tell your story. So, can you tell your story on a career site when you're out? And it's not what the CEO thinks or what the COO thinks. It's like, what is it like to work here?
And then you have to ask your people. You have to showcase your people and once you tell your story people are drawn in. So that's like on your social on your career site on your indeed page on your you got to tell your story. So that's principle number one. Would you before you go to two would you relate that story to describe in some way what the culture is or are we getting to culture later? Yeah it's not it's not core values. So core values are really important but it's what's the employer value proposition.
So if you look at really good career sites they say if you work here or become a part of us what will happen to you. You know your work will be a refuge is one that we have with a company that we're working with. That's pretty amazing right? You will have support to grow and learn. We take care of our own employees so they can take care of others. Those are those sort of brand. What does it mean for me to work here? Now, you're going to select people based on your core values.
That's like right person and then right seat, which I'll talk maybe a little bit later, but when we talk about employer value proposition, it's like, am I drawn in and do I see myself working here? So, I get really frustrated when people say, "Oh, I'm competing for cashier jobs at Walmart." And then I'm like, "You're not telling your story then because that's like saying Lorraine was either going to be a physical therapist or an investment banker." Well, although I appreciate both, I was drawn into the meaningful difference that I could make in a person's life by being a physical therapist.
Right? So, you got to write your story in that way. That's number one. Number two is you have to make it easy for people to apply. So if you have 600 loginins and you have to like put your social security number in and it doesn't render on a smartphone, there's some tools and technology that just makes that easier because if I'm an A candidate, I'm probably applying for my job on the lunchtime of my current job because I'm usually employed and nobody wants to lose me.
So if you make it too hard for me to apply, so now you've done the attraction thing, then you got to do the retention thing. So and it starts with a relationship. So you can automate the first touches because people want to know within a couple hours, oh, we got your application. It's why people are so drawn to social media because they post a picture and they get a like right away. You have to do those things. I applied and somebody responded to me within two hours.
And you can do that with tech. And then once you've gotten them there and they're in the interview stage, you need to be optimistic and realistic. You need to tell them because an RBT job is a hard job. A PT job nowadays is a hard job. You have to say, listen, it's going to be great, fulfilling work. And these are the things that are true about it. You know, because there's no sense. You lose most people when the expectation between what you sold them and what they actually experienced doesn't match.
So, let's just do that right away. And then the people who want to be there are there. So, it's building the relationship with the person. And then the next thing is you absolutely need to onboard and train people. The most exciting excited anybody's going to be is on the first day of the job. The most attached they are to their current job, their past job is on the first day of the job. So you have to take that excitement and build on that. And so I think things like day one of orientation, I think a buddy system, there's a lot of ways to architect onboarding so people are successful.
And then the last the fifth thing I think is support and training. So all of us want a chance to learn and grow. People often say to me like how do you keep talent? I said look in the mirror and ask yourself what you would want and then build that for your people. Right? It's not that complicated. But remember there's an evolutionary stage in any job. And that's why the last one, support and ongoing training, is important is because on the first day of the job, I'm most excited and I'm actually unconsciously incompetent.
I don't know what I don't know. It's like kind of a like fun place to be. Then within about 90 to 120 days, I go through the following. I become consciously incompetent. I actually know what I don't know. That's a super vulnerable stage. If somebody doesn't make it psychologically safe for me to say I'm over my head, if I can't ask for help, if I don't have a good co-worker relationship or a buddy, if I don't have a supervisor that cares about me as a person, I'm probably going to bail when I become unconsciously incompetent because I just know then I go from this place with the right support to being, you know, unconscious like I get all the way through so that I'm consciously competent and then I become unconsciously competent, I can just do it.
So, just going back, number one is you got to be able to tell your story. And you got to do it a bunch of different ways. It has to be authentic and real and come from the people who work there. Then you have to make applying easy. You can't put in all this friction. Put in the friction when you need to put in the friction and that can be technology and other. Third, you have to build a meaningful relationship that cares about them as a person during that experience of hire and onboard optimistic and realistic.
Then you need to onboard well and then you have to support and train. And if you do those things over time, you will get the best people and you'll keep the best people. And even the people who are with you for a season and a reason will be proud they came from there because not everybody's going to stay in a job forever and they'll still be your greatest referral, a future job. Sure. Sure. Yeah. It seems Lorraine that you know many business owners go about bringing on new staff as they come on and they're a part of the team and go to work and here we go and they'll learn as they go along and they'll understand and they'll learn the story.
They'll get the story. And I think, you know, when you talk to business owners that are even doing three of those five, right? I mean, even if the application process is difficult, but they get that they feel like they're a part of something that's, you know, I think there can be success. Are there any tools that you have found in any of those, you know, the kind of the five big areas? Because I a thousand% agree that if you are on target with all five of those tools I'm sorry, of those five principles.
Are there any tools that you guys have utilized in the past to assist business owners with the onboarding or with that easy application process or with the support training going forward? Yeah, I I need to kind of put on my Talentcare hat a bit here. I was a two-time customer of Talentcare and there was a reason for that. I used to believe before I came and joined them, I used to believe that you had to build the car and drive the car all yourself. And what I learned is that you absolutely have to drive the car.
That's the culture and the training and the onboarding and the supervisor training on how to be supervisors, but you didn't have to build the car yourself. So looking at partnerships because at the end of the day, we're always competing for resources, right? And resources are time and people essentially or money and people and all of them cost money. So, so you really have to say what piece of this can I leverage technology for? What piece can I leverage a partnership for? And so couple of different things.
So building a career site, getting an applicant tracking system that's candidate friendly, not system friendly. So remember some applicant tracking systems that are built [clears throat] by Hases. So like ADP has a free applicant tracking system. ADP is an awesome application to pay your employees correctly. But you have to remember that when you're a human capital resource system, infrastructure system, you're actually built for regulatory reasons to pay people correctly, to process IN to do all the things you have to do legally. Nobody sits around and says, "Oh my gosh, how easy can we make it for people apply?
And how friendly can it be for candidates and hiring managers?" So having discipline around picking a system that integrates with your HS that really helped me and then actually just having partners that could do the tech and the IT and the innovation around candidate engagement that can be automated while so I could concentrate as a COO at the time or as president at the time to make sure that I was spending time with the candidates arrive and did the piece that only I could do, right?
Like, sure, you can't wait for a recruiter to get back to their desk to respond to a bunch of texts. You should just automate that. Yeah. Yeah. Because Yeah. And I and I know at Talentcare that you guys have a number of these tools. And I'm curious a again as to you know how that then you know drives some of these principles which if I'm I'll make it up if I if I'm a 30year-old looking for you know whether a BCBA or an RBT getting a start as an RBT and I'm getting text messages and I'm not seeing anything coming back and it just seems to be an antiquated clunky system.
I'm immediately going to be turned off. And now in a world where you have one job and there are six applicants going for that job, I better fight for that job where it's clunky. But it's just the opposite now. So I can just go on to the next one. Yeah. Any friction you have. And so two things you mentioned Paul that I think are really important. One is you need to lower the friction and improve the candidate experience. And you do that by like pulling them in by telling your story, making an easy way to apply.
That's all those pieces of like if it's a bother, I'm not hanging around. Number one. Number two is the biggest thing that we're seeing in this current generation is they want an engaged employer. They want somebody who actually cares about comments who are making a difference. And I think this is an incredible generation of difference makers. And so another thing that's important is to have someone manage your reputation on Indeed and Glass Door. If you don't have a strategy for that, you don't have a candidate strategy.
We're gonna check. Yeah. And so the very first thing we know at Talentcare statistically that if you land somewhere between 3.5 and 4.2 on your score in Indeed, you're going to get a higher number of applicants. We just know that. Even more, if you are responding to every review, good or bad, it shows that you're engaged. Thank you for taking the time. And then you have to have a real campaign to solicit the good feedback because people are h happy don't necessarily say anything. So then you can tap into your own employee base and say tell the story on Indeed and Glass Door and do it in a meaningful way and nobody believes fives and nobody believes ones.
You know, they know there's outliers, but right down the center and that is something that I relied on talentare to do was as an operator was to manage. We built a library of statements so that we could be responsive on Indeed and Glass Door. And then we had an escalation queue to be able to adjust if there was somebody that needed to be elevated or if there was a concern that had some privacy issues, we could pull that that down. That needs to be actively managed.
And it's just a capacity thing. If you choose not to partner with that, then you have to have somebody inside your organization doing it. And like you're best to do only what you can do. Sure. Sure. So what a match for you having utilized talent care from the companies where you worked and now becoming their chief growth officer with many stories of success prior and now certainly with the company. Could you share a success story where you implemented some of these principles whether ABA or PT and how it improved recruitment and retention?
Yeah. So I'm going to talk about two kind of operational stories because I think they're absolutely things that [snorts] people should concentrate on. And back to your prior comment, it it's a thrill. I really set out in my career to help people live their most meaningful lives in a way that's meaningful to them. Where you sat down and said, "What does it mean to live your most meaningful life?" And for a family with children with autism, maybe it's not toilet training. Maybe it's actually going to a restaurant for a child's birthday for the first time with the rest of the family.
You know, me as a sort of middle of my life still think I'm an athlete. You know, it's that I can still run even if I don't run that fast. I mean, that's why I went into the business I'm in. And the only way you extend access to that care is if you find the right people and get them in the right seat so your business can grow. So, I feel like I get to be everybody's chief growth officer solving real problems, which I love. Sure.
So a couple of stories probably the first is we had a high amount of turnover in the PT business at the front office and if you can't staff your front office you can't have support for the physical therapist you actually have lower success on rebooking patients following up on no-shows cancellations you can't open your clinic on a Saturday you can't open it on an evening you can't you just can't do it. And we had high turnover almost 100% turnover in that position. And so we said what are we doing wrong?
And so we talked earlier you can leverage technology about telling your employer brand story. But then we did a couple of things in addition to building the better mousetrap. Great career site easy to apply. We got very specific about what our profile was and you can build that profile inside technology like in talent care if you choose. But you also say, "Who are my top performing in this role?" And then you ask them questions and you build their profile. And then instead of having a line of 900 people and hiring the first four because you have fear of vacancy, you start to use the profile to have a higher match, which means a higher probability of people like that success story.
But it doesn't end there. We also had a buddy system that said, "Hey, you're going to be buddied with somebody." Because when you go through a period of time where you're unconsciously incompetent to consciously incompetent, it's hard to tell your supervisor. It's sometimes easier to tell your recruiter. And so you and it's definitely easier to tell a colleague. So 30, 60, 90day check-ins. And you know, nothing happens by accident. It's on someone's calendar. How are you doing? Asking three questions. How much is the job we sold the actual job?
How are you doing? How can I help? And who's been helpful to you? Because then you can get excitement around thanking somebody else. And when you thank somebody else in the organization, they feel appreciated and they stay. And then probably the last piece is just the whole piece of training. So we built a training program. So, if you think about the stages of that, it was like, are we recruiting the right candidates? We built a profile and I'll tell you what exciting things happened. How do we help you be successful in the first 90 days?
30, 60, 90day check-ins with a buddy with intentional questions that are scheduled. And then, do you have the tools and equipment to do your job? So, that we're constantly making sure our training programs come from the people who do the work. And as a result of that we we improved our turnaround to less than 20% turnover. Wow. Which is amazing. Amazing. Yeah. In the ABA side on the registered behavior tech side, the behavior tech side, we did a very similar thing. Profile buddy program, training program.
And those individuals are early career, so they probably won't stay with you long term. But we did a career path, a career pathing ladder that allowed them to be to see a progression from the role that they're in to, you know, they get to start a role, then they get to onboard a new person, then they get to supervise other RBTs, and so they could see themselves in their career path. And as a result, our average time that people stayed were about six months longer than the national, and that had a very significant impact.
But what was even more exciting is those people if they left and said, "Hey, like my summer stint's over. I'm going back to university." They would often recommend a friend. Yeah. Yeah. You know, Lorraine, on the 30 6090 day, did you find that staff really engaged in that and were really sometimes and if you don't stop them at 30, 60, 90, things just build and build and build. Where when you stop them and they really have to think, did you find that they were able to get things off their chest, fix things, and then move forward?
Yeah. And there's one other thing, too. So, I'm going to give full credit Many many years ago, I read a book called Hardwiring Excellence and Quinn Stutter, if you've never met him or never seen any of his work, he's doing some great work on the human capital ecosystem right now, which full credit relational efficiencies. So like my business cares about making it easier for me, relationship with your supervisor, relationship with your co-worker, training and onboarding. And so the answer is yes. I the second thing that we did in the ABA business which I think is even more important is a meaningful weekly check-in with my manager.
And this is 15 minutes of like what are you working on this week? How can I help you? Anything else you need? Right? And people need it and want it and you just have to schedule it and make a commitment to it. Because the story people make up or the minute they go home feeling I'm not being successful and I have no forum to express that and nobody really cares is when you lose them. Lorraine, you have solved a lot of people's problems out there today.
I know this is just the start and but I think if many of you out there you know will take some of these strategies and put them to good use I know you'll have some success. Lorraine, I want to thank you for coming on today and sharing these strategies with us. And we appreciate it and st stay tuned because we'll definitely get you back on again. I appreciate it. Oh, well, such a pleasure to be here and it's a gift because the thing I like to talk about the most is people and how important they are to what we're trying to achieve in this world.
And I just really feel grateful that you gave me the space. And hey, I look forward to when we get together and we talk about this in a forum and we learn from each other because it's a problem that the world needs us to solve. Absolutely. Absolutely. No, we can we can feel how dedicated this for sure. And for all of you out there today who have listened today, we appreciate it. And if you have any questions about the discussion that I had with Lorraine today, click below and let's talk. Have a great rest of your day.
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