When Larry Kraska became CEO of Interim HealthCare in 2016, he did not have an extensive background in home health care. However, he had spent his whole career in various parts of the health care system, gaining particular expertise in workforce recruitment and retention—and staffing issues are routinely cited as the most pressing problems facing home health care providers today.
Since joining Interim, Kraska has focused on helping the company rise to labor-related industry challenges such as a caregiver shortage. Founded in 1966, Interim today employs more than 43,000 people across 44 states. The company operates on a franchise model and offers a range of home care services as well as hospice, in-home therapy, and a contract staffing business.
For the latest episode of Disrupt, Kraska spoke with Home Health Care News about his time leading a large hospital staffing company, why it’s important to create a “VIP” on-boarding experience for new hires, and Interim’s overall approach to gaining a competitive advantage through its workforce.
On studying psychology and business at Kennesaw State University near Atlanta:
When I entered college, I had no idea what I wanted to do with my career. I had a desire to possibly go to medical school or counseling, something working with people. About halfway through undergrad, I got very attracted to the business side and wanted to move into the business side of health care … my decision was to get my MBA and go into health care administration.
On his first job in health care:
As I was finishing up grad school and getting my first job, I was hired by National Medical Enterprises, which now is [hospital and medical system] Tenet.
I was fortunate because I came into that organization when there was a really great executive in the Atlanta market, Brent Bryson. He gave me an opportunity to learn the different departments of the hospital and go through a training program to learn what it would take to become a hospital administrator.
I figured I would go right into finance or accounting or program management, but my first boss in the hospital was a nurse. [Bryson] felt you had to learn how a hospital operates and health care works, and the most important thing about a hospital is taking care of patients. I learned from the beginning it’s not about financial statements or having the best equipment. It’s about having the best clinical staff working for you.
Throughout my career … the key thing I’ve gone back to is, if you’re in health care, if you don’t have the best doctors, nurses and medical staff, you’re not going to have the best overall facility to treat patients. I think that’s very true about home care.
On what he learned from being CEO of Club Staffing, a major hospital and health care staffing company:
It was great training for me. I learned the importance of identifying candidates, matching them to the position, getting them hired to work for you at the clinic, and really focusing on retaining them. One of our critical success factors was, although we were a staffing company, we had people who worked for Club Staffing for two, three, five years. So, they didn’t view it as a temp job but as a career. The key importance of not just recruiting but really retention was one of the most critical things we did well to help us grow.
I think that was a foundational time in my career … learning how to create a competitive advantage with your workforce.
On the common thread among all his jobs in health care:
In many of those jobs … the common theme was they were all about executing on trying to get the best clinical staff to work for us and become the industry leader in a particular area of the market. The other common theme was these were all investor-backed companies, where the investors brought me in to try to get the company to the next level.
On bringing his workforce expertise to Interim:
In this business, everyone’s talking about … being able to provide home care efficiently and with great quality and great outcomes. I really believe in these [health care] businesses, whether home care, ER, staffing company, it all starts with recruiting and retaining the best clinicians … that’s been a big part of our vision.
We’re competing with retail, we’re competing with all sorts of other industries for part of our workforce, but then on the nursing side, we’re competing for great nurses with hospitals and skilled nursing facilities, assisted living facilities. So it’s a very competitive time in our industry and we think that if you don’t execute on the recruiting, retention and onboarding piece of the business, everything else you’re doing is going to be affected.
On Interim’s three focus areas for staffing:
When I met with the owners in the first 90 days with the company, everyone talked about the challenge of being able to recruit enough people … As the franchisor, our job is to support our owners—and we’ve got great owners across the country—our job is to dig in and try to find out what the true issue is. As you talk to folks across our industry, even our competitors, everyone’s talking about recruiting. Recruiting’s only part of the issue. We believe there are three areas we need to focus on.
Recruiting is attracting people who want to work for Interim and want to be in the industry. The second piece is the on-boarding piece, so as we’re bringing them into the company, we’re really helping them understand why this is a great place to work. And the third piece is retention. I think a lot of executives, a lot of my colleagues I talk to, they get the recruiting and retention piece, but when you talk to people at the desk level, who are dealing with it every day, they view the problem often as being a recruiting issue and don’t always remember the retention piece is so important. Because if you hire 500 people, and a year later, you only have 50 and 400 have left to go to retail or a competitor, it’s a revolving door.
The on-boarding we view as equally important, because once [hires] are identified, we want to make sure that once they join the company, they really understand the culture and history of Interim, and that they’re attracted to our company and what makes our brand so strong, with the care we provide. We think that leads to better retention. We track retention very carefully.
On creating VIP-style on-boarding:
Looking across multiple areas of health care, when you look at the nursing shortage and physician shortage, there are many companies across the country that hire permanent placement firms to find a surgeon or go find a cardiologist to come to their hospital … they spend large amounts of money to do permanent placement with these doctors and put a lot of money into the recruiting piece. The doctor joins the medical staff, comes on board, and they just blend in with the medical staff. I’ve seen the same thing across the country with nurses, where hospitals will compete very hard to get a nurse, offer them a sign-on bonus, bring them on board, and within a matter of months, they’re just blended into the schedule, working shifts like everybody else.
I’ve worked with teams in the businesses I’ve been in, and we’re doing the same thing at Interim, we want to attract the best talent that we possibly can and be competitive in every way to get people interested in the company. Once they join, that’s not the end of it. We don’t want to get them through orientation and put them out in the field to work a shift. We think there’s a big difference between on-boarding and orientation. Orientation is part of on-boarding, but it’s not the whole thing. On-boarding is showing the workforce that’s coming into your company why we really believe that what they do makes a major difference. They’re the ones taking care of patients every day … they’re the brand.
That first period they’re with the company, it’s almost creating a VIP experience for why we really value them and why they’re so important, rather than get them through orientation and get them out to start working and taking care of patients.
On taking care of top performers:
I learned in the staffing industry, employers are always looking at why people leave. Did they leave former money? Because they weren’t happy with their boss? Another way to look at it is, you also need to look at why people stay. People that are your best employees, that have been with you for multiple years.
Rather than trying to make that group happy that went for $1 an hour more to work somewhere else, you need to really pay attention and take care of the people who have been with you and learn about what you’re doing well with those people, so you can do more of that in your training … We still look at why people leave, but that’s not the key focus.
On why workers stay with Interim:
As you talk to owners across the country, there are different answers …
I was in an office a couple weeks ago, and the entire wall of the training room was entirely filled with thank you notes from families whose lives they’ve touched … parents, grandparents, sometimes even the client they’ve served. Imagine joining a company, and you walk in, and the first thing you see are these examples of how the work they do every day makes a difference in the community. That’s just a small example of the pride the owners take in the work they’re doing.
Written by Tim Mullaney