David Jarrard, Chairman of Jarrard, Inc.: Keeping The Human Touch In The Age of Digital Communications

Van Ton-Quinlivan: Welcome to WorkforceRx with Futuro Health where future-focused leaders in education, workforce development, and healthcare explore new innovations and approaches. I’m your host, Van Ton-Quinlivan, CEO of Futuro Health.

Because of the critical role they play in our lives, healthcare organizations receive a lot of scrutiny from journalists, policymakers, employees, and others, so it’s critically important for them to be able to communicate effectively. More than 1,000 healthcare organizations across forty-five states have turned to my guest, David Jarrard, for expert communications guidance on restructurings and other complex issues. We’re going to tap into that wealth of knowledge today to understand some key elements to communications success.

David founded and led a firm which carries his own name, Jarrard, which became the nation’s leading strategic communications consultancy in healthcare. And I want to note that Futuro Health partnered with his firm on promoting a training program for in-home and community-based caregivers of older adults through CalGrows grant which we received from the California Department of Aging.

Thanks so much for joining us today, David.

David Jarrard: Oh, thank you for the invitation and for the opportunity to work with you and Futuro Health as well. I appreciate this time with you.

Van: Absolutely. Well, the mission of Jarrad is, as you have explained to me, to make healthcare better. You come at this work from the perspective of trust and storytelling, and I was wondering if you could just elaborate for us what that means.

David: It means we recognize the power of storytelling — which I know is common parlance in business today — but particularly in healthcare, the stories are powerful and  compelling. So, we work with our clients to tap that power to do what they need to get done, which can be to provide care of course to their patients and their customers, but also to energize their workforce so they reflect the calling that they have together to serve.

Stories are interesting things, we think. They slip around the defenses that we all have through which we filter information and make decisions. When you tell somebody a story, you’re drawn along in the stream in an emotional way and in bringing those emotions to communications makes it sticky, makes it palatable and makes it something that you want to be part of. So we enjoy working in story to help our clients move forward.

Van: I was wondering, David, does the storytelling change or how it’s told change given how digital we are nowadays?

David: It does. It does. The medium can certainly reflect and affect the message that you tell. A video story is different than a speech that you’re going to give. But the need to share from your heart and elements in real life is fundamental to drawing audiences along with you in whatever form, whether it’s a series of fifteen tweets, one after another, that build to a climax and then a conclusion in a story or whether you’re delivering fifteen slides on a PowerPoint before a small group of people.

We work with so many people in healthcare who come to it from a clinical background or a financial background and so then stories are like Excel spreadsheets or data reports and they’ll put up slides with variances and numbers in it and think that tells the story. They find that it doesn’t work with audiences, it doesn’t land. But when they say, ‘because of these numbers, we’re able to care for this mother better and faster; this child was able to walk or recover better and faster; this family is able to go back to work and generate income and feed themselves’…connecting the data and some of the clinical elements of healthcare to actually the experience that patients have or that employees can have turns it into a story that is compelling. So, we help them make that translation between what they’re very comfortable with and what they want to accomplish.

Van: That’s a very good tutorial, so thank you for that. Now, I mentioned that you work with over 1,000 healthcare organizations across forty-five states. Can you tell us what you’ve been hearing about workforce development and their workforce pain points?

David: Oh my gosh, workforce pain points…workforce is the pain point for healthcare today. When we ask leaders of healthcare systems what keeps them up at night, it has been this way for a long way, but particularly in Covid and since Covid, it is the number one issue. Workforce of course is a big umbrella. It covers a lot of things, but it includes recruiting the best talent, find the best talent, and then retaining the best talent in their organizations. And retaining certainly includes the kind of elements you would think about: compensation has to be right, the experience has to be right, the workflow, the days that folks can work are right, but it’s more than that.

There’s an experience of working now that is important to every employee and particularly those folks who are just now onboarding and entering the workforce. One of the things that’s changed is the demand is greater than the volume of folks who are there to meet it and so new nurses and new people entering healthcare have choices. It’s a competitive marketplace that didn’t exist ten years ago or five years ago. And so being competitive in the experience of working is a challenge particularly for traditional healthcare systems. So, answering that call, answering that need is easily the number one issue facing healthcare systems today.

Van: And so when you have these private conversations with these leaders, are they at the point of taking action or what are some thematic actions that they’re taking David?

David: Well, they certainly are and some are the kind of things that you could easily anticipate:  what can we do for compensation, how can we change vacation days or PTO or some of the more structural elements of the environment. But they’re also hearing the small things that matter in the experience of working in a hospital or health system, for example, and there might be things that you might easily dismiss if you’re not working at a nurse’s station every day. It’s things like, are the supplies that I need easy to get to? Are the towels here? Do I have bathroom breaks that I can take? Are there enough nurses for the patients that I have to serve? Sometimes very fundamental things can make a really significant difference in the experience people have working in an organization.

The leaders we work with, particularly those that are very sensitive to this, are engaging not just in the compensation questions but the work experience issues such as ‘where are the towels, where are the supplies, where are the masks, are they readily available to me.’ It makes a difference.

Van: That’s interesting because it sounds like the small issues are stacking up.

David: They are stacking up in a competitive environment when nurses — and when I say nurses, I mean clinical workers writ large — have choices. They can go across the street not just for a different hourly rate, but for a different work environment. It can make a significant difference. I’ll include, for example, parking. If you have to take three shuttles to get to your work because you’re in a downtown environment or academic environment or other environment where parking is limited, it can make a significant difference. If you have to add 30 minutes to the beginning and end of your day to get to work on time and get back home where in a different environment you can drive right up to the front door, it makes a difference in deciding not just what your work life is going to be, but what your life is going to be.

We have found on the other side of the pandemic — and not just in healthcare but in other industries too — people are approaching work with different filters. I mean, they’re measuring it sometimes in different ways. What do I want not just out of work, but what I want out of my life, what I want my daily experience to be? And we find smart healthcare leaders are taking that into account.

Van: It sounds like the temperament of the workforce is less forgiving when it comes to these small issues. So, what are some missteps that you see leaders make when it comes to engaging the workforce writ large?

David: Well, certainly ignoring some of the issues that we’ve just discussed. But one we find repeatedly is the difference between communicating to your workforce and engaging with them. Traditionally, the work has been top-down: communication leadership says this, they send a memo that says that, and they think communication has happened. The difference we find today is that the workforce is expecting a level of engagement or dialogue or conversation to take place and in a conversation or dialogue, leadership initiates a conversation and then the workforce gets to talk back. They get to share.

It doesn’t mean everything has to be a coffee conversation, but there’s using digital media, working through the management structure, even through nurses stations and other avenues…there’s ways for ideas to be shared back and forth so that even if the ideas that are shared aren’t the ones that are adopted, there was a sense of being heard, a sense of being listened to. That is an accelerator of a sense of engagement. It takes longer if you’re in leadership, it takes more work, you have to be more deliberate about it, you have to build in time for the give and take to occur. But the result is a more rooted, more grounded workforce for your organization. We have found it to be extremely valuable to retention and the sort of long-term commitment of your workforce to your organization.

Van: So, when leaders strive to be present, visible, engage and have these two-way dialogues, what kind of coaching do they normally need so that they have the right balance of presence and engagement? I’m sure there’s a range of feedback that they get, too. So, how do they balance all that?

David: Balance is such a good word because it’s not abdicating the need for leadership that any organization has or the need for leadership that a workforce has with being heard, seen and paid attention to. It’s not one or the other and sometimes leadership teams misunderstand that. They think they’re abdicating leadership by leading an engaged workforce. It’s a yin and yang. You’ve got to be able to bring both. For some schools of thought, you lead a certain way all the time and you never change your tenor or tempo or approach. And in fact, particularly in this sort of very agile workforce that we’re in as a leader, you’re listening all the time and you’re adjusting what you’re doing and how you’re doing it and how you’re leading conversations to the audience or to the moment, which is a lot of work.

It’s easy to just fire and forget, that ‘this is the way we do it.’ This is the rhythm of the conversations, this is decisions that we make and the way we make them because it’s the way we’ve always done it. It can be very safe and very…I don’t know, thoughtless in the approach. Today’s workforce demands thinking. It demands a kind of engagement from leadership that directs when the time is right for providing direction, but also listens and builds consensus when it’s time for listening and building consensus. It’s the ebb and flow that has sped up on the other side of the pandemic that I think is a challenge to leadership today.

You mentioned the word presence. I want to emphasize that as well. Part of the great value of digital media is how fast and how pervasive it is. It’s fast and furious and chaotic and can be very valuable at communicating quickly to a lot of people with great speed and really important in healthcare and a bunch of other industries as well. But the cost of that is it can become very impersonal or you can become very distant from the humanness of leadership or understanding the humanness of a workforce. So, in addition to using all the great tools that are there and leaning into the latest and best, we certainly advise leadership to get out of the office, get out of the suite C-suite, get out of the first floor, the fifth floor, wherever you are, and walk the halls. It’s old school stuff.

It’s rounding, it’s sitting in the cafeteria knowing people are there that can come and sit down and talk with you. It’s shaking hands with people, that palm to palm contact. It makes a significant difference. It’s not necessarily an effective tool in communicating a data point — this is now the new mandatory overtime procedures and blah, blah, blah — there are plenty of ways to share data, but to build trust and to build credibility, you’ve got to look somebody in the eye. You’ve got to shake their hands. You got to be slow and attentive. You got to have that moment of pause where you can actually hear and be in the presence of another person.

It’s costly because it takes time and it means that you’re paying attention to that floor or that unit or that group of nurses or employees instead of working that spreadsheet, filling out the forms, getting the machinery working. But the cost is a fundamentally important investment right now. I think people leave work now, leave jobs because they’re looking for that sense of connection in a world that is more and more disconnected. It’s a competitive advantage.

Van: And David, when you coach someone to walk the halls, how does it work in a distributed work environment or let’s say they have a lot of facilities. Is there a way to think through how to prioritize which halls you walk in?

David: Sure. It’s a really good question because in complex organizations, there’s a whole hierarchy of leaders. When we say leaders, some people sometimes think, well, if you don’t have a C -suite title next to your name, then you’re not a leader. Not true. In fact, we find particularly in healthcare, which is our specialty, that the most trusted leaders have shared peer connections and the managers that are closest to them. For instance, the nurse manager or the nurse director if we’re talking about nurses. So, when we’re talking about walking around, certainly the C-suite should visit occasionally and have those intimate moments and bring pizza to the nurses working the night shift and take ice cream to the ER at the right moment — that can be good if it’s not disingenuous, which is another conversation we can have — but it’s the managers and nurses who need to slow down and walk the halls.

It’s a challenge for mid-level managers and directors, by the way, because they have been nurses before and they know how busy their peers are and how busy they are just to get the job done. We need to redefine what that job is so they can have the freedom and the comfort of slowing down so they can make that connection.

Sometimes we find the mistake is, particularly at the mid-levels, a great sense of assumption that since I just did this job two years ago or three years ago, I know what the job is, I know what the pressures are, I know who you are and what you’re feeling. Now, it’s not true. It may be somewhat true but not fully. And the danger of assumption is we can make decisions and send folks in directions that are not helpful to them or the organization, and it can actually be costly. The world is changing and the workforce is changing very rapidly. So to go get that real time information and data is vitally important, I think, to being able to make the decisions that you want to make.

Van: So, it seems like on a weekly basis, I see news feeds that talk about mergers and acquisitions happening in the healthcare sector as entities partner with each other due to financial needs. I’m sure that is a big challenge in terms of managing all the diverse stakeholders, including patients, employees and the communities, especially when they have an established brand that is being disrupted by the change in ownership. David, what is happening here? What’s your observation?

David: Well, the healthcare world is consolidating. It’s folding together because as big as some healthcare providers are, in the scheme of healthcare — which is a most trillion dollar industry — health systems are still mom and pop organizations. They’re still small compared to let’s say Optum or a large insurance company. They pale in comparison. And so we’re finding the industry is continuing its path to consolidate, to come together and build strength through numbers. It was a trend before the pandemic. The pandemic has accelerated that.

So, we see not only more consolidations, but we see bigger consolidations, bigger organizations coming together, and that’s going to continue. There has been chatter for years in our industry that at some point in the future — ten years or twenty-five years — there’ll only be like five or ten healthcare systems in the country that will create some market strength and scale that will allow us to compete with and be a true sort of marketplace partner with the payers in healthcare and others. I don’t know if it’ll end up that small, but I think healthcare at the end of the day is pretty local. And actually it’s so local, it comes down to the hands that touch the body in the ER.

Here’s the mistake we find often in consolidation is the leaders of organizations hold the information about the possible merger or partnership so close that when it’s revealed or announced, it’s a surprise. It’s a shock as if no nurse or no doctor or no one in the community has seen healthcare coming together or that healthcare is dysfunctional and needs a solution. In a sense, it’s almost disrespectful to the very people who deliver care. Our strong advice is if an organization is considering and has begun the path for consolidation, to begin that conversation now with the people who actually deliver the care. You have to make the case for why consolidation or merging or partnering is the right thing to do, why it’s needed. Because if it’s not needed, then why do it?

So, you have to create the sense of the need. You have to explain your business case and not just in the numbers, but in that emotional sense. ‘Here’s what we’re not able to do if we remain on this course; here’s what we can do if we partner; here’s what we want to do because it’s a fulfillment of our mission’ and then begin to talk about ‘here are the steps that we’re taking. Here’s the criteria that we have in place. Here’s the only things that we’ll accept if we do partner, and then ultimately, here’s the partnership and here’s what it means for you, and here’s what it means for you as an individual member of the workforce.’ This is a step we see so many people miss.

They’ll say, here’s what it means for us as a healthcare system: we’ll be able to hit these numbers, we’re able to open these clinics, we’re able to sustain the continual operation of these hospitals or whatever. But there’s another step, which is a fundamental step, which is here’s what it means for you on this unit, on this floor, or for these waiting rooms. You’ve got to bring it down to the personal level until folks feel some sense of security in their own path and their own ability, frankly, to feed their family, send their kids to school. It’s hard for them to hear any other attributes that are part of the fix of this dysfunction that’s in healthcare. So, start there. Start with the people who matter most.

Van: David, you’re laying out a future of care that is consolidated, so let me tie that back to the issue of workforce and human capital development. Those who are listening to this podcast come from the education and workforce side of the world, as well as people who are in healthcare who care about these issues. So, if you are going to intersect this future that is a consolidated future of care, what advice would you have for us? What are things to think about?

David: There are several. The opportunities for folks entering healthcare — for new nurses, new clinicians, new staff — are going to be significant and varied. I mean, there may have been a time in the past when the options were pretty clear — I’m going to work in a doctor’s office, I’m going to work in a clinic, I’m going to work in a hospital — and the models were we’re pretty well defined. That is evolving. The options can range from working in an outpatient setting in a variety of ways, working in homes and delivering care and to working in traditional structures. Understanding and having good conversations about the opportunities and challenges of each can be really important as people decide what career path they want to choose. That’s thought one.

Thought two is, as you and I have just been discussing, this is a very dynamic industry and I would encourage new professionals entering the workforce to be flexible, to be fluid. Some folks know very early on in their lives and career, this is what I want to do and this is the path I’m going to take forever, and I’ll stay on that path until I’m sixty-five.  God bless ’em. I don’t know who those people are, but God bless ’em. But the world is going to shift. Where you and I are talking about healthcare today, it’s going to be different in twenty-four months and forty-eight months. Feeling confident to surf and ride that wave will be very helpful in how you think about your career and what success looks like.

Every piece of that education that you’re going to have as you enter the workforce is new information that will shape the professional that you’re going to become. Having that receptivity to experience as part of your continuing education throughout your career will be invaluable to you. That’s less of a course that I could offer for an academic or university that’s teaching new clinician today, but it is a mindset that I think is crucially important. Those that have that sort of malleable mind about the future are going to find great success.

Van: It sounds like the mindset is all about versatility and being able to flex the environment, but also the skillsets or the roles that you go in as healthcare changes.

David: Yes, very much the versatility in the willingness to learn. There’s a core element that we find in healthcare, which is what attracts us to it that is an important element that we feel to everyone in the workforce, and that is the sense of calling or the sense of mission that caregivers bring to it. Everything we’ve described about consolidation and versatility and agility can be very exciting and important because healthcare I think is broken and needs to be redefined and the pieces are laying all over the floor and so we’ve got to assemble this new jigsaw puzzle That’s exciting if you’re an entrepreneur, it’s exciting if you have a versatile agile mind. It can be chaotic and frightening and exhausting if you don’t. You’re expecting stability. This is going to be a challenging work environment for you.

So what is the stability in the midst of chaos? It’s your calling. It’s your mission of remembering why you answered the call of this profession. What’s your deeper mission is fundamentally important in healthcare today. That’s true for the individual — the doctor and the nurse and the tech and the clinician — and it’s true for organizations, too. I don’t know of the health systems whose mission is to have a big building, to have a big square box. ‘Our mission is to have this machine and this many floors.’ It’s not about the buildings, it’s not about the structure, it’s not about how we define the expression of healthcare. It’s a healing mission. It’s a journey to bring a better way of being for individuals and how we do that is changing and we need caregivers who are answering that call today.

Van: So David, I was in Arizona recently at a forum that gathered healthcare CEOs and their boards of trustees. It was hosted by the Healthcare Management Academy and the topic of nonprofit or tax exempt status came up. There’s increasing scrutiny on these charity care practices of nonprofit hospitals. I was wondering if you can give us some context on that

David: Well, you’re certainly right. It is an energetic conversation today. This is where not-for-profit health systems, which is most health systems, are being challenged to demonstrate that they are in fact earning their tax exempt status. You don’t pay taxes, but in return, ideally, that means you’re providing charity care or you’re doing something like medical education that improves the delivery of care in your community and takes care of those who can’t take care of themselves. And health systems, as we discussed earlier, are big in many communities. They’re the biggest buildings and there’s cranes going up because there’s more buildings being built. So it seems like they have a lot of money. What are you doing to earn this tax status? So, a lot of folks are bringing questions about it.

I think there’s a couple of things at play here up close. Some of this is just driven by the cost of care. Healthcare is just unbelievably expensive, and we’ve been protected from it for years by insurance so that’s kept us from having consumers absorb the direct cost of care. But insurance has become more expensive and that cost has shifted to consumers so the cost of care has become truly an impactful economic decision that consumers are dealing with. When pollsters ask voters, what are the things that are on your mind? What are you going to vote on? What are the things that are going to drive how you vote? The economy is certainly there, foreign affairs is certainly there, but healthcare and specifically the cost of care is a weighted, heavy and burden that people carry. I mean, you and I probably both know people who’ve stayed in their jobs only because they’re able to keep their healthcare insurance because they’ve been afraid to do something else.

That fear, which is a palatable and not unreasonable fear, is a challenge that leads to this kind of conversation about the size of healthcare systems and what are you doing with the amount of money that you’re getting. We can have a conversation about whether the healthcare systems are actually responsible for the high cost of care, but they are in the center of the spotlight. And if you’re a health system, in most cases, in 99% of the cases, you are doing everything you can to fulfill your mission and care for every soul that comes into your circle and that means paying nurses enough compensation and hiring enough nurses, enough clinicians, enough doctors, having enough examination rooms to provide that care. There’s a cost to that and it’s not getting cheaper. We’ve all seen the labor conversations that have increased the wages of nurses and clinicians and staffs over the last several years, and rightly so. As healthcare becomes more competitive, the cost of providing that care goes up, then the cost of care itself goes up and we go deeper, deeper into this broken thing. So that’s happening up close.

If we pull back a little bit beyond the cost of care, I think there’s a greater conversation about the brokenness of the delivery of care, and not just the delivery of care, but healthcare itself. And let’s bring pharma and insurance expenses and actually healthcare delivery itself into that conversation. We see it over and over again as media and lawmakers and regulators begin to lean in and look closely about what healthcare actually is versus how we envision it should be. This is the way healthcare should be. It should be delivered like this. Ideally it should be delivered like that, and when in fact it’s not, when in fact the rules and regulations require certain things in a variety of both delivery mechanisms, but also way of accounting for that care, there’s a great disconnect and great sense of the brokenness of it. And please don’t ask me what’s the solution? I don’t have a solution, but I can tell you just as an observer, there’s the day-to-day sort of examination of the way the levers and pulleys are working, but there’s a bigger question about what are we doing? Can’t we just take care of our people? Is there a better way to do this? I think that’s the question that’s driving so much of this.

Van: I won’t ask you that question, but let’s end with not an easy question.  I hear a lot of conversations about health equity and a commitment to health equity. And so in light of all of these trends that you’ve laid out, what’s your advice in terms of identifying when the commitment to health equity is authentic?

David: It’s a very timely question. I think the word equity itself has gotten caught up in a whole vocabulary challenge I think that we’ve certainly seen recently play out in other venues related to diversity and inclusiveness in a very politicized environment. So, it’s sometimes hard to have this conversation. What we find is when health systems think about equitable delivery of care, they’re often thinking externally about the populations that are underserved in their market and they’re doing their level best to identify those, not just the populations, but the services those populations need, and to bring those services to them. There’s great sort of effort to make the delivery and access to care equitable. And then the other element, of course, is as those underrepresented or underserved populations access their system, that they’re welcomed into it, that they understand that there’s barriers. It may be how do I pay for care? How do I even frankly get to care in a way that I can access it? So sometimes it’s not the delivery care — meaning are there enough machines and enough nurses — it’s about has access of care itself been made equitable so that the people who need it can actually access it?

Van: Well, that’s a great way to end. Thank you so much, David, for sharing all of your insights and coaching us on elements of the healthcare industry. Thank you for being with us today.

David: Thanks you very much. And thank you for the work you’re doing to bring this workforce to the delivery of healthcare. It’s so needed today.

Van: I’m Van Ton-Quinlivan with Futuro Health. Thanks for checking out this episode of WorkforceRx. I hope you’ll join us again as we continue to explore how to create a future focused workforce in America.