News & Articles

Title: Adaptation
Title: CEO's Job
posted by MVI | May 5 2020 - 11:42am

So far, my biggest take-away from Hospice’s response to COVID-19 is the rate at which Hospice ADAPTED. I am so proud of my friends in Hospice and how quickly they learned, taught, moved and changed to meet the needs of their patients and staff. And a corollary to this: Hospices I work with are already planning how to work within their expectation of the next-new-normal. One CEO told me last week, “We were so thankful for the teaching MVI gave to us. We adapted our systems and processes within our Model.” She’s remained operationally profitable and her staff and patients are happy.

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CEO's Job
posted by MVI | Apr 22 2020 - 12:02pm

Andrew says the job of the CEO is to create the "Conditions for Success" for her staff.I was with an organization once during what Andrew calls my "professional obligation". I told the CEO that her HR person needed to learn how to recruit in the digital age. Explosion. Face red. Outside voice in a small conference room. The thing is everyone else in the organization already knew this. The CEO tolerated, no perpetuated, a system that was ALWAYS significantly undestaffed, always underpaid market wages and always took months to go from staffing need to position filled.

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COVID-19 Exposes a Truth
posted by MVI | Apr 22 2020 - 11:52am

Just the other day, we were in a meeting with a client, and he says, "COVID has exposed our indirects." He went on to say that some of his indirect staff who are presently working from home are finished with their work much sooner than when they're in the office. What does this mean?

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Too True Horror Stories
posted by MVI | Apr 16 2020 - 12:21pm


Story 1:
First the backstory. In 2018 a good client called us with a CYMA issue. A report is fuzzy. Don’t know why. It just is. It’s legible, but just a hair fuzzy. So the accounting team swings into action. All focus goes to this report. Phones calls and emails fire between client, MVI and CYMA over two days. Nothing gets resolved because CYMA crack support team hasn’t a clue.

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Things I have seen that might be true
posted by MVI | Apr 16 2020 - 12:11pm
  • Hospice CEOs would rather hold on to poorly performing leaders than go through the pain of replacing them.
  • We’re more afraid of our nurses than we are of bad CAHPs scores.
  • It’s easier to play the “greed” card against for-profit Hospices than to fix our Hospice.
  • Wouldn’t you think that “shared-services” Hospices would be more profitable than the average Hospice?
  • A little bit of Hospice died when “smart” people took over.

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Just a question . . .
posted by MVI | Apr 15 2020 - 12:23pm

When I help Hospice build their Model, we always talk caseloads and visit models. I always ask what the “right” number of visits is for a nurse. And, predictably, I always get 20 to 22 visits a week. Like clockwork. They say that, but do they believe that?

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Three Accountability Systems
posted by MVI | Apr 15 2020 - 12:04pm

Three Accountability Systems


I’m sure there are more than three legal accountability systems we can use to tie performance to standards. I teach three. I want to know more. Here are the three I teach.

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Toward a more peaceful organization
posted by MVI | Apr 15 2020 - 12:01pm

It was an offhand comment, but quite powerful to me. We were talking about how her organization had changed in the past two and half years since we began implementing the Model. She’s the Director of Clinical Services for an organization in Southwest. When we started working closely, they were at 85 average daily census and today they’re over 150. But that wasn’t what she was talking about.

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Your Numbers are your Truth
posted by MVI | Jul 18 2019 - 5:00pm
Which is better, to run a Hospice with a census of 30 with top CAHPS scores or to run a giant 1000 ADC Hospice with mediocre scores? Which Executive Director gets more respect at big Hospice association events?
Here’s what we have learned: When you focus on the visit first, your quality first, then your other numbers fall into place.
Two examples I saw just last month at large Hospice organizations.

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Watch out for "Smart" people
posted by MVI | Feb 5 2019 - 8:48am

This ain’t rocket science. Stop hiring smart
people. They just mess up your system.

We have a benign inside joke at MVI. When we say a
CFO, or some other Manager, is a “smart” person, we
are really saying this person is too smart for their own
good. Hospice is full of highly intelligent people who
stumble over simplicity. As predictable as a Hallmark
movie, they add layers of complexity, requiring more
and more staff . . . and provides less actionable
information to prove how smart they are.

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“Andrew, thank you for being a GREAT TEACHER! The information and ideas that you presented have impacted my professional and personal life… Your enthusiasm and motivation are contagious! I can’t wait to develop Standards, implement System7 and make Mountain Valley Hospice the best ever! The ripple effect will impact many people, employees, patients and families. Thank you! WOW!”


Anna Marie Hoyer, Mountain Valley Hospice