Leaving the LTC100, you could almost feel the ground starting to shake – and you can really feel it.

It is scary for most of us mere mortals who do not have a crystal ball to consider questions like: What is the real rate of change? How much risk can you tolerate? How does operational fatigue play into it all? And how do you get your team on the same page anymore while continuing to focus on core fundamentals that get harder daily, new mental modes required to assess the future, and the cultural implications on all of your stakeholders who just need to provide great care to the more complicated residents, 24/7?

Personally, I could see Anita M. McGahan’s framework of Industry Cycles of Change in many sidebar conversations, even if they did not know they were using it!

There are really too many conferences with spins on same themes, so many talking heads everywhere around us that could operate a lemonade stand, and the plethora of online healthcare futurist bloggers telling us we are all screwed in the end, that we should give up and go into medical tourism.

I ask myself often, ‘how many futurists can you trust without just giving up and throwing in your towel (or in my place, the keys), anyway?’

There seem to be only four distinct schools of thought circling around post-acute providers that I know intimately with no clear, absolute boundaries between them.

Heck, with leadership turnover at many shops, hospital C-suites changing rapidly, and REITs getting scared of future rent collectibility in many tired and dated centers, I always say just pick one that you believe in your heart and go with it.

The schools of thought I run into often…

• School 1 – When we do the basics of quality, post-acute services will be chased by everyone so keep it simple, be a late adopter and in the end they need you anyway. Keep solid surveys, keep your team on fundamentals, squeeze your last liquidity left in the core business of fee-for-service and the other vertical healthcare providers will help pay you to convert later?
• School 2 – We must be the first to embrace the new healthcare policy, new customer mindsets, and related technologies. Go ahead and grab the ‘halo effect’ and brand equity, because they all need to find innovative providers. During that vetting period, your team can learn things like rapid prototype options and innovation frameworks, and by trying many versions, you will be the first to figure it out. You know your core business is declining daily, so why wait? Recreate like the Blue Ocean framework taught us.
• School 3 – What the heck is going on? Heightened regulatory scrutiny, closing networks, hundreds of new middlemen taking pounds of flesh soon, growing staffing challenges, just to name a few. These demands are getting insane and too risky too swallow. The provider has very little upside left – get the heck out of dodge and let one of these futurists or competitors who do not believe it will change buy us because the good days are over. Half of my close peer friends are thinking this way as we speak.
• School 4 – Our best days are ahead of us. Just ‘Andy Dufresne’ it, like Shawshank Redemption, because with digital paperless, EMR, hand-held technology, value-based alignment, gain sharing, more transparency, and lower costs, we are going to win big anyway!!! We will be ahead of surveyors finally, see customer activity virtually, and that old way was misaligned anyway. So let’s get on with it and finally make some real hay in a more aspiring way – because when it finally turns, it will be beautiful.

Here, where we are at the Revolution today, we try to live School of Thought #2, but every time we stumble big time, we revert back to School of Thought #1. But School of Thought #4 will make all of the pain turn to joy someday if we can just see the mountaintop.

There are so many mixed signals from external forces that make it challenging to get everyone on the same page, so over-communicate if time permits and don’t ever give up because they all need us even if they act like they don’t. We are still the most inexpensive service that no one ever wants, but many really need like never before.

‍