Miriam Allred (00:10)
Welcome back to the Home Care Strategy Lab. I'm your host, Miriam Allred. I am joined in the lab today by Emily Isbell, the founder and CEO of 24/7 Solutions. Emily, welcome to the lab.

Emily Isbell (00:22)
Thank you so much for having me, Miriam. I'm very excited to be here.

Miriam Allred (00:26)
Every time we get to talk like this, I look forward to it. I feel like I've learned more and more about you over the last couple of years, and I get a lot of just insights and value out of these conversations. And so you and I have been talking for a while now about this topic, and I'm really excited to like kind of hash it out in this conversation. Before we get into it, I think more and more people know you in the industry, but I personally love your backstory and where you started and...

some of the decisions you made that have led you to where you are today. So why don't we give everyone a little taste of your history and leading up to where you are and what you are up to today.

Emily Isbell (01:02)
Absolutely. So for those that don't know, I actually started in the home care industry in 2007. So I've been around for a while. I actually started as a caregiver when I was in college. And the short version of the story is that I decided to change my degree as a junior in college, add some more time to my college career. And then ⁓ all because I realized you could do a business in home care and helping seniors, something I thought that you just did on a volunteer basis.

didn't realize it was such a need. And so I actually talked to the owner of the franchise that I worked at and I asked him, I said, how can I do what you do one day? And through that conversation, he helped me in the degree change and what path I should take there. And then of course, took me under his wing and mentored me and I'm so thankful for that. So fast forward 14 years later, we had built the organizations that together into seven locations across three different states.

And we served throughout those seven locations, a million hours of care a year. So that's, that's my story when I was in home care operations. And then I always like to share, say, ⁓ in 2020, I feel like COVID pinched me, ⁓ so to speak, I was very grateful. I leaned into the fact that we were made essential and thankful for that with my team and so glad that we had jobs that we weren't told we had to stay home, but.

At the same time, it pinched me in the way that I had always wanted to be an entrepreneur. So even though I had built these businesses and done such great things, I knew that I still had that entrepreneurial itch. And so in 2021, I ended up starting this business after giving a long notice and working through a succession plan for the previous owner where I was working. And so in 2021, started 24 seven solutions. And today we have over

12 team members serving home care business owners, both in the US and internationally. And what's especially exciting today, Miriam, is I'm so glad to be doing this episode on the day that my audio book is being released. So the book is called The 24-7 Solution, its subtitle is Proven Strategies for Home Care Business Leaders. And I released that about a year and a half ago, two weeks after my youngest was born, which was

Quite the whirlwind. One of my friends said I birthed two babies at once, basically. ⁓ And so about a year and half ago, that came out on paper. And it's been such a success and a difference maker for so many home care business owners. But it was always, always said to me, you know, we're busy. We need this on audio. Please let us be able to hear it on audio. So after lots of recording sessions, I was able to record it. And I'm so excited that today it's being launched out for people to listen in on.

Miriam Allred (03:22)
Yeah.

Amazing. Congratulations on that. I have read the book and my two cents on it. It's no secret to anyone listening to this that I haven't run a home care business, but I read that book and here I was like highlighting, highlighting, highlighting. And when I finished, I thought, I actually think I could do this. Like you break it down so simply and there's so many like, you know me, I love formulas. I love structure strategies. It's like the book is like a blueprint and you read that book and there's something for everyone first and foremost.

If you're just starting out, that is your roadmap. If you're in it, there's like all of these like, you know, knobs and tips and tricks and advice that again, anyone can learn something from. And I love that it's an audio book. Here we are on a podcast. You know me all about audio formats. Like, of course there's a time and a place to sit down and read a book, but home care leaders are on the fly. They're driving to appointments. Like they're on the road quite a bit or traveling state to state as well. And so having an audio book is amazing. So did you say where people

I'm guessing it's on Audible on all the platforms. Amazing. Available today. I can't recommend it enough. I think everyone needs to read that book, especially those getting into home care, those have been doing it for a while. I've spent time with you and I know kind of your style and your personality. When I read the book, it was like, I'm talking to Emily. Like it's very much in your style and the way that you think about things and approach things. And so I just love, that's why reading is so special. It's like you get a...

Emily Isbell (04:53)
all the platforms. so wherever you listen to audio.

Miriam Allred (05:18)
walk into someone else's shoes and someone else's personality.

Emily Isbell (05:22)
Absolutely. Yeah. Well, I appreciate you saying that. I was nervous doing the audio recording. Still today, I'm like, my goodness, my country accents out there for all to hear. But at the same time, I do want it to be relatable and for people to feel like you felt that you can actually run this business and survive it. It's not not more than survive. You can thrive in it. So appreciate your.

Miriam Allred (05:44)
And just

to acknowledge your backstory, I love what you said and I think everyone, lot of people can relate to this. get into, they experience home care on a personal level in some shape or form. And then people learn, there's a business opportunity here. Like it's one thing to take care of a loved one. It's another thing to start a business and take care of other people's loved ones. And so I love that that was your path because so many leaders in home care today lived through a personal experience.

had good care or bad care, good experiences, bad experiences and think, I can do that better or I can have a much greater impact in helping a lot of families go through this.

Emily Isbell (06:24)
Yeah. And if you think back to 2007, it was a new idea. Thankfully, like today, we are actually getting a seat at the table. I think COVID helped in that regard that we actually were seen as essential as a part of the health care spectrum. And so, I was shocked that there was a way to make money, but it's also in such a good service, right? It's a necessary service. This isn't a greedy way to make money. It is providing a need that has a high demand.

you do it well, you can profit and have a good living from it.

Miriam Allred (06:57)
And you said that you grew to seven or eight offices across three states. Like you took a small operation to a large operation. And one of the things that you're becoming more more known for in the industry is management and leadership. And that is applicable to every single business. But what draws me to you into this topic is

the difference between managers and leaders and what good managers are and what good leaders are and what good managers aren't and good leaders aren't. Like we're gonna dissect that because you have lived through it firsthand. You've hired managers, you hired leaders, you currently have 12 leaders that are helping you support all these home care businesses. Like you have a lot of firsthand experience in this and you've made some comments to me recently that kind of stood out to me, you know, like.

There's a lot of good leaders in home care, but a lot of them kind of suck at managing. And so we're going to break that down what that actually means. So let's just start high level. Why is the leadership versus management a huge struggle for these home care agencies?

Emily Isbell (08:04)
So I want to start with just what I typically say about running a home care operation I have compared it to people that are outside of home care who friends family I Say it's like running a seven-minute mile Marathon, okay, so a marathon at seven-minute mile on a treadmill, which would be Underwater you add the water then that friction there so like it is just

It's intense, it's hard, it is not easy. Like that's the best way I've found to describe it, whether it makes sense or not, but for runners, they can understand that dread. And so I think we just have to be aware that the 24-7 home care business, the aspect of it being 24-7 is just tough. There's no ignoring that or making it not 24-7. I mean, I guess that is possible, but that wouldn't be providing the quality and meeting the demands that are out there. So. ⁓

I think first you just have to acknowledge it's tough. And so if you are leading or managing a home care business and you don't recognize it's tough, you're not going to sharpen your skills to be a better leader or manager in that environment. The other thing is when you start a brand new agency from scratch, you as the owner have this entrepreneurial dream. You're ready to, have that freedom that comes with entrepreneurship that they talk about.

⁓ but in reality, you have to wear all the hats. You're conducting phone screens for potential caregivers. meeting with family members. You're training new caregivers, dealing with caregivers, disappointing you and not showing up for their assignments. And then having to walk into a referral provider and say, we can handle this. We've got you. And, and with a huge smile and confidence. And it's just, I mean, behind the scenes, it's so tough. ⁓ and then after you get past wearing multiple hats and you grow to the point, you know, you survive.

survive those first six to 12 months or however long it might take you. ⁓ Then you're trying to find people who care enough about the business to do it well as if you were to do it. Right. Like the that whole entrepreneurial journey is ⁓ they say people don't care as much as as you ever will as an owner. And that's true. And yet you still to find people that can care enough to provide the quality that you want to provide and.

ensure the reputation that you want to ensure. And so you have that challenge. then, I mean, not to mention like the constant whack-a-mole, right? The fact that you came in today, you had all these plans to develop the next caregiver meeting agenda that you're hosting for all of your caregivers. And that's what's on your list. And suddenly you have a caregiver who's accused, personal story, accused of ⁓ punching a senior inside of the most ⁓

prestigious, don't know if that's the right word, but most well-known, proper, skilled nursing facility that has the best reputation in the industry, and your caregiver who's in her mid-70s is accused of punching a senior with Alzheimer's by one of the aides there. What? That was not on the bingo card that day. So you have that, and you're trying to run and manage and lead this home care agency.

I don't know about you, Miriam, but even in just talking about all that, like I'm already exhausted. I'm already ready to retire when it comes to running a home care operation.

Miriam Allred (11:27)
That's the underwater part. Everything

that you just said and then you end with a caregiver punching a senior, you're like, that is the reality. Those are the issues that actually arise. Yeah, you just listed this mountain of challenges and then it's like, and some, and there's even more. This is 24-7. It's so intense and no two days are the same. I've asked leaders,

that are running $2 million businesses and $100 million businesses. Does it get any easier? And they say, no, two days are the same.

Emily Isbell (12:00)
Right? Yeah. And you're so back to like the startup phase, you're in the startup phase, but yet you're supposed to establish policies and procedures and have these manuals. So clean cut and easy for anybody to onboard with and manage having a vision and strategy that puts you cast the vision for the next three years and having all that perfectly put in place with a bow on it. While again, you have a caregiver who's being accused of punching a senior facility.

Miriam Allred (12:28)
So let's break down management and the difference that it is to leadership because again, and we're gonna kind of swap back and forth between like startup mode and more established mode. But the thing that I want to point out is like, people are struggling with this in large businesses. Like what we're about to talk about today, and you know this better than anyone, $10 million companies, $30 million companies, they still have leaders that are caught in the management weeds. And so...

Again, we're going to kind of like bounce around on different like topics and sizes, but I think the underlying theme is that what management versus leadership is applicable at every single stage. So let's talk about managers first. What are home care managers getting wrong about management?

Emily Isbell (13:18)
Yeah. So before I answer that, I want to, I want to speak to what you just said about $10 million businesses. We've, we've consulted with clients that are large businesses and we get into the weeds of their, their data. And thankfully I have a team member, Matt, who's just, ⁓ I call him my numbers nerd cause he can help me, tease out what the numbers are saying even better than I can. And it's amazing what we learn with these larger businesses and all that we can say when we look at it is, man, they got, they've gotten lucky.

Like they've gotten to this size, honestly, out of pure luck. And so there are lots of, even when you get past the startup phase, there are a lot of things that are just, they're holding on barely. So yeah, I want to talk about management and kind of what people get wrong. think in my time doing consulting, so I've been doing this since 2021, and I'm starting to recognize, I'm sure there's other nuances to different types, but I really see that I can bucket.

the people who get management wrong into two different types. And the first is the set it and forget it managers. And so we'll dive into that a little bit too. But then the second is the, I'll just do it myself managers. That's the two types I see a lot that when we start to work with them, that's where they sit. They're in that category, either set it and forget it, or I'll just do it myself. And ⁓ as a general rule, I think the set it and forget it managers are the visionary type.

trapped, in my opinion, in the dreaming, in the bigger picture, where they want to go. And they kind of, again, I don't like to speak in absolutes. I think there's nuances to everything. So bear that in mind. If you feel like I'm calling you out, I'm not, not every one of these bullets ⁓ will apply necessarily. But I think in the, said it, forget it, they assume everyone sees the world the way they do or the business the way they do.

and would do exactly what they would do in the case of whatever X factor it is, handling a service inquiry or a caregiver inquiry. And they tend to fail to bridge that gap between what they desire and how their team can achieve it, right? Like what they know they would do versus what the team, and assume that the team would know exactly that. But I will say they do tend to be very mission-minded, they're kind-hearted, they're easy to talk to, they're charismatic. ⁓

The downfall though is that with the set it and forget it approach and I will dive, I want to dive deeper into that, but the downfall is that the team over time loses faith in them because their dreams just don't become a reality. It's almost like they're, they're not on that same planet as them and their, their team members are facing no call, no shows and real life problems. And they're in, I don't, this is going to sound offensive, but just

for exaggerating, they're in la la land, right? And so the team's not trying to accomplish what they are wanting accomplished in their goals and dreams because there's just such a disconnect. But in terms of like practicality, in terms of what set it forget it managers tend to struggle with the most, there's three main things, training team members, establishing a new policy and letting it stay, stick.

and then metrics and KPIs. And so for a set it and forget it manager, they're back to what I was just saying. They just make these assumptions that people will do as they said, or as they expect. And so, so many people will simply say, you know, ⁓ this is the paperwork you need to do when you sign up a new client, you just follow it from front to back, make sure they sign it and that, and make sure you get their schedule. And they assume that the paperwork's good enough and they send their

new employee on the way to sign up this this new client and ⁓ that's just not good for the employee right and it's definitely not going to be a good experience for the client the potential client it to me it's a recipe for disaster but so many people actually do this like i think there might be listeners going no way and the reality is it's like well we had two

new clients who wanted to work with us today, I'm going to do one, you go do one and you let the environment ⁓ excuse this behavior and you say, you got this new team member. I'm going to do this when you do that when you got this. Whereas like a strong manager, we, it's not the best acronym, but it's one I use. It's TTOE. And ⁓ essentially it's the idea of you, a good manager is going to teach, they're going to train, they're going to observe.

and they're going to evaluate. So what I mean is teach is what set it and forget it managers do. They actually teach it. They kind of speak to, this is what you need to do. So they check that box, but then they don't actually train, which is showing them how to do it, allowing that person to observe them conduct that particular, and we'll keep with the theme of a new client. So doing a consultation in the home. And then a strong manager from there is then going to observe.

Like actually take the time. So again, backing up teach, then train, showing them by the person watching them, observe the person, watch it then gets watched by the person that trained them and then evaluate celebrating the things they did well, but also coaching them on the opportunities to improve before fully signed and saying, okay, now you can go solo. Like that's a good manager. A good manager will take them through those four steps, the TTOE and make sure that.

that they're ready and able to perform those tasks. But so many, so many owners are a set it, forget it. They, they lean into experience and give way too much credit to experience. I had an owner that had a sales leader for two to three years. I had rocked it, built the business, grown it through, referral provider relationships and

pretty much in a three week span turned over the keys to them and became an absent owner. And so I mentioned too much credit to experience this salesperson because they had two to three years experience observing team meetings, observing different things in the office, the owner just assumed they could take the keys and run with it. And I think you can guess that it did not go well. Fast forward, the targets weren't 10 to 12 months later and

Furthermore, that staff member ended up leaving in a very bitter way. I won't go into too many of the details, but it was not pretty. All because the set it and forget it mindset and back to that, like those team members lose faith in those, leaders that have that.

Miriam Allred (20:09)
A couple of things. I love this TTOE. I think that's really powerful and a great takeaway right out of the gate. There's so much urgency in home care. And so I think this is a common pitfall is you hire a person to do a job and you needed them yesterday. So you're bypassing the training, you're bypassing the onboarding, the structure, the observing, you're bypassing that because there is an urgent need that you're filling.

that needed to happen yesterday. so quote unquote, there's no time for training. There's no time for traditional onboarding. we've got to take care of this urgent need now, but there's so many pitfalls there. Like you just shared that example. I have heard horror stories from these home care companies that have hired people out of good faith and they had home care experience and they have all the relationships in the community and they are too quick to literally and figuratively hand over the keys to these people.

things turn south so you can't bypass the proper onboarding for managers because you never know what's gonna happen.

Emily Isbell (21:19)
Yeah, it's the chicken or egg in home care, I guess, in terms of like, I need them yesterday, but also I need to train them to do it well. I once heard like this quote about the Pope had said, which was, if you don't have time to pray, you need to pray that much more.

And so I lean to that in a lot of ways. I think about it with planning. If you don't have time to plan, you need to plan that much more or make time to plan that much more. If you don't have time to train, you need to train that much more. So I think the chicken or the egg piece is that had you trained better the first time, if you had made an intentional purpose to train these people well, you actually wouldn't have the need to hire them yesterday as much. I'm not going to act like it's utopic.

Home care is again, you don't you walk in you didn't know that was going to happen today That's still true But I I do think you stack the cards in your favor if you take the time to train In onboarding for sure when it comes to staff

Miriam Allred (22:17)
I want to ask a specific question about when I think of set it and forget it, There are managers that are kind of visionaries, big picture. And oftentimes they put a structure or they put something in place and then they literally set it and forget it for too long. Home care because of the urgency has to be way more nimble. And so there's no time to literally like kind of set things and forget things. But my question to you is

because home care is so urgent and because home care agencies have to be so nimble, how often should you be reevaluating processes and procedures Like what's a good cadence for evaluating processes and procedures and even people.

Emily Isbell (22:59)
Yeah, this is one of my favorite things to talk about. think what allowed us to scale the way that we did was finding the sweet spot with this. And so for us, we set goals on an annual basis. And we would look at what happened last year, where do we want to go this year, and develop goals for the next 12 months.

then we would actually break those down into equaling out into a monthly and a weekly number. So if it was served this many hours of care this year, what does that look like? How do we make that a monthly number? So what does January need to land at? What is February, March and so on? So that's only with hours. We did this with everything, recruiting numbers, ⁓ sales numbers, client care, quality assurance visits, everything, scheduling, overtime, all of that.

And so we would do that annually, but then monthly we would do a one-on-one meeting with the people responsible for those metrics. So if it's a sales metric, then the sales rep would have a monthly one-on-one where they were expected to speak to how they measured up to the goals we set for the year. And it's meant to be a strategy session with your person that owns those numbers. And it's not...

We called them accountability meetings because we wanted it to have sort of that feel. And as mentioned in the beginning of this podcast, I, I worked my way up. So I experienced this accountability structure and I actually would go out of stress. ⁓ Every month I would schedule a massage the night before my, my accountability meetings. I, it was a pressure ⁓ piece, right? On a monthly basis, because I wanted to be a good student who had performed well.

Miriam Allred (24:38)
That's amazing.

Emily Isbell (24:48)
And so we did purposely name them accountability meetings so that there was this feeling that you're going to be held accountable to the goals that we set for you to achieve. ⁓ But then at the same time, it needs to be a safe space where they can speak to the challenges of not being able to accomplish maybe a certain goal or something like that. And in the leader's hat, you need to be in the nuance of that and figure out how to pivot and...

I kind of talk about like being in the gray, right? Not thinking black and white and just being ⁓ black and white. And so that was monthly. But then on a weekly basis, we had a leadership team meeting and then depending on the size of the business. So some offices, you may only have two other people in that that meeting serving all of the needs of the home care business.

And then other offices, we might have four department heads and then beneath them anywhere between one to three team members underneath them accomplishing the goals. And so on a weekly basis, we were doing a weekly review and it might've been the leadership team on a weekly looking at it together and kind of comparing notes. It wasn't exactly, it would be a salesperson, a client care, HR focused person. So it wasn't necessarily them. ⁓

the same department, but we would do that as a leadership team. And so there was peer accountability from that. And then from there, we would if there was depth, for example, the scheduling department, the director would have a departmental meeting to go over the weekly results and notes from the week, the leadership team meeting. And so I think that was the structure. And I love talking about it because I think that's the structure and executing on it is management like that. It's just you got to do it.

Within that, there's leadership and understanding the environment you're in, the fact that last week this person had a three day vacation. So of course their numbers aren't the same as they were when they had a full week in the office. And so recognizing that. what I heard from what you were saying is like evaluating that and maybe what I was kind of picking up on was the idea of changing or evaluating the goals. I will tell you that we stood firm.

on annual goals. And I think we could do that because we had had so much history of numbers to know where the bare minimum expectation could be. So that might not be true for somebody who's just getting started and unfortunately sets a goal that was just way out of reach because they had never set a goal or measured it before. But once you get into sync, I do think it's an annual goal that the whole team needs to feel like, this is what I have to do.

this is my number, period. And that was really powerful, I think, for us because we didn't, while we would have adapt within those weekly and monthly.

Miriam Allred (27:34)
Okay.

Emily Isbell (27:47)
adapt with them and their tasks to accomplish it, they still knew what success looked like and the expectation. And they didn't feel like we would be, I don't know, for lack of better words, right? Like that we would just be like, it's okay, no big deal. So I think that was a big part of us being able to scale and the traction we were able to have. set it and forget it managers forgot what the goal even was. They don't, they just

Miriam Allred (28:00)
Hmm.

Emily Isbell (28:13)
when it comes to metrics and KPIs, they might set up ⁓ numbers, but they don't even remember the details of it. ⁓

Miriam Allred (28:23)
And

that's the point that I want to drive home is the structure that you just outlined. think a lot of home care leaders listening to this are probably nodding their head like, yeah, we're on track. We've got the annual metrics. We've got the monthly and the weekly check-ins. But it's all to the execution of that, the consistent execution of that. And then the accountability piece. Like those are the two pieces that are lacking that I have seen firsthand is, okay, we've got the nice structure in place on paper.

But then when it comes down to those monthly meetings, those monthly one-on-ones, for example, the leader to the manager may think like, we're lockstep. We've been texting all morning. we've been emailing all week long. Like, we were good because we're lockstep on everything that's going on. But so they forego those monthly meetings. Don't let that happen. Like, it's all about execution and consistency. And then this accountability piece that you were just mentioning, accountability goes out the window when you let those monthly one-on-ones slip.

And that's the trap that leaders are falling into of we, we're on the same page. How could we not be because we know everything that's going on all of the time. So they bypass those meetings. And again, that's where the accountability starts to slip.

Emily Isbell (29:33)
Yeah, no matter what the size of your office is, that's a common pushback clients give me is I see her every day. walk past her every, you know, I know everything that she's doing because we're both here problem solving together, but you have got to create that space. I mean, for two reasons, one, the one you're talking about, there's this assumption that they're in lockstep with you when maybe they actually aren't that they're just putting out fires, not actually trying to achieve goals. And then the other is that you don't

you need to have a space where they can speak to you about their challenges and how you can help them. I mean, it might be something like I can think about my personal experience. remember Samantha, she's telling in that one-on-one, I find out that she's looking for a house. Like it's a personal thing. But because I just in our conversations and having that one-on-one time, hour, hour and a half together.

she brings that up nonchalantly and we had the space to do that. Whereas when we walked by each other in the copy room, we're talking about the fact that a caregiver jumped over a fence and broke her ankle instead of calling the office to help. those, those, those stories are happening, right? And so we're not focused on the fact that she's trying to buy a house. And so for me, knowing that Samantha wanted to buy a house actually changed how I led her in the sense of knowing that she needed to save money. She needed flexibility to go in the market that we were in. It was,

You had to be the first to get there, to get a bit on the house. And so like I knew then like to be more flexible and more gracious with her schedule. There's other things like that. On the negative, I had a team member because they had that space. That's when they gave their notice, which sucked to lose a good team member. But it gave space for us to problem solve it and work through it.

really talk about what the notice looked like, where she might've been giving, I can't remember the details of this person, but it might've been a two week notice. I might've, because she was a good team member, talked about can we make it three? Can we make it four? ⁓ And those kind of details. So yeah, you cannot assume that you're in lockstep at all. You have to have that monthly commitment for sure.

Miriam Allred (31:43)
100%. We could keep going down this path because there's a lot, that we could add to that. But I want to keep going to the second management type that you identified, which is I'll just do it myself managers. And everybody listen up because there are a lot of managers and leaders that are caught in this trap, which is I will do everything by myself. So I want to hear your, your points on what this looks like and how to overcome it.

Emily Isbell (31:46)
Yeah.

Yeah, so this is because I know I spoke already about the startup phase. And I realize there's people who actually acquire existing locations and they didn't have that startup experience. But I do think there is a lot of owners who had the startup experience and they can't evolve because they still have the wear multiple hats, can't let go. ⁓ People can't do it as good as they can do it. So they might as well just do it themselves. I had a client that

When I had worked with her, ⁓ she was about seven years into the business and had built ⁓ an organization and had people, but had been so disappointed in how they performed that she looked at how much she was paying them and was like, I'd just rather keep that money to myself because I've had to just do it myself anyway. So when I started working with her, she actually only had a part-time team member and she was, I think, around a hundred thousand a month in revenue. So.

That's not impossible, but it was stretched. That's pushing it. Fast forward to today, is at, that was two years ago, she's at 360,000 a month in revenue. And it's all because, that TTOE acronym we applied in her onboarding people and really taking the time to train them that now She's had two European trips in the past two years while growing to 360,000 a month in revenue. And so,

backing up, there are so many people like her that have that attitude of like, why am going to invest in a salesperson who's just going to go to true story, hang out at a bowling alley from 10 to three every day ⁓ versus just do it myself or, continue with that thought. So I think the reason people want to just do it themselves is because they haven't taken that time with the training. Also, they haven't taken the time with hiring.

Miriam Allred (33:42)
Yes.

Emily Isbell (34:00)
They tend to hire quickly or force somebody on their staff who's really, really good at whatever they're doing and shift them over to something else. It's that old adage about the, you know, a good salesperson becoming the manager, but sucks at managing other salespeople. So then everybody suffers and the sales go way down. So it's the same concept. There's a lot of owners who

don't know how to be good managers and develop their staff, or they push people into positions just because of they're good at something. So I want to back up though, When it comes to recruiting and onboarding, I think we need to be that concept slow to hire and quick to fire. And I even had this lesson where I was not quick to fire in someone that I had hired and

once I let them go, my world completely changed. And that's what I find with a lot of owners is that I, as my team as consultants, were finally telling them it's time and they just needed to hear that. And because they heard it, their worlds open up and suddenly I often say it's, ⁓ I don't know if this is appropriate to admit publicly, but I often say it's like ding dong, the witch is dead. Like suddenly it's like, my gosh, relief.

This person's gone. So slow to hire, quick to fire. And I want to say one last thing about, about hiring. I really strongly recommend with my clients doing a on the job type interview. And so for sales representatives, we, encourage mock-in services for them to perform a mock-in service as if they were presenting to a skilled rehab facility or something of that nature. So you can kind of see how they prepare and how they.

carry themselves and then for other office positions, I really recommend like an on the job two to three hour interview where you're keeping your clients confidentiality in mind, but having them do tasks in your office just to kind of see how they fit in. There's so many people who go through this and then you'll find them and they're just they're just over here looking on their phone texting and they're there for an on the job interview and

you so many people find that out on day one, before they hire them. And so that's just a quick nugget I had to say when it comes to hiring onboarding.

Miriam Allred (36:27)
The thing that I want to ask about is what is the root of I'll just do it all by myself managers. What I think it might be, and I want to hear if you think it's this or not, is a lack of trust. Hiring these people to do a job and trusting that they can do it well consistently.

Does it boil down to trust or what does it boil down to? Like what's the root issue of this?

Emily Isbell (36:53)
I think what you're saying is the kind version. What I tend to say is control issues. You have control issues. I have control issues. so with control issues is coming from the lack of trust, right? It's the same thing. And I think for owners that have the, I'll just do it myself, they're not taking that time going back to the not having, making time to.

Miriam Allred (36:55)
Thanks

Emily Isbell (37:21)
train, not making time to create things that can build trust for you. I read in a book something along the lines. it's amazing how much people's IQ increases once you trust them to do things. That was kind of the quote. was a Tim Ferriss book. And so it really resonated for me. It's like so many owners just don't even give them a chance. I had an owner who

she wanted this person to get more experience before she became a department head over other people. And I said, what, well, tell me more about what that experience would look like. And this person had been two years a recruiting person position and they, they, they had grown and they needed to add depth into the department and was trying to decide if it should be this person. And, and she said that. And I said, well, tell me what more experience looks like. And

She's like, don't know, maybe me spending more time with her. And so what she was trying to develop was a full-time job for herself as an owner to work the position with that person. And I go, why not just give her the experience? Why not just go ahead and promote her and give her that chance and you mentor her? And the owner just was like, ⁓ you can do that? It was almost like she had created this limiting belief when in reality the person just needed to be given.

chance to do the role, but with mentorship, support, guidelines, expectations, and definitely metrics and KPIs for that person to report to and speak to in her role.

Miriam Allred (38:58)
You've already like teased a variety of ways to get out of these mindsets, but I want to give you a little bit more space. Like you were just talking about like KPIs and like infrastructure because the way to get out of these management mindsets ultimately comes down to like training and infrastructure.

And there's also like the psychological aspect, like we talk about trust and control issues. I want to hear you talk about like breaking down these, these two set it and forget it managers. And I'll just do it myself. Like, how do you go about tackling this with leaders that are going through this?

Emily Isbell (39:33)
Yeah, it's so nuanced because of those two types. You have two different types of approaches. One you have to like break down the trust issues and one has way too much trust. And so I think it's ⁓ at the end of the day, the core is still the same. There needs to be training. There needs to be verification that they understand what they were trained. So that goes back to the TTOE and the evaluation period. So that's a key part. If you

You don't just teach by telling them, you don't just train by showing them and you don't just observe once, but you actually see them make progress. So, so we teach a concept of doing training sign-offs, which was inspired from the, and I talk about this in my book, the 24/7 Solution even give free resources to tools we teach with. ⁓ But, but the concept came from CNA training. If you wanted to become a CNA, a nurse would have to watch you.

change an occupied bed. You couldn't just say you knew how to do it. You couldn't write it down on a piece of paper. You had to show it. And so that's where this was inspired and what we did in terms of the way that we were able to scale. And so part of our scaling process, I don't think I even hit on this, the way we scaled was we acquired existing businesses. We didn't start new locations. And another side note, these are all individual entities, completely separately ran. They were not the same.

teams just continuing to expand. So with that being said, when we acquired existing locations, we would take them through a training sign off process to make sure they knew our ways and had that evaluation period to make sure that they understood what we expected. And so.

Miriam Allred (41:15)
Did you

get a lot of pushback? Let me just ask, because it could be someone that's been doing this for 10 years and here you come in and say, I want to watch you do this thing. What reactions and pushback did you get to that?

Emily Isbell (41:25)
Yeah, so that's a really good question. If anybody's out there that's wanting to do acquisitions, my recommendation would be that to do what we did, which was to say to them, we are actually going to hire for your position, but we hope it's you that we hire. So we actually started with interviewing, which I'm not trying to drive fear in them, but we want them to recognize this is a new day and there's new expectations. And we are not,

evil people to work with. I promise you, we knew what we were doing because we had a background. We had other team members at other offices that could be a reference if they wanted to check our references. But we would start with that. they weren't entitled to their role. The good news is we never had to choose someone else. They always had enough

good and made it made sense for the match. So that that kind of I think helped with pushback. The other thing though is you have to cater you have to have this like

Humility about it too. Like I don't know this territory I don't know the nuances of this market and so I need to lean on you as well as we talk about things but there's certain principles that You when you change an occupied bed Using that analogy you just always do these things and so we're going to teach those things to you I will say we do this with clients. We take clients. I teach clients to do this with their existing staff So a lot of my one-on-one consulting is me taking

clients through the turnaround process that I went through when I did acquisitions. And so we do, I call it a roles and responsibilities reset where we literally are telling the team we're going to retrain you. And it's a different dance in that way, because you're not saying I may not hire you. You can't start there. And I don't recommend that at all, but you do kind of do a reset to really set, reset the expectations. I'll often say to my clients, it's like they need to have a meeting.

a reset meeting that is so clear that you had this meeting that it's like they understand pre-COVID like using that reference pre-COVID and post-COVID. We all know what that we all talk like that now. Well, it was before COVID. It was after COVID. So in this case, there's a meeting that's so inspirational, but also firm and clear that people are saying, well, yeah, that's before blank meeting, whatever you decide to name it. So that's how we do it with our with our clients. ⁓

Miriam Allred (43:47)
This is so good. Reset

meeting. Like, my goodness, I think people need to hear this because there's a lot of, I don't know, passive owners. There's a lot of sleepy businesses. There's, there's a lot of people that are just, plateauing. Like we talk a lot about in home care, every business, has either been through a plateau or headed for a plateau And this is a prime opportunity to hit that reset. And I love what you're saying. Retrain everybody. Like,

There's a past version of our office and there's the next version of our office and we are hitting a reset button and we are retraining everyone. Like I just think this is a really powerful concept.

Emily Isbell (44:22)
and it really makes a huge difference. So I've seen it. We keep teaching our clients this because it works even when you have to play back a mole. So like as owners are maybe sitting here like, haha, that's funny. I worked all weekend being a caregiver and I'm the owner of this company. I get it. I hear you. But you need to work a little harder for a little bit of time because it'll make the difference from you having to do that in three, six, 12 months.

I do want to before we lose time, I want to talk about metrics and KPIs because I think.

Miriam Allred (44:55)
Jump into, I was just going to say that you've got

like a really firm structure of like four phases of KPI and metric tracking. So lay it on us.

Emily Isbell (45:03)
Yeah, so there's four phases. What I'm actually describing is not so much, well, it is tracking. I won't say that it isn't, but it's the phases of ownership and leading and managing with KPIs and metrics. so, kind of labeling people where they're at, what phase they're in. And phase one is not where you want to be. That's where...

You basically do not even measure any metrics. The closest thing you know to a metric or a KPI is maybe your revenue from last month because you finished your billing or you're looking at some random dashboards that your software, your operating software is telling you that you can just see and you don't really have any understanding of it too much, but you see it. Or maybe it's overtime, right? Like that's basically the level and

think some owners who are at phase four, which we'll talk about in a second, would be shocked to hear there's a lot of people in phase one. There are a lot of that concept earlier I was talking about just got lucky. There are a lot of bigger businesses who are in phase one. They've just somehow gotten lucky. I don't, there's reasons behind that luck. Everybody's is different, but so phase one is those people who really don't pay attention to metrics and KPIs and let it drive their business. Phase two,

is those set it and forget it type people who know that they need to measure number of inquiries, number of where they came from, number of ⁓ interviews, things like that. They have these certain metrics that they're measuring and there's data that's ⁓ being provided. And so they're doing that and they have their team doing that, but they're not really evaluating the story or what the numbers are saying. So that's more phase two, but it's better than phase one. They've actually got some numbers and some history.

Phase three is they're beginning to evaluate that story. The owner themselves or the operational leader themselves are saying, know what, every fourth quarter we have this go up, let's start being ahead of that. Let's think about what that means. What do we need to do differently? Or what do we need to do to lean in and actually get more of that? ⁓ And then phase four, that's where your top businesses are. You're more ⁓ successful, the top 5 % of these businesses

They have at this phase, have KPIs or what I call KPIs, which I'm going to break down for the way I speak to it, which is the breakdown of is key performance indicators. So to me, a KPI is an indicator of performance. so I really for the, top phase four is when you start to look at certain numbers as goals that you should achieve and recognize some metrics are just painting a picture that kind of speak to those goals.

So for example, I say indicators of performance, a good example of that in a sales world would be making face-to-face call to action meetings. That a KPI around that would be a certain number per week or a certain, whatever, however you want to create the terms on it. Maybe it's per day or per month. And so the phase four is they recognize some numbers need to be sought after, right? And influence that they can do things.

their team members can do things to influence it and they empower their team member to pivot, to adjust, to recognize because of X, I need to do Y so that I can still hit that KPI. Going back to that monthly one-on-one meeting, that's why those accountability meetings needed my monthly massage is because I've worked really hard to accomplish these goals. I've made these pivots, but I'm not sure if it's good enough and I'm gonna face my...

face my accountability with it. ⁓ And that's where top businesses tend to fall is phase four. And so ⁓ I think that's where management and leadership come together is that they're able to recognize the KPIs in your business and the metrics that all kind of need to come together to actually lead to traction and growth in all avenues.

Miriam Allred (49:10)
That was so well said. I think everyone needs to take a hard look at their business and be honest about where they're at because I think arguably a lot of owners would say we're in three or four, but when in reality, they're probably in two or three. I like what you said about, I think it was kind of phase three of there's this, it's easy to fall into this phase, phase three, which is like evaluating.

like that analysis paralysis, like over evaluating. I actually think phase three is where you think you're doing a really good job, but you're like maybe too much in the evaluation of data and metrics. And phase four is actually figuring out how you look at it, push through that and refine something that makes sense for your business. But phase three is kind of like a trap that I think people fall into and get stuck in. And then they don't actually advance to phase four.

Emily Isbell (50:04)
And I think the other thing that I may not honed in on as much as I need to phase three is where the owner or the operational leader is evaluating, but you're not empowering your team to evaluate what the story is telling you. You're holding all that. And so, yeah, you get an analysis and paralysis because you're up here. You're not in the weeds. You actually don't know why this is happening and you're not involving your team to help problem solve it. At least not on a routine, consistent structural basis. So yes.

100 % analysis by paralysis.

Miriam Allred (50:34)
Exactly. And that's why businesses get stuck there because the owner is kind of the gatekeeper of like the scorecard. And that's why they get stuck in phase three is they're not, like you said, empowering the team to flush out the data story to set the KPIs across the board, which is what actually happens well in phase four. I want to ask a few more questions here. One is in home care. And in business, I hear all the time.

Everyone should think like a leader. You hear that we I want my team. want my caregivers. want my admin staff I want I want everyone to think like a leader, but I was saying to you before this call I think there's there's a problem there because right now we are distinguishing managers versus leaders if everyone thinks like a leader if everyone thinks like a visionary who's thinking like a manager who's tackling operations? And so I want to hear your take on this because again, we're

painting the picture of like a manager versus leader. But if everyone's thinking like a leader, that leads to problems. So what's your perspective on that?

Emily Isbell (51:39)
Yeah, I think so I want to speak to operational like operational leaders ⁓ versus thinking about a caregiver being a leader or thinking about a scheduler being a leader just to hone in. We can talk about that another episode. But so I think I think it depends on the owner that that is in place if they want to be more absent or not. what's the season of business for this owner?

And so if an owner at the end of the day, to answer your question, you need both. You need to have a leader and a manager period. How that comes to be is the question I'm answering here. And so if an owner is still active in the business, but they have an operational leader kind of managing the KPIs and the day-to-day operations, then I think the owner can be a leader and that manager can be more of a manager and they can compliment each other. So

As the manager is reporting the details of the struggles they're having or the celebrations, the owner can kind of be the leader who needs to step in and evaluate how to pivot this or where grace needs to come into play versus where it needs to be more rigid or firm and kind of complimenting that manager. But if the owner is absent and really ready to enjoy what they've built and

do other things, then you need a manager who has both strengths. It can be a manager and be consistent, because that's, think, the key part of a quality manager is they're consistent. People can know what they get with them. But also have the leadership aspects of recognizing the gray and having grace when there are situations that need grace. And actually, that kind of leads to something that I think

to speak to leadership and how I would, where I think people get leadership wrong is they tend to lead more with sympathy versus empathy. And I actually, I talk about that in my book too. I actually talk about the concept of empathy over excuses. And what I'm talking about is kind of like real life experiences. Even that story I told before where she wanted her to have.

experience before getting the promotion. That's her having sympathy and pity on her not being prepared versus empathy, is understanding this is going to be uncomfortable for a second, but I got your back. I'm here to support you through that discomfort. That's what empathy is. And sympathy actually, as I mentioned, it's more so pity. Like it's feeling bad for someone. And I had a story with a client recently that she was sharing that she

She called herself out because we've worked together for so long. She was like, I know, I was more sympathetic than I was empathetic. And essentially somebody in one of her team members was given slack. Basically for a little while, don't have to work at like, you don't have to hit these numbers for a little while. And I don't know the details. don't remember the details around why the slack was giving, but now today she's faced with time to step up, but she made a exception before and was

sympathetic before and now she's trying to change the rules on her. And that just, that's tough. That's tough. Once you've been sympathetic, it's hard to turn to empathetic and actually get them to step up to the plate and get through that discomfort. So anyway, I think a common leadership mistake. So you asked about, should there be managers, leaders and all that? I think if you are going to have an operational leader who you're going to be more absent, they're going to, they need to have leadership aspects.

They need to know how to lead with empathy, not sympathy. They need to know, okay, Lexi's not hitting her numbers. She continues to do X, Y, and Z in terms of her results. It's time for me as the manager now with a leadership hat on to sit side by side with her and figure out why in the world she can't accomplish what I expect her to accomplish. And you don't do that in a judging, like hateful, shameful way. It's literally, Lexi's a real...

person from my background where I did this and you literally set by side by side and say, ⁓ in this case, this is what I would do in this case is what this is how would handle that objection or whatever the challenges are. And then they rise up, right? And then they meet that potential and.

It's just so powerful when you take that time to lead that way and lead with empathy.

Miriam Allred (56:11)
I think I could argue why this is the hardest thing as a home care leader. And I say home care leader because this is a very personal human to human business, maybe as much as it gets. And it's easy to lead with sympathy because you care about these people. But what you're saying is,

a good leader actually leads with empathy, someone that leads with sympathy, they are permitting maybe bad behavior, but someone leading with empathy is going to correct bad behavior and there's a difference there, but this is such a hard balance to strike. And again, I think I could maybe argue the hardest balance for home care leaders to strike is learning how to not lead with sympathy and how to intentionally lead with empathy.

Emily Isbell (57:01)
Yeah, and I think two quotes come to mind, something I teach a lot, is what, ⁓ doing what's right, not what's easy. And that is leadership, when you do what's right versus what is easy. And doing what's right, in the case of Lexi, was sitting side by side with her when I had plenty of other things I needed to do.

She needed that and she grew and was with me for many years after that. And then the other quote I think about is, what gets permitted gets promoted. So when you have sympathy for this team member.

you're permitting it, the other people are watching. You're setting a precedence. So you wonder why you plateau. It's because you've continued to lower the bar and people don't know the full story. And I talk about in my book about the idea of someone going through a divorce and the hard, that is hard. That is not easy. And there should be lots of empathy with that, but you still don't lower the bar. You still don't say it's okay if we don't hire as many caregivers this week because you're going through this. You find a way for them to still accomplish their goal or support them in a unique way.

that doesn't provide sympathy, it helps them to meet the business's needs.

Miriam Allred (58:10)
Emily, you brought the heat today. This has been so good. I'm serious. And I want to leave people wanting more via the book itself, because again, all of this is spelled out and some in the book. also secondly, a lot of what we talked about today is super nuanced to the business, to the owner, to the team that's in place. And you very tactically and

Emily Isbell (58:13)
you

Miriam Allred (58:35)
intentionally step into these businesses and help them work through these types of issues. So for those that aren't super familiar with your formal services, tell everybody a little bit about what you offer and how you approach it so people can understand.

Emily Isbell (58:50)
Yeah, so I think quickly I want to speak to our consulting services. So we do, like I mentioned already, we take the approach I did with turnarounds and look at your business as a business that if I were to step in and take over, what would I do differently? Now I have to marry that though, because I'm not actually doing that. I have to marry that with your passions as the owner. We never want to bulldoze over things that you're passionate about that keeps you showing up to work every day. So we have what's called a cumulus strategy. That's where we take you through that process and then provide you a 12 month action plan for you to

implement in your business as if again it would be the action plan I would use if I took over your business so that you can work to it to turn your business around or and maybe it doesn't need to be fully turned around. I don't want to

pretend like that's always the case, but maybe there's a plateau and you need to escalate growth. So that's a cumulus. That's our starting point for people who want consulting. the offering that I am most excited about that really speaks to what we talked to about today is our powerhouse peers for administrative staff. We have three different versions of powerhouse peers and in short powerhouse peers is like a mastermind group that we say.

behind the scenes and now publicly in this podcast, we say that it's on steroids. So it's more than just a mastermind group. There's a lot of tactical things in between that help make it a very powerful program. We have one for owners. We have one for operational leaders. And then we have, like I mentioned, the one for administrative staff and the inspiration for it is because all the things I said today and talking about being consistent and managing versus leading.

There are a lot of entrepreneurs in the home care industry who got into this business for the freedom entrepreneurship can bring. And there is no shame in that. The problem is, is that a home care business cannot thrive if that's their only mindset and they don't actually put things in place to allow it to thrive, like management steps. And so what I've recognized, even with my clients that do co-leadership, which is one of the more premier services working with me,

is that there comes a point where I recognize they're really good at putting in the action plan items that are projects and a new way to handle scheduling and you wait to do X, Y or Z, but they still don't show up every Monday to a team meeting with their team, that they still don't expect one-on-one meetings to happen. And so I, I've kind of beat my head against the wall for a long time. And then I just kind of realized like, it's okay. not everybody has that skill set.

And so owners recognizing that, seeing it with my clients, it's like, how can we support that need? How can we recognize that owners want the freedom to not be obligated to a monthly one-on-one in that way or the weekly management? And so we developed Powerhouse Peers for administrative staff in that it's got four parts, four features, I should say. It's a weekly KPI review of their metrics and with a 24 seven solutions.

subject matter expert. if you're a recruiter, we would put you with our recruiting expert. So weekly KPI review of that monthly one-on-one coaching with our 24 seven solutions coach, a monthly peer collaboration call. So powerhouse peers, the name is a powerhouse of peers. So this one feature is that part that you get together with other.

whether the department is scheduling, whether the department is recruiting and retention, client care, focused, or sales, you're with other sales people. Like that's your time together. It's a monthly virtual call where we're evaluating ⁓ opportunities for you to improve in your role and how to overcome objections or whatever challenges you're facing. So we do that with, it's non-competing. So if we have multiple groups so we can make sure and we're continuing to grow it.

And then fourth feature is our quarterly audits with the home care business owner, where we're looking at how is it going? How is this person measuring up? And what we often say is let us be the manager so you can be the leader. And the idea is let us put on a silver platter some of their results, the true numbers and figures and how they're doing and performing. But you as the leader still have to take that from there and lead them.

But if you're not good at that, if you're not good at that and you know that about yourself and you just don't, you're just not going to do that. This is a really great program. And that's how a number of our consultations have gone is yeah, I know they need it. I know they need the development. It's not me. I'm just not that person. So I'm glad you guys are doing this and we're just kicking off. And that's how these, these consults have gone in a lot of ways. And it's really exciting. We started this in the summer and it's really kicked off and

The way that we get started, I think is important. It's again, me applying what I learned in the turnaround process and really trying to develop people. And it really ties back to what I did with my second location, which is the idea of ⁓ when I took over, we were serving about a hundred thousand a month in a year. We were able to get to three hundred thousand a month and we had the same team. We didn't actually add team members. This was

with the same team. And so it was all about them just knowing what success looked like and how to manage and get to that and measure up to what the KPIs were. And so when we kick off we start with a KPI development call with them and our team member, not their team member, just them. And we develop what the KPIs should be for that position and that person based on their business. And then after that, we do a kickoff call with their team member.

and our team member and kind of say, all right, this is what structure kind of oriented them to what to expect, but also kind of establishing like, these are the KPIs that you're going to be measured on and we want to help you with resources to be able to accomplish them. So that's the one I'm really excited to talk about is the powerhouse peers for administrative staff.

Miriam Allred (1:04:46)
love it. There are these glass ceilings on these roles in the office, on the scheduler, on the sales rep, on the care coordinator. And like you just said, I hear this from owners as well, owners can only take them so far. So that is where this program is so powerful is they get to learn from your team of subject matter experts that have been there, done that. And then the peer element, how awesome for a scheduler to sit with 10 other schedulers from 10 other businesses.

and talk about best practices, like talk about elevating this industry. It is through programs like this where you're pulling together all of these different people, putting them in a room together, hashing out best practices, taking that back to their businesses and elevating these agencies and these operations and serving more clients in a better way. Like I just think it's so impactful. So I'm stoked that you've built out this program that it's just getting started, but there's already a lot of traction, a lot of good results. And this is just the start. You know, I think

What you do is like leadership coaching. This is like coaching for every single C in your business. And we need more of this as an industry, to be totally honest. This needs to be happening more often. Like you and I've talked about this, we go to these conferences, like there's a lot of like leadership speak happening, but how do we now take that to the next level and build out leaders in all of these roles inside of the office?

Emily Isbell (1:05:54)
Yep.

Yeah, it's pretty cool. We talk about it as a team as those peer collaboration calls being magical and it feels a little fluffy to say that, but I mean the impact truly has been pretty awesome for the people that are invested in by their owners into this program. It's really awesome.

Miriam Allred (1:06:31)
And this is just the start of so many good things to come. So Emily, thank you for joining me in the lab. This has been fantastic. Also just last plug for the 24 seven solutions book now, audio book available everywhere. And if you want to connect with Emily, all of her information, her team's information, website, the audio book, all of it will be in the show notes here. So make sure you get access to that. So we'll go ahead and wrap here. Emily, thank you so much.

Emily Isbell (1:06:55)
Absolutely, thank you, Miriam.