On New Year’s Eve 2012, Consulate Health Care, headquartered in Maitland, Fla., changed overnight. After merging with LaVie Care Centers, the company went from operating 78 centers in six states to operating nearly 200 centers in 21 states. This is where the story began, not with a whimper but a bang.

Not only did the merge bring in a large number of new centers, but it brought a number of operational challenges. Operating a company on two separate clinical and financial platforms, half the company had been on the market for years, and all this was reflected in satisfaction ratings and overall outcomes. And if that wasn’t enough, a false claims lawsuit that occurred pre-merger with two LaVie centers, and the now defunct LaVie management and rehabilitation company, had been haunting Consulate since it was unsealed post-merger in 2012.

On top of that, the industry was going through its own significant struggles with declining census and lengths of stay, reductions in reimbursement rates, labor shortages, a swell in the number of lawsuits, and unmanageable capital structures. By 2015, Consulate was a sinking ship.

Rather than letting Consulate fail, the organization took dramatic action, the most significant of which was bringing on Chris Bryson. Bryson, a pharmacist by trade and 20-year veteran of the industry, joined the company in 2015, then as the company’s chief operating officer (COO) before quickly transitioning to chief executive officer.

Reflecting on the merger, Bryson says, “When that occurred, you had two different companies, with two different management structures, and two different operating platforms that never fully integrated.”

Bryson also understood that this problem was not an easy fix, that there wasn’t a magic wand to move Consulate to a new version. What he needed was a whole new operating philosophy; he needed to change a culture. And Bryson understood that the first step in the process, before the overhaul of executives or company structure or processes, was to simply listen.

Bryson took to the road. He met face to face with nearly 200 of the company’s then executive directors and toured almost every care center, asking questions and listening intently to every voice.

“People want to be heard, and then they want to see a reaction,” he says. The No. 1 lesson he learned, he says, was the importance of listening to local market leaders and figuring out how to serve them.

“A lot of times we can get lost in thinking that we know the best way, and we’re going to jam it down the throats of all of our local market people,” says Bryson. “It’s OK to be individualized, and it is critical to allow local market autonomy. If we take the attitude of we are here to serve you, I think we gain more respect, and ultimately more trust, with that approach.”

What came out of the roadshow were revelations about the needs of each market and what leaders needed to help them be successful. “‘I don’t have a good training program.’ ‘We haven’t given raises in three years, and I have a hard time hiring people.’ ‘We don’t have paid holidays.’ ‘I’m having a hard time competing for top talent.’ ‘We spend a lot of time filling out reports and attending conference calls, we need automation.’

“We needed to make their lives easier, so that is what we did,” Bryson says.

It became clear to him that while Consulate had much to do and to change, there was a desire at the center leadership level to return this company to its previous standing and rebuild its proud heritage. As a result, the executive team met with the company’s investors and other key stakeholders and shared their optimism that there was a future here, but they would need some time and patience from their financial partners and sponsors to get there.

“It’s not a quick turnaround but rather has to be seen more as a start-up, a rebuild that will take time to get done,” Bryson says. “We shared the importance of getting the people relationships right, the community reputation rebuilt, and the trust back in our services.”

For him, the path to fixing the company’s reputation problem, and a score of other issues, began with taking steps that focused on the company’s greatest asset: its people.

“We started with our people, and that’s where we came in and said, ‘Until every single one of you don’t want to take off your name badge after you leave work, before you go to the grocery store, or the bank, our work’s not done,’” he says.

In the months following, Bryson began an overhaul of the company from top to bottom—from replacing nearly the entire C-Suite and senior-level executives to a complete operational restructure of functional departments across divisions and regions, which included the hiring of Andi Clark, chief nursing officer, and Todd Mehaffey, then division president of Florida who now serves as COO.

The first moves were all designed with one goal in mind: to return Consulate to a state of health, one that focused on the three feet around each patient’s bed, and the caregivers that occupied that space.

Some of the early moves, says Bryson, were the “easy things.” Consulate instituted paid holidays, revamped the company’s vacation schedule, enhanced its benefits package, and got a new health insurance program. The team took a hard look at the effectiveness of its employee orientation programs and redesigned them.

“We didn’t spend money on rebranding because that’s not where it needed to be spent. We did everything around improving our reputation with our employees by doing what we said we were going to do,” he says.

“Another part of the people piece is that we had to grow our leadership locally,” says Mehaffey. “We had to empower them locally. We could not possibly know every local market from our seats in the Maitland, Fla., office.”

Central to this for Consulate, says Bryson, was creating a small company feel with local market knowledge and autonomy at the executive director level, with access to big company resources.

“I think people will survive and thrive in this industry going forward if they can find a way to take advantage of both those things,” he says. And when assessing the company, it was about how to blend both worlds and how to truly support Consulate’s local leaders as trusted consultants.

This was key, says Bryson, but the challenge was that the company was operating nearly 200 care centers in 21 states in a non-local, centralized capacity.

When Bryson was hired by Consulate, he found that the LaVie portfolio had several facilities with one- or two-star ratings from the Centers for Medicare & Medicaid Services Five-Star Quality Rating System. For example, there were two low-rated centers in Idaho, one in Montana, two in Kansas, one in Nebraska, and one in New Mexico. “I went to the stakeholder groups and said listen, I can’t change the company and change the quality and change the culture in 21 states,” he says.

Consulate’s stakeholders agreed that the way to grow and empower local leadership effectively was to narrow its geographic area to those states with critical mass. One hundred-forty of the company’s buildings were in six states, and what followed was carrying out a 60-center divestiture strategy fairly quickly.

Transparency and consistent communication for all centers were the keys to successfully carrying out the divestiture strategy in the best way, says Mehaffey.

“The mentality in other divisions was: Who’s next?” he says. “However, as an organization, we had a plan. We knew the number we needed to get to. Managing those fears in the field was difficult, but we articulated a transparent plan with everyone, every step of the way.

“They had a right to understand why Ohio was going to go away,” Mehaffey says. “Teams in Pennsylvania wanted to know why we were not going to operate in Michigan any longer. So it was important for us to make not just divesture communications, but continuing operation communications with the field and home office staff as well.”

“There was hesitancy, but it was all about communication, it was all about transparency, and that alleviated a lot of fears, and we didn’t have a mass exodus either,” Bryson says. “People believed that we were going to do the right thing.”

And, finally, Bryson says, his team made a commitment to be an advocate personally for those working in the divesting facilities. “We said, ‘We’re going to make sure we find the right operator for you, to guarantee you have a job. You are good operators, you run a good company, but it’s not the right fit for us.”

The divestiture took over two years to get to 144 centers, and the company still has four to go. Remarkably during that period of time, Bryson was also able to drastically begin to address the health of the continuing 140.

Bryson and his executive team concurrently fixed their gaze on an action plan to make transformation a reality. This started with metrics. Upon arrival, he says, the primary metrics focused on census, occupancy, and finance.

“I want to rebuild the company on the foundation of people and quality—period, end of story,” says Bryson. The way to change the mindset away from financial and business metrics was to create a new philosophy.

In order to rebuild the culture of the company, with a focus on people and quality, Consulate needed a foundation to build on. That is where Consulate’s Foundations of Excellence were born. This new operating platform provided a defined set of metrics to evaluate how the company as a whole was doing.

With no surprises, the new philosophy focuses on people first. “If we don’t get the people right, we’re never going to have the quality,” says Bryson. “If we get the people and the quality right, the financial and growth will come.”

The structure is made up of four pillars—Excellent People, Excellent Quality, Excellent Finance, and Excellent Growth. The metrics inside the pillars keep the company vigilant, says Bryson. Rather than a vertical structure, it is circular. “This was a purposeful design, one that demonstrated that everything we do begins and ends with people. We are in the people business,” he says. “This was all cemented in the notion that if we can recruit and retain the best talent in our care center, our probability of success in our clinical and operational outcomes becomes much higher.”

There has been no other time in long term care history that quality metrics and outcomes have been more important than they are today, Bryson says. “The world is now judging us by how well we compare to our peers in various metrics. That’s why we make such a big deal about this.”

Today, it’s no question that Consulate has seen positive results. “Our quality is one of our biggest strengths,” says Mehaffey. In Florida, 73 percent of centers now have a Four- or Five-Star rating.

“As a company, we’ve had a 25 percent improvement in our overall star rating, and a 35 percent improvement in our quality metrics star rating,” says Bryson. “In addition, all of our buildings in Florida—over half of our total—now have Joint Commission accreditation. It’s truly a feat.”

In the area of staffing, the company has seen a substantial reduction in overall turnover and an even greater reduction in director of nursing and executive director turnover, says Bryson. Consulate’s new time-off policy, paid holidays, and revamped employee orientation program all played a part, he says.

As for finance, Consulate’s ability to responsibly manage expenses has never been better, Bryson says.

“We have been successful at renegotiating large contracts, and we have been better able to negotiate large contracts, which has improved our cost of supplies in terms of repayment,” he says. “It’s also helped strengthen the company’s ability to adjust its cost structure, both in labor and supplies.”

Bryson says the company has had great support from its landlords in helping to restructure leases, major vendors in working toward reductions in outstanding debts, and its lender in restructuring its credit facility and debt structure.

Consulate is not out of the woods yet financially, but it is definitely moving in the right direction.

In speaking with Consulate leaders, many of the achievements they are most proud of are evident in quality improvements. “To go from two stars on our quality measures to almost four stars in two years—that’s a big improvement,” says Jennifer Trapp, vice president of corporate communications at Consulate. 

“With our quality measures improving the way that they have, it proves that our interdisciplinary approach is working at every level. This was a very important initiative for Chris early on.”

“I think our biggest accomplishment is our quality measures,” says Clark. “To me that’s where the heart and soul of giving good care is.” 

Another example of collaboration is at the corporate level with a company-wide, monthly meeting on Quality Assurance Performance Improvement (QAPI).

“It’s a three-hour meeting where we discuss our progress, challenge each other to think differently about areas that may not be moving as quickly as we would like, and find solutions as a team,” says Trapp. “It’s deeply analyzing how we are addressing patient and family concerns, how are we achieving customer service excellence, and how we can provide a better patient experience through quality assurance,” she says. “I think that’s made a big difference because the focus has been on quality improvement as the primary outcome.”

Clark says that QAPI meetings themselves have evolved. “First we had to figure out what are we measuring,” she says. “I think we’re getting better; we honed in on trends and metrics.” While most long term care companies these days are collecting quality data, the difference is in how they are looked at, she says.

“When we look at any kind of a performance improvement plan, we always ask, ‘How are we going to measure it?’ Chris has asked me over the years, I can’t tell you how many times: ‘How do you plan on measuring it?’ Chris truly brought accountability to metrics and measurement,” Clark says.

In the midst of all the change, the most rewarding times for Bryson are when he walks through a building, takes pictures with the staff, and sees that retention is getting better. It’s also about feedback from outside stakeholders.

“People come up to me and say, ‘Hey, I hear good things are going on at Consulate. How do I become a part of that?’” he says. “Nothing makes me happier.”

What gets Bryson energized is seeing positive changes among staff, in corporate employees, and everyone else. It’s a leadership philosophy that’s rooted in servant leadership, says Clark.

“We all feel like we’re servant leaders,” she says. “And I think Chris is the leader of our pack.”

Supporting the local executive directors, letting them run their centers as their own companies, and making sure they have the resources they need makes a difference.

“There’s a slogan in the home office I saw on someone’s cubicle not long ago, and it says, ‘If you’re not taking care of a patient, you had better be taking care of someone who is,’” says Mehaffey. “I think that really epitomizes what we’re about.”

For Bryson, it all ties back to transparency and staying the course. “People need to see you can do it,” he says.

“It doesn’t have to be the old slash and burn—cut, cut, cut,—and that’s how you save a company. You can do it by focusing on people and quality. And you have to have the patience, and your stakeholders have to have the patience. And that’s what a lot of big companies sometimes don’t have.”