Top 3 Problems of Home Health Agencies

November 15, 2018 Articles disabled comments

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It is true that there are many reasons why some agencies seem to struggle year after year. People blame all sorts of things for not succeeding; State and Federal regulations that are always changing and making the job of caring for patients effectively and efficiently harder every year, lack of (RN/PT/OT/ST/Aide) staff, lack of committed staff who hold whatever values the leadership think are important, inability to find qualified managers or senior leaders, the economy, the inability to match the wages of the hospital to compete with the limited employee pool, the inability of leadership to understand the challenges and constraints of the field staff, the field staff’s inability to understand the challenges and constraints of the leadership, the lack of consistency in leadership’s message, and the revolving door in all areas of the organization. Did I miss anything?

Some people will tell you agencies that succeed have a certain style of leadership – and often a specific leader whose vision is the driving force behind the success of the agency. Often the “successful” leadership style depends on which management book or seminar is currently in vogue. It doesn’t matter if you are a transformational, transactional, servant, autocratic, laissez-faire, democratic, bureaucratic, or charismatic leader– they all can work.[1],[2]

What successful organizations have, and those that struggle don’t have, is the ability to set clear and realistic goals, understand the real culture of the organization, and a willingness to confront the issues, at all levels, that are inhibiting the ability of the organization to meet those goals.

One of the top problems’ agencies have is the inability to face hard truths about themselves, the culture they have created, and the work it’s going to take to fix it. Many agencies are invested in appearing to embrace change without wanting to change anything. And that can start at the C level suite and go throughout the organization.

Here’s a story about what happened in a little town in Massachusetts and what it took to get a new library. The town knew that the library didn’t meet the new Federal standards for accessibility, was too small for the growing town, and wasn’t able to keep up with the increasing technology needs of the townspeople. The Town Council said they understood the needs of the community and wanted what was best for the town to help the town grow and prosper. But the Town Council loved the old building. It had been donated by a scion of the town many, many years ago. They were emotionally invested in keeping the current library. And they knew it was going to take a lot of hard work and money to fix the issues with the current library. The townspeople weren’t happy, so the council decided to set up a committee to investigate whether they really needed a new library and how much it would cost to fix the current one to meet the Federal regulations and the needs of the town. The committee said, “There is no way this building is going to work. It will cost more to fix this building than to build a new one. We need a new building.” The Town Council thanked the committee for their work, then disbanded the committee telling the townspeople that they had “looked into it” as they had promised and did nothing to change the situation.

People complained again, so the Town Council hired a consultant for a considerable amount of money, an expert in library design and renovation, and asked the consultant to determine if they really needed a new library and what needed to be done to change the inside of the library without changing the structure. The consultant said the same thing the committee had said: the old building wouldn’t be able to meet the new regulations and needs of the town for its library. It would be too expensive to try and renovate the existing building. The best thing to do was to create a new library structure and build the library to meet the current and future needs of the town. The Town Council thanked the consultant, paid the consultant, told the townspeople they had brought in an expert who had made some suggestions that they were considering, and nothing changed.

When the people of the town complained again, the Council said they had tried twice, but it would be just too expensive to change anything, the library was “good enough” and they were a small town – why did they need a better library? But the complaints continued, so they formed another committee who said the same thing as the other two groups, but this time said they could get State funds to pay for a new building. But they had to move quickly because there was a time limit on the funds. The Town Council thanked them and said they would take their advice under consideration. The Council “considered” the matter until they missed the financial assistance deadline. At which time, they said, “Oh dear, I guess we’ll just have to leave things the way they are.”

Many home health organizations are like the Town Council. They see the need to change, say they want to change, but don’t really want to do the work needed to change. I know I’m a consultant, and it’s probably crazy to say this, but they will hire consultants to tell them what the issues are, what they need to do to change their current situation, the consultants will dutifully tell them what do to, and then the organization will resist the changes that they deem are too hard, too expensive, too time consuming, or too far outside their comfort zone. Change is hard, scary, and expensive in the short-term. If it wasn’t, they wouldn’t need consultants to tell them what they need to know, but really don’t want to hear. It takes courage and vision to try something new. Some organizations don’t have the skill set or the bandwidth to be able to do things differently. They need to hire professionals who know how to lead the change. Some organizations want the change to happen in the next quarter. But change takes time and it often results in 2 steps forward and 1 step back as the organization tries to work toward their goals. Organizations that succeed often fail first. Not every pilot will succeed, not every idea is a winner, but doing nothing new means nothing changes. Many organizations need someone outside their organization, who isn’t invested in what it took to build the organization or who made the decision that led to the current situation, and who can see the forest and the trees to help them find the paths to success.

You can be the Town Council, who keeps asking the question, hoping for a different answer. Or you can embrace the fact that your current ways aren’t working for you anymore and find new ways to accomplish your goals. You might need outside help to do that. But whether you use internal or external resources and LEAN, Six Sigma, TQM, DMAIC, AGILE, or another process improvement framework, ask yourselves these questions:

  1. What are the SMART (Specific, Measurable, Achievable, Relevant, Time-Based) goals of this organization?
  2. What is preventing us from meeting our goals?
  3. What is the current culture of the organization?
  4. Is our culture helping or hurting us?
  5. What are we willing to sacrifice to meet our goals?
  6. What are we not willing to sacrifice to meet our goals?

Home Health organizations that succeed are willing to ask the difficult questions, listen to the answers, even when they are hard to hear and take the actions necessary to move forward. They are willing to take risks, understanding that sometimes they will fail, but knowing that each step brings them closer to achieving those goals.


Need scholarly article

[1] McDermott, A. (2017). The top 7 management styles: Which are the most effective? Retrieved from

[2] MindTools. (n.d.). Leadership Styles. Retrieved from