Improving Results by Changing Systems to Meet Employees’ Needs


In 1999, a small team in the skilled nursing industry set out to create a company that would not be burdened by the persistent problems that plague many healthcare organisations. With Plum’s growth strategy centred on the acquisition of deeply dysfunctional long-term care and rehabilitation facilities with significant clinical and financial challenges, Plum grew slowly at first. With each acquisition, the company management developed new ways of solving the complex challenges they faced. Plum knew that accelerated growth would require a replicable approach to leading a people-centric culture that would systematically enable successful turnaround.


With Arbinger’s work having helped other organisations in the healthcare industry, Plum turned to Arbinger to help develop a leadership model, an organisational cultural framework and front line staff tools. These tools would enable each newly acquired facility to both integrate within Plum’s organisational culture and empower the previously dysfunctional leadership team within each facility to turnaround a poorly performing enterprise.

Strategic Consulting & Executive Coaching

Initially, Arbinger consultants provided in-person strategic consulting and over the phone coaching to the executive team. They guided the development and implementation of a strategic roadmap that would enable cultural transformation during and after each facility acquisition.

“As a result of staff at all levels doing their work in an Arbinger way, we have accomplished a 10-fold increase in the number of 5-Star rated facilities– - the highest government rating for nursing homes - among facilities we acquired in the last 4 years. This result is particularly remarkable considering that before acquisition the average Star rating was below 3.”


Co-CEO and Co-Founder


As a result of this initial work the executive team was able to develop policies, procedures and implement collaborative work practices that would serve as the footings of an outward mindset culture. Through ongoing coaching sessions, Arbinger worked to equip executive leaders with skills to grow and develop every facility administrator throughout the company.

Customised Programmes

Arbinger worked with Plum leaders to develop customised training programmes and reinforcement aids that could be deployed at each level of the organisation and which integrated Arbinger’s tools with Plum’s mission and core values. Leader specific programmes and front line reminder aids were developed to help employees implement outward mindset practices in their day to day work (Figure 1)

FIGURE 1: Customised Arbinger programme developed for Plum Healthcare

Facilitator Training

Arbinger consultants worked alongside the executive team members to train facility administrators in Arbinger’s tools and methodologies so that each operational leader would be equipped to transform the culture, performance and results within their respective facilities. To date, Arbinger has certified over 70 executive leaders and administrators as facilitators of Arbinger’s programmes.

Facility Deployment

Through the facility administrators, Plum has systematically deployed Arbinger’s programmes across the organisation. Within each facility the clinical director and department managers - who together supervise staff of 100-250 employees - are introduced to Arbinger’s tools and invited to lead and develop others in a way that accelerates patient outcomes. This outward leadership approach is reinforced through regular leadership training meetings for administrators, peer to peer mentoring and ongoing discussions to sustain outward mindset ways of working for front line employees.


By implementing Arbinger’s tools across the organisation, Plum has been able to grow at at remarkable rate (in the past 10 years Plum has increased the number of facilities and employees by almost 500%), while ensuring that each newly acquired facility is fully integrated within Plum’s results-focused and patient-centric culture.

In addition to other key metrics, Plum measures quality of care by the results of mandatory inspections conducted by regulatory agencies. Deficiencies in quality of care of a G or higher (G and higher deficiencies indicate that actual harm resulted to a patient) identified by the state agencies at all Plum facilities from 2008 to 2010 totalled 6 deficiencies, compared to an average of 29.25 deficiencies of the same severity at competitors of similar size. Additionally, acquired facilities that had been cited for significant deficiencies in the quality of care outcomes uniformly achieved dramatically improved clinical results within two years of the Plum’s acquisition and implementation of Arbinger tools (Figure 2).

FIGURE 2: Regulatory deficiencies in 5 Plum facilities measured 2 years before and after Plum’s acquisition and the implementation of Arbinger’s programmes.

Plum Healthcare now operates 63 skilled nursing facilities and five home health and hospice agencies located in strategic geographic regions in California, Utah and Arizona. In 2010, When Plum acquired 27 of their 63 facilities, they engaged Arbinger to help solve the many complex challenges inherent in assimilating an acquired company - including over 3,900 nurses - into Plum’s growing healthcare system.

The results of Plum’s implementation of Arbinger’s training and reinforcement tools throughout newly acquired facilities has proven remarkably positive. Results include significant improvement in both qualitative and quantitative metrics tracked. For example, as a result of these efforts, Plum’s Clinical Quality Measures improved 37% from 2011 to 2016. Federal citations at Plum facilities, a key indicator of the quality of care, are 34% less than the average number of citations received by competitor companies.

“Using Arbinger has dramatically improved clinical quality, resident and employee satisfaction, and regulatory outcomes. Arbinger’s tools enable us to deliver better and better quality care for residents through deep and sustainable collaboration.”

Co-CEO and Co-Founder


The figure below demonstrates the results of the annual California Department of Health inspections regarding regulatory standards of care from nine Plum facilities. In each case, the successful application and implementation of Arbinger’s programmes enabled each new acquisition to demonstrate substantial compliance during regulatory inspections - a key indicator that Plum’s outward culture enables consistent delivery of the excellent clinical care (Figure 3).

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