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CW Ep. 9: Innovations in Senior Care with Charles Turner

Charles Turner, founder and CEO of Kare, challenges industry leaders to find the All Star Champion for your team, like Tim Duncan is to the NBA. Plus, he provides the number one interview question to ask candidates.

 

I feel I need to start this episode off with an apology. If you listened to my last episode, you heard me say that I usually try to avoid sports analogies, owing to the fact that I usually find them lazy, manipulative and incomplete, but being the hypocrite that I am, the following podcast contains at least two sports analogies. Maybe more. Honestly I’ve lost count, but you’ve been warned. If there are any young children at home, I suggest popping in some headphones. Sorry. Tim Duncan is the greatest power forward in NBA history. No, I did not say he is arguably the greatest power forward. I said he is the greatest power forward in NBA history. It’s a fact just like the fact that the earth goes around the sun, mayonnaise is disgusting and Joshua Crisp posts, shirtless Jeep pictures on Instagram. Tim Duncan is the greatest power forward in NBA history.

 

Why? Maybe it’s because in his heyday he won five NBA championships, was a five time NBA All Star, NBA Rookie of the Year in 1998 and then eight time NBA All Defensive First Team Member, or maybe it was because Tim Duncan graduated from Wake Forest, the greatest university in the United States just like yours truly. Who is one of the smartest funniest people I’ve ever met? Maybe ultimately what made Tim Duncan? The greatest power forward in NBA history is because Tim Duncan was never supposed to be a basketball player in the first place. He was supposed to swim in the Olympics, but because of a bizarre set of circumstances, Tim Duncan stumbled into basketball and hacked it. But this podcast is not really about Tim Duncan. It’s about the worst hire I’ve ever made.

 

Welcome to Bridge the Gap Contributor Wednesday. My name is Charles Turner. I am the CEO of Care and that is Kare with a K, digital labor marketplace for the senior care industry. I think of this as the Uber for frontline nurses, caregivers, and hospitality roles. If you’re interested in learning more, please go to doyoukare.com again, that is care with a K. I also own and have operated senior housing and care communities and several states over the past decade, I’ve invested in and advised several different startups as well as Fortune 500 companies who are on the forefront of aging and technology.

 

So before we get back to our Tim Duncan story, I have a pop quiz for you. Here’s a little test. So pay attention. I’m going to give you two choices.

  • Choice A is simple. I’m going to give you $5 million, no strings attached. Come to my house. I will give you $5 million. No questions asked.
  • Choice B is a little more complicated. I’m going to allow you to reach into a bag and blindly pull out one of 100 ping pong balls. On 90 of those ping pong balls. They say $5 million. So if you pull out one of these, you will receive $5 million. Just like option A. But on nine of those balls, they say $25 million. Meaning that if you pull out one of these ping pong balls, you will receive $25 million. And if only one of those ping pong balls on one of those ping pong balls, it says $0. Meaning you will receive absolutely nothing.

 

So what you choose option a, the guaranteed $5 million or option B and possibly get 25 million, but also might get nothing. So in your mind, choose now. If you are like the vast majority of humans, you choose option A over option B every time and why? In my scenario, option A was a given. It’s your baseline.

 

If you listened to my podcast last month, we talked a bit about this idea of loss, aversion, or prospect theory and how it influences our decision and how it limits each of us. It limits our industry from becoming more innovative. This $5 million question is actually based on a similar question, asked by Nobel Prize winning behavioral economists, Daniel Kahneman and Amos Tversky. As we talked about in my last podcast, the vast majority of us will spend more time, energy and resources limiting our downside than maximizing our upside. And this $5 million question proves that. The vast majority of humans always choose option A over option B, even though the math says you should always choose option B if you want to maximize your upside, but why do we choose option A, because it is a fear of regret. We fear making a bad decision. We fear regret. We fear loss.

 

What if we make the wrong choice in spite of the very low probability that we actually choose the $0 ping pong ball? And it is the same in our industry. How often do we make the conservative choice? Knowing that we probably won’t be fired for doing the tried and true. It’s the same problem as the $5 million question. We constantly limit ourselves because we won’t go out on a limb and try something new out of fear of what we might lose. The next few minutes we’re going to expand on this idea. As we look at some of our hiring practices and why do we hire who we hire? Who do we recruit? How do we develop leaders? Should we hire the tried and true? Thinking we’re going to minimize our risk, or do we take a gamble and maximize our upside?

 

Ultimately, how can we hack this industry? So back to the Tim Duncan story, I did not really know Tim Duncan at Wake Forest. Yes, we went to the same university. I was one year ahead of him, but we did take one class together: Introduction to Theater. I had to have one fine arts credit to graduate. And I put off taking this class until my second semester. My senior year, the class was me, Tim Duncan, and the entire offense and defensive line of the football team. As a junior, Tim Dunkin was already a national phenom. Had chosen to leave early that year and enter the NBA draft? He would have gone first, but he decided to stay another year in graduate. My interaction with him was limited in that class, but it was very clear that this was a special dude.

 

He was quiet with a driest sense of humor I’ve ever heard. Despite his lack of animation, you could tell the guy was brilliant. The inside coming, the insight coming out of his mouth and I simple theater class was astonishing. And his ability to read the room was remarkable. I’m convinced this is what helped him look at basketball in a way that most people never think about anymore. The backstory and the guy’s fascinating, Tim Duncan is not for the mainland United States. He is from St. Croix in the Virgin islands. He is the son of a midwife and a Mason. And the thought of playing basketball never really crossed his mind at a young age. In fact, he was training to go to the 1992 Summer Olympics as a swimmer up until Hurricane Hugo destroyed his pool. And soon after his mother passed away prematurely from breast cancer. Tim Duncan never swam competitively again. To distract him from these losses, his brother-in-law pushed him to try basketball for the very first time as a freshman in high school, while initially awkward at the game, he started to excel by his senior year against relatively weak competition. When in a fluke of fate, a former Wake Forest player discovered him at, during an NBA Goodwill tour to the islands. When, and a pick up game a 16 year old at Tim Duncan, blocked Alonzo Morning shot continuously frustrating the NBA, the NBA All Stars team resulting in a game, which ended in a tie. As the story goes, when the Wake Forest coach flew to the Virgin Islands to meet him, he spoke of the virtues of Wake Forest for an hour. And while Tim’s father listened attentively, Tim set to the side and played video games, seemingly uninterested in what the prestigious university coach had to say. After an hour of talking, the exasperated coach looked at Tim’s father expressing frustration that he had flown so far to talk to Tim and Tim didn’t seem to care. And at this point, as the story goes, Tim pauses his video games, look, it looks up with the coach and repeats back verbatim everything the coach had just said for the last hour. Tim Duncan was offered a scholarship on the spot. Fast forward to his first year at Wake Forest. He was not even supposed to play his first year being thrust into playing time because of an eligibility issue with another player. On the surface, his first game stats were unremarkable. At the conclusion of his first game. After recently recovering from the chickenpox and losing 17 pounds, his statline was zero points, seven rebounds and five block shots in a losing game and a third rate tournament against the University of Alaska. Over the years, Tim Duncan blocked a lot of shots. Tim Duncan shot a lot of shots. 10 Duncan scored a lot of points. Parenthetically, if you listened to my last podcast, he regrettably did not shoot a granny shot, but while Tim blocked a lot of shots and shot a lot of shots, how he blocked a lot of shots and shot a lot of shots is actually more important than the numbers themselves. 

 

And I promise you, I’m trying not to make this sound like a Dr. Seuss poem. So here’s an example. Think about your typical college or pro basketball game. A typical play, a player receives a past year, the basket. It starts to go up for a shot out of the corner of your eye. You see a defensive player flying to view, one arm raised, and he tomahawks the ball out of mid air. And the blue ball goes flying into the stands. A major block shot. The crowd goes wild, but offensive players, teammates go crazy and violent high fives help feed the frenzy. This is so ingrained in our way of playing basketball. It is something we teach our toddlers as soon as they learn how to shoot, but there’s a problem with this. With that block shot, the ball is only out of bounds. The offensive team still gets the ball back with the opportunity to score again. All the offender did was to slow the game down and allow the offensive team to reset. After all the demonstration of aggression, what’s really changed? But if you have ever seen Tim Duncan play, he didn’t do this. He blocked a lot of shots, but when he did, he did it with the force of a gentle giant tapping the ball back into his hands so he can help lead the fast break, leading to an easy two points on the other end, Tim Dunkin was the master of the bang shot or shooting style that has all but gone away in the past few decades because well, like the granny shot, it’s not very cool, but Tim Dunkin didn’t know he wasn’t cool. Remember, he had never played basketball until he was almost 15 years old in a corner of the world where no one was there to show him otherwise. Combined with a keen, but quiet brilliance, he figured out basketball on his own without anyone telling him he wasn’t cool. Tim Duncan had hacked basketball. Shaquille O’Neal derisively called Tim Duncan The big fundamental, because his game was fundamentally sound and fundamentally boring. And why did Shaq call Tim Duncan the big fundamental? Cause Tim Duncan used to own Shaquille O’Neal. Tim was everything Shack was not. He had no prior prejudices on how he should play. Tim was not so fundamentally sound because he was taught to be so. Tim was fundamentally sound because no one was around to tell him not to. He studied the game with an outsider’s view and learn fundamental arts that have been lost for a couple of generations. So what does this have to do with senior care? Well, at the risk of too much self aggrandizement, I’m going to talk about me and my teams for a second.

 

I read a lot of stories in multiple industry publications about people in our industry. They usually go something like this: I got into senior care at a young age, caring for my grandmother or my aunt or various elderly family members and friends. And I fell in love with caring for seniors. And so I worked in the industry in college and or through the family business to the point of where I am now. Well, this is not my story.

 

While I was close with multiple elderly family members, they all lived a thousand miles away and I saw them on summers and Christmases. And while I love my elderly family members and have always been drawn to engaging with seniors, I came to this industry completely differently. My background is in real estate development and before that I was running corporate planning strategy and finance for large international software companies.

 

In fact, we got into the senior care business because well, financially the world had fallen apart and we could access capital better than most developers could. I stumbled into senior care for financial reasons, but a decade later, I’m not going anywhere. The reason we were able to gain such a reputation as innovators. In fact, the reason I’m able to record this very podcast is because we did not come from the industry. It all started a decade ago when I was building our first ground up development, we elected to install RFID door locks on our resident doors. You know, the ones I’m talking about, the ones installed in your hotel room door, where you tapped the key card to open the door and looking at our design. It seemed like a no brainer, but unlike how a hotel uses the lock for access control, we knew this lock tracked data. And we could use this data to measure who comes and goes, exactly how much care we were providing and movement trends of our residents. We just figured all modern senior care developers did this, right? But apparently we were wrong. They didn’t. From what we could tell, we may have been the first. We actually received a lot of press for this. Apparently we were revolutionary, even though I had used RFID tracking almost 20 years before in a prior career life. No one from our team had come from senior care and from that point forward, we made a lot of mistakes, but we implemented a lot of innovations that started to improve the lives of our seniors. Did we screw things up? Oh yeah, you bet we did. But did we create a data strategy that allowed us to actually measure the quality of care we were providing?

 

Yes. Yes we did. Which brings me to the worst hire I’ve ever made. So for the sake of anonymity, let’s refer to this hire as Kenneth. Kenneth was hired as an executive director in one of our buildings that already had a very innovative culture. Kenneth was a friend that I had known for a long time. And personally I was very excited Kenneth was able to join our team. Kenneth new regulations, cold and I had been in the industry since high school. I love Kenneth. The board loved Kenneth up until he ran off half his leadership team and half the staff and five bucks. So what went wrong? Like I said, I loved him. The board loved him. He knew his business cold, which is exactly why we all wanted to hire him. Kenneth also liked to hunt and play golf. That was not the problem, I like to hunt and I love, well, watching the Masters on TV, but Kenneth likes surrounding himself with people who also like to hunt and play golf, which in and of itself is not the problem. But if that’s your criteria for hiring people, what does that say about your goals for the business? Does hunting and golf drive innovation, or does it drive culture? 

 

In a later podcast we’re going to explore this idea of culture and why? I think the whole conversation around culture is kind of stupid. So you have that to look forward to, but here’s a sneak peek for you. Culture is where innovation goes to die. For now, just chew on that, knowing what we will be discussing this issue in the coming months. So Kenneth was a meat and potatoes kind of guy, and I mean meat and potatoes and only meat and potatoes. I like meat and potatoes. But ask Kenneth to try something different and he would say, well, I’m not going to try any of that fru-fru food. And while we initially found this endearing, we realized that spoke to Kenneth’s leadership style and outlook on life.

 

One of the things we were able to accomplish as an operator was the beginning of the ability to truly measure the effectiveness of our care through no action required by our residents. We were able to measure the exact amount of care given to a particular resident, as well as how their strength had improved or declined, how well they were eating, how much social isolation they had relative to their peers and how effective our staff was in welcoming new residents. We also have the ability to compare how effective one of our communities was relative to another on a whole host of operational metrics months before we ever closed our financials, allowing us to quickly intervene in the event of a significant issue.

 

But when we presented these concepts to Kenneth, he actually said out loud, I have no idea what I would ever do with such information. I get everything I need from reading my financials, which brings me to one of the greatest lessons I ever learned. A CFO I used to work for decades ago, taught me a very valuable lesson. He said, Charles, if you were managing your business, using your financials, you are not managing your business and why? It actually has to do with something called the 90 day problem. If you have an operational problem, it takes 30 days for the problem to happen. 30 days for it to show up in your financials and at least 30 days to fix the problem. That’s not managing your business, but back to Kenneth for a minute, Kenneth never understood the concept of if you can measure it, you can improve it.

 

Kenneth wanted us to spend more time training on so-called soft skills, making our staff “nicer” as if they were not already nice. He really pushed us to have our associates go through programs like the Disney training course or the Ritz Carlton training course, or maybe several other ostensible soft skill training courses. I hear this a lot in our industry. We want to put our team members through this type of training because we want our communities to be more like high end hotels or a resort. And that’s admirable, but here’s the dirty little secret. Do you think Ritz Carlton and Disney are successful because they train their people to be nice? No, they hire people that are already nice. What makes them successful is not the soft skills. It’s the math. They measure every thing. Everything by measuring it, they can improve it. 

 

But Kenneth with 20 years experience only wanted to focus on the nice people who hunted and played golf. How many senior care communities are there out there? How many different operators? Kajillions off them, right? And we think we’re going to outpace the competition. I think we’re diluting ourselves. So after five months, more than half of Kenneth’s team left, they had signed up for a culture of constant improvement, collaboration. And what they got was more of the same old, same old top down management and just the same old, same old. So why stick around? Same with our residents and their families. A lot of them left because they didn’t want to see the same old, same old “old folks home.” And this was completely my fault. I made a decision based on my own personal preferences and not on the mission of constant improvement.

 

I needed a Tim Duncan. And what I got was well, Kenneth, and here comes our second and mercifully a final sports analogy for this podcast. For me, it was like hiring a football coach who was an expert in the wishbone offense. When the rest of the world had evolved to the spread offense. For those not familiar with football offenses, the wishbone is like, well, just look it up or ask your dad or your granddad. So how can you find a Tim Duncan? Well, that’s a lot to ask, but I feel I’ve been able to hack into how to hire innovative team members. And it comes down to one simple interview question. How they answer this question will tell you if someone pursues innovation or as someone who difficult to get to change. Are you ready for it? Here it is. The greatest interview question I’ve ever been able to come up with is this: tell me about a recent time you ate a food that was new for you. And did you like it?

 

I have a dozen different variations on this question, such as given the choice of 50 ingredients at a restaurant you have never been to before. What are you putting your pizza? Or if I could offer you a free trip to Afghanistan and 100% guarantee your safety, would you go? There are a bunch of them. What I’m looking for is flexibility. Does this candidate like trying new things? Are they curious? Are they willing to be disappointed? Are they willing to risk not liking what they choose or do they always go back to meat and potatoes? And looking back through my career, I have interviewed and hired hundreds of people. And every one of my organizations, I always like surrounding myself with curious people. Those who want to challenge the status quo, ask stupid questions to challenge me. When I look back, every person who has never worked out always had the same characteristic. They were completely inflexible when it came to food. Don’t ask me why there is a correlation. I really have no idea, but I found it to be the number one indicator of an innovative personality or not. So it has become my number one screening question in all interviews. And it has never proven me wrong.

 

In fact, Kenneth failed this question, but because of my friendship, I overlooked it. Worst hire ever. A few weeks ago, I interviewed a computer engineer for my company. His resume was impeccable. His skills were second to none. He was very friendly. He knew his stuff. I then asked him the pizza question. He said he would only get ingredients he was used to when I asked why he said, what if I don’t choose the ingredients that I am familiar with? And I get an unusual pizza and I don’t like it. And I have to throw it away.

 

This candidate clearly would take option A, the $5 million. He was not my Tim Duncan. So instead we hired a guy with less experience, but he was far more curious. So how do you hack your job or your company? Well, start by looking at your own business processes. Are they the exact same as they were 10 years ago? Has anything changed? Here’s a scary thought for most companies, especially when it deals with change and our company at Kare, we placed thousands of caregivers and nurses and hospitality workers in senior care communities every month. We have no office. We have never bought or used a printer. We have no checkbook. We have an operations team in Mexico, engineers in China, a project manager in Seville, Spain, executives in Pittsburgh and Houston, and a graphic designer in Pakistan.

 

Yet our business runs 24 hours, seven days a week, with multiple thousands of transactions every month. Because we are so digitized, we have very few fixed costs and we provide thousands of dollars every month in labor savings to our customers, but in order to do so, we had to question everything we had ever done to this point in our careers. We had to hack what it fundamentally means to work. Question everything. Remember not all ways are better, but there are always better ways. I’m sure a lot of you have you listening to me nodding your heads in agreement, but nodding doesn’t lead to improvement. So take option B go for the $25 million. Find a Tim Duncan, find someone who is highly capable, but doesn’t know any better. Thanks for listening to this week’s BTG Contributor Wednesday, I’m Charles Turner. I’d love to hear your thoughts. So please connect with me at btgvoice.com.

 

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  1. […] last month’s episode, I gave a bit of a preview of this month’s episode. I said, the conversation around culture […]

CW Ep. 9: Innovations in Senior Care with Charles Turner