The first thing that strikes you about Nancy Diller-Shively is her energy.
She greets you at the Akron headquarters of Cambridge Home Health Care with a vigorous handshake and a wide smile — a genuine smile. She’s not faking. She really is this happy.
“I love what I do, can you tell?” she laughs. “We have plenty of challenges, don’t get me wrong. But I really believe in what we’re doing. To be able to keep somebody in their home, it really is rewarding.”
Diller-Shively has reason to be happy. Despite the uncertainty facing the health care industry, Cambridge Home Health Care is booming.
In February, Cambridge opened its 18th location in Ohio since its launch in 1994. The family-owned company serves 1,850 patients a week in their homes, helping them prepare meals, grocery shop, run errands and do laundry, and offers nursing services as well.
Diller-Shively, a registered nurse, was working in the intensive care ward at an Akron hospital when she received a call from a colleague who needed a nurse to supervise home health aides. She wasn’t sure that was what she wanted to do, but she decided to give it a try.
“I walked into the first home and I knew it was my destiny,” Diller-Shively says.
She stayed with that home health care company, which was later sold to a national firm based out of New Jersey. Diller-Shively was put in charge of acquisitions by the new owners, but after eight years, she became discouraged by the company’s hunger for growth and indifference to its employees.
“That’s when I decided I wanted to start a company where we don’t lose sight of the people,” she says.
Diller-Shively picked up a phone book and started calling brokers looking to sell a company. From there, she found a husband and wife team in Medina County who wanted to sell their home health care company and were willing to finance the sale.
Cambridge Home Health Care was born.
Smart Business talked with Diller-Shively about her expansion strategy and the challenges facing her industry.
How do you choose your locations?
Before getting to that point, I’ll let you know before I got into business, (expansion) was not the intent. I had no game plan to be a statewide provider or really anything other than being a company people enjoyed working at.
We began to grow, basically on reputation, and the word got out that we provided a good service, and we would have agencies from different locations call us and ask if we would be willing to open in their cities. When someone’s asking for something like that, I certainly have a difficult time telling them we can’t help them out. So, the majority of our growth has been by invitation.
Part of that strategy involves getting the staff to buy into it. I’m a firm believer that if we don’t have the whole team, especially the team that’s directly involved with that new location comfortable with that, then we should not move forward. So far, no one has said no.
My former boss at one point criticized me and told me I led by committee. He used to bang his fist a lot, ‘You have to stop leading by committee.’
I feel there are certain things where a leader does have to make the decision on their own, but things that involve the organization and individuals having a bigger work load, I really believe you have to have buy-in, or else your setting up the organization for failure.
Generally what happens, either we’d get a phone call from someone needing our care in a community where we did not have a location, I’d bring it back to the team meeting, throw it out to the team, from the finance department to the individuals who would have the operational management piece, to quality assurance director. I would say, ‘We’ve been asked to open up here, how do you feel about it? Do you think we can do this without having a negative impact on our current business?’
I’ve been blessed with a group of go-getters, and they have readily bought into the big picture, and that’s really how we’ve grown the operation.
I’ve had one acquisition along the way, and that’s interesting, too, in that, I wasn’t pursuing it. I received a phone call. It was a friendly competitor of ours, who for medical reasons wanted to exit the business.
Some of the locations were in our current cities, and I think there were three offices that were not where we were currently located. So I told them, ‘No, I’m not interested. We’re growing fine without an acquisition.’ They told me what they were asking for the company, and I still said, ‘No, I don’t think so.’
Several months later, they called back, cut the price in half, and said they would hold the note interest free. I said, ‘Well, let me get together with the team to see if they would be interested in this.’ It was a decent size acquisition.
I took it back to the team, ‘This is really interesting, we’ve been asked to buy this company, and now they’ve come back and lowered the price.’ It made sense from a pricing standpoint. It was valued at much less than what the going rate was at the time, so it was very hard to say no.
They all bought into it, and they said, “Yeah, let’s do it!”
We’ve never done a market research study or anything like that. The growth rate has been pretty phenomenal. Columbus came about very similar to the rest of them. It was really more the staff wanting to move into that area.
We really didn’t have a call from a provider requesting our services because there are probably 50 or 60 in the Greater Columbus area. But we had a staff member who felt we would do well in the marketplace, and that’s why we decided to open up there.
Who’s on your team?
We used to have three district managers and we just added a fourth. Then I have my husband on the team. He’s really been a Godsend in that he has brought to the organization efficiencies. He’s very good with the computers.
We’ve been able to maintain our overhead at the support office and not had to add any new personnel for billing or payroll or anything. That’s the secret: Economy of scale. If you can increase in size and keep your overhead low, that’s a no-brainer.
How do you create an environment that nurtures go-getters?
I’ve just been blessed with a group that loves their job and loves to work for the company. I had worked at a company that lost sight of what the product was, and that’s people.
That was my mission. I wanted to have an organization where people really enjoyed coming to work. We spend so much of our life here. I knew we could accomplish that and still be successful, and that’s what I set out to do.
The team has really made it happen. I’m the risk-taker; they’ve really made the growth happen.
Why is the team buy-in so important to you?
Part of it has to with my history. The 10 years before I had my own business, I was with a company that did not believe that. I saw from that experience what happens to the morale of the individuals, and from a business perspective, it didn’t work.
Knowing that, I realized I’ve got to do this differently. To have them buy into the major plan, whatever we’re doing, is extremely important. Disgruntled staff equals disgruntled patients or customers. It’s pretty simple, but it’s working here, at least.
How has the national nursing shortage affected you?
It’s our biggest challenge. Not only the nurses, but the home health aides. It’s difficult to have enough workers for the amount of cases we have.
We did a three-month analysis, and if we were able to have enough staff to cover everything we have requested in terms of the cases that come in, our business would have increased 20 percent.
That’s just one company. So, you know there are a lot of individuals who need care who aren’t able to get it because staffing is so crucial. We’re pushing 1,000 employees now. About 35 percent are either RN or LPN, and there would be about 10 percent that would be considered the office, and the remaining would be home health aides.
People are living longer. The technology that used to only be provided in a skilled facilit
y,
such as a hospital or a nursing home, that same technology is available to patients in their home. People can receive dialysis at home, a ventilator, all kinds of different treatments.
People, for the most part, want to be in their home, so I just see this industry continuing to grow by leaps and bounds, but the challenge is attracting and keeping employees.
How have you managed to make a profit when so many other health care providers are struggling?
It has to do with administrative overhead. We don’t compromise at all in terms of the individuals providing the care, but the secret is to do what we can administratively, as the number of patients grows, and the number of field staff employees grows.
We have the same overhead here to be able to produce all of what goes with it, in terms of the payroll and so on. Again, I have to credit my husband with being able to bring his expertise here and maximize the efficiencies.
We have the same gal doing payroll that we’ve always had. Now, I tease her, ‘What were you doing eight years ago?’ When we started, our employees were probably 70, now we have 1,000, and we still have one person doing our payroll.
Some companies error on that. They look at the numbers and think, ‘We have this many more patients, therefore we need another person to do the billing.’ There are other ways to have that accomplished if you stay on top of the technology, and that’s what we’ve been able to do. How to reach: Cambridge Home Health Care, (330) 668-1922, or www.cambridgehomehealthcare.com
