Dr. Todd Schmeideler, Senior Vice President, Trilogy Health Services and Trilogy Foundation
Nearly two years ago Trilogy Health Services began an innovative Apprenticeship program for Caregivers working in their 115 locations located in 4 midwestern states. The results of the program have been impressive and the program continues to provide very positive results both or Trilogy and caregivers alike.
Interviewer: Todd, why did you begin the apprenticeship program?
Todd: You know, there's two reasons. The first is to give our direct service employees an opportunity to grow in their knowledge and their pay. Right? The second thing is, is that our company has a fundamental principle that we're trying to give our employees hope and confidence in everything that they do. Hope that they can be more than they might've been without us... and confidence once they start down that road that they can achieve it because they're not alone in it.
Interviewer: Have the goals changed since the beginning?
Todd: They’ve expanded more than changed. We started with two apprentice programs. [caregivers and culinary workers] They've been highly successful and I would say that because of that and because of the impact that it's made on the employees that we started getting other employee segment populations coming to us and saying, “Could we get an apprentice program?”
Our goal is to continue to offer more apprentice programs than just the two. We've added two in the last three months and we're anticipating adding up to six more in the next year. This is in four Midwestern States. Our locations are primarily in Indiana, Ohio, Michigan and Kentucky. We have 115 senior living facilities. We're also starting an apprentice program with our pharmacy company which has more locations that are spread out throughout the country. They have a smaller number of employees. We're going to be doing a pharm tech program with them to offer the same kind of hope and confidence for their employees.
Interviewer: How many employees are participating overall?
Todd: About 6,000 in total. Indiana has 65 of our 115 locations, so they have 3,500 apprentices. Ohio has 1,000 and Michigan and Kentucky each have six facilities or about 700 participating in each state.
Interviewer: What the key components of the apprenticeship program?
Todd: Well, our nurse aid program is our largest and has three segments:
The first is to take people who want to enter into healthcare, particularly bedside care and get them certified as a nursing assistant-Certified Nursing Assistant - or CNA. They'll come in uncertified, we'll get them certified through the state.
The second level is to get them dementia certified. So working with you guys [NCBAC} our goal has been for them to have an understanding of the cognitive awareness and abilities of our residents. We want them to be able to serve them better, but also so that they can serve family members better.
The third stage is what we call specialty certifications. And there are five specialty certifications in that track. So once you get through the first two, the CNA and then the dementia, you have a choice of those five.
Interviewer: How do dementia caregivers participate in the program? Can anybody be an apprentice? How are they selected?
Todd: They're selected by their job code, their job title. We started with nurse nursing assistants, and then added culinary, those were our first two. Obviously with nurse assistants -the dementia program was existing. However culinary students don't access the dementia training. They have their own culinary program that they use. We've recently added life enrichment, which is basically our activities group, as well as hospitality. Both have dementia as a component as one of the certificates they earn in their pathway, as well as on an exception basis.
Though we don't have an apprentice program,we have been training our environmental services staff - that would include housekeeping and laundry services - in dementia care. We're planning an apprentice program for them. And the dementia certification will be one of those that they can earn as a primary area of achievement. When they learned about the dementia program, they asked if they could be added to it. When they spoke out, what we saw was that that population had a very small pathway. There we have lot of well tenured people in environmental services and we had not been giving them a pathway to increase their knowledge and pay.
Interviewer: Do your team members volunteer for the program or are they assigned to it?
Todd: If you have a specific job, you're automatically in the apprentice program. I often liken it to the more traditional apprentice programs like plumbing. If you want to become a plumber, you go to a company, you get hired and that company says, "okay, you're now going to be a plumber assistant with union. We don't have a union. If you're going to be a nurse aid with us, you are an apprentice in the nurse aid track. That doesn't mean that you have to be active - to be learning in some path that is predetermined by someone else. You're not up against time limits. You do it at your pace. We're really trying to motivate more through encouragement.
There are little letters on their name badges. When they finish each segment it spells out something like "DEMENTIA". It's very powerful encouragement. It's also one of the more powerful ways that you build culture. When people can see it and they're proud of it, other people want to join in.
Our culinary program is another great example - we call four star chefs. And so each time that someone earns that first certificate, they earn a star. So then when they finish the second one, they get the second star. And when they finish the third one, they get a third star. When they finished the fourth one, they become a full four star culinary chef within our program. That has really driven the success - that is the ability to recognize not only the person going through it, but to recognize it as an important part of our culture.
Interviewer: Are the apprentices taking courses online? Do they get one-to-one mentoring? Tell me what the typical participant experiences.
Todd: With some exception, they're online, on demand and mobile friendly. Our providers are typically using our LMS [learning management system]. Of course we also have 1-1 mentoring.
Interviewer: So by mobile friendly you mean they'll do it on their phone?
Todd: Yes. Lots of times they'll do it on a phone or a tablet. You know, they don't have traditional laptops. We don't have a lot of laptops in our campuses. We have a few computers that they could use, but we don't designate time in their workday for them to use them. This is an outside certification that they earn on their own. That's also why we don't pressure them to do it. The course is typically in our LMS. That means we know exactly how far along they are and when the last time they were in the system. We have visibility and can encourage them appropriately. how We can encourage and have them be more successful by utilizing our own systems and doing it on demand - online on demand.
Interviewer: Do you find that most people who are enrolled in the program or completing the program, you're in your second year now?
Todd: Yes We've had time for people to complete the program in its entirety. I wouldn't say the majority because at any given time we've got 4,500 nursing-related candidates we might have 1500 journeymen.
Interviewer: A journeyman is somebody who's finished their apprentice program?
Todd: Yes, they've earned it in the nursing program. Or they've earned it in the culinary program, where they have to earn four certificates. Regardless of the program they are called journeyman if they've completed. It's a department of labor term.
To go back, just one thing besides the online on demand, we do two other three other things that I think have created success for us. First is that we have a, a "preset mentor" kind of help. So it's a peer supervisor who supports the apprentice going through the process. They also do all the competency check-offs on site. And it doesn't matter what apprenticeship it is, we always had those support mechanisms. The second thing that we offer is we offer what we call success coaches. Success coaches travel from campus to campus, working with individuals to help them overcome their obstacles and challenges. They give them access to programs and employee benefits that they might not have otherwise known about. The third thing that we do is we have communication that's tied to workflows or progress. One example is communication that happens when they get halfway through a certificate. In your case, I think the NCBAC course has nine modules. When they get through their fifth module, then they get a message the next morning that says, "Congratulations, you're halfway through to a pay raise."
Milestones are progress markers and that's automated. And so we send that out hundreds of thousands of those a month. We have 6,000 people in the program and they're all going through it at their own pace and in their own way. We want to message globally and build our culture around it.
We also understand each person needs to understand we are having a conversation with them. If we're not having a conversation with that person, whether it's through the preceptor or the mentor or the success coach or these messages I just described, then you're probably going to feel pretty alone on an Island. That's never been a recipe for success. We want everyone to know they are a part of something special, so those are the communication mechanisms that we put around the overall program.
Interviewer: Are you getting feedback from residents that they see a difference in the higher levels of training?
Todd: I think actually, yes. I'll tell you what we hear from many of residents. They are as proud that the person earned the certification and celebrating with them as the person who's earned it. It's like our name badges. We make it very public when they earn another certificate. We have a party for our employees every month. That's where they get this certificate. They get an award. They get called up in front of the rest of the employees and often residents and they get congratulated. It's almost like a receiving a diploma. So think about going to college. You've got all these people graduating and everybody gets up and everybody's cheering. Well, the family for our employees are our residents and their coworkers.
So by allowing them to have part of that success, it feeds the encouragement of the employees who say, "I couldn't possibly do that". It gets back to that hope, you know? And when you congratulate one person publically, you build more general confidence cause everybody else is cheering you on and they're letting you know, "great job on that". Then you're see it on your pay stub and you say "Hey, I did this!"
So our real goal with the apprentice program isn't just simply to help people get through and become journeymen. It's to convert them from journeyman, if they have a desire, to get a college degree. Many times people have have gotten into a role and they've been in that role a long time and it's been a long time since they been, in school. Maybe they weren't even very good, students while they were in school. But today is a different day. They might be in their late twenties or thirties or forties who, I mean, we've got somebody in their sixties who all of a sudden when they got through their apprentice program, they said, you know what, I'd really like to go to college. And we converted all of those certifications into college credit. And as a result of that, now we're getting people who are literally going to college who we helped them pay for their college, but they also earn this college credit. So they don't feel like that they can't do it. They just need the support to be able to do it.
Interviewer: What would you say are the most valuable parts of the program? When you started the program, you obviously thought it through in great detail. What is the most different? What were the biggest surprises? What are you happier about that you than you expected in terms of how is it playing out differently than your original idea?
Todd: What am I happier about?
Two things. I'm happier with the quality of the experience that our employees get from our internal team of leaders who do this. I'm also happy about working with our third party partners. You never know what to expect and as you go through this, not everything works. I'm happy about going through this process and being with people who are willing to adjust with you. People that know that you don't have the end result yet because nobody's done this. Nobody has done this in healthcare. In our four States we are by far the largest apprentice program. That's not just for healthcare. Largest apprenticeship program, period. To share some scale with you, we've got 6,000 apprentices now. I read an article very recently that cited CVS as the only healthcare company that cited on apprentices. They've done a thousand apprentices over eight years. We have 6,000 active.
I think that that doesn't happen without the right people. The other thing that I'm probably most surprised about, pleasantly surprised, about is how it's been embraced by our employees that we didn't even build a track for. I really thought, okay, the nurse AIDS are going to like it because they're going to get pay increases. The chefs, which was a much harder thing to do than I had ever planned on. The chefs because they don't have a culture of growing like ours - like our caregivers do. I'm refering to a culture that centers around bedside care.
In the kitchen when you're a cook, you usually don't do online classes to become a better cook. You just cook more. When you cook more, you get incremental pay raises. Like everybody else cooks receive a raise of a few percent in that year, but they don't necessarily experience where they can go out and they can earn a certificate and all of a sudden that certificate gets them a pay raise. Restaurants typically are small businesses. You've got the big ones , but most of the time they're small mom and pop restaurants and they don't have these kinds of tools that we have.
So it was harder to get them going. We had to put in additional incentives in and we really had to partner closely with our vice president for dining services. He became the champion. That was a learning lesson. Most of the time when we're doing these things, we have agreat deal of credibility. That's because of our foundation and because of our other educational things that we've done. People generally like us, we've granted 3000 scholarships. So partnering with the champion who could be our voice of trust within that group was critical. Right now, we've got about 200 journeymen in our culinary program. Going in to this year we had two.
Interviewer: So do you notice a difference? Can I ask you if the food is better at trilogy?
Todd: The food's better Trilogy because we bought better food and because we hire better people and we have standards. Are the tools that they're learning helping them or find how they do their job so that they can do it in an easier, more efficient and a more effective way? I believe so. Not every single time is every single meal going to be better because they are a journeymen, but consistently they're going to be better positioned and they're going to be able to share that knowledge with people who are working with them that are hopefully gonna make everybody better.
Interviewer: So outside agencies come in to take a look at trilogy? I'm thinking about government agencies. Do you have a few different kinds of organizations that look at you and want to be sure that you're doing the right thing?
Todd: We got audited by DOL. Every state.
Interviewer: Have you noticed differences in those ratings as the program progresses?
Todd: Um, you know, I can't yet. We not run the numbers on that. We've run the numbers on things like turnover and retention. A very direct correlation is that this past year we had our two highest ever employee satisfaction results through Great Places to Work. We know the connection between the employee satisfaction. When it goes up, our customer satisfaction goes up. When our customer satisfaction goes up. Then our ratings go up. You know, both from a clinical standpoint done by the state as well as by our customers. When that happens, we actually have a better in ROI at those campuses. We know that for 20 years. basically profit. Campuses make more money when we invest in them. It all stems back, we believe in what we call the flywheel to success.
That flywheel starts by having an engaged, educated employee workforce, that are happy and want to come to work. They want to do the right things. Because they are engaged, they want to make sure our customers have a great experience, not have to cause they're getting paid a paycheck, want to because they feel loved and cared about on their own. Then ultimately when your customer feels that way, they're going to continue to utilize your services or refer to you. That's how we're going to make money. We don't make money sitting around thinking about how to make money. We make money by treating our people right. We make money by reinvesting the money we make back into our people. So every year we've done dramatic new things to support our people. In 2018 the apprentice program was one of them.
In 2019 we expanded our student loan repayment program and doubled it. Now 1500 employees get a payment on their student loan of $100 every month that they work for us. Or we started a brand new program where it's free tuition for our full time and part time employees at Purdue Global for their 171 degrees with no work requirement connected to it. When they finish their degree. 6% of those people in a criminal justice degree. So in five years they don't owe Trilogy anything. They owe Trilogy is a thank you for being with us. Trilogy owes them a thank you for being with us.
If somebody wants to be a police officer and to do that they needed to get a criminal justice degree, they can do that through Purdue Global and they're going to be with us another two to four years to get that degree, then I want them to go where they want to be. Otherwise I'm breaking our fly wheel.
We want an engaged and educated workforce. The minute that I handcuff somebody, they stop being engaged. They may be educated but they're not engaged. And if I break that one, then the rest of the thing is broken.
You can't go back. You know? It's a hard thing because there are very few companies that do that. I don't know, another company who is investing in free tuition at a major institution for all of its full and part time people and not having a work requirement related to it. Frankly, sometimes our internal people think I'm crazy. But you know, these are the things that have paid the most dividends. Sometimes things don't seem like they're good business decisions. . But in reality, they're good people decisions. When you do the right thing for the right group of people, they will respond appropriately. I believe it.
Interviewer: Will trilogy take this to other States and/or will you stay in the four States where you're operating? Of course I mean Kentucky, Indiana, Michigan and Ohio.
Todd: Trilogy is a Midwest company. We're not going to go outside of our four States that we can foresee. We going to help other companies who are currently seeking how to do what we've done? We're going to try to help them. How? I'm not quite sure yet, you know? But we think that good leaders don't hoard. They share, you know, and I'm not really in competition with them. You know? That's the mistake I think that goes on is I'm not in competition with else or something else. I'm in competition. Do what's right.
That is hard enough in this world, but when we stand up for what's right, it always pays dividends. Even if sometimes you can't see it on paper.