With ABA providers beginning to feel the growing pains of a maturing business, many are looking at course correction.
Still, it can be challenging to determine when it’s time to invoke a turnaround strategy and how to implement those changes. A good turnaround strategy may include training new leaders, breaking down clinical and operational silos and keeping leadership accountable.
The definition of a turnaround is broad and may be triggered for financial, operational, or even cultural reasons.
“Likely a turnaround is an underperforming asset. ABA [applied behavior analysis] companies, which we might consider an underperforming company, may have a really strong top-line revenue, but perhaps it is not performing in terms of EBITDA,” Sarah Trautman, CEO of Inspire Horizons, said at the Autism Investor Summit. “Sometimes a turnaround can be from a cultural perspective, and you really have to turn around a culture to impact clinical quality.”
Inspire Horizons is a Tucson, Arizona-based ABA provider. It has two locations and offers one-on-one services.
Often, during a period of rapid growth, providers begin to see some cracks in the company’s original foundation and look to remedy this through a turnaround plan.
“We grew at a really fast pace, and we kind of lost a lot of what made us great in the beginning,” Natesh Kumar, CEO of Empower Behavioral Health, said at the Autism Investor Summit. “So it’s understanding that we can still grow, but what needs to be established first? What made us great at the smaller size, and how do you recapture that culture? A lot of it was just communication. A lot of it was traveling around to all the clinics and making sure the RBTs and the BCBAs still knew that even though we were bigger and entering new markets and couldn’t know everybody’s name at all times, you still could recapture that success.”
Empower Behavioral Health offers ABA services to children with autism. It has more than a dozen centers across Texas.
Turnaround tips
Training new leaders is a critical part of a turnaround strategy. The autism services industry faces challenges that many health care sectors face: a person may be an excellent clinician but not have the appropriate management skills for a leadership role. Additionally, the ABA industry is unique because the majority of its workforce has been in the industry for less than five years.
“We promote clinicians to leadership positions and roles on the executive team because they’re excellent at what they do,” Jamie Bassos, executive vice president of BrightBridge ABA, said at AIS. “They’re excellent clinicians, but leading a team and managing people and operations is a completely different skill set than the actual clinical work that they do on a day-to-day basis. So you’ve got clinicians who are put into leadership positions that are now reactive, which leads to high burnout, and then high turnover.”
North Carolina-based BrightBridge ABA is an autism service provider with three locations in the state.
A structural way to help remedy this is by breaking down the operational and clinical silos often set up in health care. Clinicians becoming more savvy on the operations side could help improve future leadership and operation folks seeing more of the clinical side could enhance their overall understanding of the business.
“They’re speaking completely different languages, and you’ve got to get everybody on the same page,” Bassos said. “But in order to do that, everybody needs support and training. It doesn’t just happen magically.”
Bringing more folks into a company’s decision-making process could also be a critical part of turning around a company’s culture and building transparency across an organization.
“As we got bigger and bigger, we started to make more siloed decisions and realized that when we made bad decision, we heard about it from every single person in the company,” Kumar said. “I started to expand that decision-making team. So, at first, it was just our C-suite. Then it became the leadership team, regional team, and clinic level, and then as we started to push down those decisions together, it felt like we weren’t dealing with uproars all the time. So it wasn’t like we were defending all our decisions to every employee. Employees made those decisions. We had six levels that agreed with those decisions.”
Transparency and accountability is a major factor in a turnaround process. Organizations also need to foster an environment where employees can discuss problems so they can be solved quickly.
“We can’t solve problems that we don’t know about,” Trautman said. “the most important thing you need from people that are in management positions in your organization, especially during a turnaround, are people that are identifying the problems, and that doesn’t mean they need to have every answer, but they’re bubbling them up. That’s been really crucial.”
