Building a Values-Driven Organization

Each week, BAYADA Home Health Care’s more than 20,000 healthcare professionals provide in-home care to 26,000 clients from 300 offices in 21 states and India. In 2002 President J. Mark Baiada was looking for a way to formalize the important but unwritten principles that had guided the company since he founded it in 1975. He read a moving and insightful open letter to home health providers by Al Freedman, PhD, the father of Jack, a medically fragile BAYADA pediatric client, and engaged Freedman to help him define the company’s mission, vision, values and beliefs. Three years later The BAYADA Way—a brief, eloquent document that spells out key results and actions to demonstrate the company’s values—was introduced. (You can download a copy at www.bayada.com/the-bayada-way.asp.)

IH Executive talked with Mark Baiada about the project 10-plus years on, and about how fostering a values-driven culture has benefited the company and its clients for the past 40 years.

Why should an organization document its values?

It’s the foundation of our work. Any person or group who wants to accomplish something has to have a clear goal and a reason for working hard and going through the trouble to get there: “What are we trying to do, and why are we doing it?” Unless you can answer that question as a group, people will start working at cross-purposes, because they’ll have their own goals.

What are the benefits of spelling out your mission and values as clearly as you and Dr. Freedman have in The BAYADA Way?

It helps the people who work here feel they’re connected and aligned, working together as a community for a worthy, large purpose. In our case it focuses them on our clients. “Our clients come first” is belief No. 1.

It also has another interesting effect: As we state it that way, people who are looking to work for a company like that can find us. We’re a little different. We’re not just looking for skills; we’re looking for people who feel like we do, who like helping people, who like working hard, who like giving great service and making sure it’s reliable. So it’s, “Oh, I’m that way, are you that way? Let’s work together for the good of our clients”—and then business usually takes care of itself.

Has documenting your organization’s priorities changed the way you recruit staff?                           

Yes, because we lead with the BAYADA Way; we lead with mission and values. So rather than looking for an RN who can do pediatric care at home, we’re looking for somebody who’s compassionate and wants to help families cope with taking care of their child at home. You keep putting it out there, and people self-select. If you join the Marines, you know what you’re getting yourself into. Well, if you join BAYADA, hopefully people know what they’re getting themselves into, because we stand for something and repeat it often.

How do you use the BAYADA Way in training staff?

You need formal and informal training. We have formal training, with supporting materials. We do it in person. There’s more online, just because it’s more efficient. But it’s not one-and-done. It has to be engaged in all aspects of your work. If you have a good coach, it’s all 24/7 on the team, from “tuck your shirt in” to “play the right position and develop your skills.” We’re all in every time we have an interaction. And then you have to model the behavior. If you expect a behavior, you’d better be what you expect.

How do you promulgate values with a workforce that’s spread out geographically and working in clients’ homes?

There are three steps: Clarify your values, communicate your values and then align the values. Doing this across all our disparate locations is hard, but we keep working at it so we have something consistent to offer the people who need our help and something consistent to meet the needs of people who want to join us as employees.

How do you align BAYADA’s values with day-to-day operations?

Starting with the interviewing process, and then through our orientation program, we mention the BAYADA Way. All our performance reviews have the BAYADA Way in them. Anytime we’re addressing a large group or facing a decision, we refer to the BAYADA Way. There’s usually something in there that relates to the issue at hand.

We just had a case where we were relocating an office. An elderly woman who’d gotten service from that office for years was frightened. And someone in the office had quit, too, coincidentally. [The client said,] “Oh, you’re moving. The person I’m working with left. What does it mean for my care? It’s been good, but now is it going to change?” The regional director called her to reassure her; so did the director. The regional director said, “I want to make sure that we’re consistent with the BAYADA Way in how we handle these things,” which means supporting her through this.

Does that alignment of values help with employee retention?

Most nurses become nurses because they have these values to begin with. So I think it helps us on recruiting and retention. I get a lot of e-mails and feedback from our staff: “Thank you; I believe in BAYADA; I believe in what we’re doing.”

The other aspect is, it’s not a job. It’s an identity. If you become a nurse, you’re not working for the local hospital—you’re a nurse first. Well, we’re a type of nurse. We’re a BAYADA nurse, which is a unique type of nurse—or therapist—that does home healthcare. It’s a calling and a value-based identity.

Do clients become familiar with the BAYADA Way?

Some do. They’re a little overwhelmed in their lives sometimes; they just want to get by. We’re actually trying to increase their knowledge of it, with our employees.

Sometimes I get a letter of complaint. People will quote The BAYADA Way and say, “I’m not getting that.” And I say, “You’re right; you’re not getting that, and I’m sorry, and we’re going to see what we can do to fix it.” Because under Reliability [in The BAYADA Way], we say, “Be creative, flexible and determined. Get the job done for our clients.” So I say, “I hear what you’re saying. Let me figure out a way to see how we can get your needs met.”

Do you share The BAYADA Way with other provider organizations you integrate care with, and does that help with referrals?

We do, but the way we view it is, we really care about people, we’re going to do excellent work, reliably every day. So, they’re going to call us back. We’ve built the company based on just really good service and good quality nursing and therapies. And it helps business. That’s Business 101: Listen to your customer, take care of their needs.

How has your commitment to a values-driven organization evolved over the past 40 years?

When I first started out, I was naïve about others. I thought everybody who’s going to be doing home care is certainly going to have a big heart or they wouldn’t do it, and they’re certainly going to make sure they do their job well, and they’re certainly going to show up every day. Well, some people approach work differently. Over the years, I probably would have been more careful in picking people based on values and their ability to get the job done, rather than based on skills. More on their basic competence in being able to handle decision-making, handle situations and exhibit good values.

What made you want to document the company’s values—and how did you go about it?

When we decided we wanted to be here in 100 years, I started examining companies and organizations that lasted a long time. And I realized it’s not money that holds the company together, it’s a value system, a philosophy. And most of them had it written down or codified in some way.

That’s when I met Al Freedman. At first we thought, We’ll just write down what we think we stand for. “Al, you represent the clients, and I’ll represent the caregivers—the nurses, the therapists and the office staff—and away we go.” And then we realized, This is bigger than us. It has to come from the hearts of the families who are receiving the care, our nurses, aides and therapists. So Al went out and did scores of focus groups with like-minded people. “When home care is working, what does it look like? What’s going right? What values best express the work we’re doing?”

We did overnight retreats. We did a survey of every client and every employee. I think we sent out 20,000 of them. And so it took a couple of years to distill this to the document we have today.

Interestingly enough, it ended up being very similar to the value systems we had had for the 30 years to get up to this. But we went through the process of putting our own feelings aside and seeing how other people think when they think a little deeper.

MaryAnn Fletcher is a freelance writer based in Georgia.