Motivational Interviewing, Matt Fleming, and Healthcare Culture

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Welcome to today’s episode of The Communication Solution podcast with Casey Jackson, Danielle Cantin and our guest today, Matt Fleming, Chief Operating Officer of Sun Sunshine Health Facilities in Spokane Valley, Washington. We love talking about Motivational Interviewing, and about improving outcomes for individuals, organizations, and the communities that they serve. 

Today we are talking about Motivational Interviewing in Healthcare. Matt shares his incredible career path that has led him to where he is today. He provides us with the background of his journey, his passion for the elderly and how Motivational Interviewing has enhanced his career.

About This Episode

• Motivational Interviewing in the Healthcare Industry
• Leading people and conflict
• Being compassionate and empathetic without being emotional
• Development of leaders and investing in staff
• Training outcomes
• MI culture shift
• Team challenges
• Compliance issues
• Training executive leadership
• Stress and workforce burdens
• Ambivalence
• Motivation and retention
• Behavior and Values
• COVID and the healthcare culture
• And so much more!

You don’t want to miss this one! Make sure to rate us or share this podcast. It would mean so much to us!

For those who are new to this podcast, the MICA is the Motivational Interviewing Competency Assessment. For more information or to schedule a training visit https://www.ifioc.com/.

Thank you for listening to The Communication Solution. This podcast is all about you. If you have questions, thoughts, topic suggestions, or ideas, please send them our way at casey@ifioc.com. For more resources, feel free to check out ifioc.com. 

Want a transcript? See below!

Welcome, everyone. We’re so glad you’re here to join us today for this episode of the Communications Solution Podcast. I am Danielle Canton, your facilitator. I’m here with our amazing host, Casey Jackson, the Executive Director of the Institute for Individual and Organizational Change, and we are thrilled to have a guest today.

Yes. We have Matt Fleming here. He is the Chief Operating Officer of Sun Sunshine Health, facilities in Spokane Valley, Washington. He’s got an incredible, career path that has led him to where he is today and Casey, we’re thrilled to have Matt join us today. Absolutely. So, Matt, thank you Danielle, and thank you, Casey for inviting me.

I’m, I’m happy to be here and. You know, talk about, share my journey in healthcare, because it really started as a passion work for me. So just to give you guys a little background, I think it’s, it’s really helpful to start from the very beginning. I didn’t, I didn’t fall into healthcare. It was intentional.

It was a decision I made when I was a young kid. I was raised in a small farm, in a community right outside of Spokane. And I did not. Farming. I did not like to be dirty. I didn’t like anything about it so, you know, that’s not great for a farm kid not to like to get dirty. So my dad said, you know what, Matt?

You don’t have to work on the farm, but you have to work. I was about 16 and he said, what do you love to and I said, well, I love old people. I’ve always, and I’ve always loved old people. Like I just was drawn to the elderly population as a young kid. Just always wanted to sit next to the little old ladies at church or whatever.

So I said, well, I, I love old people and he goes, okay, well let’s check out how to get you working in a nursing home and so just to, as soon as I, as soon as I turned 16, I drove into Spokane, and went to work at a nursing home. As got my c. In high school, I went to work at a nursing home, cna, right away.

And I knew that that was where I meant was meant to be and that’s weird for me now to look back and think, how did I know that as a young kid at 16? At 16, knowing that I wanted to land in this profession? I think that’s really rare now looking back on it. But at the time, It wasn’t, it’s just what I knew.

I, where I belonged. I loved that population. I loved taking care of them and, but I thought, you know what? I think I could do it better than it’s being done. I think if I went to school and became a nursing home administrator, I could, make a difference. In the staff, which would make a difference in the, in the elderly lives.

So that’s exactly what I did. I went to school, Eastern Washington University, graduated with a degree in healthcare administration, and you know, doors opened as they did and I landed as the first time administrator at 22 years old in Lewiston, Idaho, running a nursing home and a retirement center assisted living facility.

So it was a campus, I couldn’t believe it. I look back on that now as a COO and think, what was he thinking? Hiring this young kid as, an administrator over his, his business and. I think the Lord, I had a strong director of nurses that I think felt sorry for me, took me under her wing, and she taught me really how to be a leader and how to be a boss and how to be a manager of people.

So, you know, my career stayed kind of in that nursing home administrator profession. Roughly 20 years. I, well, maybe 15. I, I ran that building for about five and then I came back to Spokane and ran their largest nursing home. It was 164 bed nursing home here in Spokane for the next 10 years. And I, and I loved it.

I loved it. I loved leading people. I felt like I was good at it, but I’m one that doesn’t like conflict and so that was always tough for. to have those, what I would call a courageous conversation with folks. You know, I, I just, it was really tough and I, I, I remember my very first time I had to fire someone in that, in that facility down in Lewis.

And I cried. I cried with her and looking back on that now, I think, boy, I was really way too sensitive to be a leader or a boss. I just didn’t have the tools at that time in my life. I was too young. So, you know, now I’ve learned more and I’ve grown and had more experience and of course discovered mi, which gives.

The tools to, you know, have those conversations a whole lot better. You know, Matt, I’m just curious, how many, how many staff did you have with 165 bed skilled nursing? How many employees did you have? I believe it was around 220 at that time. Just around the 200 mark. Okay. So I, I was there for that period of time.

And I decided that it was time for me to do more. So I went to work for a larger regional company that owns about 30, maybe 60 nursing homes, and I ran 13 of ’em. So I was the regional vice president in Washington State running 13 skilled facilities, and that was a real wake up call to me, you know?

Being the boss of administrators, trying to have those conversations taking and it was hard on me because it took me away from the patient care, which I was, my passion, I learned to have kind of that new passion of, of growing leaders and inspiring leadership. So, so, but that was a real growth time for me, you know, when I was, you know, almost 20 years into my career.

Shifting gears like that was. After about four years with that company doing that job, I was approached and invited to apply at United Healthcare. A division of United Healthcare is called Opt and it’s a Medicare Advantage plan, specifically in nursing homes to be there. Vice president for WA from WA for Washington State, running that Medicare Advantage plan.

Well, of course I had. No background in Medicare Advantage plans, but I knew so many of the players in Washington State just based on my, my long term career. So I took it and I did that for the next four years. While I was there, I was promoted to the VP of that product line across the country. So I was the vice president of institutional special needs products, which has to do with that plan across all states.

So my plan was in, we had 60,000 skilled nursing members on my plan nd, it was a, a really important role for me to have a, my, my growth in my career because I learned how to think strategically. I learned how to. Have conversations with really high level CEOs and COOs of, of healthcare companies because I was selling this plan to them so they would allow us to sell it in their nursing homes.

It was not my bliss. I was too far away from healthcare, and as luck would have it two years ago, the owner of Sunshine Health Facilities. Called me and invited me. He said, you know, I’m looking for a new COO and I would love you to consider coming and running our company here in Spokane. Where is my home?

You know, so I thought, I have young kids. It’d be so great to get home with them and not on the road all the time and I took that opportunity and came back home and am running a very diverse healthcare company with roughly 320 employees. So more than I had, of course, at that one facility, but it’s because I have about five business lines here.

I have a home health company where we take care of people in their homes, basically skilled nursing in their homes. I have a skilled nursing facility. I have a memory. I have a behavioral health division where we have an adult residential treatment facility on campus. We have, adult family homes, four of those.

 We have assisted living, enhanced assisted living, which is a step down from skilled nursing. So, you know, managing, all those business lines and all those leaders. It was my career that brought me here to be ready to take on this challenge of my life. As I settled into my role, I had known about MI of course, and motivational interviewing and, and what it could do and, the owner is very much a supporter of the development of our leaders and investing in our staff and we were having challenges with a number of things across campus from our behavioral health folks to our home health people, to our patients, to our skilled nursing patients and I, throughout the suggestion, why don’t we bring Casey in and start training our leaders?

You know, we could train our case managers at the behavioral health company. We can train our home health nurses, we can train our leadership and, and so that started our relationship with I F I O C probably. Maybe a year and a half ago, Casey, I think you’ve done. Yeah, I think that’s about it. Yeah. So it’s been really fun to watch the mi, I don’t know if it’s a, if I should call it a way, but the MI culture shift here and that’s the first time I’ve ever been able to bring MI into it. What, oh, sorry, Casey. Go ahead, Danielle. Matt, what was the, what were you thinking when you were looking at the situation with your team and seeing the challenges? What was the trigger in your mind that said motivational interviewing might be able to help them?

Yeah, it was probably two things. At the same time, so at home, at my home health business, the administrator, so when you go into home, when you go into people’s homes as a clinician, in order to get paid for the the 30 day, you know, time frame that you get paid by Medicare, you have to see them so many times.

Compliance in the home according to health. Like if a nurse goes into a home and the person doesn’t want it, just cause the doctor ordered it, they’re gonna say, get outta here. I don’t want you and then the nurse has to leave and we get penalized. We get a massive reduction in penalty and that person in their home doesn’t get the care and the support they need to get better. So that was going on and I was hearing noise about that and my administrator actually had, had heard a MI previously and she had talked about that actually. So it was weird that I had had it in my brain. She brought it up and I always think that’s, you know, the universe telling me or you know, listen to that information that’s coming in.

At the same time, at my behavioral health company, I’m pointing over here, that’s where it is. Sorry, the behavioral health company. Is, we were having, a challenge with our case managers, our social workers. They, they, these folks live in our here on site. It’s a, And we manage their care. So these are folks with schizophrenia, with personality disorders, challenging, challenging patients and trying to convince them to take their medications or to follow their treatment plan.

It wasn’t working. We were, we were, it was failing people that the social workers were burning out. We were losing them and case managers and nurses are really hard to find, right. So I was wanting to invest into that population, that group of employees, give them a tool that would help them do their job and I thought MI might be perfect for that and I brought it up to the leader over there and he said, that’s a great idea. So that’s kind of where it started. It was twofold. Where it went was interesting, you know, like where it’s gone has been interesting. But that’s where it started. Yeah and you know, Matt, when you and I first had conversations about, you know, doing some work at Sunshine, You know, when, when we’re talking strategically, one of the things that I recommended is, you know, have a cohort of, you know, direct line service staff, you know, maybe some supervisors who go through the training and then have them give you feedback whether or not it’s actually worth their time or not, because it, you know, one of the things we always think of at if IOC is I just wanna maximize people’s resources and not take resources that can be applied to their places and so, you know, one of the things that I’d recommend is, hey, Have some frontline staff go through the training, have them assess it, give you feedback. Don’t go for the whole full meal deal until you get some feedback and find out is this relevant. And if it is relevant, then you really do need to have your executive leadership go through second.

Otherwise, you have your workforce disconnected from your executive leadership and, and they want to charge forward. An executive leadership kind of supports it, but doesn’t really understand the dimensionality of how you can apply motivation. To an organization. So, so that’s what happened. We, we launched with, you know, the clinical workforce first and then what, what was the feedback and kind of how did that play out for you as you were thinking strategically?

Oh, you know what, thank you for reminding me about that. I kind of forgot about that. The eruption of excitement that happened after that first cohort and that’s exactly what it was. Casey. It was this incredible. Oh my goodness. Thank you. Thank you. It was so. He helped us so much. He gave us the tools we need and, and I was able to have this conversation or that conversation.

Well, that went all the way up to the owner and he said, you have got to bring him back in and train the leaders and you have, and I want to be there and our owner, who is phenomenal, but he is busy. I’ve never seen him sit through a training, so I thought, well, we’ll see. You know, it’s just not, that’s not his thing, right?

So I, I, I was so interested that he was like, planted around my schedule. I wanna be there. I want to hear, I’m hearing too many good things about it. I wanna sit through this and find out what all this noise is about. So, you know, and then hearing the stories of the case managers and the Yes. You know, the home health folks and at that time I did have a social worker in my nursing home go through it too. Yes and starting to hear the like, oh, I used MI on this, or I used MI on this and it worked, or, You know, having that conversation was so exciting for me and so validating that, you know, it was worth the investment for me to bring you into my, my on campus and have you train those cohorts, that first cohort for sure and that noise around that made the demand for the second one that much stronger. I think that, you know, Go, Danielle. I was just gonna say, I think that’s one of the most brilliant things I’ve ever heard, is starting because I have experience in senior living as well as branding and marketing and so I’ve worked with a lot of different companies in Casey. Most of them are, start from the top down. Yeah. Is the philosophy and when I heard this story, I was like, we need to share this because the, I feel like the dignity and respect. At the core of that choice, yes, is huge. Of what you just did for your team, Matt, with, with, giving the frontline workers exposure first?

Danielle, I don’t know if I would’ve done that without Casey saying that. Like, I remember thinking, oh, that’s a good idea, but I would’ve started at the top because that’s what we do. You know, we train our leaders and then we expect them to push it down. So when he said that, I thought, oh, well that makes sense.

You know, give our, because that was where I was hearing the issue. I was really grateful for that and it really did pay off in spades. You know, the thing that when I’ve worked with so many organizations and, and hearing that, what tends to play out, because Logic would say, get leadership involved. If leadership support say, you know, they’ll support staff.

In reality, what my experience has been is when it becomes from administration, it literally becomes one more thing on their. We’ve got one more initiative. We’ve got one more training we have to go through. When are we gonna do this? Oh my God, we can’t. How are we gonna get people off the floor? How are we gonna get people, you know, where’s coverage gonna come in? And people just start to stress, and then it’s, it’s workforce burden, which generates resistance and it’s just, and then they feel like administration is disconnected and administration is doing it with the best of intention. To support the workforce, and usually the workforce has been asking for training around things like communication, and then when administration approves it, then they just end up stressed and frustrated that, oh, we’re just getting another initiative thrown at us and I think what’s always intriguing to me, the vast majority of the time, When live level staff go through it and start to apply it, they do want administration to understand itand I think it is this kind of, this meld between, you know, the workforce going, wow, this is a phenomenal skill set. Then administration understanding truly contextually, not just, yeah, our staff went through MI training, they went through Motivate, they got into evidence based practice that it’s like, this actually can be transformative.

I’ll tell you, this is fascinating for people listening. You know, Danielle hasn’t been with if I o c particularly too long, but that was the first in person experience Danielle got, was actually with, with Matt’s team at Sunshine. To be able to observe some of that, which was just an interesting dynamic.

 I think the thing that was so fascinating as well is, We can talk theory, we can talk motivation, we can get into role playing. But honestly, one of the most profound moments, and Danielle, you’d missed this, and I knew you were really bummed, bummed about it cause it was so impromptu, is when your administrator of home health, with struggles with retention, Brought in an email, you know, with permission, you know, she chose to bring it in and we reconstructed it in an mi inherent way, and it was so fascinating to watch the staff.

Just to see their brains shift because it was so concrete. Like, here’s an email that I sent desperate to keep nurses, you know, holding them by the ankle, begging them, please stay. Please stay. Please stay. Which is just the state of retention right now in the country. Reten, especially like you’re saying, Madden Healthcare.

Behavioral health, it’s just so difficult to get those positions filled and then how do we keep them and not feel like we’re caught over a barrel? You know, because now that you begged them to come on, then all of a sudden becomes more difficult to manage. I mean, these are all the things that, you know, as a, as a senior administrator.

So I think that was so fascinating that we gotta go so concrete and drill down to a specific email, reconstruct that, and just to watch people. Oh my gosh, I understand the model better. Mm-hmm. , not, not just because of this email, but it’s like, this makes sense. We’re working really hard and it doesn’t mean we’re actually engaging people more effectively.

 It’s this, we surrender some things because it’s almost an act of desperation and now we’re trying to tap into values and really get values driven people and I’ll tell you, that’s the thing for me as a trainer, that was so. Evident that it just radiates that Sunshine is a values driven organization and those are my favorite organizations to work with because it is a matter of, is our behavior aligned with our values? And I know that the owner, Nathan It, he preaches that he, you know, shouts out from the rooftops. We’re a values driven organization. We’re values driven organization and so I think that was so fascinating to go and this is a, an evidence-based practice.

This is a tool, this is a learnable skill. With communication that can bring that desire to have your behavior in line with your values to fruition throughout an organization. I mean, that, that, that’s why I think for me, this was such a, a, you know, just a, a fun project to work on. Just a passionate pro project to work on.

I know it was really inspiring for me to be there because as I mentioned, I’ve just worked with so many different organizations and many are, say they’re value driven, and I’m not saying that they don’t believe that. Right, exactly. It’s a whole different ballgame to, to really have the courage to stand up and say, oh, is is my behavior really aligned with what I’m saying?

I mean, as a leader, Hats off. Hats off to you guys for doing that because it is, it is incredible. The result I would imagine on retention when your entire leadership team and your frontline employees see the courage and the willingness. Thank you. To do that is, is really inspiring. I appreciate that, and it’s been, you know, I, I do think that this is passion work for me, right?

So it’s a calling and I feel that, and I think my staff know that. So it is important to me that we live the values of this company, very important and that’s why MI was a really good fit for us. Yeah, I knew enough about it to know that it’s a model in which we communicate that aligns the values and the person and I just knew enough to not to know that it was good, but not know how to do it.

So when Casey came to do this second cohort, right? We did the first one was. Frontline staff, those that really, you know, and then they created this uproar of excitement that all the leadership then, I mean, it filled right up like that next cohort Casey’s like I can do about, you know, I think we said the perfect number, I don’t know, 25 or something. And so it just filled up immediately and it was super cool to see that shift in culture and I will tell you right now in healthcare, Coming out of the, the, you know, the fire of Covid culture is king. If you don’t have a strong culture right now in healthcare, you’re not gonna survive.

Right? You will not get the staff, the nurses, to take care of the patients in order to admit, in order to cash flow and all that. So when, We know that here at Sunshine and I knew that MI could help with that. So to see that culture shift after Casey presented his, you know, he did a two day and then he came back two more days, did, you know, spaced out and to see how.

I didn’t realize how important all four of those days were until we went through all four of those days, because that’s when it really kind of shifted is that it glued it and I call that hardwiring, right? We, you know, that we hardwired it a little bit more and then we started using the vocabulary of mi, which really does, when you have a shared vocabulary in a, in a workplace that drives the culture and the leadership started talking about, you know, equipoise and you know, the MI words that were really important that you know, and started seeing and I started thinking MI conversations when I was having employee. Issues, which takes the emotion out of it. Yeah. I can be a really compassionate, empathetic leader, you know, and I, and I know that those are two different things, but I can, I can be without being emotional and without putting my stuff on the conversation, and just have a two-way conversation and find their ambivalence and then work through.

And that’s the thing you, you learn in mi. It’s not about me and the person. It’s not this, it’s about this. That’s what Casey does in his trainings, right? It’s not a, you wanna get away from this and you want to go to here because it’s about the employee and their actions usuallyand are they in line with the values?

There’s probably some ambivalence there. Let’s talk it through because. At the end of the day, I wanna retain every employee. Yesand employees are humans and humans make mistakes and so this is gonna happen. Yesand the worst thing you wanna do as a leader is get into a, a fight with ’em and, you know, start doing this compliance thing.

The best thing you can do is have a behavior change conversation is, which MI talks to you about and teaches you how to do. It’s such a science, it’s so overwhelming, but it’s so valuable when you are having these conversations on a, on a daily basis. I, I just had one actually. Case Aman, I just had one, yesterday, you know, today, Saturday, so Friday I, I had a situation where, a director, one of my direct reports, a nurse and she was frustrated. It wasn’t, it was IT, right. So it was technology, right? It’s my IT director and a floor nurse who kept screwing up her password. She screwed it up like five times and. So he, he got frustrated as any of us would and you know, it will be the one thing that people just lose their mind over.

So, there was a complaint lodged and my IT director and I needed to address it and I know that’s not how he wants to be. That’s not where his heart is. That’s not his values. I know what a wonderful, hard working employee he is and cares about our company. But that in that moment, that was not an example of, values of our company.

So I was able to, to sit down and have just honestly what could have been a really awful conversation without MI tools, a very values based conversation with him and it wasn’t about me and him, it was about how he was feeling, what was going on in his body and his head and at the end of that conversation, he said, you know what?

I need to go, apologize. I need to go make it and it was just effortless for me. But that, that’s just one example of something really recent that happened, but these things are happening all the time. You know, Matt, I, I think when you brought up the thing about how culture is key right now in healthcare, I mean, I think in any, in any.

You know, field or profession right now, but so profound in healthcare. One of the things that I’ve been talking quite a bit about is just what the nature of a Western medical model is, and it that is the culture of a Western medical model is things need to get done. There is a hierarchy there. You do follow a treatment plan.

You do need to show up, you need to get this done and it’s so a culture of compliance fundamentally because you’re talking about human life. I think that at first blush it’s like, yeah, this, this is a behavior change thing. Why would that work In healthcare, we, we’ve got, we’ve got people that are, you know, not doing well that we need to manage, and we, we have liability.

We have moral responsibility tooand I think that’s what’s so fascinating for me when organizations, like Danielle had said, when they genuinely want their behavior to be in line with their values and, and to have an evidence based practice that helps you navigate it and get on that balance and figure out how to balance on a very tight balance beam where there are compliance capa, you know, issues, but you really are fundamentally trying to transform lives.

It, we say that in theory, but it’s so hard to actualize that and I think this is what’s been so fascinating watching it at Sunshine in terms of, you know, that that desire to be values driven and the, the proof is in the pudding. I mean, I hear, you know, the, some of your staff, the more they use it or when they say, yeah, we used MI that people are less stressed about those things and it doesn’t negate that there’s times for compliance. Correct. You know, but it does change a fundamental, just like the example with it, it does change the fundamental energy around when there’s conflict. Because we’re reducing resistance. You’re helping just human beings who are trying to do the right thing work through their own ambulance professionally, which is exactly what you wanna do with your client population as well, too.

 You know, when you go into home health, you know, and, and somebody is just angry and upset and you know, they’ve decompensated and they don’t wanna feel like they’re sick and they don’t want somebody in their house, a stranger, but they don’t, they don’t want things to get worse either. How do you work through that ambivalence?

I mean, I, I think this is what’s so fascinating to me. Taking theory and putting it into reality and, and this is why I was so excited about having this conversation, which I just genuinely appreciating you taking time to, to kinda illuminate some of these things for people. Oh, for sure. Case yand I want to tell you, that was probably the, my biggest takeaway.

Every conversation I approach now as a COO in my brain, there’s a little reel that goes real quick. Is this a behavior change conversation or a compliance conversation? Because. How I’m gonna approach the conversation. If it’s behavior change, it’s mi, if it’s compliance, then it’s compliance and it’s, you know, an action plan and you’re going down that road.

So as a leader, you, you have to know that, and you do know that. It’s really easy to know thatand I knew in Friday it’s a behavior change conversation that wasn. That wasn’t a compliance conversation. There’s other times it is. So no, thank you for letting me share the story. I makes me excited to hear you say that because that’s usually, it’s one of the first, it’s one of the first things in the first intro training is just professionally.

It’s not whether or not motivationally is right or wrong. It’s not. Should you have used it? Should you have used it? It’s exactly what I wanted people to think about. Do I want compliance or do I want behavior change? So the fact that that’s your default is like, whoa, every time That’s my, that’s case scenario case.

Cause that’s professional, that’s professional discernment and that just, it just thrills me to hear that, oh well, we’ll give you the credit for sure. We appreciate if I c coming in and, and we intend and plan on having a third. It’s definitely the desire of the ownership here and, and me as the COO to continue that investment in my staff and truly it, at the end of the day, it affects quality and that’s what we’re all about, you know, so not only the quality of a place to work for my employees, but a quality of care for my, my patients, clients and residents. Excellent. Thank you so much, Matt. Anything else Dan? No, thank you so much for being here.

I think this could potentially be the longest podcast ever cuz I just wanna keep going, , talk to you guys about it. Would you be willing to come back at a later date and update progress? Okay, great. Of course, of course. Wonderful. Any advice to our listeners about, there’s so many people out there, I think, beautiful human.

That are leading companies and teams looking for solutions, similar to you? Any advice for them on their journey? Boy, that’s, you know, so many things, right? I think about when you, when you ask me that question, I just think every single person matters. So every person I come into contact with, from a housekeeper, to a laundry employee, to the IT director, to the ceo, They all matter and they all have a voice and they’re all part of it.

So I just, I think treating everyone with respect, kindness, dignity, and always assuming that they are there, there to make a difference and start from there before you assume the worst. I think that’s just the biggest thing. You know, it starts with the person, right? The leader, and every single person’s important.

So that’s just, you know, one little thing I would. One big little thing.

Oh my gosh. Thank you so much. Matt. Thank you, Casey. It’s just a pleasure spending time with you. Excellent. Thank you. Take care everyone. Bye-Bye.