4C Health
By: Barbara Abadi
“What worked well? Our numbers say it all.”
Over 250,000 hours returned to our staff’s lives.
89% of staff want to continue 4DW
75% reduction in stress and burnout
88% positive impact to staff lives
73% staff endorse providing better care under 4DW
4.2 Star Patient rating of care experience
No negative fiscal impacts
Introduction
Established in 1975, 4C Health is a nonprofit whose mission is whole health wellness. Care that is Compassionate, Collaborative, and Competent (the 4Cs). The organization’s 400+ employees deliver behavioral mental health services, crisis services, primary care, and recovery services in 14 North Central Rural Indiana counties.
4C Health’s data speaks to the consumer and staff benefits of 4DW but often for a movement to be adopted widely businesses need to be able to see the operational and fiscal benefits also. Jason Cadwell, CPA, CFO & CAO shares their organization’s 4-day week experience from idea to implementation in 2022.
4C Health’s 4-Day Work Week Journey
Jason: Coming out of the pandemic in July 2022, 4C Health’s behavioral healthcare providers were very tired and reporting higher levels of burnout. So, we asked - What can we do to revive our workforce? After bouncing around several ideas, I said - Why don't we do a four-day work week? You could hear a pin drop, most were really unsure if this could work for us at that 1st discussion.
Like all healthcare nonprofits, we faced flat, outdated, and unsustainable payor reimbursements, shortages of healthcare providers especially in rural markets, regional wage wars, and high industry specific turnover. I felt we needed to be transformative beyond the typical salary increases, adding an extra holiday to our benefit offerings, or work social perks that did not impact quality of life for staff. I knew immediately after looking through a clinic operational efficiency and fiscal lens this could be done in our organization. We had spent nearly 10 years eliminating workday waste, redundancy, and old habits of thinking of where work can/should be done. We embraced a hybrid
workplace years before the pandemic. As the saying goes, “Work is thing you do, not a place you go”. This undoubtedly cleared the way and established the foundation to undertake 4DW without disrupting access to care or hours of operation.
People talk all the time in business about “lean” and what it means to be a successful lean organization with a high-performing culture, business mentality, and data-driven results within their respective industries. However, we feel a true scorecard of “lean” success is one’s ability to implement and maintain a 4DW without exception.
This “lean” foundation is what allowed us to pivot nearly 90% of our staff to a 4-day week in just 30 days. For the remaining 10% of staff, 5% included nursing staff who were early adopters of the 36-hour week with 3 12-hour days which is typical in the healthcare industry, and the remaining 5% make up our Leadership who have freedoms
and flexibility to find their “4DW”.
What Works Well
Jason: For 4C Health, the 4-day week is integral to our whole health wellness mission. 4C Health’s core values are the same for clients and colleagues. But it is hard to find the right wellness program for all employees. You ask 20 employees about wellness initiatives or “work life balance”, and you get 20 different perspectives on ways to address wellness. With the 4-day week, we are saying to the employee – “You get one day back, or “x” hours each week and you decide the best way to improve your wellness and/or balance!”
Out of the gate our goal was retention, if 4DW enhanced recruitment that would be a bonus. We also believed that 4DW would positively impact the quality of consumer care. As part of this, we were very intentional about data collection and outcomes metrics we tracked. The metrics we have made available publicly reflect that success across retention, access to care, quality of care, positive wellness on staff without any negatives impacts to the operational and/or fiscal health of our business. In my decades in behavioral health, I have not seen this level of population impact before. I truly believe that 4DW is a public health intervention without having to totally abandon long standing business principles or your “bottom line”.
Challenges
Jason: Like most organizations we had too many non-essentials clogging our workday schedules such as redundant meetings that would wander off agenda and go well beyond times allowed. In addition, emails that were way too long and could have been handled with a 2-minute phone call or sifting through 100’s of daily emails with the dreaded “cc” function. Add in that we embrace hybrid work, you can see real benefits in
the integration of hybrid and 4DW work environments reducing commute times, decreasing facility space needs and the overhead and
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