The St. Nicholas Center: A Roadmap for Behavioral Leadership Success

...the same behavioral science approach they use to improve the lives of their clients would also be of value to their own leadership practices...

The St. Nicholas Center for Children in Lake Charles, LA, was founded and launched in 2008 by Executive Director Christy Papania-Jones and provides a wide range of services for children with autism, developmental delays, and neurological disorders. Its approach to treatment emphasizes therapies developed in the field of behavioral science, or what’s more commonly known as Applied Behavior Analysis (ABA). After a period of expansion Christy, and Clinical Director Zack Storer, recognized that the same behavioral science approach they use to improve the lives of their clients would also be of value to their own leadership practices and would enhance their efforts to improve employee engagement and have a positive and sustainable impact on their bottom line. Zack contacted Aubrey Daniels International (ADI) to assist them with their behavioral leadership journey. ADI Senior Consultant Bart Sevin supported St. Nicholas on this project. The following interview with Zack Storer describes what St. Nicholas did that led to their success.

Sevin: St. Nicholas came to ADI in support of developing a high-performance culture using a behavioral approach to leadership. What were some of the areas St. Nicholas targeted for improvement?

Storer: A few of the areas targeted for continuous improvement were the case managers’ level of production, supervisor feedback, and cross-departmental communication.  

Sevin: Following the training ADI provided, St. Nicholas participated in a behavioral roadmapping session whereby employees at different levels worked with ADI to build a behavioral roadmap for center-based services. How did this process work for your team and what was the impact?

Storer: One outcome of analyzing behavior across levels was that while leadership had developed and tracked a comprehensive set of business metrics, we saw a need for an accompanying set of robust leading indicators. As a result, we specified key practices at different levels of the organization. We also saw an opportunity for additional antecedent and consequence-based strategies to support us in our existing continuous improvement efforts. During the (behavioral roadmapping) session, we were able to appropriately analyze and pinpoint targeted behaviors that truly moved the needle on our desired leading and lagging results. The behaviors were specific and observable, and common to all high performers. We were then able to use the output from the session as a roadmap to inform us on what behaviors we should target for coaching interactions. Since the training we have had 14 out of 15 analysts consistently hitting their goals around the targeted leading and lagging indicators.

For example, one of the set of behaviors identified during the roadmapping session included consistently planning and scheduling services more than a week ahead and reviewing insurance authorizations on a regular basis.  As a result we were able to successfully increase revenue and schedule adherence when case managers and supervisors focused on the critical behaviors involved in driving these metrics.

Sevin: The behavioral roadmap created for center-based services was carried over to the school-based personnel. Was the team able to identify behaviors specific to that service that were critical to results?

Storer: Center-based leading and key performance indicators (KPIs) around increasing revenue improved after the initial training, but school-based KPIs stayed consistent. This result was an error on our part of not taking into account the different barriers that the school context has, that the center does not. During the first behavioral roadmapping session, the high performers were all center analysts, so when we created the roadmap, we did not get the perspective of the school-based Board Certified Behavior Analysts (BCBAs). During the second roadmapping session we were able to isolate barriers and apply some antecedent-based strategies (e.g., using laptops rather than desktops) to allow them to work more efficiently. The antecedent-based strategies were pinpointed by analyzing specific behaviors by our higher performing school-based analysts (e.g. checking out a laptop to write reports during the session). Now both sets of analysts—school and center, are performing at or above the expected goals.

Sevin: What suggestions do you have for others going through this process? What worked well for your team in creating the behavioral roadmap? What would you do differently next time?

Storer: One suggestion for organizations looking to go through this process is to make sure to select high performers across different departments or areas. If you have two different settings where you are looking at the same desired result, there may be two different sets of critical behaviors.

It would also be beneficial prior to the behavioral roadmapping session to review current data on KPIs to inform the selection of leading and lagging indicators as targets for improvement. Understanding where the gaps are also greatly facilitates identification of best practices that are likely to drive the improvements.

Also for our team, it was beneficial to do a PIC/NIC Analysis^® before the behavioral roadmapping session to better identify the underlying consequences that were reinforcing undesired behaviors and punishing desired behaviors. We did this prior to developing the school-based behavioral roadmap and found that it was highly beneficial.

Sevin: Applying ADI’s coaching process is important when implementing a behavioral roadmap. How did you apply this coaching process to develop the behaviors identified in the behavioral roadmaps?

Storer: We started with our desired result(s) or lagging indicators and then looked at any related leading metrics. This began with the executive director and me. Then we brought in the next level of our organization, the BCBA supervisors, to begin to analyze what critical behaviors would positively affect the desired results. After that, we did a PIC/NIC Analysis^® as a group to assess the different consequences that we needed to modify in order to accelerate the desired behaviors and to begin eliminating the undesired behaviors.

We were able to build in more positive reinforcement (e.g., getting things done faster) for the desired behaviors, as mentioned above, by providing some of the resources needed to help people work more efficiently (e.g., laptops assigned to school analysts so they could do programming when there were gaps in working with clients). This allowed the analysts to spend more time providing reimbursable services and less time doing non-reimbursable administrative work

We also looked at critical behaviors from the director level down to the supervisor and case manager levels to make sure that all pinpointed behaviors had a steady flow of planned coaching interactions and reinforcement. Direct, face-to-face coaching interactions occur from the director level to the supervisor level, with an emphasis on the coaching supervisors are doing with their case managers. This creates a nice flow of positive reinforcement for desired behaviors from the top down.

The coaching process also involves weekly meetings, which builds in nice accountability and continuous improvement elements into the system. Each level brought their coaching logs to the weekly meeting, where they reported out on the coaching they did with their reports. This process has allowed us all to shape best practices in each others’ coaching techniques to positively affect the company’s leading and lagging metrics.

Sevin: What impact has St. Nicholas experienced following the development of the behavioral roadmaps and implementation of the coaching process?

Storer: We have a number of systems and tools, from weekly accountability and improvement meetings and face-to-face coaching, to the behavioral roadmapping processes, which allow us to continue the successes we have had since the initial ADI Training.  

One example of this is our performance-pay system, which provides natural contingencies of reinforcement for discretionary effort. We’ve started to develop more systems based on positive reinforcement as opposed to negative reinforcement. We have also started to assess consequences more frequently instead of only looking at antecedent modifications (how to vs. want to assessments).

Sevin: What advice would you give to others who are considering applying a behavioral approach to improving their leadership and organizational culture?

Storer: Absolutely do it! We have gained a set of tools and practices that will benefit our organization for years to come. ADI’s approach, from the training to the on-site follow-up implementation support, leaves you with actionable recommendations and tools that last well beyond the first week. ADI helped shape our organizational culture and we continue to use the practices taught today.