Plum Healthcare

In 1999, a small team in the skilled nursing industry set out to create a company unburdened by the persistent problems that plague many healthcare organizations. The result was Plum Healthcare. Plum's growth strategy centered on the acquisition and transformation of deeply dysfunctional long-term care and rehabilitation facilities. Because these facilities were often saddled with significant clinical and financial challenges, Plum grew slowly at first.​

Bullying, Fear, and Regulatory Failures

The facilities Plum acquired weren't just underperforming, they were toxic. "It wasn't friendly and warm. I felt like it was real distant," one administrator recalled about the culture before transformation. Staff described a constant state of fear and criticism: "'You're doing things wrong.' 'You're doing this wrong.' 'You're doing that wrong.' I always had people chomping at my heels."​

Leadership operated through intimidation rather than development. "It was my way, or that was it. You were gone. I'm going to get someone to do it my way," one leader admitted about their former approach. The dysfunction created facilities where basic human connection had disappeared. "People didn't smile, people didn't say hello. You could walk down the hall and pass somebody that was in the office next to you, never say a word."​

Seeing People as Objects, Not Humans

The root problem ran deeper than poor management tactics. "Everybody was just objects to me," one leader confessed about how they viewed their team. This dehumanizing mindset cascaded throughout the organization. "In your organization, are you seeing people as people? Or are you seeing them as impediments, obstacles, irrelevant?" Staff felt the impact directly: "I felt sometimes that there was even maybe some type of bullying."​

The question became unavoidable: "If I'm the staff and I have this happening to me, what's happening with the families?" Poor treatment of staff inevitably meant poor treatment of the most vulnerable patients. Employees questioned their purpose: "There were a lot of times I thought, What am I doing here?"​

No Replicable Model for Turnarounds

With each new acquisition, company management refined ways of solving the complex challenges they faced. But they knew that accelerated growth would require a replicable approach—a reliable means of building the people-centric culture upon which every successful turnaround hinges. The co-founders recognized the stakes: "For the sake of the company, we can't cheat the company, and we can't cheat these people. If the result we're trying to achieve is to enrich the lives of a million people, and we're not focused on how we really do that the right way, then we're not really enriching lives." 

Healthcare Consulting for Scalable Transformation

Because Arbinger's healthcare consulting had helped other organizations in the industry, Plum turned to Arbinger for support. They needed to develop a leadership model, an organizational cultural framework, and front-line staff tools that would enable each newly acquired facility to transition successfully. In this case, success meant integrating within Plum's organizational culture and empowering the previously dysfunctional leadership team of each facility to redeem a poorly performing enterprise.​

"The thesis was, if we could take an under-led, or underperforming facility, and take essentially the same team, and help them see the possibilities that they could then turn this around," explained the leadership team about their acquisition strategy. They weren't looking to replace people—they were looking to transform them.​

Strategic Coaching and Cultural Roadmap

Initially Arbinger consultants provided strategic in-person consulting and over-the-phone coaching to the executive team. They guided the development and implementation of a strategic roadmap that would enable cultural transformation during and after each facility acquisition. As a result of this initial work, the executive team developed policies and implemented collaborative work practices that would serve as the footings of an outward mindset culture.​

Through ongoing coaching sessions, Arbinger worked to equip executive leaders with the skills to grow and develop every facility administrator throughout the company. "When you've put something into place, like Arbinger, it gives you a common vocabulary, to talk about things," one leader noted about the framework's practical value.​

Customized Programs Integrated with Mission

Arbinger worked with Plum leaders to develop customized training programs and reinforcement aids that could be deployed at each level of the organization. These programs integrated Arbinger's tools with Plum's mission and core values. Leader-specific programs and front-line tools were developed to help employees implement outward mindset practices in their day-to-day work.​

"Plum created this company centered on Arbinger principles. And by doing that, it's accelerated the result that we could achieve," a team member explained about the integration. The focus shifted fundamentally: "They acquire these facilities and it becomes 100% people focused. And as a result in growing and developing our people, financial stability follows."​

Training 70+ Internal Facilitators

To internalize and perpetuate the benefits of healthcare consulting, Arbinger facilitators worked alongside the executive team members to train facility administrators in Arbinger's tools and methodologies. Each operational leader was equipped to transform the culture, performance, and results within their respective facilities. Arbinger certified over 70 executive leaders and administrators as facilitators of Arbinger's programs.​

This train-the-trainer approach ensured sustainability. "It's not just something that's talked about, it's something that needs to be lived," one leader emphasized about the ongoing commitment. The transformation became personal for many: "My wife, I know she can really see it because it was like night and day," one administrator shared about how the work changed him beyond the workplace.​

Systematic Facility Deployment

Through the facility administrators, Plum systematically deployed Arbinger's programs across the organization. The clinical director and department managers of each facility, who together supervise staff of 100 to 250 employees, were introduced to Arbinger's tools and invited to lead and develop others in a way that accelerates patient outcomes.​

This outward leadership approach was reinforced through regular leadership training meetings for administrators, peer-to-peer mentoring, and ongoing discussions to sustain outward mindset ways of working for frontline employees. "If you have that foundation, it'll show through in every thing that you do," a leader noted about the cascading impact. Another observed: "When you care that much about somebody else's wellbeing it's pretty easy to spread that care to others. And I hope that's what we are able to invite in everyone in this company."​ 

By implementing Arbinger's tools across the organization, Plum grew at a remarkable rate. Plum increased its number of facilities and employees by almost 500%, growing to operate 63 skilled nursing facilities and 5 home health and hospice agencies strategically located throughout California, Utah, and Arizona. Much of this expansion happened when Plum acquired 27 of their total 63 facilities, incorporating over 3,900 nurses into Plum's healthcare system.​

Dramatic Quality of Care Improvements

The quality of care provided by Plum increased through utilizing Arbinger methodologies. One key quality metric is derived from mandatory inspections conducted across the industry by regulatory agencies. A particularly problematic performance metric is the incidence rate of patient experiences that result in actual harm while the patient is in the treatment facility, labeled in inspection parlance as a G-L Deficiency.​

From 2008-2010, the average number of G-L deficiencies recorded at similar-sized competitor organizations was 29.25; Plum had 6. This important indicator of quality care also indicates Plum's internal efficiency. Facilities that had previously been cited for significant G-L deficiencies dramatically improved their clinical results within two years of being acquired by Plum.​

From 2011-2016, Plum's Clinical Quality Measures improved 37%. Federal citations at Plum facilities, a key indicator of quality of care, were 34% less than the average number of citations received by competitor companies. 

From Failing to Substantially Compliant

A final indicator that Plum's outward culture enabled excellent clinical care is demonstrated by regulatory compliance results. Comparing results from California Department of Health inspections at nine facilities, many of which previously failed to demonstrate adequate compliance, following Plum's acquisition of these facilities, they all successfully passed inspection with substantial compliance.​

"When I joined Plum, we had eleven facilities, and we've grown to 50, in the last 6 or 7 years," one team member reflected on the rapid expansion. Co-CEO Paul Hubbard summarized the impact: "Using Arbinger has dramatically improved clinical quality, resident and employee satisfaction, and regulatory outcomes. Arbinger's tools enable us to deliver better and better quality care for residents through deep and sustainable collaboration."​

Culture That Attracts and Transforms

The transformation in culture was evident to everyone who experienced it. "And it just brought about a whole different atmosphere. Everybody is so nice, everybody is so friendly, everybody goes out of their way," one employee described the change. Another noted: "They've taken these buildings and revitalized them, and brought amazing life and healing, and it's just been incredible."​

"What Plum has done...it's totally different, it's just like a makeover," an administrator summarized. The message to employees shifted entirely: "I feel like if you live and operate a facility, the Plum way, it really sends a good message. It says that we're here, we care about you, we want to invest in you as people, we want to grow and develop you as people."​

Staff now understood the connection between culture and outcomes: "We just apply it to the staff, residents. It's a representation of how we achieve what we achieve." The question that guided growth became clear: "Your question isn't, 'What are we going to give up to grow?' But, 'What do we stand to gain?'"​

 Plum Healthcare proved that scaling rapid growth in healthcare doesn't require sacrificing culture, it requires making culture the foundation of your turnaround strategy. When acquiring deeply dysfunctional skilled nursing facilities plagued by bullying leadership, regulatory failures, and staff who saw patients as objects, Plum needed more than facility-by-facility fixes. They needed a replicable model. By building healthcare consulting partnership with Arbinger into their acquisition strategy—training 70+ internal facilitators, deploying customized programs at every level, and systematically transforming each facility's leadership—Plum grew 500% while achieving 79% fewer patient harm incidents than competitors and a 10-fold increase in 5-Star rated facilities. Facilities that previously failed compliance inspections passed with substantial compliance within two years. The lesson: you can't scale excellence in healthcare with the same leadership approach that created dysfunction. Transform how leaders see and develop people, and clinical quality, regulatory outcomes, and growth follow.