Redefining Autism Care: Scaling Starts with a Game-Changing Company Culture

Building a game-changing culture in any industry goes beyond parties and free food.  In the autism therapy space, turnover is staggering compared to other sectors. In fact, the Behavioral Health Center of Excellence previously reported a 65% median turnover rate across the whole industry, with large autism therapy providers seeing rates as high as 104% turnover rate.  A clinician-first culture is the key to high-quality ABA therapy and catalyzing multidisciplinary care provided all under one roof.

While we can never be perfect in our pursuit of a flawless company culture, there are six principles healthcare leaders, and particularly those in autism care, can incorporate within their business to build a clinician-first culture that supports team members, leads to improved engagement and retention, and serves as the foundation to improved outcomes overall, especially when companies look to scale within their industry.

1. It starts at the top: build a cohesive senior leadership team.

Having a senior leadership team that is emotionally and intellectually connected is paramount to company cohesion. We have all made mistakes when assessing the abilities and potential cohesion of leaders – this is one you have to get right or make right. We live in a fish bowl whether you are at a Fortune 500 company or a small practice, team members can sense when senior leadership is connected and when they are not. It’s unfortunately rare and a beautiful thing when senior leaders can work together fluidly with good humor. 

2. Articulate a genuine mission that resonates with the team.

You need to build the foundation by defining the mission. As senior leaders, we have to be rooted and united in this mission with a depth of real passion – not just saying it.  

At JoyBridge Kids, our mission is to help kids diagnosed with autism which in turn massively changes the dynamics of their families. This mission is reiterated in everything we do, and for me, it’s personal. I understand the journey these families take when faced with an autism diagnosis because my family navigated the same journey when my son was diagnosed with autism. Supporting parents as they navigate autism care and providing multidisciplinary services all under one roof is important to me and vital to our mission. It is really that simple.  

Our first strategy toward this end is to provide the highest quality care first and foremost to our clinicians. Because if we provide them with the right tools, the right environment and perhaps some sense of joy in a hard job, then the kids will benefit.  

3. Establish a clear direction for the company and focus on operating disciplines.

In the autism care and ABA industry, it necessitates children getting one-on-one time with behavior technicians.  So, this makes the job intensely difficult.  Therefore, you have to have amazing structure and operating processes which ironically provide a sense of comfort in a highly emotionally charged environment.  

4. Over-communicate with your team and stakeholders.

As a senior leader, you have to massively over-communicate.  We always try to explain the “why” behind what we are doing and tie to it our values and mission, because if someone doesn’t love the new decision,  knowing or understanding the “why” can help them get there.  

We always run all new initiatives, programs, and improvements through all clinicians first. That way we ensure that we are on the right track with what’s happening in the real world and in the clinic. We can then ensure we put forth the best product. I’ve said to my team many times “Don’t let us make stupid decisions.” And they don’t; they always hit us “right between the eyes” with rich and thoughtful feedback, knowing it’s their company too and there’s no “us versus them” mentality across the organization.  

Additionally, we communicate through multiple media channels often, including chats, emails, meetings, etc. When we talk about re-communicating something over and over, I often hear, “But Mike, it’s already stated on page 3, in the third paragraph of the new policy and procedure guide.” However, communicating through multiple channels helps ensure clarity and mitigates chances of confusion.

5. Proactively ask for feedback to solve problems before they arise. 

In a highly close and emotionally packed environment, we try our best to stay in front of any problems that can surface. Sometimes it’s miscommunication or a misunderstanding or sometimes it’s a legitimate concern that we need to address. So, how do we stay in front of it?  One of the most powerful tools we use (and it will sound corny) is what we call “Joy Check-Ins.”  It’s a 15-minute check-in with every team member monthly to ask:

• ‘How are you doing?”
• “How can I help you?”
• “What changes what you like to see made at JBK?”

Additionally, we conduct quarterly engagement surveys. These are eight simple questions (scored 1 – 5) with the opportunity to provide written feedback anonymously. If we see any scores below 4, then we huddle with the Clinical Directors to address them – our job is to team up and help solve the issue not to pass judgment.

Lastly and very importantly – remove toxicity quickly – no matter what the cost.  Every time I’ve had to make that difficult decision, I’ve always said, “I wish I had done it sooner.”

Ultimately, it’s a mindset that we deeply care about and value our clinicians who have a rewarding, yet incredibly hard job.

6. Support and develop your team like crazy and bolster leadership.

While turnover rates in applied behavior analysis (ABA) can range up to 100% or more, JoyBridge Kids has only seen a 4% turnover rate per month in the first part of this year.  The very first strategy that we determined is to offer the highest quality care first and foremost to our clinicians – chronologically this will transcend to the kids and families. We have invested in providing the right tools, the right environment, and hopefully some sense of joy.  We’ve invested in engaging RBT training leveraging CentralReach software. We develop leadership by teaching our Clinical Directors tactics for employee relations, and how to read a profit and loss statement and we share best practices and thinking.  It’s an honor to work alongside these marvelous leaders!

A people-first culture consists of values, processes, and events that elicit connectedness and joy. This should be represented and ingrained in every part of the business to ensure the success of employees, the business, and its overall mission. A unified approach to autism care, coupled with a clinician-first culture and comprehensive service offerings built on collaboration and teamwork, enables children to receive the well-rounded, expert-driven care they need to thrive.

When an organization in this industry seeks to grow, the goal should not be to hit a certain number of clinics or to scale in a set timeframe, but to focus on doing the right thing at the right pace.  Our decision-making starts with what’s in the best interest of our clinicians and what’s in the best interest of the kids.  The rest will take care of itself.