The Virtuous Cycles of Skilled Nursing Facilities
(See subsequent slides for further breakdowns and more zoomed in views.)
(Note: these figures reflect anecdotal data points from interviewees and were verified where possible through industry reports, academic publications, or informed estimates.)
Created by Celeste Bean
What's a Virtuous Cycle? Walmart's Productivity Loop
Walmart's success is rooted in its "Productivity Loop," a powerful virtuous cycle where operational efficiency drives continuous growth and market dominance. This focus on value and efficiency allows Walmart to maintain a significant competitive edge and expand its global market presence.
Lower Costs
Achieved through efficient supply chains, bulk purchasing, and operational innovations across all departments.
Lower Prices
Cost savings are passed directly to customers, making products more affordable and highly attractive.
Higher Volumes
Attracts a larger customer base, increasing sales and boosting overall revenue and market share.
Reinvestment
Increased profits are reinvested into technology, infrastructure, and logistics to further reduce operational costs.
Created by Celeste Bean
The Virtuous Cycle of Staffing
(Note: these figures reflect anecdotal data points from interviewees and were verified where possible through industry reports, academic publications, or informed estimates.)
Created by Celeste Bean
How staffing decisions snowball into clinical and financial gains
  1. A stable, veteran workforce strengthens the facility’s employer brand, shrinking time-to-hire and chipping another US $100k + off annual agency fees.
  1. That pride in work lifts morale and retention, letting the facility keep experienced team members (10 % lower turnover ≈ US $100 k saved per year).
  1. Better staff-to-resident ratios cut overtime and agency spend, freeing nurses for direct care.
  1. The same stability drives adherence to workflows, where tenured staff follow procedures, clawing back ~30 minutes of care time per nurse each day.
  1. Reliable workflows enable more-focused care (meds and assessments delivered on time), which in turn cuts avoidable readmissions (one fewer readmit per month ≈ US $180 k/year preserved for partner hospitals).
  1. The chain culminates in better resident outcomes, which loops back through reputation effects to make future hiring even easier (the virtuous cycle administrators kept pointing to in our interviews).
(Note: these figures reflect anecdotal data points from interviewees and were verified where possible through industry reports, academic publications, or informed estimates.)
Created by Celeste Bean
The Virtuous Cycle of Resident Care
(Note: these figures reflect anecdotal data points from interviewees and were verified where possible through industry reports, academic publications, or informed estimates.)
Created by Celeste Bean
How better resident care cascades into competitive advantage
  1. Visibly improved clinical outcomes give the facility true market differentiation: a single-star ratings lift unlocks US $10-20 PMPM in shared-savings bonuses and wins premium referrals, with no need to chase census with margin-killing price cuts (-5 - 7 %).
  1. Reputation feeds patient trust & engagement from day one; when residents believe the plan will work, they stick to it, driving therapy uptake and cutting complications like pressure-ulcers (each avoided ulcer ≈ US $5-7 k).
  1. Plan adherence yields shorter stays as short-stay residents recover faster. 15 % better treatment adherence frees 1-2 bed-days worth US $200-300 per day and side-steps $1-5 k quality fines tied to one-size-fits-none care plans.
  1. Improved well-being & quality of life reflect dignified, choice-driven care, which cuts anxiety, slashes grievances (20 % fewer saves ≈ US $30 k/yr) and turns residents into vocal advocates.
  1. Healthier residents translate into demonstrably better clinical outcomes, the metric hospitals and payers track most closely. Freed capacity and positive word-of-mouth loop straight back into delivering even more choice-driven care, closing the virtuous cycle that administrators kept highlighting.
(Note: these figures reflect anecdotal data points from interviewees and were verified where possible through industry reports, academic publications, or informed estimates.)
Created by Celeste Bean
The Virtuous Cycle of Revenue Management
(Note: these figures reflect anecdotal data points from interviewees and were verified where possible through industry reports, academic publications, or informed estimates.)
Created by Celeste Bean
How quality-driven reinvestment compounds into revenue growth
  1. Better resident outcomes (clinical wins visible to hospitals and payers) push public scores upward.
  1. Higher scores attract more ratings-boosted referrals, where even a 1 % uptick equals roughly US $200-300 k in annual top-line revenue for a US $20 M facility.
  1. Extra placements raise occupancy & daily revenue. Hitting 95 % census instead of 85 % can add ≈ US $250 k to EBITDA, while filling high-acuity Medicare beds spreads fixed costs.
  1. Healthier cash flow funds strategic reinvestment: upgrades in staffing, training, and automation. Every US $1 put into smart tech yields US $3-5 in annual labour savings.
  1. New tools drive improved operations & quality.
  1. Leaner workflows enable faster, safer delivery of care; trimming 10 % of process delays releases US $100 k+ in reimbursable bed-days and burnishes the facility’s reputation.
  1. Speed and safety translate back into even better resident outcomes, closing the virtuous revenue loop administrators described.
(Note: these figures reflect anecdotal data points from interviewees and were verified where possible through industry reports, academic publications, or informed estimates.)
Created by Celeste Bean
The Virtuous Cycle of Family Engagement
(Note: these figures reflect anecdotal data points from interviewees and were verified where possible through industry reports, academic publications, or informed estimates.)
Created by Celeste Bean
How quality-driven reinvestment compounds into revenue growth
  1. Better resident outcomes (clinical wins visible to hospitals and payers) push public scores upward.
  1. Higher scores attract more ratings-boosted referrals; even a 1 % uptick equals roughly US $200-300 k in annual top-line revenue for a US $20 M facility.
  1. Extra placements raise occupancy & daily revenue—hitting 95 % census instead of 85 % can add ≈ US $250 k to EBITDA, while filling high-acuity Medicare beds spreads fixed costs.
  1. Healthier cash flow funds strategic reinvestment: upgrades in staffing, training, and automation. Every US $1 put into smart tech yields US $3-5 in annual labour savings.
  1. New tools drive improved operations & quality—example: automated med-dispensing alone saves ≈ US $70 k each year and cuts error rates.
  1. Leaner workflows enable faster, safer delivery of care; trimming 10 % of process delays releases US $100 k+ in reimbursable bed-days and burnishes the facility’s reputation.
  1. Speed and safety translate back into even better resident outcomes, closing the virtuous revenue loop administrators described.
(Note: these figures reflect anecdotal data points from interviewees and were verified where possible through industry reports, academic publications, or informed estimates.)
Created by Celeste Bean
References
  • Mukamel, D. B., Saliba, D., Ladd, H., & Konetzka, R. T. (2022). Daily variation in nursing home staffing and its association with quality measures. JAMA Network Open, 5(3), e222051. https://doi.org/10.1001/jamanetworkopen.2022.2051
  • Gandhi, A., Yu, H., & Grabowski, D. C. (2021). High nursing staff turnover in nursing homes offers important quality information. Health Affairs, 40(3), 384-391. https://doi.org/10.1377/hlthaff.2020.00957
  • Shen, K., McGarry, B. E., & Gandhi, A. D. (2023). Health care staff turnover and quality of care at nursing homes. JAMA Internal Medicine, 183(11), 1247-1254. https://doi.org/10.1001/jamainternmed.2023.5225
  • Brazier, J. F., Geng, F., Meehan, A., et al. (2023). Examination of staffing shortages at US nursing homes during the COVID-19 pandemic. JAMA Network Open, 6(7), e2325993. https://doi.org/10.1001/jamanetworkopen.2023.25993
  • Shen, K., McGarry, B. E., Yu, H., & Gandhi, A. D. (2023). Staffing shortages, staffing hours, and resident deaths in US nursing homes during the COVID-19 pandemic. Journal of the American Medical Directors Association, 24(5), 588-596. https://pubmed.ncbi.nlm.nih.gov/37253431/ (PMCID: PMC10165011)
  • Harrington, C., Dellefield, M. E., Halifax, E., & Fleming, M. L. (2020). Appropriate nurse staffing levels for U.S. nursing homes. Health Services Insights, 13, 1-15. https://doi.org/10.1177/1178632920934785
  • Pradhan, R., Davlyatov, G., Chisholm, L., et al. (2025). Agency nursing staff utilization and turnover in nursing homes: A longitudinal analysis. Healthcare (Basel), 13(4), 379. https://doi.org/10.3390/healthcare13040379 (PMCID: PMC11855161)
  • Mukamel, D. B., Saliba, D., Ladd, H., & Konetzka, R. T. (2024). Longitudinal associations of staff shortages and staff levels with resident outcomes in US nursing homes. The Gerontologist, 64(2), 249-259. https://pmc.ncbi.nlm.nih.gov/articles/PMC10826288