Culture’s impact on recruitment and retention in the healthcare ecosystem: A conversation with John Shagoury, president and CEO at IntelyCare

In this episode of The Heidrick & Struggles Leadership Podcast, Heidrick & Struggles’ Josh Clarke speaks to John Shagoury, president and CEO at IntelyCare, a leading healthcare workforce management platform. Shagoury shares insights drawn from his extensive career in both operating and investor roles, explaining how these differentiated experiences helped him develop as a leader and what ways he’s found effective to engage teams. He also shares what it was like joining IntelyCare as the COO, which was a new position and an expansion of the executive team, and shares what leadership skill sets and capabilities he found critical to being in a new environment and a new role, and what it was like joining a founder-led business. Turning to healthcare, he discusses culture and its critical role in driving recruitment and retention, and what challenges he anticipates facing the health tech talent market. Finally, he shares how and why it is so important to find the right balance between the people-first side of the organization and encouraging and enabling innovation and disruption mindsets to thrive.

Below is a full transcript of the episode, which has been edited for clarity.

Welcome to The Heidrick & Struggles Leadership Podcast. Heidrick is the premier global provider of senior-level executive search and leadership consulting services. Diversity and inclusion, leading through tumultuous times, and building thriving teams and organizations are among the core issues we talk with leaders about every day, including in our podcasts. Thank you for joining the conversation.

Josh Clarke: Welcome to the Heidrick & Struggles Leadership Podcast. I'm Josh Clarke, a partner in Heidrick & Struggles’ Boston office and global leader of our Health Tech practice. In this podcast, I speak with John Shagoury, president and CEO at IntelyCare, a leading healthcare workforce management platform. At the time of our recording, John was serving as the chief operating officer.

Prior to IntelyCare, John was a venture partner at SB Health Investors and president and CEO of Eliza Corporation. He was executive vice president and GM of the healthcare division at Nuance Communications and president at Dragon Systems, Kubi Software, and Corporate Software & Technologies. John, thank you for joining us today.

John Shagoury: My pleasure, Josh. Glad to be here. 

Josh Clarke: Throughout your career, you've worked in various environments: public companies, private equity-backed businesses, and in multiple industries. How would you say having these differentiated experiences has helped you develop as a leader? 

John Shagoury: I think, over time, you learn that no challenge or no issue is unsolvable. The scale and the impact of the issue may differ based on the size of the company or the stage of its life, but, at the end of the day, I’ve realized that if you can take away the fear and the panic and get a team to just really focus on the issue, there's always a manageable solution. I've had my share of fear and panic over the years, but ultimately come to that realization. It's been a big help. 

Josh Clarke: I'm curious, just to drill a bit deeper on that, what have you found to be effective ways to engage the team and to get them on the same page as you just described? 

John Shagoury: I think it's really about openness. It's engaging people and making sure they feel like they can be part of the solution—that everybody has a chance to be heard. When you're in difficult situations, you want everybody's opinion. They don't all necessarily get a vote, with the vote being the way we make a decision, but everybody should have a chance to be heard. You've got to listen with an open mind. 

Josh Clarke: When you joined IntelyCare in 2019, the COO role was a new position and an expansion of the executive team. What was taking on that role like for you? Any leadership skill sets and capabilities that you found critical to being in a new environment and a new role? 

John Shagoury: Really, what I was looking to do—and what the founders were looking to do—was to have me bring in a level of experience and maturity around how to grow a business. The company had a really good foundation, it had some good momentum behind it, and it was ready to scale. So, what was important was thinking about how to put that growth engine in place and how to do it in the most effective way? A big piece of that for me was really spending the time to listen: not assume I knew anything, but really build a rapport across the team. Ask a lot of questions, listen, and then drive conversations based on that. 

Josh Clarke: Building on that, what was the experience like joining a founder-led business? Any particular lessons learned that stand out to you? 

John Shagoury: Yes. I've joined three or four founder-led businesses, and I think this one has been the most successful and rewarding so far. 

I think it really starts at where the founders' heads are at. Coming in here, the founders didn't assume they knew everything. Probably of all the companies I've come into with founders, this was the one where the founders knew what they were good at, but also knew what they didn't know.

That was really important. Then, for me, my job was to come in and play off the culture that they had built, because it was a strong culture and it was propelling a lot of the momentum. I really came in with the mindset that my role wasn't to be a change agent, but rather to be a growth agent, to bring in some new experiences and talk through some things, but ultimately to help facilitate and accelerate the growth of the business.

Josh Clarke: That's great, and I wonder if you could use that as a jump-off point to a related topic.

Here at Heidrick, we recently did a short survey with technology industry executives, including health tech, and almost half of the respondents reported that company culture was one of the most important factors for them to accept a new position.

How do you personally drive the culture of care within your organization and teams? How critical do you think culture is—to you personally, but also IntelyCare—for recruitment retention, especially given the dynamic with shortage of nurses that we're dealing with in the healthcare ecosystem at this point?

John Shagoury: You know, we take culture very seriously. We have four values that we've defined in the company: take big swings, be driven by wonder, carry forward care, and together we thrive.

And so, as we think about culture, one of the things we do is we are consistently communicating. We have a 30-minute weekly all-hands meeting where the whole company gets on. One of the things we do there is rotate the leadership. So, everybody director-level and up gets anointed to lead the meeting on a weekly basis. They have to start by picking one of the four values and talking about how it relates to them. That helps to reinforce the culture a lot of ways. 

The other thing we do is we really strive for open discussions. We're constantly referring to the values, and we really do make an effort to practice what we preach. And then, as we go to hire candidates—especially senior level candidates—somebody's experience in resume could be right on, but if we don't feel the chemistry fit is right, the cultural fit is right, we'll always pass on that candidate. 

Certainly, as you know, in a growing company, every new hire affects the culture one way or the other. You have to make sure that you're protecting that culture by hiring people who are going to fit in, or support, or help move the culture in the way that you're trying to move it.

Josh Clarke: Our survey also indicated that, for health tech companies specifically, there's an expectation that hiring over the next six months is going to continue at the pace it has for the last few years. And so, with that in mind, and considering the culture factors that you've just mentioned, what hiring and retention challenges do you foresee? What tactics, in addition to the culture test, will you use to continue to attract and retain talent?

John Shagoury: You're right. The recruiting process is a very challenging environment. As a company, our practice is try to hire people locally. We don't have a very large remote workforce, other than our nurses. So, the challenge posed by the shift to a work-from-home environment can be tough sometimes. We do respect people's ability to do that, but we do have certain roles that require a certain level of in-office attendance.

I think the other thing is really getting candidates to truly understand our business. At the surface, we could look like we're a nurse staffing company, but in reality, we're a tech-driven, two-sided marketplace that's really been a very disruptive force in an industry. Getting people to think about being part of that disruption—the underlying technology that's pretty leading edge and cool to deal with—becomes part of the challenge.

Then, certainly talking a bit, not only about our growth rate, but the mission or the purpose of the company, the ability for an employee to impact the lives of other people—to us, this is a very compelling reason to join the company. And at the same time, if that doesn't resonate with people, they're probably not going to fit into our culture.

Josh Clarke: I'm curious, as you work through those processes, how important is it for you to find the right balance between the people-first side of the organization, and encouraging and enabling innovation and disruption mindsets to thrive?

John Shagoury: I think it goes back to a couple pieces of the culture: you have to create an environment that people feel they can thrive in.

One of the things we talk about in our culture is we have a fast-fail culture. So, when you're on the leading edge of an industry and trying to be disruptive, you want to be able to try a lot of new things, and people anywhere across the organization can have great ideas. 

So, we really encourage a lot of ideas. We'll figure out how they may address a situation or an opportunity. Then, we'll spend a little bit of time and create some tests and launch some programs or launch some A/B testing, understanding that a lot of them will fail. But, as long as we learn from those failures to move forward, not only are we creating a great environment around creativity, but we're also ensuring people understand there should be no fear of failing.

Failing is part of the learning process, and I think that's one of the things that a lot of our employees gravitate to the most: the feeling that they can be themselves, they can speak openly, and that any idea is worth talking about. 

Josh Clarke: Shifting gears a little bit here, I want to touch upon some of your experience on the investor side.

How do you think that having that experience as an investor has impacted your day-to-day as an executive and operator within a company?

John Shagoury: It's really interesting question, Josh. Sometimes as an operating executive, you can really get focused on what's literally right in front of your nose. At the end of the day, I think what's really important is you've got to stay focused on creating long-term value for the company—really focus on what the big picture is all about and what a company has to do to maximize its long-term opportunity. 

Virtually every company has got investors, whether it's a public company or private company, and those investors are there investing in the long-term value creation. They have a belief that you can be successful in the big picture, and you really need to stay focused on that.

Josh Clarke: Following up on that, I'm curious, how are you creating a culture within IntelyCare that strikes a balance between a hyper-growth environment (some might say a growth-at-all-costs sort of mentality or expectation) with the need to build a sustainable, scalable business over time? How are you translating that for the team to get them inspired and on that same page? 

John Shagoury: It's a tough balance. At the end of the day, it is about growth; it's not about growth at any cost, though. It's really about the metrics and the KPIs that you put in place to make sure you're building a foundation that's sustainable for long-term growth. There are a number of things you can do to maximize short-term growth, but sooner or later, the foundation crumbles if you haven't really built it. 

So, it really comes down to: there's plenty of opportunities for growth, but how do you do it the right way? Because at the end of the day, you don't want the big ebbs and flows in the business. You want sustainability, and that starts with a strong foundation. That's everything from how you build out your platform, to how you think about the organizational structure, to how you address the opportunities in the market.

Josh Clarke: On the IntelyCare website, there's a question. It says, “Ask a what-if question and see where it leads you.” So I want to reflect that back to you, John. What what-if question have you asked as president and COO, and where has that led you? 

John Shagoury: Well, it's interesting. That is really driven through one of the values we have, which is be driven by wonder. We use that mostly to think about how to address business challenges. So, we've had situations—I'll give you a couple of examples—that are not necessarily questions I've asked, but that others have asked that have led to real positive things in the business. 

So, in this business, there's always the challenge of a nurse picking up a shift and then, the day before or the morning of, having the call off because something came up or whatever reason. That's one of the challenges we always face. Getting feedback from nurses who have done that, a lot of it has to do with economic reasons. 

And so, somebody asked the question, “What if we could find a way to pay these nurses pretty much instantly after they worked as opposed to a weekly paycheck?” That led to some investigation and an opportunity for us to roll out a function called Daily Pay, where a nurse could work a shift and get paid literally hours after completing the shift. That actually did a lot to support the growth in our business.

We had another situation where, especially during COVID, there was such a shortage of nurses and different clients competing for nurses. We wondered, “What if we could give clients the tool to allow them to raise their hand, in a different way, on the importance of certain shifts?” It led to the idea of a concept within our pricing model called the Boost button, where (even though we have contracted pricing with our clients) if the client's willing to pay more for a specific shift or a specific nurse, they can press a simple button in the app and allow themselves to do that.

We then communicate that out to the nursing workforce and have found that it led to much higher positive results for the client. So, it’s about thinking about framing a problem as an opportunity—what if this? what if that?—and then thinking creatively on how to solve it. 

Josh Clarke: John, one final question as we begin to bring this conversation to a close: looking ahead, what specific leadership skill sets and capabilities will be most important to help IntelyCare meet its strategic goals? 

John Shagoury: We're fortunate, in a way, that we're in a business that is not opportunity constrained. The market opportunity is huge, and it's about focus and execution. 

And so, for us it's about cutting through the opportunities to stay focused on the one or two big ones that we think can make the biggest impact on the business, and then really ensuring that the entire team is not only aligned around that but understands why: why we've made the trade-offs and choices that we've made, and what it’s going to take to maximize those opportunities on the focus that we have. 

Josh Clarke: John, thank you for taking the time to speak with us today. 

John Shagoury: My pleasure. This has been a great discussion.

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About the author

Josh Clarke (jclarke@heidrick.com) is a partner in Heidrick & Struggles’ Boston office and a member of the global Technology Practice.