Case Study / Employee Survey Trilogy Health Services

Trilogy Health Services

Founded in 1997, Trilogy Health Services offers skilled nursing, assisted living, rehabilitation, and pharmacy services across six states and over 100 campuses. Trilogy employs over 10,000 people to serve 9,000+ seniors. Trilogy has been working with Activated Insights since 2018.

Trilogy Health Services Logo


higher employee retention

Executive Summary

Trilogy's strategy is best described by the "flywheel of success" in Jim Collin's Good to Great book. Trilogy invests in its servant leadership culture, which then drives engaged employees to stay, providing customers with a stable workforce and the highest level of service. In turn, this culture leads to better financial outcomes through higher occupancy and better payer mix for its SNF beds, which means the "flywheel" ability to keep investing in its culture. With such a clear strategy, Trilogy carefully tracks and correlates all its success metrics. For instance, in Trilogy's skilled nursing facilities, the most engaged campuses have ratings that average almost 1 star higher and enjoy employee retention rates nearly 10% higher than in less engaged campuses.

Trilogy Health Services Logo


Trilogy Health Services


Prior to working with Activated Insights, Trilogy was doing well, but struggled to show consistent improvement in its bottom-performing skilled nursing facilities. Challenges included:

  • Leadership felt the lack of engagement among team members in lower scoring campuses but did not know what to do - or the impact on overall employee engagement.
  • What's more, Trilogy's action planning process was not working in the lower performing campuses. As a result, their operational fire drills were a drain on the management team's time.
  • During COVID, it was more important than ever to engage employees, as skilled nursing facilities nationwide battled against the pandemic.

How Activated Insights Helped 

Activated Insights' Culture Coach worked with Trilogy to understand its people strategy, then reach its goals and quantify successes.

  • Because Trilogy already knew the impact of the Trust Index on its key operating and financial metrics, they set a goal to increase their overall Trust Index by 2% with every survey.
  • This effort was complicated by the 80/20 rule. As with many companies, 20% of the bottom performers take an inordinate amount (80% or more) of the effort. The same was true at Trilogy, some campuses consistently struggled.
  • The Culture Coach helped Trilogy identify 15 campuses to focus on and helped to create an internal "SWAT" team for targeted interventions.
  • The Culture Coach also helped Trilogy deploy "pulse check-in" surveys, a tool they hadn’t previously used.


Within two months, the 15 consistently low-performing campuses showed improvements averaging 3x higher than the rest of the company.

  • The Culture Coach guided Trilogy to set up and use "pulse check-in" surveys to monitor progress in their initiatives.
  • To everyone's surprise, the 15 campuses had improved a dramatic 3x more than the rest of Trilogy’s campuses.
  • Trilogy’s partnership with Activated Insights has led to a meaningful improvement in employee engagement, with a corresponding measurable impact on company performance. Their most engaged campuses achieve 26% higher average CMS STAR ratings and 9% higher customer satisfaction scores, leading to 8% higher employee retention.