Shari Dingle Costantini – Founder & CEO, Avant Healthcare Professionals

Shari Dingle (Sandifer) Costantini, RN, MBA, is a renowned expert in the healthcare industry, with 29 years of experience in strategic leadership, nursing, and international nurse staffing. As a registered nurse and accomplished business owner in healthcare staffing, she offers a unique perspective and keen insights into a wide range of issues affecting medical staff today, and is an authoritative source on issues concerning international workers.

Costantini is a strong advocate for creating supportive work environments in which healthcare workers will thrive and improve patient outcomes. Her company, Avant Healthcare Professionals, has placed more than 1,500 international nurses, physical therapists, and occupational therapists throughout the U.S. The company, which has grown 40 percent annually since inception, is recognized as an industry leader and innovator in healthcare staffing.

Avant was a founding member of the American Association of International Healthcare Recruitment. Through AAIHR, Costantini actively lobbies Congress for immigration reform to allow a consistent flow of highly-skilled healthcare professionals. She belongs to numerous professional organizations and she has authored various articles and blogs. Costantini is on the Rollins College Center for Advanced Entrepreneurship and the Central Florida Foundation boards, Immediate Past-Chair of Orlando, Inc., and Chair of Regulatory Affairs for AAIHR.

Tell me about your early career.
I earned my bachelor’s degree and became an RN in 1988. I left bedside nursing in late-1989 to become an admission counselor in hospice. The hospice benefit had just expanded to include all end-stage illnesses. My role was to educate discharge planners and physicians on the expanded benefit in an effort to increase their use of hospice. I grew the most successful territory in Hospice, Inc., now known as Vitas, as measured by admissions. When the Chicago branch locations were impacted by negative press coverage, I was asked to relocate and rebuild the territory of the Chicago medical district in 1991. After I finished my MBA, I moved to Michigan where I began working in home healthcare. There, I grew the Flint agency location to be the largest location in the national home health organization, delivering over 6,000 visits per month. After a year, I managed an eight-agency region. At that time, Medicare was shifting from a cost-based reimbursement system to an interim-payment system and a perspective payment system, which proved to be a challenge. Through these challenges, I acquired knowledge on the potential regulatory issues faced by healthcare providers. While in home healthcare, I was introduced to the world of international recruitment. I moved to Boston to work for O’Grady Peyton (now owned by AMN Healthcare) where I gained an understanding of the complex recruiting process involved with international healthcare staffing. In early 2000, PPR Healthcare recruited me to start an international nurse recruitment division.

How did the concept for Avant Healthcare Professionals come about?
At PPR Healthcare, I saw the gap between clinical practice for nurses overseas and in the U.S. I had observed that clients and nurses on hospital units, in particular, did not appreciate the difference in clinical practices. As a result, there was mismatch in expectations and understanding. This was particularly difficult on the nurses transitioning cultural, socially, and clinically to the U.S. With Avant, I wanted to offer innovation clinical programs for both the international, educated nurses and the clients. For the nurses (and therapists at Avant), we offer comprehensive clinical and cultural transitions programs designed to close the gap on practices differences and prepare the nurses and his/her family, if applicable, for the cultural and social adjustment. Clients (primarily nursing leaders and nurse preceptors) receive educational seminars, webinars, and ongoing support designed to assist them to most effectively orient, transition, and retain the nurses.

How was the first year in business?
The process of recruiting internationally-educated healthcare professionals typically takes 18-22 months. I was able leverage my network from being in the business for 6+ years, and we placed our first nurse on assignment with a client hospital in 10 months. As with most startups, I was wearing multiple hats, including client sales. International healthcare staffing is very capital-intensive, so we were definitely bootstrapping it.

What was your marketing strategy?
We did not have a marketing strategy in the early years. Our sales efforts were based on lead generation from trade shows I attended, as well as cold calling hospitals that had nurse vacancies. I did all of the sales activity including in-person meetings.

How fast did the company grow during the first few years?
The company grew at an average annualized growth rate for the first three years of 275%. After year three, the company encountered a significant regulatory issue impacting its only service line: internationally-educated nurses. The company had to pivot and diversify. Over the years, there have been many immigration and healthcare regulatory changes that required the company to adjust its service offering, client base, and geographic footprint in both supply and demand markets. Despite all of these changes, the company has achieved an average annualized growth rate of 40% since 2004.

How do you define success?
I define success by the lives we have had the opportunity to change and impact through Avant. Avant is a mission-driven company committed to our core values. A company with a strong foundation will be able to adapt to the inevitable challenges, twists, and turns we need to make to survive and thrive.

What is the key to success?
I believe it is different for each person. I believe my persistence and work ethic combined with compassion and integrity has driven my success. Building a business is more of a marathon than a sprint. The traits or attributes that I mentioned – persistence, strong work ethic, compassion, and integrity – have allowed me to create an environment that attracts likeminded people. It keeps them engaged because they feel valued and they have leadership by example.

What is the greatest lesson you’ve ever learned?
The greatest lesson I’ve learned is to keep an open mind and never stop learning. In my opinion, the greatest CEOs are constantly learning and evolving.

What are some quotes that you live by?
Probably one of the most important, to me, is by Calvin Coolidge – “Nothing in the world can take the place of persistence. Talent will not; nothing is more common than unsuccessful men with talent. Genius will not; unrewarded genius is almost a proverb. Education will not; the world is full of educated derelicts. Persistence and determination alone are omnipotent. The slogan, ‘Press On!’ has solved and always will solve the problems of the human race.”

What are some of your favorite books?
Business books are The Five Dysfunctions of a Team by Patrick Lencioni, Mastering the Rockefeller Habits and Scaling Up by Verne Harnish. Personal books are Lean In by Sheryl Sandburg and Daring Greatly by Brene Brown.

Tell me about one of the toughest days you’ve had as an entrepreneur.
One of the toughest days I’ve had as an entrepreneur was the day that the national licensure exam testing was suspended for physical therapists from the Philippines, Egypt, Pakistan, and India. When immigration changes stopped the flow of registered nurses internationally, we pivoted to recruit in place internationally-educated occupational and physical therapists. After close to 18 months of gaining traction in this new service line, the national organization that administers the licensure exam suspended testing for therapists from the markets where we were recruiting. We have overcome this challenge and continue to grow. However, it was certainly one of the most challenging days I’ve experienced.

When faced with adversity, what pushes you to keep moving forward?
The mission keeps me moving in the face of adversity. That may sound a bit cliché, however, it is more about keeping your eye on the big picture than the adverse situation in front of you.

What advice would you give to young entrepreneurs?
The advice I would give to a young entrepreneur is to always stay focused on the vision. The vision you have for your business is more than just a product or service. Those products or services will undoubtedly change and evolve over the life of the business. It is the vision or the bigger picture that you need to stay focused on to lead in the time of change and create sustainability.

This interview was conducted for research purposes by Jason Navallo for his upcoming book, Underdog.