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November is National Hospice Month; a month in which the nation’s attention should be on the wonderful care and support hospice organizations provide to dying people and their loved ones.  Unfortunately, this month we are still reeling from Time magazine’s October 25^th article, No One is Coming: Hospice Patients Abandoned at Death’s Door.

I have dedicated my professional life to working in hospice care, to helping people and organizations be their best, and the vast majority of hospices strive every day to do just that. But for those whose experiences of neglect and unanswered phone calls are the basis of the Time article, our track record and good intentions mean nothing.

In response to the piece, the President and CEO of the National Hospice and Palliative Care Organization Edo Banach wrote in part in his letter to the membership, “…The authors cite 3,200 complaints filed with state officials in the past five years.  During that period,...

Image Above: Dr Ariel Malamud and Patti on a hike with the Alembic Institute group outside Santa Fe, NM

A recent email from my physician friend Dr. Ariel Malamud, a Gastroenterologist in a large metropolitan health system resonated powerfully with me, and I wanted to share it with you, with his kind permission.

He begins by describing how moved he was when, during his daughter’s lacrosse game after a player was injured, the members of both teams silently took a knee and focused on the injured player while she was tended to by the medics and referees. He goes on to say,

“…The practice of medicine has an important challenge: the physician must attend to the needs of the sick using acquired knowledge and experience and updated skills without lacking the sensitivity to kneel mentally for the hurt human being…

Many health systems promote this with inspirational conferences once in a while. There is a need to rather make it part of the institutional culture. And...

Image Above: Danny Meyer on Hospitality...the root word of Hospice

In my last newsletter I introduced Danny Meyer the famous NYC restauranteur with radical ideas about "enlightened hospitality".  His commitment to extraordinary customer service begins first with an excellent staff.  How do you hire - for skills, or for people smarts? My philosophy has always led me to look first for personality, a sense of mission, and cultural fit, because the rest can be learned.

Danny dealt with a similar situation in staffing his first restaurant. As he describes the process, “My brain was looking for people with restaurant skills, but my heart was beseeching me to cultivate a restaurant family. The job application form I wrote was idiosyncratic: I typed questions like, “How has your sense of humor been useful to you in your service career?” “What was so wrong about your last job?” “Do you prefer Hellmann’s or Miracle Whip?” If...

I have been thinking a lot about intentions: Merriam Webster dictionary defines intention as “a determination to act in a certain way”, and goal as “the end to which effort is directed”. When I ask myself what my intentions for the day/week/year are, versus what my goals are, I come up with very different answers.

Last week, I had a few days in my office. My desk was overflowing with documents that were once urgent but had now become simply interesting and the mountains of paper threatened to topple at any moment. My goal was to bring some order to my office work space, and maybe even catch a glimpse of the lovely maple desktop buried deep under the detritus. 

I confess, that has been my goal for over a year!  But the difference this week was my intention.  I was determined not to get frustrated or impatient with the task, or let myself be beguiled into doing something I enjoy more (like connecting with my clients and colleagues)....

I hear it every day from the leaders in the not-for-profit hospice world: We’re losing ground. Caught between a rock – reduced federal dollars – and a hard place – the crushing proliferation of regulations – hospice leaders are adopting a bunker mentality, hunkering down to provide the basics to those in their care, while forced to let go of many of the extra services that bring comfort and meaning to their final days. It looks grim – yet I can’t help but feel like we’ve been here before.

There weren’t a lot of resources for us at the start of the hospice movement – and no Federal money for hospice – but there was enthusiasm, and partnership within the communities we served. We cobbled together alliances, trained volunteers, worked with what we had, and made life better for dying people and their loved ones.

When I look at where we are today, what occurs to me is this: What might we be able to accomplish, if we more...

I was touring a hospice care center when the smell of freshly baked chocolate chip cookies drew me to the kitchen, where I found a group of girls from the local high school. They told me that once a week they come to bake cookies for the families and patients in the care center. What a terrific way to enable young people to express their budding instincts to serve – and to create ardent ambassadors for hospice in the community.   

When I’m assessing a hospice program, one key measure of quality is the number of active volunteers and their level of involvement. How many volunteers do you have? What kind of things do the volunteers do for hospice? How long have they been volunteering? As we move forward in this new world of hospice and health care reform, volunteers are going to have an even greater impact on the lives of people who are facing serious illness and death. 

What kind of person is likely to volunteer at a hospice? Most often, volunteers will be...

Image Above: Acting Administrator of CMS Andy Slavitt and C-TAC Board Co-Chair Tom Koutsoumpas

Is hospice a commodity?  Is it a payment system for the dying? Is it only for the final days of life?  Is it only about giving morphine until a patient is no longer in pain?

Last week I attended the National Summit of the Coalition to Transform Advanced Care (C-TAC) in Washington DC.  The speakers were Congressmen and Senators, health care leaders and insurers, pastors, and seriously ill people, and the Acting Administrator of Medicare/Medicaid and the Secretary of Veterans Affairs; all people interested in making the care that serves those in their final years of life as compassionate and creative as possible.

While the meeting had outstanding speakers, what struck me was that most of these dedicated, intelligent and caring people think that we need a "new model of care" for people with advanced illness and hospice was hardly mentioned. They described this model...

In hospice, your only product is service, and nothing is more important to that than proper staffing. No matter how powerful your mission statement is or how beautiful your facility, your people have to be service-oriented and fully committed to the work. Hospice doesn’t run on a nine-to-five, five-day week; it’s 24/7, and we can never be less than our best. We deal daily with the dying and the grieving, and that means that everyone, from the social worker to the nurses’ aide to the bookkeeper, has to be emotionally stable and mature enough to handle that.

     What do you look for in a potential hire? My first priority in doing executive searches for clients today is the same as it was when I was hiring as an hospice Executive Director; I look for people who have a belief in something greater than themselves. I don’t mean religion necessarily, but faith in goodness, faith in humankind, faith in the rightness of the universe. People who...

How hospice has changed since the movement began! Back at the beginning, there was no competition, because there wasn’t any money. But today competition is fierce, and requires that we as leaders re-imagine and upgrade our relationships with our clients, our communities, our donors and our referrers. Beyond offering superb care, delivered consistently, and unfailingly going above and beyond what is expected, how can you stand out from other providers in your market?

 Last time, I offered up the first five of these ten ways to thrive in an increasingly competitive market; here are five more.

1.  Know what your community really wants. Often hospices offer programs they think are important but which may not really meet the needs of their community. Great organizations get to know intimately what their customers want. That means spending time talking with patients and families, not just sending out a survey.

2.  Know what your referrers...

When hospice began, there was no competition between us because there was no money involved. But the last ten years has brought an explosion in hospice growth, and today many good hospices find themselves jostling for market share in an ever-more-crowded field.

Beyond offering superb care, delivered consistently, and unfailingly going above and beyond what is expected, how can you stand out from other providers in your market? My work with high-performing hospice organizations inspired me to pull together this list of what I see as the top ten differentiators; here are the first five.

1.  Know how you’re different. Every hospice is required to provide basic things under the Medicare hospice benefit. What sets you apart? Key differentiators are the quality of care you provide, the responsiveness you show to patients and families, physicians, and referral sources, and commitment to your community.

2.  Be timely and do it right the first time. Determine how long it...