While researching a report on leadership succession planning for hospices (which members of the National Hospice and Palliative Care Organization can read in NHPCO’s NewsLine newsletter, March 2006, starting on page 3), I was introduced to the concept of a hospice sabbatical – taking a significant break from one’s job routines, as educators sometimes do.
The issue is how long-time hospice executives (or other professionals) can stay fresh, committed and creative in their jobs. How do they retain a personal connection with the underlying values and meaning of hospice care while staying on top of productivity, compliance, budgeting and other essential managerial tasks of running today’s complex hospice programs in an increasingly challenging and competitive environment? How do they avoid isolation from the larger health care system, from the intimate concerns of patients and families, and from perceptions of hospice care held by others?
Ann Luke, who retired after a varied career in non-profit, health-system and corporate hospice management in Colorado, related to me a story about Dr. Sylvia Lack, the first medical director of the first U.S. hospice. Lack believed that hospice medical directors should take a break from their hospice work and step back into traditional medical practice every six years or so. “Otherwise, you can limit your access to what’s happening in the real world.”
Luke wonders whether it could be a healthy practice for hospice administrators, as well, to take a sabbatical from their jobs. An executive who is professionally trained as a nurse or social worker could step back into that professional role as a kind of sabbatical. Given the pace of change in medicine, it could be an invaluable learning experience as well as a perspective-enhancing break from a current job rut.
Just as in academics, taking some months off from administrative responsibilities to pursue new skills, new interests and new roles could go a long way toward revitalizing the executive’s vision and leadership. Participating in an international delegation, such as those sponsored by the Foundation for Hospices in Sub-Saharan Africa, could provide indelible new viewpoints. What about a job exchange with someone in a very different setting – even another country?
The Shorter Version
I realize that few hospice executives are going to take months off from their jobs for a sabbatical, because of the disruptions and logistical challenges of installing an interim replacement. But there are more feasible options that don’t involve such a long time commitment while still exposing them to the real-life experiences of seriously ill patients and families, either before or after their referral to hospice.
Experts interviewed for my NewsLine article emphasized the value of arranging regular, face-to-face contact with patients and families. An executive could make joint home visits with the hospice’s professional staff in a supervisory, educational or just observational capacity. Executives who retain qualifications as health professionals could take on an occasional patient to manage. Others could visit patients as lay volunteers. I once heard of a hospital president who cooked pancakes for patients on the hospice unit. Whatever else fills the executive’s 50-to-60-hour weeks would need to be juggled to free up a couple of hours on the front lines of hospice care, in order to rediscover in concrete ways how the agency manufactures this unique widget called hospice care.
Other suggestions include taking a shift answering calls in the intake department, listening to the concerns of newly referred patients and those who are responsible for their care. As part of a quality initiative, be the one to call survivors three or six months after the patient’s death to hear their evaluation of the care they received. Ann Luke suggests contacting the people who were referred but then declined hospice care to find out what they perceived about it that made them turn it down. Even more instructive might be to take a few shifts as a home health aide or homemaker, experiencing hospice care at its most concrete level. While you’re at it, offer your clerical and billing staff the chance to make an occasional home visit – even just delivering the next prescription refill or carton of chux. Any of those measures could provide an opportunity for renewal and for sharpening rusty listening and communication skills.
Writers Also Need Human Contact
This question is relevant to my writing about end-of-life care. Although I was originally drawn to the human encounter with mortality and the ultimate questions that hospice care at its very best aims to facilitate, that’s not what I spend most of my time writing about. Instead, I regularly address hospice coverage, eligibility, reimbursement, regulations, staffing, organizational issues and the like. All important to the consistent provision of high-quality hospice care, but at an arm’s length from the deeper spiritual and existential questions. Only occasionally do I get to meet patients or bereaved survivors, which is always a highlight of my work.
I was drawn to hospice volunteering before I started writing about the field. Through much of the 1980s and 1990s I was a hospice patient care volunteer in San Francisco, visiting patients’ homes and doing shifts in residential settings. With no professional health care skills to bring to that role, I had to fall back on intangibles such as listening, presence and patience. But I haven’t done any hospice volunteering since 1999.
Just as I encourage hospice or palliative care administrators to incorporate face-to-face encounters with patients into their job routines, I recognize the same need in my own work, writing about hospice and palliative care. This week I was interviewed by a hospice volunteer coordinator in my community and I signed up to take a volunteer training course starting in May. We’ll see what comes of that.
Send your tales of hospice sabbaticals or other front-lines experiences intended to keep your job fresh to me at: email@example.com.