A Challenging Picture

If a picture is worth a thousand words, how much is a thousand words worth? As a spring 2005 Leadership Survey of hospice organizations shows, quite a lot! Conducted by the National Hospice and Palliative Care Organization and the Furst Group, the survey provides a challenging snapshot of end-of-life issues facing hospice organizations.

As hospices begin their third decade of existence in this country, one finding is that 82 percent of the executives responding to the survey were over the age of 45, which pointed to a leadership shortage within 10 years. In the context of that shortfall, the survey showed that leadership development and succession planning were key to tomorrow’s success. When the picture was enlarged to encompass the question of what one thing would best prepare hospice organizations for the future, respondents chose “becoming a learning organization.” What does that mean?

Nearly two decades ago Peter Senge’s bestseller, The Fifth Discipline, presented a revolutionary approach to the practice of management by introducing the theory of learning organizations to business. It was written during a time when America was trying to cope with the threats posed by Japan’s early adoption of the Deming approach to quality management. Among other things, the book challenged American business and industry to begin creating shared vision, implementing team learning, and incorporating systems thinking into their organizations.

Historically, hospices were primarily founded and managed by RN’s and social workers and were focused on delivering clinical and social services to dying patients and their families. Becoming a learning organization was not on their short list of things to do, and, in fact, better managing Jim or Betty was generally not on that list either. If Jim and Betty were breathing and knew their job, hospice management expected them to lead, follow, or get out of the way, because there were dying patients and their families to care for! In those days, our shared vision was taking care of the sick and dying in the best way possible with little or no thought given to leadership and management development.

Team learning consisted of nurses, social workers, aides, chaplains, physician, and volunteers knowing something of the others role, but each too busy helping patients and families to think systemically. There was no time to consider how our various services and tasks were part of an integral whole. While we talked about our interdisciplinary team approach, we did not think in terms of systems and certainly not in terms of our organization as a behavioral system – a culture. We were not alone; most businesses in America were also doing their “own thing” with little regard for thinking about the integrative, cultural aspects of their organization – hence, the popularity of Senge’s book.

The good news is that since those early years of hospice, the picture has improved. We have new management terms, concepts, and tools with which to analyze our strengths and weaknesses, evaluate our services, and even examine our niche in the marketplace, but like healthcare in general, the survey shows we lag other organizations in developing the necessary leadership and management capabilities of our staff. Even though we are committed to the principles of continuous improvement in the clinical area, we still fall short when it comes to improving organizational leadership and management.

The good news is that the skills necessary for becoming a learning organization can, themselves, be learned. Survey respondents were able to identify specific educational and management needs necessary to create a learning organization and develop the next generation of leaders. Hospice organizations need employees who work with others to create clear direction and vision in themselves and those around them, create excellent customer service, build effective teams, and practice sound financial business management.

While it is recognized that good managers could become better ones through proper education and training, a consequent realization is that without people development, there is no organization development, and without organizational development there is eventually no organization. A crucial insight!

In the hierarchy of adaptive, flexible organizations, hospices are not on the cutting edge. Technology companies usually hold that distinction. Hospice, however, do have the knowledge to reinvent themselves even in an era of tighter budgets, consolidations, competition, and constrained Medicare and Medicaid funding. By providing information about where we are and where we need to go to create a better and brighter future, this leadership survey challenges hospices to begin that task. Not a bad snapshot – in fact, a picture worth a thousand words.