As a nonprofit, Hope Hospice has undergone a tremendous evolution from a small agency to a major presence in south Florida. What is perhaps most remarkable is the ability of Samira Beckworth to withstand the pressure of the bottom line. Hope Hospice is a nonprofit organization, but it has grown into a going enterprise that is -- by all appearances -- surprisingly corporate. The influence of strong leadership can be felt in the single-minded way that Hope Hospice has tracked the mission. This paper briefly examines the organizational attributes of Hope Hospice and explores the motivation behind the mission. Collins' analytical framework was used to explore and discuss Hope Hospice with (Collin, ).
The purpose of the paper is to examine the influence of leadership on the resiliency of Hope Hospice as an agency and on the fidelity to its mission through periods of substantive change in domestic healthcare and the status of finances at the national level.
Description of Organization
Services and Size. Hope Hospice is nonprofit agency focused on healthcare and end-of-life care that emphasizes patient and family control of their care plans. Increasing the number of employees from 50 to over 400 -- and a patient census of 200 to over 2500 -- is remarkable growth for an agency in the hospice and home care sector. Based in Florida, the agency began providing services in one county and now has establishments in nine counties, covering 10,000 square miles with a population of 1.8 million. Hope Hospice receives private insurance, Medicare, and Medicaid payments. The hospice also accepts private donations, participates in government grants, and holds numerous fund raisers. No one who comes to Hope Hospice for care pays out-of-pocket for services.
Mission, values, philosophy. The agency's mission is to provide exceptional care and support to every individual and their loved ones as they fulfill life's journey. Closely aligned to the mission, the agency's vision is to create an environment in which the life journey is cherished. The agency operates under the basic principles that all people deserve access to compassionate care in a place they call home, and that all people should be free to choose the type of care that meets their needs and be given the information they need to make informed choices.
Further, with regard to the business side of the agency, the employees believe there is no substitute for exceptional care and they work to foster an atmosphere of continuous improvement. The agency strives to be a good steward of resources and vows never to compromise the quality of care for financial gain. The agency views employees and volunteers as valued resources and ensures that they have the tools that they need in order to succeed at their work.
Infrastructure, structure, process and outcome. Deming (2000) and Donabedian (1988) developed models for quality improvement processes and the assessment of quality improvement. They were proponents of the concurrent study of structure, process, and outcome in order to obtain complete information sets that could be used -- and that one could be confident was credible. Experts in quality improvement processes set out a series of steps that follow the declaration of a company vision and objectives -- and the strategy to achieve both. Goals and objectives must be operationalized through the articulation of performance measures or indicators. These performance measures form the basis for action planning and implementation of action plans, such as those outlined in Deming's (2000) Plan-Do-Check-Act framework for continuous quality improvement. The strategic goals of Hope Hospice are to increase access to and provide exceptional care and services, and to be good stewards of their resources. The provision of healthcare services is complex, even within the bounded environment of a hospice. Services must be negotiated with patients, patients' families, insurers, and governmental institutions (Meijer & Vermeij, 1996). A complex matrix of structural attributes related to quality of care outcomes must be navigated (Meijer & Vermeij, 1996).
Level five leadership. Samira Beckworth, CEO of Hope Hospice, appears to be the poster leader for Collin's good-to-great level five leadership. Beckworth's motivation for shaping Hope Hospice into the type of organization it has become stemmed from a serious illness she had that required long and frequent stays in the hospital, and considerable time in doctors' offices and clinics. Suffering from Hodgkin's disease and exposed to conventional institutional care, Beckworth observed that some areas of medicine were not advanced and resulted in unnecessary patient suffering. This experience ended a way of thinking for Beckworth (Wheatley, 2005). Her experiences during this time are a good example of thin-slicing in which a person gauges what is really important from a brief or constricted experience (Gladwell, 2005).
Beckworth's goal became helping others, particularly patients suffering from serious illness or about to die. She sought to create an environment where empathy, symptom management, and pain control would prevail -- and would reflect the best that medical practice could provide. Through these efforts, Beckworth demonstrated the characteristic "paradoxical blend of personal humility and professional will" (Maney, 2009).
First who then what. Starting small in one county with 50 employees, Samira Beckworth understood the importance of recruiting, hiring, and retaining the right people. When only a few people make up the staff, it is critical that each person be the best that can be hired for the job. And when the clients -- the ill or dying people served by the agency and their family members -- are vulnerable, it is even more important that the work be carried out by trustworthy and conscientious people. Beckworth knew how to put first things first -- people first is her rule -- and then she was able to concentrate on growing the agency. Management at Hope Hospice is participatory, and skills training and collaboration are encouraged and practiced with employees. A social worker by training, Beckworth understands the value of strengths-based management (Buckingham & Coffman, 1999). She does not treat all her staff members the same -- rather, she gives to each employee the kind of support, encouragement, or feedback that they need in order to be their best. Employees are guided to find the best position for them -- given their innate strengths -- and then they are expected to perform better than anyone else in that position.
Confront the brutal facts (yet never lose faith). Faced with an aging population, whose members increasingly find themselves without sufficient healthcare, Beckworth looked for ways to work around the numbers. During the fiscal crisis of 2008-2009, Beckworth found ways to work with other providers, cooperating to ensure patients had access to healthcare and hospice services (Deming, 2000). Beckworth's high level of emotional intelligence is partly a result of her training as a social worker and partly just who she is as an individual. Her early experience with a serious illness increased her empathy and also underscored the need to identify people's interests and needs in order to collectively accomplish goals.
Hope Hospice has begun to share of patient feedback across the organization but, follow through to address the negative feedback has been lacking. As the agency steps up to the plate to establish a stronger program of client service recovery, they will have taken steps toward becoming a stronger learning organization (Senge, 2006).
The hedgehog concept. The allegorical fox may know many things, but a smart little hedgehog with business acumen knows one great thing well enough to make it a success. Beckworth had the passion to grow the Hope Hospice organization. But the sweet spot only develops when the economic equation and the best of the best core businesses come together to meet passion. With these three forces in play, a company can go from good to great. Beckworth knew that she could improve on the provision of hospice service -- she had developed a business idea that would become the one thing that the agency could do best. The core idea: Hope Hospice clients and families could drive their own care plan. And because the services at Hope Hospice were of such high quality, demand for their services grew -- the business expanded accordingly.
A culture of discipline. Beckworth exemplified an entrepreneurial approach to the business. She conceptualized a niche and then worked to create a viable enterprise from that early vision, fundamentally bringing about diffusion of her own innovations (Rogers, 2003). Beckworth doggedly added services to the core business as clients and their families made their desires known to her. As she has conceived new programs of care and worked to integrate them into the going enterprise, Beckworth has followed two fundamental principles: (a) Improve the quality of hospice care and healthcare -- but reduce costs at the same time (reducing bureaucracy and taking an entrepreneurial tack can actually make this happen, though at first blush, it seems like an oxymoron); and (b) expand coverage and increase access for all who come to the agency in need of…