A Humble Takover?
Hospice faces a cruel reality in this country; it makes money. As we have discussed throughout our studies, money is power. An article noted that “As it turns out, not even hospice care is immune to private equity’s takeover of just about everything. One study found that the number of US hospices owned by private equity firms nearly quadrupled between 2011 and 2019. And the percentage of American hospices that operate for-profit in general has ballooned dramatically in the past couple of decades—going from approximately 40 percent of the total In 2001 to 72 percent in 2020.”[1] This is concerning as many Hospice faces are being bought out by companies who do so only to make money. Pursuing this Doctorate has been career-making for me; I was able to move up in leadership, and on July 1st, I received a promotion for a job designed for me by our Vice President. A week later, news came down that after about 17 years of existence, our company was bought, and on January 1st, we came under new ownership, new rules, and new anxiety.
In reading Humble Leadership: The Power of Relationships, Openness, and Trust by Edgar Schein and Peter Schein, I am drawn to this way of leading with humility. Schein and Schein define humble leadership as “concerning itself with creating the culture that makes purposeful forward movement sustainable as the world of work evolves.”[2] My company works hard on our culture. I bang the drum of keeping our culture, and now we inherit a new culture. Thankfully, the owners put their heart and soul into our work, and when they sold the company, they waited for a company whose culture aligned with ours. Our new company has its mission and vision in every job description, and easily found on their website, it’s called CAPLICO. The first C said it all and made me think of Humble leadership. C= Customers Second, A=Accountability, P=Passion for Learning, L=Love one Another, I=Intelligent Risk Taking, C=Celebration and O=Ownership. When you work in healthcare, you usually find healthcare workers who have a humble heart and servant’s heart, and it becomes easy to put the customer first, especially in Hospice. When a patient dies or is dying, it is easy to put yourself aside and show up. That is what you do most of the time, except when it’s outside of your scheduled hours. Putting customers second is an act of Humble leadership.
“Level 1 Relationships are defined as Transactional role and rule-based supervision, service and most forms of “professional” helping relationships.”[3] This is how I would describe Hospice, as we tend to think we are the “one” who shows up and is needed. Authentic, Humble leadership and Customers Second means we care for ourselves. By setting boundaries, we practice humble leadership by knowing our colleague has it! It doesn’t have to be ourselves; we are a team, and all have a role. To do this well, we must be in “level 2 relationships as defined as Personal cooperative, trusting relationships as in friendships and effective teams.” We need to trust our colleagues to handle our patients. I look forward to seeing how this particular mission plays out in January!
Accountability and Ownership are also important leadership qualities in Hospice. As mentioned at the beginning of this blog, many private equities are getting into profitable Hospices and have abused them, even committing mediocre fraud, so now we need accountability more than ever. When my new company says ownership, they mean us, the local branches. I see this working well only when our CEO buys in. The CEOs of the company taking over believe in this mission. They were named one of the country’s top 10 Hospice companies in 2024.
Schein and Schein note that the future of humble leadership involves “Context over Content, cultural Heterogeneity, Distributed power, mass customization, dynamic organizational design, and virtual presence.”[4] We have spent much time discussing why leaders fall off the rails in this class. Perhaps a lot of it concerns the future of humble leadership, which will have to “challenge the individual abuse of power.” Hospice, as well as all healthcare, is a team effort.
As I face a future of being a leader in healthcare as we move into the next company, I find myself drawn to the exercises in chapter 9.
Exercise 1: “Reading and Reflecting.” [5] Perhaps the future of leadership challenges the leadership team to read and reflect together. Finding common ideas and influences can enhance our functioning and move to function as a level 2 relationship organization. This is a tangible exercise I believe I can make happen.
Exercise 2: “Homework at your desk: Analyzing Your Present Relationships and Planning for Future Relationships.”[6] This exercise would be particularly significant as my roles in leadership are varied and have changed. Sitting down and reflecting on these changes and the relationships around and with me could be very helpful.
Exercise 3: Enhancement of Behavioral Skills: Personization by asking or revealing (either approach can work).[7] Asking questions of another person is something I will be adding to my Doctoral project. Being able to ask good questions and express empathy is crucial to the courageous conversations around End-of-life.
I wasn’t sure a place like healthcare could genuinely have a humble leadership model, but as I review CAPLICO’s mission statement, I am hopeful that this model of Humility can help us thrive!
[1] https://www.thenation.com/article/politics/healthcare-medicare-illness-privatization/
[2] Pg xi
[3] Pg 24
[4] Schein, Edgar and Schein, Peter. Humble Leadership: The Power of Relationships, Openess and Trust. (California, Berrett-Koehler Publishers, inc, 2018). Pg 100-101
[5] Schein and Schein, Pg 131
[6] Ibid, Pg 135
[7] Ibid, Pg 137
About the Author
Jana Dluehosh
Jana serves as a Spiritual Care Supervisor for Signature Hospice in Portland, OR. She chairs the corporate Diversity, Equity, Inclusion and Belonging committee as well as presents and consults with chronically ill patients on addressing Quality of Life versus and alongside Medical treatment. She has trained as a World Religions and Enneagram Spiritual Director through an Anam Cara apprenticeship through the Sacred Art of Living center in Bend, OR. Jana utilizes a Celtic Spirituality approach toward life as a way to find common ground with diverse populations and faith traditions. She has mentored nursing students for several years at the University of Portland in a class called Theological Perspectives on Suffering and Death, and has taught in the Graduate Counseling program at Portland Seminary in the Trauma Certificate program on Grief.3 responses to “A Humble Takover?”
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Jana, I’m glad to hear you are finding that their mission aligns well with the previous owner’s mission/culture. I hope this continues to be true and plays out well for you. And I really hope that they buy a place in Bend and you have to come to Bend regularly :).
Hi Jana,
Thank you for your post that provides a real picture of the condition of hospitals in the United States. In our context, it is very difficult to find a hospital that is truly willing to serve the lower middle class or people experiencing poverty humbly. There is often a jargon in our society that says, “Poor people are forbidden to get sick.” Very ironic. Although Catholic and Christian hospitals give different colors, it cannot be denied that money remains important for someone to be served well (sincerely?) or not. What is your strategy in applying the values in the Humble Leadership book in the context of your work? What are the biggest challenges you will face, and how will you overcome them?
Jana,
As I read your blog, I can’t help but think how grateful that I am that you are an advocate for so many. Hospice care is such important work, I truly feel like it’s God’s work. It makes me sad that something so sacred becomes another field that is privatized for profit.