How Hospice Leaders Can Reduce Burnout and Improve Retention

Narrator: Welcome to the Voices of Hospice Leadership Podcast. Uh, the show that reveals how to take your hospice to the next level. We cover all things hospice, from marketing and automation to billing and operations. You'll also hear from professionals in the industry as they share their stories of success and practice growth tactics. Here is your host, Brian France.

Brian Frantz: Welcome to the Voices of Hospice Leadership Podcast. Today I'm joined by Katie Quinn, uh, a hospice leader coach and founders of Leaders on the Edge. We were talking about burnout, retention, and what hospice leaders can do to better support their teams. Katie, can you start by sharing your background in hospice and what led you to start Leaders on the Edge?

Katie Quinn: Absolutely. So I definitely never went into nursing thinking that I was going to be building a leadership platform, but I kind of lived my way into it. Um, started in hospice right out of nursing school. I knew right away that I wanted to go into hospice before I even graduated. But as soon as I got into hospice, I was really exposed to the depth of this work. And I started in an inpatient unit. I moved into case management leadership. Um, eventually finished in a director role. And through that time, what I started to notice was we teach leaders what to do, how to communicate, how to delegate all of those skills, but we don't really ever teach them how to hold what this role requires. And Leaders on Edge came out of a very real season of my life. On paper, felt like I was doing everything right. Everything looked good, hitting expectations, showing up, but I was really unable to process internally everything that was going on. And I started to realize it wasn't just me. I'm looking around at peers and, you know, strong, capable, committed people. And I'm seeing the same patterns. They're pushing through, they're carrying everything, but they're really starting to slowly disconnect from themselves in the work. And that really made me stop and ask, you know, why is this happening? And that shifted everything. And I really went on this look into behavioral sciences, psychology, and the way our nervous system responds to stress and pressure. And it really, none of it's random. We need to do a better job teaching our leaders how to hold all of this.

Brian Frantz: Awesome. What first drew you to hospice work?

Katie Quinn: So I actually went to visit a hospice center in my first clinical rotation of nursing school. And we walked into this beautiful facility. 12 beds, private rooms, balconies. And just watching how everybody in that environment interacted and the care, the patients received, it just immediately, I knew right then and there, this is what I'm going to do. This is what I want to do.

Brian Frantz: Yeah, awesome. What, and what point did, did you realize there, there was a real gap in support, uh, for hospice? Ah, leaders and teams.

Katie Quinn: Um, really, as I went up in leadership, that was when I started to realize, you know, everything is really, you know, we're focusing on the same things repeatedly day in and day out. Meanwhile, we have this team out here in the field that's really, really struggling. And, you know, we're struggling ourselves. How can we support them? And that's really kind of where I started to notice there was such a big disconnect. And, you know, we're in silos and, you know, we're teaching skills, but we're not teaching how to hold all of this.

Brian Frantz: And how did your own leadership journey shape the, uh, the work you do now?

Katie Quinn: I, um, was actually very lucky to have a leadership coach through one of my, um, previous employers, and it was something I didn't even know existed. So as I started to dig more into this and I think back to my time with her and how much of an impact she made on me and my leadership, and I really just wanted to be able to do the same for others.

Brian Frantz: Love it. And you've seen hospice from the, uh, from the field all the way to the exact, to the, to the leadership position, which gives you a unique perspective. Right. On what teams are really facing.

Katie Quinn: Yes. Yep. Absolutely.

Brian Frantz: A lot of hospice leaders focus on census growth. But you said staffing stability is a huge part of that.

Katie Quinn: Yes.

Brian Frantz: How are those, and why are those two connected?

Katie Quinn: So the census is not going to grow in a vacuum. It builds and grows through trust and, and trust is really built through having consistent teams. If your staff is constantly turning over, there's no consistency. You're losing people, you're losing relationships, continuity. And if you're not stabilizing your team, how can you stabilize and grow your census?

Brian Frantz: Right. Why do you think staffing is sometimes treated as, uh, uh, separate from group, from growth strategy?

Katie Quinn: I look at as such, you know, your staffing stability is your growth strategy ultimately. And you really need to look at what people want beyond, you know, that pay and the benefits that you get. Um, right. Sorry, I lost my train of thought.

Brian Frantz: Yeah, that's all right.

Katie Quinn: Um. Oh, my goodness.

Brian Frantz: You move on. What, uh, what happens to a hospice organization when staffing instability becomes the, the norm?

Katie Quinn: It. Well, I mean, hospice is a big but small world. So everybody starts to find out it's not just within your organization. So you're going to have a harder time recruiting people. You're going to get this reputation of, you know, we're the ones that are coming in with seven. Seven different nurses every single day. And, you know, people talk, people are looking for recommendations, and people are going to say, hey, I had an amazing experience with xyz. I had the same consistent nurse, the same schedule, and those are the things that people are going to remember and they're going to talk about.

Brian Frantz: Yeah, yeah. I think that's important, too, for families. And definitely. How does, uh, uh, team stability affect patient care and family experience?

Katie Quinn: Team stability. If you don't have team stability, obviously your team is going to feel the pressure, feel the stress. Ultimately, whether they mean to or not. It does roll down to the families. It does roll down to the level of care that you're able to provide them. And ultimately, if you're constantly stressed, how can you be fully present with the families?

Brian Frantz: Right. Love that. Uh, and that. Yeah. So I think that connection is so important. And, uh, you know, a lot of leaders are focused on growth goals without realizing, you know, how much team. Team health impacts those outcomes. And so what. What do hospice staff need to do today? Be beyond pay, beyond benefits, and, uh, if you want them to stay engaged and committed.

Katie Quinn: So, you know, hospice is so emotionally complex. You need to create an environment where those that are working in it, they feel acknowledged and, you know, they have the ability to process these complex cases and these complex, you know, situations that they're dealing with. And if they don't have that, eventually they're going to start to disconnect. Even if they see. Stay physically employed, it's really about feeling that support. And, you know, leadership presence is steady versus leadership presence is reactive.

Brian Frantz: Yeah. How much does culture play into retention?

Katie Quinn: Culture is huge. I honestly think culture is one of the number one reasons that people stay at a job. And that's, you know, people are looking for jobs based on culture now.

Brian Frantz: Yeah. Yeah. I think the, uh, siren just went by and that set off your dog. Right. Sorry about that. Yeah. Um, that's all right. Are you seeing differences in what newer generations of clinicians are looking for?

Katie Quinn: Yes, without a doubt. It's hard because we kind of have put this stigma around millennials and them not wanting to work. But I feel like a lot of it comes back to. It's not that they don't want to work. They want to work in the right environment, and they want to feel like they're valued and they want to feel like they're actually contributing to something meaningful. It's more about, um, not so much just having a job anymore. It's, you know, what do you get out of it? What fulfillment do you have? And money only goes so far in that, I think.

Brian Frantz: Yeah, definitely. Well, what do you think makes a team member feel supported in a way that actually lasts?

Katie Quinn: Really listening to what they have to say, giving them opportunities to voice their opinion, share what they're seeing in the field, and also in those kind of intentional touch points, not just operational ones. You know, obviously you have to have the staff meetings, you have to get the information out there, but just, uh, a, hey, how's it going? What are, what are you struggling with right now? What are you carrying right now? Those questions make such a difference because it shows that you're caring and you're. You're there for them, right?

Brian Frantz: Yeah. What? Uh, yeah, I think that really gets to the heart of what people are looking for now, especially in a high pressure, you know, setting like hospice.

Katie Quinn: Without a doubt, they want to feel like they have the ability to have those conversations with leadership. And, you know, it's just, you have to have the give and take there.

Brian Frantz: Yeah. Burnout is, uh, a. Is a major, major issue in, in hospice. But what do you think are the earliest signs that a team member is starting to, uh, disengage?

Katie Quinn: Usually in my experience, I've noticed, you know, we're fully engaged to really looking at tasks only. You know, we're on a checklist. We want to get our tasks done, we want to finish our day. Minimal engagement. Beyond that, it's just a less presence. When we're in idg, you notice less engagement, less interest in the patients, less passion for the families and what's being discussed and really just kind of withdrawing from the team and communicating and, um, also definitely increased frustration, I will say, you know, when you notice your staff are frustrated, something's going on and you need to figure out what it is. Um, yeah. So when you start to see someone who used to care very deeply become quiet, that's disconnection happening there.

Brian Frantz: Uh, yeah. Are there certain behaviors or patterns leaders should be paying closer attention to?

Katie Quinn: I think it comes down to really knowing your team so that you know when something is off, you know, having those one on one conversation. So when you see Sally or Joe in the hallway and they just aren't interacting the same way you're used to.

Brian Frantz: Yeah.

Katie Quinn: It's a red flag. If you don't know them, how are you going to know if something's off?

Brian Frantz: Yeah, I love that. What do you think, uh, leaders often miss in those early stages?

Katie Quinn: I think a lot of times they miss that withdrawal Starting to happen. You know, they might not realize how connected their team is on the outside. So chances are the team is starting to notice this person is withdrawing, but the leader needs to be noticing that as well. And that's how you can, you know, fix it or attempt to fix it, rather than getting to the point where, you know, we're at a crisis level.

Brian Frantz: Mm. Well, once you notice disengagement, what do you think should happen next?

Katie Quinn: There has to be conversations there, there has to be understanding and also, you know, close the loop on any concerns that they bring up. Because if you stay silent, you don't follow up and you don't keep your word. You're just eroding trust further. So it's really just being proactive. As soon as you notice something, having those difficult conversations, finding out the real why.

Brian Frantz: Yeah, love that. Uh, I think that's especially helpful because most people, you know, don't leave overnight. There are usually signs, you know, um, warning signs before it gets to that point. Yeah.

Katie Quinn: And usually they're subtle. And I will say, I think the team members that work closely with them on a day to day, they realize it first and they start to notice, but constantly have to keep an eye out and just know what's going on in the field.

Brian Frantz: And when we talked, you mentioned that, uh, field clinicians get kind of lost in the shuffle. So what can leaders do to better support the people in doing the boots on the ground work every day?

Katie Quinn: Giving them the opportunity to share what they're seeing, share their concerns, share their recommendations, ideas. Nothing's too crazy, nothing. They might not fully understand the operational piece, but they might have an idea of something that, yes, it doesn't work exactly the way they present it, but maybe it can work in some other form. You know, they really have so much knowledge and in depth understanding in these relationships. So we really need to tap into that and give them that voice and, you know, let them know that we value what they have to say.

Brian Frantz: Great. And.

Narrator: Yeah.

Brian Frantz: Why, why, why do field staff feel so, like, overlooked?

Katie Quinn: Sometimes I think that they just feel like they're out there, they're doing the grunt work and, you know, the decisions are coming from the top down. There's no explanations. And they're just kind of out there on this island with all of the knowledge of what's going on, and it's very hard to not be able to bring that back and actually notice beneficial changes or, you know, notice that things are actually being taken into consideration.

Brian Frantz: Yeah. All about what kinds is what.

Katie Quinn: Oh, sorry, that's okay.

Brian Frantz: What kinds of support actually make a uh, difference for them?

Katie Quinn: Um, one on ones.

Brian Frantz: Yeah.

Katie Quinn: Team growth and building activities like obviously, yes, the you know, pieces you have to do all the time trainings. But taking 15 minutes and doing a team activity, finding out why everyone is there and when you do that, I think you start to realize that everybody's there for the same reason. Um, and it just helps build that culture of inclusivity and you know, collaboration and openness. So there's lots of little things to do just to keep that relationship and you know, build those relationships and keep your staff happy.

Brian Frantz: Right. What, what thinking uh, about here is any uh, practice, like small practice or rhythms that can help clinicians reset between visits.

Katie Quinn: I think just it's so important to take a pause. It doesn't seem like it's a lot, but it truly does reset your nervous system to just sit back. Could be a minute, could be two minutes, could be five minutes. But just thinking about nothing, just breathing and then moving on to the next. You know, I do a lot of work on um, what I call recovery cycles, which is basically, you know, that five minute or three minute pause and breath that you're taking. Obviously you need to do more in the long term and long run to maintain your ability to, you know, sorry, my words aren't working the way I wanted them to you there's a lot more you have to do long term. But in the moment just simple little things like that are going to make a world of difference.

Brian Frantz: Yeah. Ah, just a minute of some breath work or some breathing exercises.

Katie Quinn: Yes. It does wonders for the nervous system.

Brian Frantz: Yeah. Yeah. That uh, ah, idea of supporting the field team better also connects to how leaders think about uh, the day to day experience of the work, not just uh, the outcomes.

Katie Quinn: Absolutely. The field staff, they see it also. They know where there's inefficiencies already. They know where there's dynamic issues. And they also sometimes can really tell you what's sustainable and what's not. They're doing it so they know. And if it's not sustainable, how are you going to make it sustainable long term?

Brian Frantz: Right. And as, as he moved m into higher leadership roles, you saw tension between KPIs and people.

Katie Quinn: Very much so, yeah.

Brian Frantz: How should hospice leaders balance both?

Katie Quinn: So I think a lot of the issue is we look at it as one or the other. We're not looking at them as a whole. And you know, they matter. They absolutely do. But they don't create performance. They show the outcome of the performance. But your People, those are the ones that are driving those KPIs. So those are the ones that you need to focus on. Because if you don't have a solid team that's driving your KPIs, ultimately the numbers aren't going to be what you want them to be. So you really have to start at the beginning.

Brian Frantz: Love that. Why is it so easy for organizations to drift towards metrics over people?

Katie Quinn: Because I think it's very easy to look at numbers and say, yes, this is good, and no, this is not, when in reality there is so much gray area in how we came to these numbers and know there's a lot of other things that go into it. And I think metrics, it's just easy to look at. You know, here's a number that makes sense to me. Cut and dry. But it's not that simple.

Brian Frantz: Right. And I.

Katie Quinn: They don't want to. It's a lot of work to put into the other side to understand.

Brian Frantz: Yeah, definitely. What, what do you think leaders can do to stay accountable to. To performance without losing the human side?

Katie Quinn: I think just. It all comes back to. I say it time and time again. At the end of the day, people and relationships matter. And, you know, making sure that you're building those relationships, maintaining those relationships at the end of the day, that's going to be your, like, absolute gold. You know, whether it's relationships with your staff, relationships with referral partners, people in relationships are the key.

Brian Frantz: Love it. Well, what do you think? What did you learn, uh, what did you learn about that balance from, uh, from your own experience?

Katie Quinn: It's very hard at times, especially in hospice. I know myself personally. I'm very, very passionate about hospice and I'm very, very passionate about people side of hospice. So I definitely. There have been times where I have struggled to look at the bigger picture, I'll say with the importance behind those numbers, because I'm so focused on the people. It's just there has to be a balance. And that's what I've done. A lot of the research I've done and a lot of the work I do now is based on how can we find that balance, because there has to be one.

Brian Frantz: Awesome. Yeah. That balance seems to sit at the center of so many leadership challenges in hospice.

Katie Quinn: Yes, we're passionate in hospice. We are very passionate about what we do.

Brian Frantz: Yeah. What are some practical things leaders can do to improve retention before someone gets to the point of leaving?

Katie Quinn: Um, definitely normalizing, having conversations about challenges they're seeing and then creating space for them to kind of have an influence on how things are done, where it's possible. Addressing tension right away. Don't ignore things. The more you ignore things, the more they compile, the worse they become.

Brian Frantz: Yeah.

Katie Quinn: And going back to your people, recognize the effort your people are putting in despite the outcomes. Because sometimes, yes, there's going to be a disconnect, but your people are working as hard as they possibly can. So acknowledge that.

Brian Frantz: Love it. Um, what conversations should leaders be having earlier than, uh, and more often,

Katie Quinn: biggest things. Where are you struggling? What, you know, what are you carrying? That's a challenge right now. Sometimes it's something so little, or sometimes it's not even work related. Sometimes it's personal life related, but it's boiling over into their work. So it's just the constant, constant, constant communication. Communication. M. And then slowing down without an agenda sometimes is a huge, huge help. Yeah.

Brian Frantz: Love it. How can managers, uh, create more trust with their teams?

Katie Quinn: I think it's very important. From my perspective, those mid level managers, they need to have experience in the hospice field so that they can relate to what's going on with their employees. And if they come into hospice without having that, they need to get out there with their employees so that they can see what's actually happening and understand what the situations are and just get a sense of what's happening day to day. Because if you have never done it.

Brian Frantz: Yeah.

Katie Quinn: You can't even begin to wrap your brain around how much actually goes into a day in the life of a case manager. So really just taking the time to learn and understand what they're doing.

Brian Frantz: Right. From your experience. What, what, what's the one retention strategy that, uh, has the biggest impact?

Katie Quinn: I think they all kind of, you know, come together to have a good impact. But those one on one conversations right from the very beginning, like get to know your teammates as soon as they're on the team, you know, that's your direct report. You should be having a conversation with them in person within that first week and then on regular intervals after that. And just the more face to face engagement you have, the more value people feel.

Brian Frantz: Yeah. I think retention comes down to whether people feel heard and valued and supported before they, before they mentally check out.

Katie Quinn: Absolutely. If they're just a number with a productivity tag to them, eventually, you know, it becomes unsustainable.

Brian Frantz: Yeah. And you, you, you mentioned when we talk that frontline staff often have really strong ideas, but those ideas don't always go anywhere. Why is it important for leaders to listen more closely to the field?

Katie Quinn: Because they know what's working now, but they also know what's not working now. So they can give you ideas or they can give you, um, things that might help make their day a little bit easier. And, you know, they really know what's going on and they understand the relationships and just all the little pieces putting it together. We have to give them more of a voice. There's been so many amazing ideas that I've heard from staff in the field, and it's just, they get lost and maybe it can't work exactly the way they presented it. But let's look at a different option. Let's look how else we can do this.

Brian Frantz: Yeah. So, uh, I think you shared that, you know, you've seen ideas get stuck. And why do you think that happens?

Katie Quinn: I think, you know, someone has a great idea, they bring it to, you know, eventually it gets to a person that has to make a decision whether we're going to move forward or what are we going to do next. And if that person doesn't do anything with it, that idea dies. Yeah. And, you know, there's no such thing as a stupid idea. Sometimes the greatest things come from this, like, smallest, most minuscule thing. But sitting down and having a conversation with everybody that matters in that decision gives everybody an opportunity to share. You know, yes, this is feasible. No, this is not. This is what we need to do. Or, you know, this is how we can go about it. Just have to bring it to that point. And I think that a lot dies before it gets there.

Brian Frantz: Right? Yeah. And then, like turning those ideas into action. What, what do you think leaders can do to create a process for that?

Katie Quinn: I think one great way to really include the field staff that come up with these ideas is if we get something presented that seems like it's. We could move forward with, or this could be something. We could turn into something. Something great. Let's get a committee together. Let's have a. Let's bring the field clinician in, let's get their experience, let's pull in others who aren't this particular person, get their feedback, you know, just including them. A steering committee where, you know, the field clinician might be the chairperson. Give them that empowerment.

Brian Frantz: Love it. Yeah. That feels like, uh, the, uh, great opportunity. Especially since the, the people closest to the patients and the families. Right. Often see these things before. For leadership.

Katie Quinn: Yes. And then when ultimately they're right and something collapses, the frustration that they feel and, you know, they weren't listened to, their voice wasn't heard. So, of course at that point, if they were already starting to check out, that's just going to finalize it for them.

Brian Frantz: Definitely. Yeah. And, uh, so hiring for hospice, how do you tell the difference between someone who wants a job and someone who truly has a passion for this work?

Katie Quinn: I want to know their story of why. Because everybody that is passionate about going into hospice has a reason. Even if they didn't directly have a loved one in hospice, like me, I went to hospice unit in school, and that just solidified for me. This is where I belong. So they always. There's a story about why they want to be there. If they're really focused on things like schedules and, you know, tasks and lists, that's not somebody that's looking to come into hospice for the reasons that we do hospice.

Brian Frantz: Right. Yeah. What do you think the. The, uh, the most important qualities are when hiring

Katie Quinn: in hospice? You have to have passion. You have to be able to listen. You have to be able to sit in silence. I think is something that a lot of people struggle with. I still do at times because it's uncomfortable. Um, but how somebody handles a period of silence says a lot about them as a person. And sometimes you just need to be able to hold space. So I think that that's very important. Other qualities I'm going to look for, um, understanding of the weight of the work that they're doing. Because sometimes I think it's very easy to kind of get lost in the, uh. You know, this is a job. I'm a nurse. I can do this. There's so much more beyond just the skill that you need to think about when you're going into hospice. So I think, you know, making sure that they understand that and they really have that awareness is huge as well.

Brian Frantz: Love it. Yeah. Are there certain questions that you found effective during the interview process?

Katie Quinn: Um, some of the funnier questions that we ask people or I've asked people. I had a mentor who I loved, but she always had some very strange interview questions. And one of them was always, what's something that you do that aggravates others? And then, you know, what's something that aggravates you? And it gives you just a little bit of an insight into kind of, you know, people's personalities. And you can very quickly tell who's being genuine and who's trying to say the right thing. Like, oh, I'm very easy to get along with. Nothing aggravates me. Everybody has something that aggravates them. So just really getting people to open up and be who they are. And sometimes those are the best questions to do it.

Brian Frantz: Great. Hiring well is such a big part of this conversation. Retention often starts with getting the uh, right people in the door.

Katie Quinn: Yes, absolutely.

Brian Frantz: For hospice owners and leaders listening today, what is the one thing they can do right now to better support the teams or their teams and uh, create more stability?

Katie Quinn: I would say definitely slow down, slow down and check in with your team without having an agenda. Don't go through your checkboxes, find out what's really going on. You know, they don't need more initiatives and you know, pressure put on them. They just need you to be present and aware and listen to them. You know, it's very simple. Just take a few minutes.

Brian Frantz: What do you think they should start if they're overwhelmed or if they feel

Katie Quinn: overwhelmed by staffing, uh, challenges, leaders or the field staff?

Brian Frantz: The leaders.

Katie Quinn: Leaders. I think you're always going to have that pressure. But knowing how to decompress and distance yourself from the situation at times and using those tools, taking that deep breath, you know, sitting down and prioritizing, you know, what actually has to be done and what can wait and you know, using those skills that you're given as you learn to be a manager for pieces like that, but really just taking the time to make sure that you are focusing on yourself and you aren't burning yourself out. Because at the end of the day when that happens,

Brian Frantz: what, what message would you want, you know, every hospice leader to remember from this conversation?

Katie Quinn: Pay attention to your team's capacity and not just their performance.

Brian Frantz: Yeah. Love it. Awesome. Uh, and what, uh, going back to Leaders on the Edge, can you share a little bit, a little bit more about that which in uh, last word there for, for uh, for your organization?

Katie Quinn: Yeah. So Leaders on Edge, we are a healthcare consulting business. Um, work with individuals, work with organizations. We offer tools in person, virtual. Um, we have a great, on our website we have a great service, um, called Leaders Lounge where you get weekly reflections and touch points and forum to have conversations with other like minded individuals. And then of course the M coaching is the main piece and helping individuals and organizations develop their internal capacity to be able to do this work in the long term.

Brian Frantz: Awesome. Katie, thank you so much for joining me on the Voices of Hospice Leadership podcast. This was a great conversation and a uh, timely reminder that stronger teams lead to stronger hospice organizations.

Katie Quinn: Absolutely.

Brian Frantz: Thank you again for being here. Thank you everyone for listening. Thanks so much.

Narrator: If you're looking to attract more families and share your hospice mission with a wider community, visit hospicecaremarketing.com schedule to schedule your free consultation with marketing expert and founder Brian France. Plus, join our free hospice marketing mastermind group on LinkedIn to connect. Connect with other practice leaders and stay up to date with the latest strategies. If you enjoyed this episode, please take a moment to leave us a five star review. We'd love to hear from you.