Special Report: Improving Staffing Quality

Quick tips for creating an effective hospice team

Conflict resolution is key to success

In any group of people who work together under stressful and demanding circumstances, there are bound to be interpersonal conflicts that can reduce the team’s effectiveness. However, hospice managers who would like to prevent some of the more common conflicts and resolve the inevitable ones might follow these tips from Martha Lasseter, MBA, RHIA, vice president of compliance, and Kathy Moon, RN, BSN, clinical director of day programs, for the Hospice of Martin and St. Lucie in Stuart, FL:

Let experts do their jobs.

Conflicts often arise when one member of the team decides to provide a service that is outside his or her expertise, and this steps on the toes of another member of the team, Lasseter and Moon say. "Say the nurse tries to handle the financial end of a patient’s care. This can hinder the social worker from doing her job," Moon says.

"You have to respect the experts on the team," Lasseter says. "We’ve had a situation where an LPN on the team was proselytizing or trying to deal with the spiritual, religious issues that are the domain of the chaplain," Lasseter adds. "That’s what we’re talking about in respecting other people’s expertise and boundaries. She wasn’t doing it the right way."

Recognize that each team has its own personality.

Hospice managers need to recognize that teams will develop their own personalities as they become effective and cohesive, Lasseter notes.

"Each team has its own personality, and each becomes very protective of their patients," Moon says. "So when you move a patient from the home to a hospice residence, it’s hard for the home team to let go of that patient and to allow the staff in the residence setting to do their jobs." This could lead to staff crossing boundaries and creating conflict with other teams, she adds. So it’s important for managers to address this potential conflict up front and let teams know that they will have to trust that the services they provide will be handled satisfactorily by the new team taking over the patient’s care, Moon says.

Provide grief support to staff.

"We have grief support services and specialists in our agency, and we make that service available to our team members, as well," Lasseter says. "For example, there isn’t anything as hard-hitting for a team as experiencing the death of a young child or a baby," she notes. "During team meetings, if a supervisor sees that her team is struggling with grief, she’ll have them take extra time to talk among themselves."

Remembrance services held for staff, families 

Also, there is an employee assistance program that provides counseling to staff free of charge, Lasseter says. "We have services of remembrance held several times a year, and this is where staff can share that grief with family members and co-workers," she says. "And we have remembrance services specifically addressing children."

Since the hospice provides grief support to families for 13 months after the patient’s death, staff are encouraged to remain involved, Moon says.

Make standards of conduct very clear.

The standards of conduct spell out what’s appropriate and what is not, Lasseter says. "We ask employees not to take advantage of a patient’s hospitality or to get into the middle of family conflicts," Lasseter says. "We have guidelines in terms of what they are able to accept in terms of a gift, and it must be valued at $25 or less."

While hospice staff are not expected to hurt a family’s feelings by turning down some small token, they are not permitted to accept significant gifts. Instead, they should suggest the person make a donation to the agency by contacting the agency directly, Lasseter says. Also, staff are told to not give out their home telephone numbers or associate with patients and family on their days off, Lasseter says.

Focus on improving communication.

"You always have communication issues, and we try to resolve those by making sure that if we have a nurse or social worker who’s going to be off for a few days, then the person who is filling in is made aware of the patient’s situation," Moon says. "Or a night nurse can call and leave a report that the staff can listen to." Also, staff leave three days’ worth of notes, called a "traveling chart," in the patient’s home so if a nurse calls in sick, she’ll know what happened on the last three visits with the family, Moon adds.

Encourage teams to go the extra mile.

There was one hospice patient who had never received his Purple Heart for being wounded in action, and the team social worker set about to correct that problem, Moon recalls.

Patient receives long-lost medals 

"So she made some contacts, and the gentleman not only received his Purple Heart, but there were several other medals he never received, and she was able to get those and present them to him," Moon explains. "The nurse had notified the social worker, and together they figured out a way to do this and ended up creating a media event of the gentleman receiving his medals."

Managers should make sure to have an open door.

"Team managers are responsible for making sure the team is cohesive and works as one with respect for one another," Lasseter says.

"We encourage managers to be approachable, not to build this wall between them and their staff," Moon says. "But managers have boundary issues too — you don’t want a manager to become your best friend." The hospice had one manager who treated staff that way, and when she left the organization, her team had a difficult time adjusting to a new team manager who had a more appropriate approach, Moon says. "There was difficulty with the trust factor, but eventually the team learned that she was there to guide them and not to be their best friend, and now they trust her," Moon adds. "Once a team trusts you and knows you have their backs, so to speak, then you develop loyalty and have a true team."

Keep it light.

"You are never too busy to laugh," Lasseter says. "In the field of hospice, you have to defuse a lot of situations with laughter." For instance, the hospice has had a manager show up for a team meeting dressed in bedroom slippers, a bathrobe, and curlers, Lasseter recalls. "This was just for a few minutes of the team meeting so she could make them laugh," Lasseter says.