Hospice of Santa Cruz County (HSCC) has been providing a spectrum of refined end-of-life services, including palliative care, to individuals and their families in distress for more than 40 years. HSCC has become the most experienced, largest non-profit hospice serving Santa Cruz and Northern Monterey Counties. It has an annual budget of about $22 million, with charitable contributions, including bequests, at about $1.5 million. HSCC currently employs some 175 staff who are supported by more than 300 dedicated volunteers. Nearly 95% of revenue is earned income, principally from Medicare, with some MediCal and private insurance reimbursements. Average daily census of clients served is about 200. The next CEO must be the creative and deft entrepreneur who understands how excellence must be maintained while managing increasing operating expenses, the likelihood of diminishing Medicare reimbursement rates, and competition from aggressive profit-driven corporations. Institution-building and change management, the daily diet of nonprofit leaders, require exceptional leadership talent and the ability to overcome challenges.
HOSPICE OF SANTA CRUZ COUNTY
Scotts Valley (near Santa Cruz), California
CHIEF EXECUTIVE OFFICER
“When someone you love is seriously ill, you want to do as much as you can to make certain they are comfortable and have the best care possible…. We do too.” For 40 years, the Hospice of Santa Cruz County (HSCC) has been providing a spectrum of end-of-life, including palliative care, services to individuals and their families in distress. HSCC has become the most experienced, largest non-profit hospice serving Santa Cruz and Northern Monterey Counties, exceling in an area with exceptionally high rates of hospice usage in serving more than 80% of qualified individuals. For all of those at HSCC, the privilege of making this impact on so many lives is attended by deep-seated mission-driven values of service and driven by a pervasive dedication to excellence in offering a broad continuum of service. Only rarely does an organization achieve such eminence; only rarely is the chief executive of such an organization offered a life opportunity to make such a difference.
The Hospice of Santa Cruz County has an annual budget of about $22 million, with charitable contributions, including bequests, at about $1.5 million. HSCC currently employs some 175 staff who are supported by more than 300 dedicated volunteers. Nearly 95% of revenue is earned income, principally from Medicare, with some MediCal and private insurance reimbursements. Average daily census of clients served is about 200.
The HSCC commitment to excellence is reflected in every way: accredited by the Accreditation Commission for Health Care; a recipient in 2019 of Hospice Honors from HEALTHCAREfirst after being assessed by 24 quality indicator measures; rated most highly of all hospices serving Santa Cruz County by Family Caregivers and receiving the highest percentage from those professionals of hospice recommended; results of Gallup surveys of staff satisfaction have reached the pinnacle 98th percentile, with staff turnover at the unusual low rate of 7%; offering a rich continuum of services that complement core hospice services as no other hospice in the area provides; enjoying unparalleled community support as an extraordinary regional nonprofit service provider. The opportunity for the next Chief Executive Officer to build on this foundation of excellence is exciting.
In addition to a rich array of core hospice services offered through a large cohort of physicians, nurses, and other physical and mental health clinical professionals, HSCC is known for services that are supported not by Medicare reimbursements but by charitable contributions. These donor-subsidized enrichments to core services differentiate HSCC from for-profit entities not offering a community-funded continuum of care. Last year, HSCC’s palliative care program provided services to more than 160 transitional and palliative care clients; more than 2,500 loved ones received grief support, with more than 700 youth receiving grief support and in-school grief education; and, dozens of children attended Camp Erin, a weekend of fun, friends, and healing for children exposed to traumatizing loss of a loved one. Last year, more than 1,700 people were counseled about hospice and advanced healthcare planning; the Pet Companion Program celebrated its 5th anniversary; more than 1,200 clients participated in the Music Therapy Program – all while patients, their caregivers, and families received nearly 4,000 home visits from HSCC volunteers. Imagine, just imagine, the difference made by this galaxy of nonprofit programs in this region – and imagine the potential enhancement and diversification of services that the effective chief executive officer can implement during her/his tenure.
Institution-building and change management, the daily diet of nonprofit leaders, require exceptional leadership talent and the ability to overcome challenges. Because the next chief executive of HSCC will follow the distinguished tenure of CEO Michael Milward, who has announced his retirement on the appointment of his successor, and will inherit a tradition of excellence, a dedicated and exceptional staff, a committed governing Board of community leaders, and generous donors throughout the communities served who enable HSCC to be far more than a superior hospice-service provider in its offerings of a continuum of nonprofit hospice-supporting services – many of the new CEO’s challenges will be strategic, not tactical.
Strategic challenges will always include the perpetuation of HSCC’s continuing financial health, managing resources well, attracting community support, negotiating reasonable reimbursement rates, overseeing an efficient and productive organization where “head adequately supports heart.” Certainly it will continue to be critical that HSCC remain the most respected nonprofit service-provider in its region and also vigilant about opportunities to serve new communities, new clients, to provide new services, to manage growth supported by staff and financial resources. Certainly, HSCC’s next CEO must be effective in maintaining both programs and community awareness of the richness of services and organizational culture that must continue to differentiate a venerable nonprofit provider from for-profit would-be competitors representing themselves as equivalents in their value to patients. And, certainly, the next CEO must be the creative and deft entrepreneur who understands how excellence must be maintained while managing increasing operating expenses, competition from profit-driven organizations, and the likelihood of diminishing Medicare reimbursement rates.
As to this last, the next CEO will understand the power of advocacy and collective action in expense management, promotion of best-practices, and in bargaining for reasonable rates of reimbursement. A mid-sized hospice in Santa Cruz County must seek partnership through collaboration with organizations similarly at risk of diminished reimbursement to create the expense-side benefits and bargaining power that come with scale. Modeling collaborations among hospice providers in other states (e.g., Ohio’s Hospice, Oregon Nonprofit Hospice Alliance, Teleios Collaborative Network), HSCC has been a pioneer, with The Elizabeth Hospice of San Diego and Mission Hospice (San Francisco Peninsula), in creating the California Hospice Network (CHN). CHN represents with these founding hospices a daily census of more than 900, and it is hoped that other hospices throughout California will join as well.
CHN has a governing board and leadership from the member hospices, and has already begun to produce shared savings through collaboration on the expense side (e.g., night nurse triage, employee benefits, insurance), anticipates savings in shared IT development, increased purchasing power in supplies and devices, multi-organization back-office consolidation, etc. With the high probability of future reductions in reimbursement rates and with large health insurance and medical service providers likely to become more influential in negotiating rates, CHN understands the advantages both of being the collective advocate and being the collective service provider in negotiations that are critical to the financial viability of all the hospices. Taking this long view and being among the leaders of CHN will be an important component of the next CEO’s job. The effective leader of HSCC will have the capacity to manage both of these roles. See www.cahospicenetwork.org for more information.
The services of HSCC are offered throughout Santa Cruz and Northern Monterey counties, with administrative offices in Scotts Valley, a few miles north of the city of Santa Cruz and about 20 miles south of Greater San Jose. The satellite office in Watsonville benefits greatly from the frequent presence of HSCC’s leadership. San Jose has a population of about 1 million and is the home of Silicon Valley. Santa Cruz County has a population of about 300,000, bounded by the Pacific Ocean and the redwood-covered mountains, influenced greatly by large predominantly-Spanish-speaking agricultural communities, by Santa Cruz as a beach destination impacted by tourists, and by the 17,000-student campus of the University of California. The topography, demographics, and somewhat insular location of the County heavily influence the Hospice’s provision of services, the life styles of the area’s residents, and the values of the professionals and their families who thrive in this unusual environment. A leader who will be successful in this position must understand, enjoy, and be resonant with the life styles of this region.
The Chief Executive Officer reports to the Board of Directors. Reporting to the CEO are: Chief Financial Officer, Chief Compliance Officer, Chief Medical Officer, Chief Clinical Officer, and Chief Mission Officer. For collective and collaborative bargaining power, and for adoption of shared systems and practices, all achieved through the California Hospice Network, the CEOs of the partnering hospices will report to the CEO and Board of the Network (comprised of affiliate board members).
The Chief Executive Officer is responsible for the management and operation of all programs and services provided by Hospice of Santa Cruz County, and for implementing all policy decisions of the governing Board. S/he oversees the administrative and fiduciary functions of the agency. S/he represents the agency and is an embedded leader of high visibility in the community, building strong relationships with key stakeholders, agency staff, and the Board. S/he is an indefatigable fundraiser, leading staff and partnering with the Board in promoting charitable giving to support HSCC programs now and in perpetuity. S/he seeks relationships with similar nonprofit service providers, understanding the power of collaborations, and values the potential of California hospices partnering in sharing best practices and achieving internal efficiencies, and promoting external relationships with a united front.
Specifically, the CEO:
Works in partnership with Board leadership to build and maintain a governing board with the commitment, involvement, diversity, outside networks, and skill sets needed to maintain the wellbeing of a complex healthcare service organization in a fragile funding environment. Helps determine and ensure, in partnership with the governing Board, that the mission, values and vision of HSCC are carried out. Embodies the historic dedication of HSCC staff and Board to hospice services and the desire to supplement core services with a community-supported continuum of services to adults, children and their families confronted with end-of-life or grief challenges
Attracts, mentors, and nurtures exceptional staff colleagues, earning a reputation for professional excellence, appreciation of the complexity and challenge of working with seriously ill patients and their families, dedication to team-building, collaboration, open and honest relationships in a caring and non-toxic staff community.
Anticipates changing needs of seriously-ill patients and their loved ones with vision and imagination, understands public policy trends and anticipates new developments in funding sources, initiates long-range strategic and operational planning, and is responsible and accountable for implementation of all such plans. Is also able to maintain the readiness of HSCC to adapt quickly to the unanticipated, while maintaining clarity about HSCC’s mission, values, and priorities. Demonstrates a high level of ability in combining vision, informed decision-making and values-driven flexibility, with ability to muster HSCC resources, to lead, to implement.
· Demonstrates finely honed business acumen, with the ability to anticipate how programs can be mounted and maintained at suitable levels of quality in ways that both HSCC and the community can afford. Pursues business development opportunities for new or expanded services, as part of a well-conceived and articulated plan, but also has the entrepreneurial agility to assess risk, evaluate cost-benefits, and to seize unanticipated opportunities. Has the capacity to initiate viable programs; has the capacity to say “no” to programs that present significant long-term financial risk to HSCC or that risk a drift from institutional mission, or, that risk HSCC’s reputation as a provider of consistently high-quality services. Works with staff to recommend budgets, oversees revenues and expenditures, maintains internal controls and financial discipline, and collaborates closely with the Board and its finance/audit committees to ensure the financial wellbeing of the organization.
· Understands how information informs decision-making, how assessment, evaluation, and disciplined quality monitoring and compliance relate to agency improvement, and is comfortable with new technologies that can enhance HSCC functioning. Appreciates the value of accreditation processes and standards; appreciates the value of participating in state and national organizations that facilitate replication and dissemination of innovative and best practices.
Represents, and is a trusted and effective advocate, of HSCC services to community stakeholders, government, associations, agencies, and the media. Has the capacity to lead at county, state and federal levels in the development of public policy and funding in service to end-of-life patients and their loved ones. Is an excellent manager of time and priorities, with the executive capacity to integrate the responsibilities of leading HSCC with those of leadership involvement with the California Hospice Network, National Partnership for Hospice Innovation, etc.
· If not already a local leader, has the outgoing style and enjoyment of relationships that will enable him/her to become embedded in the Santa Cruz community, with a history, ideally, of having adapted relatively quickly in the past to leadership in different communities. Understands and is easy in the role of principal major gifts fundraiser, with the readiness to work closely with Board members and fundraising staff to identify, cultivate, and solicit private sources for charitable gifts in support of the programs of HSCC, recognizing the desirability of increasing contributed income and the cultivation and stewardship of a broad base of community support. Has a demonstrated history of collaboration with foundation and government funders, and an exceptional reputation among those funders and donors who have invested in his/her programs.
· Ensures compliance with all requirements of the Centers for Medicare and Medicaid Services. Takes executive responsibility for agency compliance with all applicable non-profit laws, contractual obligations, and donor restrictions, and maintains appropriate internal policies and procedures to ensure such compliance.
The ideal candidate will have:
Deep compassion for clients and their families and passion for the benefits of Hospice services.
· Maturity, integrity, centeredness that enables him/her to engage Board and staff colleagues authentically and collaboratively, to share and take responsibility, with the wisdom and confidence to synthesize varying opinions and to make difficult decisions. A deliberate style, characterized by excellent listening skills, considered judgment, ability to calculate risk, to assess cost-benefits, and to move teams forward with attentive follow-up and attention to detail in successful implementation in a rapidly changing funding environment. An understanding of the working partnership between the nonprofit chief executive and his/her board, and the ability to engage and involve high level volunteers in their appropriate roles.
· Non-profit experience as a key executive, long-term volunteer, and/or board member in the health and social services fields. The preferred candidate will already have demonstrated understanding of the services and funding streams of the nonprofit hospice; the preferred candidate will understand clinical services, clinical staff, the needs of palliative care and hospice patients and their families, and will already have enjoyed extensive positive relationships with the community stakeholders of the large nonprofit. Notwithstanding these preferences, candidates with high levels of transferable skills will find in the excellent staff infrastructure of HSCC an opportunity to learn quickly on the job, and are encouraged to invite evaluation of their suitability for this leadership position.
· Highly developed communication and fundraising skills, and the ability with thoughtful credibility, charisma, ease, and articulateness to advocate passionately for quality services and to represent HSCC to all constituencies, locally, statewide, and nationally. Ability as an effective negotiator. Merger experience a plus. Association board experience a plus. Experience in geographical expansion of services in a competitive environment a plus. Experience as a nonprofit executive competing against for-profit service providers a plus.
· Ability and commitment to identify, recruit and mentor capable, diverse staff, and to motivate, develop, and inspire an effective professional and volunteer workforce. Ability to develop high performing teams with trust and close working relationships among team members, to discourage siloing of function. Modeling excellent delegation and avoidance of micro-management. A no-job-too-small attitude, a willingness to work in the trenches, not to do the job of anyone else but to promote cooperation, humility, and the value of attention to detail. Ability to integrate functions, enhance cross-functional communications, and to promote a sense of unified enterprise. Ability to promote HSCC as a true “learning organization” by systematic involvement of staff (and Board) in discussion of program outcomes and strategies for outcome enhancement. An understanding of and sympathy for the compensation needs of staff, and ability equitably to balance staff and agency interests. A personable, accessible, direct, mentoring and collegial style, supported by the strength to hold all staff accountable for their performance and to make difficult personnel changes if necessary. A commitment to the maintenance of a congenial work environment.
· Ability to work closely, in partnership, and in a position of leadership with a diverse staff and clients, in a style of respect and collaboration and a commitment to project HSCC as a multicultural agency in every facet of its values, its people, and its services, reflecting the diversity of the communities it serves. Conversational Spanish a plus.
· An understanding of the power of partnerships and coalitions among service providers, such as California Hospice Network, and the integrity and diplomatic skills to bring suitable and complementary agencies together for service delivery. The strength to lead; the strength to follow. The strength to innovate; the strength to imitate, adapt, and replicate.
· Ideally, experience, participation and an intuitive understanding of public policy trends, both with respect to need and funding, affecting delivery of palliative care, hospice care, and home-based primary care.
· An understanding and appreciation of the ideal learning environment necessary to enhance staff skills, personal development, and program performance in a professional organization, and an eagerness to promote and reward commitment and talent in staff. An understanding of the value of ongoing institutional self-assessment, with clearly defined and widely adopted outcomes being tracked internally to inform program maintenance or change. Experience with the benefits of accreditation.
· Essential will also be: high energy, durability, a mature perspective on the human condition and the well-lived life, a healthy sense of humor.
Lifelong learning and educational achievement appropriate to the complexity of the position. Significant familiarity with healthcare policy, practice and funding, and particularly familiarity with end-of-life services, preferred.
Compensation is commensurate with the complexity of the position, negotiable based on experience.
Robert M. Fisher and Michael Loscavio of Rusher Loscavio Fisher Nonprofit Executive Search are privileged to provide recruitment and transition counsel to the Hospice of Santa Cruz County. For more information about one of America’s premiere nonprofit executive search firms, see www.rll.com. The Hospice of Santa Cruz County welcomes qualified candidates of all persuasions and backgrounds. All discussions with prospects for this position will be treated with utmost discretion and in strict confidence.
We would be grateful to receive inquiries, expressions of interest, nominations and applications (with resumes) addressed to the following: email@example.com
Internal Number: HSC1
About HOSPICE OF SANTA CRUZ COUNTY
Hospice of Santa Cruz County (HSCC) has been providing a spectrum of refined end-of-life services, including palliative care, to individuals and their families in distress for more than 40 years. HSCC has become the most experienced, largest non-profit hospice serving Santa Cruz and Northern Monterey Counties.