In May I wrote a post entitled Are Sales People Killing Hospice? that sparked an interesting discussion among members of the LinkedIn Hospice Group. A tangential discussion thread within the My.NHPCO Clinical and Operations Management Group on the use of admission representatives instead of nurses to make the initial visit prompted this post (if you are not an NHPCO member you probably won't be able to access the discussion). Specifically, NHPCO’s ethics guru (not an official title), Tim Kirk’s use of an ethical lens to think about the issue of informed consent reminded me of a perhaps underutilized NHPCO resource – the Ethical Marketing Statement.
I want to call your attention to several items within the document, starting with a reference to the American Marketing Association’s Statement of Ethics, which is a great read for any marketing professional and includes this:
“As marketers, we recognize that we not only serve our organizations but also act as stewards of society in creating, facilitating and executing the transactions that are part of the greater economy. In this role, marketers are expected to embrace the highest professional ethical norms and the ethical values implied by our responsibility toward multiple stakeholders (e.g., customers, employees, investors, peers, channel members, regulators and the host community).” American Marketing Association’s Statement of Ethics
I love the idea of marketers as “stewards of society” – more on that in a second.
The NHPCO Ethical Marketing Statement includes:
“…if competitive practices strive only to gain an advantage based on promises that go unfulfilled or overextension of services that in essence become inducements for referrals, this leads to inferior quality and reflects poorly on the hospice and palliative care industry.” NHPCO Ethical Marketing Statement
So here we are, hospice marketers and leaders, with a responsibility to be stewards of society with the ability to damage the reputation of the hospice and palliative care industry. This is a huge responsibility and one that is not thought about and emphasized enough. It is the crux of my concerns regarding sales people within hospice. Of course I do not think all hospice “sales” people are acting in an unethical manner. What worries me, and I hope it worries many of you too, is that hospice marketing happens outside the context of our values.
The NHPCO document goes on to state:
“NHPCO believes that hospices must accurately represent the capacity and services of their organization in all marketing, outreach and education.” NHPCO Ethical Marketing Statement
Staff who are representing your organization out in the community – specifically those who talk to seriously ill people and their family caregivers -- have an ethical responsibility and a moral imperative to accurately represent your hospice organization’s capacity to meet the individual needs of the patient and family. As hospice leaders, your responsibility is to ensure that what your sales staff is saying is accurate. We’ll come back to that in the section below.
Okay, let’s look at one more section of the NHPCO Ethics statement:
“The promise of services before an in-person assessment is conducted is a questionable practice that is not appropriate for hospice providers. Additionally, rewarding admission staff bonuses based on predetermined admission goals is not appropriate and must be discouraged. This practice can lead to rushed admission visits that result in a poor understanding on the part of patient and family members and/or questionable eligibility assessments. Informed consent can also come into question. If admission staff priorities become that of a sales force, critical clinical information and service will suffer.” NHPCO Ethical Marketing Statement
I bolded those two sections of the paragraph to highlight what I see as possibly perverse incentives for people who interact with potential patients and family caregivers. Those on the receiving end of a hospice intake/admission visit do not necessarily understand what hospice is, are frequently in desperate need of support and the services that hospice can offer, and may be emotionally exhausted. That combination of factors can make it hard for these often vulnerable people to take in new information and make what can be an incredibly difficult decision to elect hospice, let alone choose the best hospice to meet their needs. What these families often need is TIME to think through and process the information presented.
Wait, I can hear people already saying, "Kathy, we don’t have time – referrals are coming in to us too late as it is." And that is absolutely true, yet if this process is rushed, I believe more and more families will leave the hospice experience feeling as if the promise of hospice was unfulfilled.
What to Do
Enough background, here’s what I think hospices (and any organization) can do to ensure they are using ethical marketing practices.
- Clarify, communicate and reinforce your values
Having a set of values that you display in your office, post on your website or review in staff/volunteer orientation is not enough. Ethical marketing starts with the values of your organization, which means that your marketing plan must reflect those values. This is a rich topic and one deserving of a longer post, but here are a few action items to reinforce your values:
- The leadership team must embrace and act within the context of the values. If compassion is a value then human resources policies need to be administered with compassion. If openness and honesty are values, then staff need to see the leadership team communicating in an honest manner
- Link values adherence to performance reviews
- Recognize employees and teams/departments that exemplify the organizational values
- Weave values into educational offerings, providing examples of how a topic can be addressed in the context of the value
- Ensure that department goals – especially the marketing department’s goals – are written within a framework of your values
- Don't assume
As leaders it’s our responsibility to know what our staff are saying when they represent the organization.
- Periodically accompany marketing and intake staff on visits to hear how they present the organization to referral sources, patients and families.
- Mystery shop – call or have someone you know call your organization pretending to be a family member seeking information about the care and services you offer
- Ask questions on your family satisfaction survey about the intake process and on the referral satisfaction survey about the marketing team
- Eliminate all bonuses tied to admissions
When my son was little, a teacher told us that every day our son was acting out and being taken to the office for a time out. As we talked more with the teacher, we learned that while in the office he was able to play with Legos, one of his favorite toys. Just as children cannot resist the temptation to act out when rewarded for bad behavior, neither will our staff.
Monetary rewards for intake or marketing staff cannot be tied to admissions or length of stay. Period.
Tools You Can Use
- NHPCO NewsLine: Marketing Hospice: Ethical Practices
- Office of Inspector General Report Medicare Hospices That Focus On Nursing Facility Residents
- Ethics & Hospice - An Interview with Christy Whitney
Posted by Kathy Brandt, MS, Principal of the kb group
Marketing audits identify areas to increase your census, ensure compliance with regulations, and strengthen your brand. To learn about marketing audits and other Survival Skills for Hospices, a collaboration of Weatherbee Resources and the kb group, visit our website or email firstname.lastname@example.org