Hospice Board, Executive Coordination Essential to COVID-19 Response

Effective governance becomes even more critical to hospice providers during emergency situations. As the COVID-19 pandemic continues to spread, one of the many ripple effects is its impact on the role of hospice leadership.

Even before the World Health Organization (WHO) declared the coronavirus disease (COVID-19) a pandemic on March 11, 2020, it was spreading quickly worldwide. Information is rapidly unfolding on the disease’s transmission, prevention, incubation periods, depth of trajectory, treatments, and which populations are at the greatest risk. Among those at highest risk are hospice patients, and leadership plays an important role in addressing COVID-19 concerns across the organization and its stakeholders.

“What’s really crucial during challenging times is that there’s a good partnership between the board and the chief executive,” said Bill Musick, founder of Hospice Governance Academy – Integriti3D, a national organization focused on hospice and palliative care board development. “A good partnership is exemplified by a coordinated effort that people are playing to their strengths, their clear plans.”


A mutually supportive relationship between boards and executive leadership is a universal element of cohesive collaboration, especially in times of crisis.

“In hospice settings during this emergency, things really depend so much on the relationship between the board and the senior leadership of the organization,” said Frank Puglisi, vice chair of Hospice of the East Bay’s board of directors and executive director for California-based Health Care Interpreter Network. “A board needs to trust that leadership will not hesitate in coming to them for things that they need and vice versa. What can the board do to support the entire organization in making sure that they’re protected in terms of its fiduciary responsibilities?”

Playing a steering role is one of the varied ways a board can support hospice leadership during critical times, in which each member works together to ensure organizational sustainability.


“This role includes ensuring things such as strategic planning, ensuring support that the organization has resources and providing feedback to the chief executive as a supportive partner,” Musick said. “Every board member being a limb of the body is important because they can make a huge difference during an emergency, and this is a time when there needs to be partnership and that trust and understanding with each member and how they are going to play a role.”

Part of the board’s steering role involves streamlining processes and approval procedures to be effective and responsive of hospice leadership to address challenges resulting from the outbreak such as staffing demands and workforce support needs.

““The fundamental issue is establishing that the board has a responsibility at this time, and defining what that includes,” said Puglisi. “What are the resources a board needs to approve the organization’s staffing to get their jobs done without having to various meetings? How can a board revise and expedite their routine approval process normally followed and be able to cut through all that in these serious conditions?”

Keeping a long-term perspective is another important role for a board, allowing senior hospice leadership to focus on the urgent needs at hand as they arise during the COVID-19 outbreak.

“There’s a tendency to gravitate towards the latest piece of news about the outbreak,” said Musick. “The board can be a sort of steady anchor for the organization because leadership is going to be focused on those immediate issues, whether it’s getting protective equipment or being able to deal with staff that can’t work for one reason or another. That’s where the board can help in terms of trying to look even at least a couple of months out and make sure that the organization is thinking both long- and short-term and staying focused on all of it as more urgent, hard problems are taking priority.”

Hospice leadership can in turn play a supportive role to the board by clearly communicating organizational needs and how the board can help in meeting them. Additionally, leadership can clearly identify the primary communicator, whether an executive or a board member, to address stakeholder questions and concerns or those of patients and families.

“Even just a few sets of clear expectations are really important for leadership to provide,” Musick said. “Boards need to know how they can be supportive and not assume that they know how to be a support. Each chief executive may need or want different things from their board at this point. Streamlining all those needs and getting them out through one cohesive designated channel or person is helpful in maintaining a two-way street of communication.”

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