Hospice leaders can benefit and improve by staying engaged with bedside care. This is one of the most important lessons that Empath Health CEO Rafael Sciullo has learned during his 40-year career in health care.
This week Sciullo will retire, with Empath President Jonathan Fleece standing ready to take the helm. Fleece is the former CEO of Stratum Health, which merged with Empath in 2020.
Sciullo joined Suncoast Hospice in 2013, which is now an affiliate of Empath Health. There, he realized that patients would benefit from having a network of home- and community-based services that begin long before a six-month terminal prognosis. With this in mind, he spearheaded the creation of Empath Health in 2014. The Florida-based organization is now a parent company to 17 affiliates and two philanthropic foundations, with more than 23,000 people enrolled in its programs.
Empath offers hospice care through Suncoast Hospice, Suncoast Hospice of Hillsborough and Tidewell Hospice. Its other programs and affiliates provide home health care, primary care, palliative care, PACE, AIDS and sexual wellness care, and adult day services, among others.
On his last day in the office, Sciullo sat down with Hospice News to talk about the need for care integration and his strategies for effective leadership in community-based health care.
Before coming to hospice you worked as an oncology social worker in Ohio. How do you think your experience working at the bedside informed your approach to executive leadership at Empath?
I wouldn’t trade that experience for the world because it really helped me to be a better leader and a better person.
The people that we care for, you have to be able to see their faces. When you’ve sat by the bed and have really been a part of their care delivery, and really experienced with them the challenges that they are going through, you certainly become deeper in your commitment to provide the best quality care as a leader.
Every leader should have that exposure. I’ve shared many times that I was so fortunate to have been mentored by Florence Wald, the founder of hospice in America. When she saw that I was getting positions of leadership she said, “I just have one line of advice: Always stay close to the patient, and you will lead very well.”
I’ve never forgotten that. She’s absolutely right.
You’ve spoken before about keeping the patient and family as the “true center of hospice care.” That was the term you used at that time. Would you offer some insight as to how executive leaders — who are engaged, but somewhat removed from the bedside — can maintain that focus amid all their competing priorities?
I would say take the time. Take the time to read some of the letters that we receive from our patients and families. Take the time to go to a care center, or to make a visit with one of the team members. There will never be better time spent.
We all get wrapped up in meetings, and certainly, I’ve seen that happen in my 40-year career as much as the next person. But there really is an important time when you need to step away from that and get closer to what it’s all about — or you can lose sight of that.
It helps you bring that to the table in leadership and with your other team members who are leaders with you. It is the one thread that is woven through all of us.
We may have different positions. We may do different things. We may have different responsibilities. But the one consistent thread in our life is that we’re all responsible for the care of the people who have come to us. So why not try to be as close to that as you possibly can? You need to make it work. And it does work when you really want it to happen.
Those would be the ways that I think you can get closer. Of course, we do provide other care in Empath through our PACE. One of the most meaningful times for me is when I’m able to go to our adult day center in PACE and really be able to sit down with the participants as they’re playing bingo and just see what it is that this program means for them.
It has been a journey for us, the whole PACE journey, and many times it has not been easy. But certainly, I think if you continue to stay in touch with the reasons we do what we do, you can only see that through the face and the words of the patient and the participant.
One of the things that I’m hearing a lot in recent weeks is that in the coming years, hospices will become a more integrated component of the health care continuum and won’t be as much in the silo to which it’s currently relegated. Do you agree with that observation, and if so, what do you think a more coordinated system might look like?
I absolutely agree. We cannot segment care, particularly as it relates to the chronic, advanced illness and terminal populations. We really have to provide that full-life care that is so needed, through those very challenging and difficult episodes of a person’s life. Unfortunately, with so many issues with short lengths of stay and some of the care that we’re providing in hospice, this really expands that for us.
I have been asked more than once in the last few weeks, what am I most proud of, and I’m really most proud of the creation of Empath, because, for me, that really represents the transformation that we can do in people’s lives and the impact that it makes on them.
To be able to create an integrated network of care where your relationship does not begin one week, two weeks or even three months before a person dies — but your relationship with them begins so much before that, in PACE, in home health care, in our HIV care, in our palliative care — that just expands our ability for transformation. That is really where we need to go in the future.
It’s been a couple of years now since the merger with Stratum and I wonder if you could talk a little bit about how you and Jonathan [Fleece] have progressed in terms of integrating Empath’s own expanded care continuum, bringing those teams together and unifying all those elements into a single organization?
Well, it has clearly been a journey, and I do not use that term lightly. I know, it’s a term that is used quite often, but it seems to be very much appropriate.
I mean, look, you had two very long legacy organizations, excellent in the provision of their care, meeting the needs of their community, but certainly some differences in culture. So much of our energy has really been in aligning our culture and in aligning our care.
We are on a track of unification, which is so critical for us to achieve our goal as an integrated network of care. And what was wonderful about it was that each organization brought some very, very powerful things to the table and had a history and stories to tell that could really only be enriched even further by our coming together.
Just this past year, we have begun an adult day center, which is the first time we put that into our integrated network of care. We are going to be beginning additional PACE programs so that will be three in total for us, which is significant for the state.
We will be bringing on additional hospice programs and are now in discussions with the Hospice of Marion County. [Empath affiliate] Suncoast Hospice of Hillsborough is providing care. We just received the confirmed certificate of need for Polk, Hardee and Highlands counties [in Florida].
Being the biggest really was not the goal in coming together. The goal in coming together was to create as much of an impact as we could on the way that people live and the way people die. And so we have seen through that program expansion, initiatives, new partnerships, and expansion of geographic territory, that we are really fulfilling our mission even further, and even more than we have before.
What advice would you give to other hospice leaders who are now building out their range of services and seeking stronger collaboration with other providers in the system?
I would say have a firm conviction of the values of your organization and where those values can lead you. And listen to the needs of the communities that you serve.
You will find that if you listen to them, they will tell you that they want more than hospice from you. They will tell you that they want a longer relationship with you. They want you to continue to provide care for them and meet their needs that are really changing.
I mean, just in the 40 years that I’ve been in health care, the needs of individuals have changed in priority, and we’ve got to move with that.
I would say, have the courage to step outside of your comfort zone, and realize that in many ways that’s how hospice began.
When Dame Cicely Saunders came forward with hospice care, it was a revolution — and not welcomed by the medical community. But she had courage. We need to hold on to that courage because what’s at stake here is the really most compassionate, skilled, loving care for the people who need us.