As a new generation of hospice leaders rises to the forefront, hospices must carefully plan and execute CEO onboarding, which can be a complex process.

Bringing on a new chief executive requires strong involvement from an organization’s board, a commitment to transparency and the ability to connect with frontline staff and fellow leaders, according to hospice CEOs and board members who spoke with Hospice News.

In CEO onboarding, the board plays a critical role, Rebecca “Becky” Miller, CEO of Hospice of the Chesapeake, said. Miller took the helm at her organization in spring 2024. She previously served as the hospice’s chief operating officer.

“The board was really instrumental in helping make introductions for me to key stakeholders, whether they were key donors that had been in our realm, or business partners or things like that, that were local to the community,” Miller told Hospice News. “Being CEO is much more external facing than what I had when I was in the COO role. So a lot of the board members reached out to me to say, ‘Hey, if you want to have this kind of an introduction, I’m happy to help.’ That was really helpful in the onboarding process.”

Hospice of the Chesapeake in 2023 cared for more than 3,900 hospice patients and roughly 2,200 supportive/palliative care patients across four Maryland counties.

Miller joined the organization in October 2021 as chief clinical officer, and a little more than a year later was promoted to COO. As COO, she led Chesapeake’s clinical terms with an emphasis on ensuring quality.

Going forward, Miller’s priorities will include the development of sustainable programs to address the needs of the seriously ill and expanding the company’s regional footprint, including service diversification, she said.

She ascended to the CEO position after the company’s previous leader resigned. Hospice of the Chesapeake’s board was set to begin a national search, but with Miller in an interim CEO role, it became more apparent that she was the right fit to lead the organization in the long term, according to board chair Nancy Smit.

“[Miller] ended up meeting on a regular basis with our executive committee. We decided to use the executive committee more than the full board. We have full board meetings every three months, and so Becky was in front of the full board for each of those, but really we use the executive committee,” Smit told Hospice News. “That was the group that met most often with her to really discuss her goals for her position and for the organization, and that’s continued as an ongoing process.”

Ensuring that a CEO is educated about and integrated into the company’s organizational culture is also key, according to Smit. 

To transition in the CEO seat, Miller engaged with more than just the board. Conversations with frontline, staff and volunteers helped set the tone for her leadership style, she said. Her executive assistant, Jessie Syms, was also instrumental.

Transparency is also critical when it comes to bringing in a new CEO, according to Dr. Clevis Parker, former CEO and current chief medical officer for ProCare Hospice in Nevada.

“Preparation is absolutely paramount. On top of that, you need transparency. You need to know where you are as an organization and be honest and give permission for everyone on your team to be honest, because everybody’s perspective is different,” Parker told Hospice News. “I didn’t want any surprises. So from my perspective, it was to listen and be completely honest and transparent.”

ProCare operates multiple business lines, including hospice, a 14-bed inpatient unit, palliative care and one of the largest pediatric programs in its home state. The company’s current average daily census is 260, about 120 of which are pediatric patients.

Parker occupied both the CEO and CMO seats from 2020 to this past January, leading the company through the COVID-19 pandemic and beyond. Recently, he decided that separate leaders should occupy those roles. Stepping in to lead the organization is Keith Everett, formerly the CEO of Hospice of Acadiana in Louisiana.

“The one thing I probably appreciated more than anything was having conversations with Dr Parker, having conversations with the owners and the board members. They were truly activated, because this was so well planned out,” Everett told Hospice News. “They were really on board about sharing information, looking at the organization and its mission, vision and values. The one thing I really appreciate about it was that they gave real perspective around what their reality was.”

Everett pointed to five essential components of CEO onboarding. This includes a strong understanding of a company’s mission, alignment with an organization’s vision, a keen look at regulatory compliance, knowledge of its strategic plan and executive integration.

Another key element is building a connection with frontline staff and becoming engaged with them, according to Laura Tortorella, CEO of AccentCare, which she has led since 2023. Leaders also need to be in regular contact with their boards and to form connections with outside stakeholders like payers and other providers in the continuum.

Dallas-headquartered AccentCare is a portfolio company of the private equity firm Advent International, offering hospice, palliative care, personal care, non-medical services, home health, care management and high-acuity home care. The company operates more than 260 locations in 31 states, caring for 210,000 patients and families annually.

“Being out in the field and listening to the feedback from our team members who are providing care every day and have an intimate understanding of our patients needs, the challenges and opportunities and ways that we can support them, is very important,” Tortorella told Hospice News. “That’s certainly how I spent a large part of my first year here at AccentCare. The second is continuing to work with board members and senior leaders as you think through where the health care industry ultimately is going in the post-acute space.”