3 Proactive Strategies for Retaining a Passionate Palliative Care Team

Julie has been on her hospital’s palliative care team for over seven years. For the first several years, she loved the work and being part of the team. Lately, Julie has not felt as connected to the team—or as passionate about her work—due to a lot of change and uncertainty within the organization. She has not felt comfortable sharing this with her colleagues or leadership. Instead, she has decided to apply for another position outside of the organization.

In the field of palliative care, where workforce shortages are critical, attracting and retaining a stable team is more urgent than ever. If someone leaves, the costs and stakes are high. It takes time to find skilled clinicians and build the team chemistry that is critical to supporting those with serious illness.

In my over ten years of consulting with palliative care teams, I have had the good fortune of working with a diverse range of teams and leaders to conduct team assessments. This has involved asking questions about the team's work and the interests and passions of the individuals who make up those teams. Through this experience and my own tenure as a leader in formal administrative and operational management roles, I’ve learned a lot.

As such, I’ve identified three simple, proactive steps that palliative care leaders and teams can take to encourage team engagement and inclusivity and help identify risks of unexpected departures:

An “exit” interview can bring forward new information, but it’s often too late. We often forget to ask people on the team, “Why do you stay?” to get a sense of the current pulse of team members. This practice is sometimes referred to as a stay interview. It is a simple and often fun exercise that involves asking team members to identify what’s going well and what needs improvement. Some questions include:

• What brings you joy in this work? What is going well for you in your role or on this team?
• What saps your energy in your work or your role? If you had a magic wand, what is one thing you might change?

Just like palliative care clinicians ask patients and families open-ended questions to understand what’s important to them and to open a new dialogue and greater understanding, these questions can get conversations started within the team that can ultimately increase retention. The idea of open-ended questions like these is not to try to immediately solve issues or promise solutions. Instead, it is to gain a better sense of people’s passions and opportunities for engagement—and demonstrate that you value your team member’s job satisfaction.

Stay interviews are a simple exercise that can be done 1:1 while on clinical service together, over coffee or lunch, or during a regularly scheduled meeting. Penn Medicine’s Sarah Winawer-Wetzel, MBA, wrote a wonderful blog on her experience with stay interviews that includes several detailed tips and approaches to this technique.

When people are engaged in interesting projects they care about, they are more likely to stay and actively contribute. My colleague, Chin-Lin Ching, MD, and I host monthly CAPC Virtual Office Hours on Improving Team Effectiveness and Resilience.

Dr. Ching always talks excitedly about the passion projects that she and her colleagues choose to work on. Ideally, the team chooses projects that are both interesting to them and help the team improve. Sharing updates and progress with each other creates a deeper connection and can inspire new ideas and passions.

One real issue in health care is the sense of the lack of choice or the inability to do what is right by a patient, a colleague, or their professional role. Some of this frustration is driven by issues out of our control, such as organizational pressure to see a certain number of patients or taking on extra tasks when the team is short-staffed.

To counteract this frustration, teams and leaders can integrate daily team practices that enable all team members to share perspectives and fully engage.

• Rotate who leads the team meetings, including all disciplines within the team
• Offer opportunities for individuals to present a relevant topic of interest to the entire team that offers a new perspective or inspires new ideas
• Offer opportunities for everyone to provide input into team processes like coverage schedules and triaging/patient assignment—and test changes to those processes
• Include all the disciplines on the team; start daily team huddles by reviewing patients that might require psychosocial needs, as well as medical or nursing needs

All of these ideas and actions boil down to encouraging engagement and inclusivity, and all are empowering for palliative care team members. I continue to observe that the more team members feel a part of a team or can contribute to the team's work, the more likely they are to stay engaged and remain on the team.

As you implement these strategies, keep in mind that while retention is the goal, unplanned turnover or attrition can have high costs for the team. But, sometimes, turnover can be healthy. Turnover can benefit the team if the person leaving had an approach or style that did not match the team’s overall culture. A move can also create a new opportunity for someone on the team to move into the vacant position. Of course, these situations are especially beneficial if the team member leaving has found a promising opportunity that is a better fit for their skills and goals.

Anticipating whether a team member may be considering leaving a position is difficult and can cause a lot of worry and stress. Like many others, I have personally made mistakes or missed opportunities to intervene (including when I was focusing too much on a deadline or deliverable or forgetting to check in with the team). Looking back now, I know I was a better leader when I engaged with the team, involving individuals in key decisions and prioritizing assignments based on the interests of those on the team.

CAPC offers a wide range of tools and resources that can help retain members of your palliative care team, as well as other team wellness priorities.

• Virtual Office Hours: Join virtual office hours for small-group consulting calls with leading subject matter experts, who will answer your questions on a wide variety of topics.
• Building and Supporting Effective Palliative Care Teams: This CAPC toolkit helps leaders make decisions about team staffing, program operations, and health team functioning. The toolkit includes resources about recruitment and retention, and others that help assess and strengthen team wellness in support of both concepts.
• On-Demand Webinars: Filter by “High-Functioning Teams” for topics such as hiring and onboarding, team assessments, and role clarity
• Blog: Browse the “Leadership” category to read about stay interviews, leadership skills, and relationship-building.

Edited by Melissa Baron. Clinical review by Andrew Esch, MD, MBA.