0:01

Welcome to TCN Talks. The goal of our podcast is to provide concise and relevant information for busy hospice and palliative care leaders and staff.

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We understand your busy schedules and believe that brevity signals respect.

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And now here's our host, chris Como.

0:23

Hello and welcome. Our guest today is a good friend, a longtime friend, Samira Beckwith.

0:29

She's the Executive Vice President of Chapters Health System and also the longtime CEO of Hope Health.

0:35

Welcome, Samira.

0:36

Thank you, Chris. It's such a pleasure to be with you today.

0:40

Well, it is awesome to have you, samira. I've really been looking forward to this show.

0:43

In fact, I think we hypothesized this show in the back of a taxi cab together in Washington DC and we had just seen Nancy Pelosi outside our window, and then you and I got to talking.

0:53

I'm like I need to have you in my podcast.

0:55

So I don't know if you remember that Completely it was so much fun seeing her come out of that building and wondering what she was doing, seeing her come out of that building and wondering what she was doing, and then we just started talking about some of the past experiences that we've had in hospice.

1:11

Yeah, that's going to be a beautiful segue, Well first off, before we jump into that, samira, what does our audience need to know about you?

1:18

Well, like so many other people, chris, I'm very passionate about our mission and the work that we do about our mission and the work that we do, and my passion really began years ago in the 70s, when I was maybe I shouldn't say 70s, but many years ago when I was diagnosed with Hodgkin's disease.

1:37

I was in a graduate program and I was very interested, because of my own experience, about how the healthcare system cared for people.

1:48

At the same time, I read Kubler-Ross Dame Cicely Saunders' book and started talking with other people in our community about how to change the healthcare system so that we cared for patients as people.

2:06

Well, samara, first, there's so many different ways I want to give you a shout out.

2:10

But you may not know all of this story, but I was 25 when I went to work for Covenant Hospice in Pensacola.

2:16

I felt it was a very providential thing how I got there.

2:19

But I came from the business world and didn't know hospice but just started to feel the sense of this passion.

2:25

But you were a legend already and this is about the mid nineties.

2:30

There was Mary Labiak, samira Beckwith, and you were always so gracious to me.

2:35

I mean you were like a legend to me, this amazing hospice CEO, and you always went out of your way to make me feel just welcome and you know, kind of like when you're young, you kind of put people on pedestals.

2:47

You're a CEO, you run this amazing program and you taught me such a great lesson that I've tried not to forget as I've been a CEO later on in my life is just to be gracious to other people, because you just never know the impact it may have on them.

3:00

And I just wanted to give you that shout out and your passion.

3:02

I mean you know, if you infected other people with that passion for the mission, that's a good thing and I think I'm one of those that you certainly just watching you and listening to you and just your love for what this sacred work is, and you have passed that on to the next generation of leaders like myself, and I just want you to know that, thank you.

3:22

Chris, and I just want you to know that. Thank you, chris. You know, I do believe that we never know what we're passing on to other people and to hear you say that really warms my heart and just makes me feel very special and I'm just so pleased to know that.

3:38

And really you have carried that passion forward.

3:43

I love this TCN talks that you're doing and I might also add your book that just came out, anatomy of Leadership.

3:50

I read it. It's spectacular and I think everyone, no matter what they're doing or how long they've been working in any field, can benefit from some gems that you have in there field can benefit from some gems that you have in there.

4:06

Well, thank you, samara. One of the adages that I got from working with Quint, who's a mutual friend of both you and I, he would always say you know, you throw that pebble in the pond and the ripples, and that, to me, has always been a beautiful metaphor for our lives and purposes intersecting with one another.

4:19

So well, I think that's going to be a good segue, samara, you just have such a rich history and I think we're at an interesting, maybe a crossroads for our hospice movement or a hospice field, and what I always admired about you is you're always so bold I mean, you were a rebel of sorts.

4:35

You're continually thinking outside the box innovations that you've implemented or thought about implementing, and I just love for you to share those because I think that you know I hope you work another 20 years.

4:46

I don't know what kind of what your plans are, but imagine you're at least in the latter half of, maybe, what you plan on doing, and I think you have so much rich wisdom and that you could pay forward to that next generation.

4:59

So what are some of those innovations that you know you're the most proud of as you look back over the years?

5:10

Well, chris, you know, sometimes I believe I've been on the cutting edge and sometimes I've been on the bleeding edge, and you know, I think about the fact that you know, if you don't have a lot of ideas, thomas Edison said this and you know, I live in Southwest Florida where his winter home was located and is still here and he said if you don't have a lot of ideas, you won't be able to come up with any outcomes.

5:30

He phrased it better than that, but I think that's true, and because my passion with hospice really began as wanting to have better care for people and focus on quality of life, focus on what we can do, because so many people end up in the situation where it's difficult to look at what they can do, and because of what we do in hospice, I started looking for other ways to better care for people or use our values, our principles, our skills and our knowledge in other ways.

6:07

So I feel as though I've always been scanning the horizon, having conversations with people about ideas about how we could add programs or services or improve our own programs and services, and you know that has led to opening a PACE program, program for All-Inclusive Care for the Elderly.

6:30

I remember first talking to other of my colleagues about it and they said why would you want to do that?

6:37

And I said because this group of people who look like our hospice patients, long-term hospice patients that don't have a prognosis that makes them appropriate for hospice we could care for them and using our skills and our knowledge and our underlying principles of hospice care, I've tried to take those and move them forward into other settings and locations.

7:03

The PACE program we have a home care-based service program, really being a lead agency in two of the counties we serve, and so that's really been my approach and it's led to different programs and services that we've offered.

7:22

Well, what kind of occurs to me, samira, is that you were a country before country was cool, because I think a lot of these innovations now are becoming, I want to say, commonplace.

7:31

But commonplace in people's strategic plans, Like now, we know we need to do those things, and so which are the ones that you think, which are the ones you're most proud of?

7:41

Or is it those or the ones you feel like kind of go to the top that maybe have been the most impactful, the most successful?

7:47

Well, you know, as I think about it, we added an umbrella name to Hope Hospice and made it Hope Healthcare, because we saw our vision as being broader and our ability to impact more people being broader.

8:02

So, you know, I think that was one of the first steps that we took was to have the umbrella name so we could encompass more of the communities that really could benefit, the people that could benefit from our care and services, and from the most impactful.

8:19

It's really hard to say. You know our bereavement, our music therapy, our art therapy.

8:25

We were one of the first to have full-time physicians, have our own pharmacy, different programs and different ways of delivering care that improved our ability and, chris, that never stays the same.

8:42

So what I find so important is to continually be thinking about improvement.

8:49

And what do they say? Continuous quality improvement.

8:52

You're never done, and so I think that's the message that I would want most people to keep in mind as they're continuing their career and moving forward is that if you're not moving forward, you're done.

9:08

Absolutely so. Here's what occurs to me.

9:11

I want to mirror back what I feel like you're saying Some kind of way.

9:14

You were always in touch with what the patient, the family, the community needed and you were innovating from that space.

9:20

Is that a way of paraphrasing what I feel like you were saying?

9:23

I would say exactly, much more concisely than I said and I appreciate that, but it's always to be connected to your staff and to your community.

9:33

Whatever your service area is your mission.

9:37

Thank you to our TCN Talks sponsor, deltacarerx.

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Deltacarerx is also the title sponsor for our April and November 2024 Leadership Immersion Courses.

9:49

Deltacarerx is primarily known as a national hospice PBM and prescription mail order company.

9:55

Deltacarerx is a premier vendor of TCN and provides not only pharmaceutical care but also niche software innovations that save their customers time, stress and money.

10:07

Thank you, delta Care Rx, for all the great work you do in the end-of-life and serious illness care.

10:14

Well, let me ask you this question because one thing I always admired about you and like, for instance, like I think this is an innovation, you were one of the first leaders that did like the dancing with the stars.

10:24

In fact, weren't you showing me a picture in the show prep?

10:27

Did you have a picture behind you there? I do, you'll have to pull that up in a little bit, but just, I mean, you were always doing so many things and I think you should run for Congresswoman one day.

10:38

By the way, you just have such a great presence about you and you're one of the smartest public policy people I've always known as well.

10:44

How, when you're doing all of those things, how did you still keep the pipeline of what the community and the patients still needed?

10:51

I mean, that just feels astounding to me.

10:53

Well, thank you, chris, and for even bringing that up, because I believe that having visibility in the communities that we serve is very important.

11:03

So why did I, after five years of being asked, participate with the Red Cross in their Dancing with the Stars called Starstruck in Southwest Florida?

11:13

It's because we want to be integrated into the fabric of the community.

11:18

We want to be a part of the community and the only way to really do that is to be involved.

11:25

So being a Rotarian saying yes and working with other organizations, so, and the only reason I finally did it was I couldn't think fast enough of a reason not to do it.

11:36

But you know what? The community loved it and I raised money for the Red Cross by doing it, and it shows the fact that we're a part of the community and we're not our own island, and so I believe that's really important because we want to support others that are also taking care of people in the community and, for example, our bereavement care.

11:59

We work with the sheriff's department.

12:02

They rely on us. We help to debrief, sometimes our own first responders and they call on us.

12:09

So I think it's that integration and being woven into the fabric that's so important.

12:15

You know, something that occurs to me again just watching you over the years Samara, like I could think those things were in my task list in the past and I use that word very deliberately but there's something about you that it was more than a task and there's something the way you led the way in those things where you truly did integrate hope into the community.

12:35

So it's almost like the spirit that you kind of tackled those things produced that integration.

12:42

So, like you know, I went to Rotary and things like that and I still have some relationships to this day.

12:46

But I think there's something and there's probably a lot of other listeners like yeah, been there, got the t-shirt, check that off the list.

13:04

But there's something and there's probably a lot of other listeners like, yeah, been there, got the t-shirt, check that off the list.

13:07

But there's something about the way that you did it. Does that strike true to you? Because it just feels like you did it in a way that had great impact and it created these ties into your organization.

13:11

So't know the secret, except maybe it is that I really do care, and not saying that you don't care, that others don't care, but it's to be present with the people and to not just be thinking about what I'm doing for hope, but it's to really be a part of the community.

13:27

And to be a part of the community and to I guess I care.

13:31

I really care about everyone.

13:34

I think that actually knows it. Samara, Again just knowing you over the years, it's like you're as passionate about your mission than maybe those other places, and then how you knit the two together, maybe that's really part of your superpower.

13:47

And then, as you've done those things, I think that's what actually is produced, Because, again, I think there are a lot of us like you know, I did some of that but I'm not sure it had the impact that it did for you.

13:56

And then I didn't kind of prep you for this one, but just watching you in some of the public policy stuff.

14:02

I'm just curious if you have any advice there, because I've always admired you in that area.

14:06

It's not something I ever felt was a superpower of mine, but is there any just advice or wisdom of how you've navigated that over the years?

14:34

talking with our legislators and our regulators in Florida and other nationally. It is to build relationship, because I have to believe that they want what's best for their constituents, for their communities, for their family members, and so to tell the story and to build that relationship in a way that people can understand.

14:51

Sometimes I think that that it's possible to start just talking generically or, you know, not having the conversation be in context and maybe, I don't know, try to make it too complicated.

15:06

So I think some people do that make it so complicated that the point is actually missed.

15:15

That is well said. And again, watching you over the years, I've seen you build those relationships and then when the rubber met the road and you needed to call upon that relationship to get something done, that may have seen Herculean you made it look almost effortless whether that was something in the Florida legislature, but also at a national level.

15:34

So two great pearls there the relationship building, the passion.

15:40

But I think there's something about how you played your role that genuinely made those legislators feel like you cared for them and their purpose and their passion as well.

15:48

So I feel like that was a little bit of a master class right there.

15:52

Whether you know it or not, samira, that was awesome.

15:54

Well, thank you, chris. Can I just add, though, that we do have to care about each other and the legislators, the regulators, and their positions, and try to understand what it is that they need to accomplish and then how we can work together.

16:08

So sometimes it's not easy and it takes time, but it's very important to do, yeah it feels like that old Covey adage seek first to understand, then to be understood.

16:20

But you do it in such an authentic way. The other thing I remember, just as thinking about public policy we had gotten you and Tom Kasumtis on a call about some certificate of need stuff within North Carolina and your intimacy and your passion like created a steel rod in my back of by golly, this is the right thing to do and we're going to go make it happen.

16:42

And so just your confidence from having navigated that over the years certainly helped us in a positive way in North Carolina many years ago, and so I don't know what was kind of behind that.

16:52

That was just your experience speaking. Also your passion because of what happens when CON goes away and what that does to the community, but I don't know if you want to add anything to that.

17:02

I remember that conversation and the battle you had going on in North Carolina and it's also important to have facts and figures and information, and I think that that's what we really talked about that day is how to present it in a legislature for the state who really needs to be concerned about cost and quality and access, and how to package that in a way again that people can understand.

17:37

I think sometimes we overcomplicate the topic and I do remember that conversation and I was so pleased that you were successful because it does make sense to have some I would almost say barrier to entry, but assuring that the marketplace doesn't become so proliferated with so many hospices that nobody receives the best care possible.

18:03

Yeah, that is well said and I think I shared this with you one time I was giving our national presentation and it was a spur of the moment and we just said let's kind of see who has the most hospices.

18:12

And so we started, like you know, how many have 25 in their market?

18:16

50. Last hand standing was 180 hospices.

18:19

It was in Tulsa, oklahoma, and it was like, oh my gosh, that's that's just, that's crazy and not good for anybody involved in that situation.

18:27

Crazy and not good for anybody involved in that situation.

18:32

Well, samara, you've had so many innovations and sometimes we learn from some of our greatest mistakes.

18:35

Are there any that, as you look through the rear view mirror, like you know, here's some great learning lessons from some of the innovations I was trying to implement.

18:42

Oh, you know what? Absolutely, I think.

18:44

As I mentioned earlier, you know, thomas Edison said you have to have a lot of different ideas to have a few that are successful, and sometimes you can have a great idea In fact it's brilliant and it just didn't work out.

18:58

And so one of those for me that often comes up in conversation is when I had this idea to open a funeral home under the Hope umbrella, and the reason that I thought this might be really important, and especially the vertical integration or just service to the community more than vertical integration, is a number of people that, in bereavement that we serve, that came back and wrote letters or talked to one of our staff, or even talked to me about it in the community, the way that they felt that, after their loved one died, that they didn't have the support that they needed, and some of them even felt like they had spent too much money on the services or that their wishes about the way that they wanted to celebrate their loved one's life weren't respected.

19:52

So for all those different reasons, I thought, well, maybe we could open up our own celebration of life service, our own funeral home, our own cremation service, whatever you want to call it.

20:06

Well, I thought it was a great idea, got to the point of the licensing hearing and then I realized that I was the canary in the coal mine and that here comes, at the time, big business that didn't think that it was a good idea because it would take away from their business.

20:27

So they came. Many of them came to the hearing and wanted to be sure that we weren't approved.

20:40

So it was a very interesting experience. And you know, what I find really interesting now, Chris, is the way that the funeral industry I'm going to call it has changed.

20:48

Now they're opening Celebration of Life Centers. They have different ways of remembering a loved one.

20:53

They have bereavement services.

20:56

So I think they took lessons from us after the idea surfaced that maybe we would extend our services to include some of theirs.

21:07

That's so good, samira, I mean truly. I mean you have a gift where you kind of see there's certain people that can see over the horizon and now, kind of looking back, I do think that's actually a part of your gift as well, which maybe gets.

21:19

My next question is, as you're at the latter half of your career now, what are some of the innovations that maybe you see in the future?

21:28

Maybe you'll get to be a part of them, maybe you kind of are prophesying for us who might be carrying the torch?

21:35

Well, you know what I am in the latter part of my career, I plan on working as long as I can because I love what I'm doing, and so I am always looking at that and I'm not sure what the next thing is, except that we have to be very careful to be sure that we don't lose the essence of what it is that we provide for people, because you mentioned this earlier the work that we do is very sacred and it's very important.

22:07

You know, we as a society, as a community, think so much about the birth of a new child.

22:13

We can never lose sight of the fact that the way somebody closes out their life and transitions to whatever is next, people have different beliefs and how that period of time goes, whether it's weeks, days, months or even years, that's what's going to live on in the life and the mind and the spirit of their loved ones.

22:36

And so, you know, we have to keep that in mind, because it's never going to be easy, and I'm afraid that people now are trying to make what we do as a commodity, you know, and it's not a commodity.

22:51

It's not just palliative care or palliative medicine.

22:55

I'm also concerned that people will think that palliative care is a positive, and it could also be a negative, because if people are in palliative care, they may never get to caring for the person as a whole and not just the illness, and what we've done for so many years will be lost.

23:18

So I don't know that that's a look at an innovation, but more raising a concern about what we have to do to be sure that we hold on to the essence of what's so important about what we do.

23:33

That is profound. Samara, first off, your comment about Pouty Care is not lost upon me at all because you know the team I was a part of.

23:41

We were kind of the innovators of Pouty Care and I always felt like maybe you were a word of caution in that and I can even remember being in like a debate in our senior leadership team and Tina Gentry, one of our leaders, quoted you and talking about like the deaths that occur on palliative care and the shortfall of what that was.

24:00

Now there's not a hundred percent of people that are going to choose hospice but in that rationalization there's still people that don't get the hospice.

24:09

That could have made a much bigger difference and it's not diminishing the work of our amazing powder care people, but it is not the standard that hospice is.

24:18

And you use the word essence. I love what you just said because I think that's probably even more important than some prognostication of some great new innovation, because I think what you just nailed is probably the greatest concern going forward that some of these we use the term substitution competition.

24:36

Is that the same thing as hospice?

24:39

So can you just maybe unpack a little bit more? When you said the essence, what is it about that model of care, that hospice that creates that essence model of care, that hospice that creates that essence.

24:52

Yes, well, it is so important because we created many of us early pioneers.

24:55

I'll refer to the fact that it's the caring for the person, not the patient and not the illness.

25:03

It's caring for them and their family members.

25:05

It really is about surrounding people with love and support, and I think that's the essence.

25:11

You know, it's the expert work in terms of the medical team, the nurses, the social workers, the chaplains, and so even listing out that it is the surrounding people with what it is that they need, and not medicalizing this phase of a person's illness or their life.

25:33

And that's what concerns me is a medicalization or the fact that just becomes an insurance product, and that isn't what we want for people.

25:43

This is a stage of life that's so important, and I also am concerned that people don't necessarily have a good death, but they have the best quality of life while they're living during this very difficult time, which is the closing chapter of their life, and we can make it the best possible.

26:07

But it's tough, it's really tough to say goodbye to the people that you love, and so how can we help them and be with them?

26:17

You know, it's almost like they're on the journey by themselves, and we have to be sure that they're not alone.

26:24

That's well said, samira. Just something occurred to me.

26:27

I think I've heard it quoted different ways.

26:29

We plan for retirement, we plan for marriages.

26:31

I'm actually taking a sabbatical this year and our family and I are going to go on a pretty big trip out west and all the planning of that because you compared it earlier our birthing and then our death and the sacred responsibility of that we get no do-overs in that which makes it hard to measure like how good was it and impactful.

27:00

I don't know if there's anything you want to add to that, but I'm just feeling the weight of what you just said.

27:04

Of course you were taping this podcast on the heels of Dr Bayak as well and he was talking about it, and of course he's a physician, right, so you'd think he's more about the medicalization.

27:14

But what I've always admired about Dr Bayak is kind of his wisdom and skill set and tool set about the holistic being, and so I think he used different words to caution against the medicalization.

27:28

So I don't know anything else you would add to that, because that does feel weighty.

27:31

Well, you know, I've known Ira Biok for many years In fact.

27:35

He was in Montana. I was in North Dakota back in the early 80s and starting hospice care and hospice there, and I did appreciate his comments and I think we are.

27:49

I think we have similar ideas and maybe similar thoughts about that is the fact that we cannot move away from why it is that we exist.

28:03

There are some people who have thought maybe if the entire health care system in society changes the way, transforms the way that they think about the closing chapter of life, then we won't be needed anymore.

28:16

I think that's not true. I think we'll always be needed.

28:20

It's just as though we'll always need cardiologists.

28:24

We'll also always need specialists.

28:26

So I think our mission continues into the future because it's about humankind and being sure that people are treated appropriately.

28:38

Well, samara, final thoughts. You've got the ear of lots of hospice and palliative care staff and leaders, and, of course, we have a lot of board members that listen.

28:45

Now, what's your final thoughts, would you just like to share with them?

28:48

members that listen now. What's your final thoughts that you'd just like to share with them?

28:53

Well, is to continue the mission and really to think about what is best for people in the communities that we serve, what's best for themselves, for their family members, and just that focus on the essence.

29:05

I really believe that we can balance mission with business and I don't want people to think that I'm not realistic and don't understand that we have to have money to balance our mission and, at the same time, we have to be sure that we don't start thinking about what we do is only a business, and I think that's what I'm starting to see.

29:32

Big business profits, the profitability you know.

29:38

Should we offer this? Well, it costs a lot.

29:41

Maybe we could have a higher margin. So those kinds of cautions that I have for people going forward.

29:47

Some people sometimes think I'm not realistic, maybe a little bit too much of a Pollyanna, and I'd rather be that than be so bitter or think of only business when we think about our mission.

30:03

That is well said. Well, I wouldn't call you Pollyanna, I would call you and I'd mean this as a compliment, because I've sought out people in my life that are idealists, because idealists are always pushing you towards the ideal.

30:14

We may never achieve it this side of eternity, but there's always.

30:18

We're always a work in progress, working towards the ideal.

30:21

And it almost feels analogous, as you said.

30:23

That's like the financial pillar, whatever nomenclature people want to use.

30:28

It's like the medicalization to the patient.

30:31

The financial pillar is to the organization.

30:34

It's like a one-dimensional approach, and what made this model so brilliant and just so beautiful is that a human being is body, mind, spirit, social, emotional component, and an organization, as an analogy, is much more holistic as well.

30:49

And finance is only one dimension. You have quality, you have service, we have the people pillar.

30:54

Don Berwick was brilliant with the quadruple aim because I think in a way he was kind of imputing that wisdom to say you only deserve a place in the future of healthcare if you're working on a better service, better quality, yes, lower cost, but your employees have to have a great experience.

31:09

And he codified that as the quadruple aim so well.

31:13

Samara, thank you, it's always a pleasure to hang out with you.

31:16

Any final words before I close this.

31:18

Well, I think your summarization there, and quoting Don Berwick, was just perfect.

31:24

And it's always fun to hang out with you and I look forward to sharing a cab with you again at a meeting in DC.

31:32

Amen to that Well, to our listeners. I hope you pay this show forward to all your hospice and powder care team members and peers.

31:38

Be sure you hit the subscribe button if you've not before, so you don't miss an episode in the future.

31:43

And thank you for making our podcast the most listened to podcast in the whole powder care field.

31:48

This is due to you, our listeners, and the amazing guests that we continue to bring on the show.

31:52

Just like Samira, and as always, we always want to end with a quote.

31:56

That's kind of something to make you think, kind of the end of the bookmark, if you will.

32:01

And so Samira picked one and I picked another, so we're going to use two, and I'd love if she picked the Jimmy Buffett quote, since we both spent a lot of time in Florida in our lives and careers.

32:11

Jimmy Buffett said yesterday's over my shoulder, so I can't look back too long.

32:16

And then, john Maxwell, if you want to impress people, talk about your successes.

32:26

If you want to impact them, talk about your failures.

32:31

That's John Maxwell.

32:35

Thanks for listening to TCN Talks.