Healthcare Leader: Liz Fowler, Hospice of the Bluegrass

LizFowler--colorLiz Fowler

President and CEO at Hospice of the Bluegrass; President and CEO at Palliative Care Center of the Bluegrass

Education: Master of Public Health from the University of California Los Angeles; Bachelor of Science from Syracuse University

Hobbies: Skiing, hiking and most any outdoor activity. When I’m indoors, I read.


What was your first job in healthcare?  What did you take away from that job that you use today?

After graduate school, I moved from Los Angeles to Southwest Florida and quickly found a job as a patient educator in the Staff Development and Patient Education Department of a 400 bed regional medical center.   Within weeks of my arrival, the director of the department suddenly resigned.  I asked to step in as the interim director while a national search ensued and ultimately was selected for the job.

It was a great first experience for a number of reasons and there are four things I learned that still stand out for me today.   First, be quick to identify opportunity and step up when you know you have something to offer.  That’s how I obtained the job in spite of others who had more tenure and experience.

Second, the CEO became my mentor and I experienced the value of mentorship.  He shared his insights and allowed me to participate in diverse meetings and projects as an opportunity to learn.  Today I make time to be a mentor. Developing others and encouraging them to be their best is important. As well, I always have one or two mentors of my own – people who challenge me, give advice and help me to be my best.

Third, I learned the importance of hiring talent that will bring unique skills to the business and that will supplement the existing team.  Like most hospitals, our leadership team had predominately worked in healthcare and many had been promoted from within.  One of the first individuals I hired was a management/leadership trainer from a technology company.  His experience and application of basic management principles from another industry helped hospital managers to better understand their role. He brought perspective that in those days couldn’t be found within the hospital.

Finally I took away, the importance of closing any gaps in understanding between the finance and clinical departments.  During the preparation of the annual budget, I paired myself with the finance department to train our clinical leaders in budget preparation.  In reality, I facilitated mutual understanding and respect for profitability, efficiency and most importantly clinical excellence.

Where do you do your best thinking? 

When I am able to walk, I do my best thinking.  I like to be active and am always multi-tasking.  Walking fulfills my need to multi-task but settles my mind from other distractions.  Sometimes, I plan to walk and talk with a friend, confidant or mentor to stimulate really great thinking.


How do you approach management and leadership at Hospice of the Bluegrass? 

I came to Hospice of the Bluegrass just over one year ago following Gretchen Brown who was CEO for 32 years.  Gretchen was quite successful in her role and has been renowned as a trailblazer in the industry.  She hired and developed some of the most seasoned and talented folks in the hospice industry who are pioneering and innovative.

For Hospice of the Bluegrass, my approach to management and leadership is to further our success by inspiring, fostering innovation and seeking opportunities to further our mission of caring for very seriously ill people. To keep the organization performing at its’ prime, it’s also important to be wary of complacency and measuring our value on past success. My leadership style won’t allow for complacency and my team will tell you, I am energetic and rely on them to perform at their optimal level.

As a high performing team, we are ambitious with our goals and accountable to each other.  When goals are set and a department or individual isn’t meeting their targets or performing at their optimal level, we don’t t point fingers or rationalize why the goals aren’t being met.  We analyze what needs to be done and commit to a plan so that everyone can support and cheer on the course correction whether the responsible party is an individual or group.  Likewise we celebrate successes along the way but recognize that our mission is never finished.

As a leader, we all face many challenges.  What challenges do you face in your role that are unique because you work in healthcare?

In hospice and palliative care, our work is providing medical, nursing, social, emotional and spiritual care to patients and families.  Most often we do this in homes, hospitals, nursing and long term care facilities when the illness is severe.  Families are exhausted, stressed and fearful because they are facing an unknown and painful experience.  Every patient and family is unique and we only get one chance to provide them our very best care.  Most healthcare leaders will likely have a similar response when we discuss the challenge of caring for our patients.

As a leader of a business that is mission driven and provides care for very ill patients mostly in their homes; the unique challenge is evaluating the impact of each and every decision on our mission and how it will make the care and services we provide to each patient better.  My decisions are ultimately about caring for people.  For me, that adds meaningfulness to every challenge.

What is your very best skill — the thing that sets you apart from others?

Early in my career, I had the great privilege of working with a Board of Directors who were, for the most part, retired executives of Fortune 500 companies.  Individually they were fiercely independent thinkers and very opinionated.  I learned from this group to respect and seek out strong and diverse opinions.  This group would have extensive debates (arguments actually) about service line development, allocation of resources and the strategic vision.  Despite their very strong and different opinions, ultimately we would come to a consensus.  The meetings and discussions were very difficult, but in the end the business grew exponentially during the tenure of this Board.

From that experience, I learned not only consensus building but also collaboration and more importantly to seek out collaboration with non-traditional teammates and partners.  I think that sets me apart.  I actively seek out different opinions, partners and groups and do not just seek to achieve consensus but true collaboration.  There is great value to being inclusive of differences to make great decisions, form a great team or develop a great partnership.

What was the most significant event/development at Hospice of the Bluegrass in 2015? 

We are participating in the Centers for Medicare and Medicaid Services (CMS) Innovation Center CCTP (Community Care Transition Project) demonstration to reduce hospital readmissions.  This is not a hospice program.  The patients in the demonstration have chronic but not life limiting illnesses.

This year CMS has given us accolades and announced that we are a top performer in the CCTP demonstration, reducing avoidable hospital readmissions.  CMS conducted a site visit in June and has highlighted our work in a number of learning collaboratives.  This is one of the ways that Hospice of the Bluegrass has been innovative.

We are leveraging the skill, competency and passion we have in caring for complex patients in their homes.  Hospice and palliative care providers are superior educators and are able to teach patients and caregivers about disease progression, medication management and symptom control which eases patient and caregiver anxiety and can obviate the need to rush to the hospital.

In addition to the accolades from CMS, we began helping additional hospital partners reduce their readmission rates by providing a service similar to that of the CCTP demonstration.  We are not just a hospice and palliative care provider any more.

What opportunities do you see for Hospice of the Bluegrass in 2016?  Challenges?

The continued transition away from traditional fee-for-service reimbursement for health service towards reimbursing for quality is an important trend. Hospice and palliative care is both high quality care for seriously ill patients and high value care for our health care delivery system. Consequently there are myriad opportunities for us to be creative in service delivery and innovative in partnerships and collaborations with providers and payers. You will see Hospice of the Bluegrass bringing more solutions to our healthcare partners that improve care of seriously ill non-hospice and hospice patients in the non-acute setting.

With respect to hospice specifically, we will likely see more patients but for less time. While hospice is designed to be a benefit for the last six months of life, the median length of stay for hospice care nationally is around 17 days which often leaves patients and families unable to take full advantage of the scope of hospice services.  The decreasing length of stay for hospice patients is a national trend which is beyond the scope of this article.  However, the decreasing length of stay can have pernicious effects including but not limited to diminished staff engagement and lower patient and family satisfaction.  We are being proactive to these anticipated challenges.

With respect to palliative care services, the ongoing challenge is one of reimbursement for services. Palliative care done well involves a team of highly trained medical professionals including but not limited to physician, nurse practitioner, nurse, social worker and chaplain. Unfortunately there is not a sustainable reimbursement mechanism for palliative care services. High quality, sustainable palliative care takes innovation, collaboration, dedication and support. While the lack of the reimbursement for palliative care programming is a challenge, it is also a huge opportunity because palliative care has been shown repeatedly to deliver on the triple aim. Because of the favorable clinical and financial outcomes associated with palliative care, we are seeing an increase in the number of our partnerships with payers and other providers.

If you could eliminate one of the healthcare industry’s problems overnight, which would it be?

My training is in public health and with that training and my belief system; I put a lot of emphasis on the cultural and behavioral determinants of health. If I could change one of our healthcare industry’s problems, wouldn’t it be great if I could change our culture to one that supports health?  If our culture fully embraced health, our healthcare costs would deescalate and the quality of life of many Americans would improve.

How do you revitalize yourself?

That’s easy!  A really great work out!

What’s one piece of advice you remember most clearly? 

I’ve told you that I have always had mentors and they have given me really great advice throughout my career.  The one piece that stands out is, “Always remember the patient.”  At Hospice of the Bluegrass, this is our focus.