← Leading Organizations That Matter
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- [00:00]
Woody Hungarter
Foreign.
- [00:10]
Ray Spadoni
Welcome to Leading Organizations that Matter, a podcast about leadership, organizational culture and how we find meaning and purpose in our work. I'm your host, Ray Spadoni, former healthcare CEO, current consultant, author, teacher and speaker. Today's topic is Preserving the Legacy, an interview with Woody Hungarter Elwood, or as most people know him. Woody Hungarter has taken the helm at two important nonprofit organizations, both with long and very impactful histories. The first was the VA of Philadelphia, one of the very first agencies of its type in the country, with its founding dating back 138 years ago, and the Karen Ann Quinlan Hospice, an organization that was formed by a dedicated and very mission driven family. Woody is going to describe that in some detail in this episode. He has been a registered nurse for the past 40 years and holds a Master's degree in organizational Management from Misericordia University. He's also an end of life Doula, earning his certification from the University of Vermont. Woody has worked in hospice and home health for the past 32 years with both nonprofit and for profit organizations and is well known as a leading expert on the leadership of such organizations. I hope that you enjoy the interview.
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Interviewer
Hello Woody, thank you for joining me on the podcast. I appreciate your time and I know that our listeners are going to enjoy hearing your thoughts on preserving the legacy of long standing mission driven organizations. You are quite uniquely qualified to discuss this topic, having led both the VNA of Philadelphia, one of the very first visiting nurse associations in the US formed some 140 years or so ago, and now the Karen Ann Quinlan Hospice, which of course is part and parcel of the legacy of the landmark Karen Ann Quinlan case of the 1970s and into the 1980s. So again, welcome and thank you, Woody.
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Woody Hungarter
Thanks Ray. It's really nice being with you. This is such an important topic, especially with the state of health care today. So thank, thanks for this opportunity.
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Interviewer
Yeah, absolutely. First of all, I guess can you give our listeners a sense of the Karen Ann Quinlan story going back to the very beginning, you know, what happened and then what has happened over time to make it so historically and I'd say culturally significant?
- [03:05]
Woody Hungarter
Yeah, well, it is very interesting because, you know, all of this happened right around when I was graduating high school. So I did have somewhat of an understanding of the Karen An Quinlan story. It was quite a tragic story where, you know, she was in a situation where she had a medical emergency, was in a persistent vegetative state and, and her parents, knowing that she would not want to live that way, you know, had tossed around the idea of actually taking her off of the respirator that she was on, and the hospital at the time would not allow that to happen. So they had an attorney friend, Paul Armstrong, at the time represent them to actually go to the Supreme Court of New Jersey and give them the right to make that decision of removing the respirator. She was in that. That vegetative state, and she was not able to communicate. She had had anoxia, so she had brain involvement. And it was quite a tragic situation. So at first it was. The court case was denied. It went up to the Supreme Court, and there was a Judge Hughes who actually made the decision to allow the family to remove. Take her off of the respirator. And it turns out that when they took her off the respirator, she ended up living for another 10 years, which was very unexpected at the time. But what happened with this is it brought to light the family's ability and the patient's ability to have medical decisions made in situations where, you know, the patient can't make the decision. It brought to light the need for advanced directives. Another thing that came out of this was the development of ethics committees and hospitals where physicians and families together could help to make these decisions on the right to die. And so the whole thing on bioethics, and it was just such. It was a case that just the timing of it brought a lot of things to light. And it. It's really interesting. Now, I don't know if you want me to go to this part of the story, but, you know, I'm not sure whether Karen Ann herself would have actually ever been eligible for hospice. But what the family did was they actually had a. There was a movie made, there was books written, and the family had a. An active interest in end of life, primarily from their parents. So Julia Quinlan, who was Karen Ann Quinlan's mother, her parents were in there, like around 100 years old, and they were living. They were actually staying in a hospital for medical reasons. But back then, there was a. A lack of options of people being treated in the home and that type of thing. And so they used the proceeds, all of the proceeds from the book and the movie and all that about Karen Ann. They went over to Europe, they met with Cecily Sanders and. And really investigated how the beginning stages of hospice throughout the. Throughout the world. And in fact, they. They went to London and all over Europe just checking out different hospices, coming back and wanting to start hospice in the United States. And so they ended up starting their hospice program, naming it after their Daughter Karen Ann quinlan. Back in 1980, Newton Medical center donated two rooms for, for them to have an office space. And before there was actually a hospice benefit. They started their hospice and used the proceeds from their book and their movies and things to actually get the program started. So it's quite a remarkable story and a chain of events that really have had an impact not only on medicine, but also just on end of life care.
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Interviewer
Well, I appreciate you walking us through that, Woody. The current organization, the hospice, is the physical manifestation of that legacy, but there are many other dimensions to the legacy. I certainly remember as I was growing up, not being in the New Jersey area, but it was national news, it was well covered, well documented, and there was an element of drama to it. And so many folks will remember if they were around during the 70s and into the 80s, they'll certainly remember this case and the movie and the book, as you said, and so forth. Before we get to the, the hospice organization, what's your sense of how her story and the work of the family, but really what happened back then to Karen Ann herself? How has that had an impact on how we think about end of life care and the very difficult decisions that sometimes must be made in these situations?
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Woody Hungarter
Yeah, well, I think it's really giving the people, giving people the right to make those decisions for themselves. And right now we're really focused on educating people on the use of advanced directives where people can start thinking about what they want for themselves at the end of life and having the tools to be able to, you know, totally document what they want to happen, what they want to occur at the time, and so their wishes are honored at the end. So the whole movement of advanced directives, the development of pulse forms, living wills, all of that comes out of, you know, this story. And, and you know, the one thing that's really amazing I can tell you from a hospice standpoint is both Karen Ann's mother, who was Julia Quinlan, she's actually still part of our agency at 96 years old, and also the attorney who represented the family, Paul Armstrong, who was a judge, he actually sits, still sits on our board of directors. So it is a really tight knit family and group of friends who have an active interest in, you know, giving the, giving people the right to die in a manner that they want. And so they've really been instrumental in leading that effort.
- [11:44]
Interviewer
It's quite the long term commitment. You know, out of personal tragedy has come something very impactful to all of us. Let's fast forward a bit. So how did you Become involved with the Quinlan family and the current organization and then maybe just talk a little bit about your role and what you oversee there.
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Woody Hungarter
Okay. Yeah, I, it, it's a while ago I was actually the president and CEO of VNA Philadelphia and really a very similar mission driven organization. They've been like you had said earlier, they were there since they started in 1886, 138 years old, really solid program serving the unmet needs of, of citizens within Philadelphia, heavily involved in social determinants of health and, and all of those types of programs for the underserved population in Philly. We had always said, you know, we took care of people in the four poorest zip codes in the country. And so it was a very important mission at VA Philadelphia and, and I had such a great experience there. After I decided to leave there, I started doing some part time work, actually 20 hours a week. I started working with Bayada and helping them with some hospice joint ventures through different parts of the country. But then I got a very interesting call seeing if I had any interest at all in helping out Karen and Quinlan Hospice. I always, I felt that it would be a great way to end my career and so I, I decided to say yes. I gave them a very specific time limit that I would stick with them for a year to two years, you know, just to try to bring in some new ideas and you know, help them face some of the challenges that independent, not for profit organizations have within our healthcare environment. And so that's my primary goal there is to help them with strategies, education and really expose them to a whole different world changing world of health care. You know, it used to be back when hospice started, about 80% of the hospices were non profit. And now, now it's about 20% and 80% are for profit. I can tell you that my background, I've worked in hospice and home health. 20 years of my experience has been for, I've actually worked for, for profit companies for, for 20 years and about 15 years for not for profit. So I do have that blend of experience of education and trying to develop strategies for success while organizations are continuing with their mission. And that's where the real challenge is nowadays.
- [15:16]
Interviewer
And that's, that's the perfect lead into, you know, the primary topic of this episode which has to do with preservation of the legacy. As we discussed, this began several decades ago and has manifested forward into the current operations of the Carina and Quinlan Hospice. For profit companies of course are driven by profits and return and owner or shareholder value. Nonprofits do need to focus on their financial performance, obviously, but they're more so driven by things like history and mission and community impact and the longer term legacy considerations. It's often the job of a board of directors, some of whom can be founding members, as is the case with Karen Ann Quinlan and their leaders, to preserve the legacy of their mission driven organization. I often talk about organizations that matter. That's part of the title of this podcast. And it's safe to say that your organization and its work has certainly mattered and for a long time and in a very impactful way. How are you working with the board to preserve that legacy given that it's a changing world out there and there are new industry pressures and obstacles that didn't previously exist?
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Woody Hungarter
It's interesting because we are actively doing that right now at Karen and Quinlan Hospice. And you know, one of the things that I can say is there's a blend on the board of the people who are really lead by their emotion and, and their passion for the original, the origins of the agency and really have a commitment to that. But then we also have board members who are more actively involved in the business world and have an understanding of finance. And so one of my key roles there, not only in, in communicating with the board, but also then taking that message to the staff is how do we blend that our mission and with the actual finances that go along with providing the service. And that is a real struggle sometimes with non profits because people that go into, into non profit health care especially, they don't really care about the money part and they never really had to learn it. It's not something that is taught in nursing school or, or places like that. But nowadays you have to, you have to find the balance. I, I once when I worked for Sacred Heart Hospital, back in the old days, I did a presentation to the Daughters of Charity Health System. It was in Chicago. I had just started up a program for the hospital it was on called a physician's house call program. And when I went to the presentation in Chicago on the first day, the, the lead person for the Daughters of Charity came out to open up the session and there were hundreds of people there from around the country. The first words out of this individual's mouth, and this is a Catholic health system, were no money, no mission. And do you know, that was said to me probably, probably 35 years ago and it's still seared in my brain because it is so accurate. So that's probably the biggest thing that I deal with with, with our board of directors and the Communication with the staff is people having that understanding on how to balance mission with the financial impact of what, what is going on in business, especially hospice nowadays.
- [19:54]
Interviewer
On your board you mentioned that you have some who feel the history and the mission very deeply. It's deep in their bones. And then others might be a little bit more pragmatically inclined and maybe thinking about what's happening in the business world and so forth. In your experience, is that variability on your board something to bemoan? Is it a challenge or is that attention that's necessary and maybe even healthy?
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Woody Hungarter
Yeah, that's a great point. And I think it's extremely healthy. To be honest with you. I am a strong believer in life having balance. And I think, and that's what's unique about our board at Carenane Quinlan Hospice is we do have that balance between, and I'll say the money guys and the, the pure, the purists who are, are helping off, offering their time and committing their time to the mission of this organization and the value of the organization with, not even regarding what's going on with, with the finance part. So you had, that's where you find that balance. Because if you don't have either of them, you're not going to have an organization. And so that, that's, that's the beauty in all of this and that's the real challenge. But you've got to have both sides.
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Interviewer
Well, that balance also, I'm going to assume and suggest must be something that you yourself have to contend with. And you know, as the on the ground leader, you probably have a little bit of that tug of war going on within yourself. Is that, is that fair?
- [21:57]
Woody Hungarter
Absolutely. Yeah, absolutely. You know, I got into this business for, you know, the same reasons that most other people did. You know, I've dealt with a lot of situations in my life professionally. Plus, you know, at a very young age I had a wife who was diagnosed with leukemia and at the age of 37 passed away. And through that experience, you know, I actually got to, you know, her wish was to be at home and so I was able to care for her at home. Having a 5 year old son at the time, but having, creating the resources to be able to do that and eventually coaching her through her last breath. And you know, that's a really powerful experience to go through, understanding end of life planning. You know, at that time, I'm in my 30s, she's in her 30s. We hadn't prepared for anything. But you know what, I quickly understood the need and the importance of Having those discussions as early as you can in your life, advanced care planning, end of life planning, life reflection, all of those type of things. And one of the things that has come of this is I actually became also an end of life doula. And you know, specifically to start talking to people earlier in life about preparation. You know, the, the time that we have on this earth is very limited. And so I would much rather encourage people to get involved in preparation and, and bringing value to their life and having those discussions earlier in their life. So, you know, I've learned all of this through life. The importance of, of, of really having these open discussions while you still can. Because when you get hit with a diagnosis or some type of tragic incidents in your life, you may not have time to fully have these, these discussions that are very important.
- [24:46]
Interviewer
Wow. Well, I'm sorry that that happened to you, Woody. That's a lot for someone in their 30s to go through. Clearly it impacted you and helped form you to what you ended up doing with your career. What else in your personal history prepared you for the task? And I have to ask, as you mentioned, your time as a CEO of the VA of Philadelphia, which also faced its own legacy preservation quest. Can you talk a little bit about that as well?
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Woody Hungarter
Yeah, that, that was a really unique situation for me. It was a very large agency, you know, of course, very well established. But you could actually see, you know, I, I, I was able to actually see the, where this whole thing was going and how as powerful as we were and what a strong mission we had within the Philadelphia community. That mission that we felt was so important. And this is why I always recommend these organizations. Key, you have to keep looking. You have to reevaluate your mission every year and make sure that it's still relevant, still, still important to the people who you are trying to serve. Because, you know, in Philadelphia we're providing all of these great services. I got actively involved in developing all types of new programming. We started a food bank. We were doing stuff for opioid overdoses. We were doing narcon training for all of our staff. Just, we had great relationships with the, the universities, with research projects and that type of thing. But it, I could actually see how we were getting squeezed out by both hospital programming with their home health and hospice programs. Insurance companies started to affiliate and have strong relationships with their own hospice and home health programs. And we were finding ourselves getting squeezed out. As important as we thought we were, we were getting squeezed out of the market.
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Interviewer
Yeah.
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Woody Hungarter
So that is a real, that's something That I learned. As powerful as you think you are and as, as important as you think that you are in the mission that you're providing, if it's not really flowing with the rest of the community and the community needs and the direction of where health care is going, you're going to get squeezed out of the market. And Just last month, VNA Philadelphia, after 138 years, closed its doors. A very sad day. Incredible. But that's what happened. That's. Nobody would have thought that could have happened, but it happened.
- [28:07]
Interviewer
Boy, does this cut close to home and really sound familiar to me.
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Woody Hungarter
Yes.
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Interviewer
You take your relevance and your importance for granted at your own peril. Yes. Yeah, no question. Have, you know, over the course of your time in Philly and then certainly at Kearney and Quinlan Hospice, have there been any particular surprises or lessons learned during this process?
- [28:45]
Woody Hungarter
I think the biggest lesson is and, and actually the biggest surprise is there is a, and still is a general, and I'm trying to find the right word. It's not a misunderstanding, it's just people don't make that connection between business, finance and health care. And what we have to understand is you've got to find the balance and somebody has to pay for the, for the, for the service. Like nothing in this world is free. Somebody is paying for it. And so people have to know that that is the reality. It, and it, it, it is a constant battle for me to, to educate people and bring that level of understanding to their day to day operations. You know, the clinicians are so focused on providing such great care with amazing quality outcomes, but I have to bring to them the, an understanding that somebody's got to pay for this. That you know, we, because we all want to get paid for the work we're doing, but the money has to come from somewhere. So you've got to create that balance within your organization that there is an understanding of the financial part, not that it overshadows the clinical and the quality part. So it's just finding that balance that's been the biggest eye opener for me in, in this line of business. Because years ago nobody worried about money. You know, when I first started in the business, I didn't know anything about who paid for it. And you never worried about that stuff, you know, but nowadays you have to worry about it.
- [31:07]
Interviewer
Well, as you said, the money has to come from somewhere. Is that embraced today much more readily by clinicians, frontline folks, those who are patient and client facing more so than five, ten years ago?
- [31:25]
Woody Hungarter
Yeah, I, I think the reality has presented itself. And, you know, people and organizations are organizations that you think would have been there forever are finding out that they're having to close the doors because the money stream has dried up. And so we all have to have that sense of that reality of how important the financial piece is. And you can do that without giving up your desire to provide great service and great care. You just have to create that balance within yourself. And so that's my biggest, that's my personal mission within this organization, is to provide that education and that understanding in order to support what they are doing every day. They do amazing work. You know, there is nothing more special than really helping people at the end of their life allow them the dignity and the respect that they deserve in, you know, dying a peaceful death. And so you. It's like we had gone back at the earlier part of this interview. It's all about balance, right?
- [32:59]
Interviewer
Yeah, that's, that's, I think, the key to this conversation. And you know, as you're suggesting lots of things in life given. Who listens? The folks who listen to this podcast tend to be leaders of mission driven nonprofits, board members, donors. A lot of students are listening to this. What advice do you have to them as they're trying to work to preserve the history, legacy, relevance, impact of their organization for the long haul in this sometimes very rapidly changing world? How do you get the balance? What can they do? What can they put into effect that will help them?
- [33:46]
Woody Hungarter
Yeah, it's really to be open minded. You know, one of the things that I introduced at VNA Philadelphia and I introduced at Karen and Quinlan Hospice, it's no secret, you know, we have to really look at diversification not only in programs, but also look at opportunities for strategic partnerships. You can't live in a siloed environment. You have to open yourself up. We need to look for those different opportunities. At Karen Ann Quinlan Hospice, for example, we not only have our hospice program, we have a, an inpatient facility, independent inpatient, freestanding inpatient facility. Beautiful place. We have an freestanding bereavement center. That 85% of the business that comes out of that bereavement center is t is addressing grief in the community, non hospice with children and suicide victims and those type of things. We just started a palliative care program over a little over a year ago because we see a huge advantage in palliative care and getting people treated well before they become eligible for any type of hospice benefit. And most recently we started the end of life doula program and we have trained 20 doulas within the last six, six to nine months. We've trained 20 doulas already. And so you've got to diversify like that. You've got to spread out and really have an understanding how all of these programs can enhance the experience of each other. And, and you've got to provide value to strategic partners. And it all comes down to quality of care. Looking at changes in reimbursement and, you know, value based care and all of those type of things. You, you've got to be. We all think that we're valuable. Like we think our mission is the most valuable thing, but we have to look outside and make sure that our mission is still valuable to the community that we're trying to serve. And you know, because sometimes you get so within your own organization you, you really stop looking at what's going on outside of you. So I, I think that's the biggest part of, is looking outside in that diversification. That's what'll help to give you some success in the future along with strategic partnerships.
- [36:51]
Interviewer
Great. Wise words, Woody. Thank you, thank you, thank you for your willingness to be on the podcast and you know, with appreciation to you and admiration for the work you do at Carney and Quinlan Hospice and that you've done throughout your entire career. With appreciation and gratitude to the entire Quinn Quinlan family for the impact they've had not only on the immediate community there, but it's been a life's work that has had impact that's reverberated well outside of New Jersey and you know, into, into the broader environment. It's had a lot of impact. So to the Quinlan family and certainly to you, thank you very much.
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Woody Hungarter
You're. You're very welcome. I appreciate this opportunity.
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Interviewer
Awesome.
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Ray Spadoni
Thanks for listening. I hope that you'll consider leaving a five star review on Apple Podcasts or your platform of choice that will help others find us here. My mission is to help empower organizations that matter by supporting those who lead them. Feel free to learn more about me and my work at Red Sail Advisors.
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Woody Hungarter
SA.