Q2 2020 Leadership Letter - Donna Deblois

June 26, 2020

Donna Deblois

President of MaineHealth Care at Home

Donna Deblois is President of MaineHealth Care at Home, a home health and hospice provider under the Mainehealth Care umbrella. MaineHealth Care at Home is part of the MaineHealth system which consists of 22,000 employees across 12 community hospitals in Maine and New Hampshire.

Donna was previously the Executive Director for Kno-Wal-Lin for 14 years leading the organization and fostering utilization of technology to improve care for patients. In May 2016, three leaders in home health care — HomeHealth Visiting Nurses, Kno-Wal-Lin Home Care & Hospice and Waldo County Home Health and Hospice — joined together to form MaineHealth Care At Home. Donna was named the CEO of MaineHealth Care at Home after a nationwide search and now serves as the President of the organization.

Matt:  It’s great to start near the beginning, especially when exploring a path like yours that ranges from nursing to executive leadership. What drew you into nursing?

Donna:  Growing up, I always wanted to be a nurse. I don't know why. There is no one in my family who's a nurse. There are no health caregivers in my family.  I did not come from a dysfunctional family, which many nurses do, unfortunately. During my summer between my eighth and ninth grade years, I was actually a candy striper (a hospital volunteer back in the day) for the summer doing two days a week in the emergency room. The staff at the hospital knew I wanted to go to nursing school, so they let me do things they should never have let me do, and they would never let you do today. But partially because of that, I had a really wonderful experience. Later, I went to a hospital-based nursing school. I saw my very first baby born on my second day of nursing school. At first, I was horrified. I thought “Oh my God, I would never go through that.” But time and experience change perspective. Since I went to a hospital based nursing school, I walked out knowing what I was doing when my feet hit the ground looking for work. This was good preparation for new nurses entering the profession during a nursing shortage. During this time, if you were a warm body and you had a nursing license and you were willing to work nights - Tag you're it. I graduated from nursing school on a Saturday, and I started as a camp nurse on a Sunday because they needed staff. It was one of the best learning experiences I ever had. While I worked there, I was studying for my nursing boards, and I had a student nurse who worked with me. I’m a big believer in the best way to learn something is to teach it, so I was able to teach during this time which helped my learning tremendously. 

In the fall of that year, I immediately went back to school to get my bachelor's in social work. During my time in the social work program, I started my career as a nurse in a hospital. I made the decision to pursue my bachelors in social work because I had had the pleasure and fortunate experience of a clinical rotation with home health, and I fell in love with it. I worked nights on medical surgical units while I went to social worker school full time. The day after I graduated, I moved to the Ozarks of the boot heel of Missouri. 

I was a home health field nurse the entire time I was in Missouri. We moved back to Maine in the mid-80s, and I began working in some form of leadership role as I progressed through my home health career. In the late 1990’s, I was a consultant. I helped start a hospital-based home health agency, and we were successfully Medicare certified and Joint Commission accredited within four months. We did a tremendous amount of work to accomplish this goal. I left consulting to bring more stability to raising my children. For a short time, I worked for Kindred, and then started another not for profit home health agency. In 2000, I went to Kno-Wal-Lin Homecare and Hospice, where I was the Executive Director for 14 years. It was with Kno-Wal-Lin that I really got a taste for technology and had the ability to make some decisions that would embrace where we were going and how we could leverage technology. When you're on the coast of Maine, you serve many different islands, and deal with the driving challenges of several peninsulas. You can't travel between the two, and you’ve got to go back and forth. So for us, finding technology and leveraging it in a meaningful way was really critical. So I have been a very, very strong proponent of technology, particularly telehealth since 2000. In 2014, I left Kno-Wal-Lin and joined Home Health Visiting Nurses of Southern Maine initially as an interim CEO, and then transitioned in the agency's CEO role. In 2016 we merged Kno-Wal-Lin into our organization, and we changed our name to MaineHealth Care at Home allowing all MaineHealth affiliated agencies to become one organization for the health system.

M: Can you share a little bit about MaineHealth and MaineHealth Care at Home’s role within the hospital system?

When I went to Kno-Wal-Lin back in 2014, it was part of a whole system called Pen Bay Healthcare, I wanted to be part of the health system in which home health and hospice would be an integrated service within the continuum of care. That's what we were, and we worked hard to get to that point. I actually was an equal member of the executive team there. Now, here at MaineHealth, which is a $2.5 billion organization, home health and hospice sits at the table and equal to all the hospital presidents. It doesn’t mean I'm still not the vocal minority because I still am the vocal minority, and that's okay. Now as COVID has impacted healthcare, it's been interesting. We're starting to look at different models of delivering care with fewer human touchpoints. Home health and hospice has suddenly been invited to a lot more tables than we were invited to before, which has been wonderful.

M:  I know for home care, that's always been something that we've been fighting for. So it will be interesting to see how MaineHealth and other organizations explore how home care can be a solution to help with COVID and healthcare in a post COVID environment.

Donna:  We have to be proactive because unfortunately, as an industry, we've typically have been very reactive and whine. I don't know a better way to say it, but our industry has a tendency to whine, and people don't listen to whiners. It is important to come to the decision-makers table with an opportunity that’s going benefit them [the care continuum], and then they'll listen to you.

M: Do you feel like you had a natural aptitude for leadership or the business side of healthcare? Tell us what drew you from being a hard-working field nurse to someone who is more involved in leadership within healthcare.

Donna:  Part of it was the times that we were in. Many nurses, myself included, were put into management positions as soon as they graduated. When I worked in the hospital, I was always a charge nurse, despite being one of the youngest nurses on the floor. I learned early on to prove my value to an older, more experienced team, and show what I brought to the table. One of the values, I do have, and that I learned from my mother is the value of fairness. She really drilled that into our heads. I think my brother, sister and I are all very good at this and act in congruency with the value of fairness. Also, my values of respect and consistency contributed a lot to my experience in leadership. Just because you're the new kid on the block doesn't mean that you know all the answers. You need to learn how to ask questions and ask for help. Also, I think one of the biggest things is communication. Close the loop, never leave it open. It drives me crazy when I get an email from a team member, and they'll say, “Oh, thank you so much for getting back to me,” and I’m like what do you mean? Doesn't everybody get back to you? The little things are what have made a big difference for me and my path.

One thing I’d like to add - I'm a big Quint Studer fan. I like his model for management. One of the things that I have practiced since the first time I ever went to one of his programs was the value of a handwritten thank you note. And I'll tell you, there are days I don't feel like writing a lot of thank you notes. In our organization, we provide a new admissions with a “We are listening” survey. In this survey, patients have the ability to respond and rate the team members that provided care to them. They can make a donation too, but the biggest thing is, I get these notes with team members' names on it and the wonderful things the patients say about our staff. When I read these, I write a handwritten note to each team member mentioned, and it is sent to their home. It’s funny, I get more ‘thank yous’ for sending them a thank you note. It's amazing to see the impact it has on our team.

M:  Speaking of Quint Studer, I wanted to ask if there are any books on leadership or a program or model that you follow or recommend to others? 

Donna:  I highly respect Quint Studer and the Studer Institute because he's really about treating people respectfully. They have a lot of content on managing up and sharing feedback with your managers. Also, they discuss how you deal with your low performers, your middle performers, your high performers and understanding who takes up all your energy. Oftentimes, it's the low performers, and you have to decide, are they going to move up to become a middle performer, or are you going to perform them out? Sometimes people have a very hard time with that, but it's not that they're performed out suddenly. It's a progression and it takes time.

Another one that I really like, and we give this to every staff member that comes here, is a book written by Joe Tye. It's called The Florence Prescription. It's a fictional story about the values of Florence Nightingale. It encapsulates her recognition of everyone who was part of the care team, whether it's the person who provided the environmental services, or it was the physician who did the surgery, everybody's the same. It has a lot to do with ownership. I think if you don't have an engaged workforce, they will never own who you are or what you're trying to promote as an organization. If you don’t have that, then you have nothing. You have an organization with a name, but if you don't have ownership, you don't have anything.

M:  Do you have any behaviors that you've started working on or doing differently in the past few years that you feel have had a big impact on your career or personal life?

Donna:  One of the things that I love to do is sit down and talk to new nurses. I enjoy talking with them and picking their brains about what it is that they want to do. I enjoy this because I often learn something, but I try to focus on what interests them the most in nursing. I always leave them with the notion that:

“Whatever your passion is, whether it's pediatrics or emergency room or critical care, find the nursing organization/association that works in that area and join it. It's important that you have like-minded peers. It's also important that if you're going to participate in something, be fully engaged in it. Don't be a warm body sitting at the table because that's a waste of everyone's time. If you're passionate about certain things just do it.”

I'm passionate about the role of home health and hospice in the healthcare continuum going forward and how we prove that value. For example, I'd like to say that one of my legacies, that took 11 years to pursue, was building an inpatient hospice facility because hospice is a passion of mine. It has been my passion since I went to nursing school. Actually, when I was in school for my social work degree, I wrote several papers on hospice when it wasn’t even a covered healthcare benefit at the time. The hospice benefit didn't even come to Maine until 1988, and it started elsewhere in 1983. But I’d say, you just need to find something you're passionate about, and stick with it. I can ping around like anybody, but there are certain things I feel very strongly about.  I think it’s important to help others find that within themselves.

M:  Failure is part of the learning process and you’ve been a testament to showing how asking questions and learning from others is part of that process. Do you have any examples of a time where you experienced a failure or something that didn't go as planned yet learned from it?


Donna: It’s funny that you ask that because I always come back to this one example. It was a big decision that I made by myself and did not listen to other people’s inputs, and I failed. It had to do with one individual.  I'll never forget that lesson because it came back and haunted me, and I will never do that again. Now, I will always ask for opinions and perspectives from my team and other people that I value. I can be talked out of things. I'm not stubborn that way.  You can talk me out of things. I also may have a strong opinion about something, but that doesn't mean you can't talk me out of it or help me understand a new perspective. Another realization I had about myself or lesson I’ve learned is that I don't do well with poor or low performers who don't even try. I will give everybody ample opportunity to succeed. Sometimes I take longer than I should, maybe that’s the social worker in me, I don't know. With that being said, I also set the bar pretty high. I know what the expectations are, and they’re communicated. How you get there is how you get there. You may not get there the way I think you should get there, but if you get it done, it's fine. I can live with that.

M:  You mentioned starting your career during a nursing shortage. You could say we’re in a similar position or trending that way today. What are some of the things you’ve focused on to cultivate growth for new staff as they come into MaineHealth?

Donna:  We've created a pretty strong preceptor program internally, but more broadly in the state of Maine through an organization called the Lunder-Dineen Foundation, we have developed a really nice preceptor training that we send our staff to. This gives our staff the ability to train to be preceptor from a more generic standpoint - What it means to be a preceptor, and the responsibilities that come with it. Then it enables our staff to translate it into their own clinical environment. We've had really good successes with that. Generally speaking, retention is still hard. We are in a nursing crisis in Maine because we are one of the older states for nurses. Currently 92% of all nurses who are licensed in Maine, are working, and they're working the hours they want to work. They're working full time or part-time. So you can only steal from each other, unfortunately. The struggle that we face is: How can we make home health and hospice attractive through autonomy and other benefits that outweigh what a hospital can pay you? We can't compete with their wages, so we have to promote our value in a different way.

M:  You're a big proponent of telehealth and have been for a long time and you mentioned Maine is more at risk of a nursing shortage. How do you envision tackling the nursing shortage if there is a fixed number of people that are coming into the field?

Donna:  I look at it this way - We are not going to have any more care team members, and I think we need to find ways to achieve the same clinical outcomes and keep patient engagement high with fewer touchpoints than we had before. I think COVID has helped us because the word telehealth is becoming more mainstream than it was before. We're fortunate that the telehealth product we use has a really nice video visit capacity. We use it for home health nursing visits. We're starting to use it for orthopedics, which we’ve had push back in the past from surgeons. For orthopedics, you can do a video visit and then follow up and do measurements. We also use telehealth for hospice. With hospice patients, it is not necessary to capture all the biometrics. With hospice, we’ve leverage telehealth for our high-risk patients, patients who are more unstable, who are very remote, or may live on an island. Triage for hospice telehealth is monitored from our hospice house. In this model, a hospice nurse is talking to a hospice patient or a family member, which is done through a video visit. The patient can immediately talk to a triage hospice nurse who can actually talk them through whatever they might need assistance with. When they get off that video visit, the nurse would end it with “Are you okay?” or “I’m on my way”. With hospice telehealth, the patient or family receives immediate gratification regarding their concern. Another focus of our telehealth program is in the population health environment. We do telehealth kiosks in several housing facilities, some of them elderly, some not. We provide them on some islands in their health clinics. These are considered our Connected Care Clinics. We provide a nurse onsite once a month to provide education, collect vital signs, and answer a resident’s questions. Between these clinics, the resident can connect whenever they want and do a video visit or send in their biometric information to our telehealth triage team. Unfortunately, during this public health emergency, we've had to cancel our monthly on site clinics. We will slowly start these clinics during the summer.

M:   As you said, if we're not going to have more bodies, we have to be able to serve patients in a different way. Do you feel like the technology is there to match the demand for what's going to be needed in the future?

Donna:  I think there's a lot of room for improvement. It's funny, I have the opportunity to do a virtual demo day next week, and I was looking at all the companies that they're having present, and nobody's new. We need new blood. We need new thoughts. There is so much technology out there that we haven't looked at clearly because our industry is so focused on the idea that a product has to be sold as a home health or hospice product. But it doesn’t. Maybe it can be modified for home health or hospice, but it's serving a different paradigm of patients at the moment. I think we have so much to learn, and there’s a lot of room and need for progress.

MDo you have any examples of bad recommendations that you typically hear on how to operate a home health and hospice organization that people should consider?

I think an agency can get stuck in a rut when they only see patients that qualify for a payment methodology. In my opinion, that's the wrong place to go. It depends on what your mission is, but I think payers should not drive care. Unfortunately, payment does often drive care. We're 84% government-funded between our hospice and home health programs. So we're highly government funded. But there are questions to address - How do you deal with the homeless population? How is it you deal with population health? Home health has been doing population health through education for years and years. You're not going to improve the health of the population or reduce costs until you do some education. That's a big part of what we do. When we go into a patient's home, not only do we deal with their primary diagnosis, but we look at all parts and pieces of what's going on with them. When you leave them, however many days, weeks later, you've covered all of that. 

One of the things I used include in presentations was a slide of an older gentleman with a huge bowl of ice cream in front of him with all these different flavored ice creams. The point of the slide was when a patient's in the hospital, they're hydrated, they're fed appropriately, they've gotten some rest, they've gotten a little bit of education (9% will be retained) and then they go home. What is the first thing they do? Unless you have somebody going in and teaching them, they could go right back to what they're comfortable with, which is to open their freezer door and see what's in there. One of the things I love about telehealth is that in telehealth the patients get continuous education. They get little snippets every single day to help with behavior modification. That's an old term, but they get reinforcement - what's good for you, what’s not okay. They learn the red flags to look for and how to respond appropriately. Telehealth allows for that, and I think there are other technologies that will enable that as well.

M:  You mentioned COVID a little bit already. Obviously, this has been like a very challenging period. Being the leader of the organization, what kind of mental models or thinking do you use to handle adversity when trying to make decisions during a difficult time?

Donna:  For one, I don't make decisions by myself. With COVID, we instituted an incident command meeting every day. We discuss: What's going on today? Do we have the necessary PPE? Do you have everything you need? What's the patient census looking like? We held this meeting every day, as we ramped up and headed toward the peak of COVID. After several weeks, we found that the environment became more stable. At this point in time, our team discussed the idea of reducing the frequency of these meetings. The answer I got was a resounding “no”. The leadership team found value in the nine o'clock check-in every single day. I think it's important that we have a team (those who are in the field), who feel like they're being supported. We did some management and leadership changes to better support our team members. We've done a lot with education. We did a nice Zoom last week on the subject of resiliency, and we're going to repeat it again. Our staff loved it. We did daily updates for the first 11 weeks, and then we cut it down to three times a week, then twice a week, now we're down to once a week. In this update, we talk about what our numbers are every day, what our staff need to understand, and other important updates. Everything was changing so quickly. Guidelines went from don't wear masks to wear masks. Things just kept going back and forth. Like everyone, we were learning as we go, so we had to communicate that to our staff. Prior to COVID, I have been doing a monthly update so the entire agency knows where we are financially, where we are with our quality scores, what we're working on, and I would end it with an inspirational reading. During this COVID period, I think the biggest hurdle for home health and hospice is really the isolation of people. We encouraged them not to come to the office, we did have to furlough some staff, unfortunately, and we have some working from home. We are how starting to transition back to the office, particularly in the administrative roles, they're having a very hard time with that. But ensuring our staff that we’re here to support them, and leveraging our team to make the best decisions for our organization is how we’ll navigate through this tough period.

M:  Do you have anything else you want to add or that I didn't ask that pops into mind?

Donna:  You know, there's something I wanted to say because I always thought this was funny in regards to leadership. A number of years ago, probably in the mid-2000s, I met this gentleman who was a consultant outside of New Orleans. I was doing a presentation at NAHC, and he was asking about my leadership style. He asked, “How do you foster a collegial leadership team?” And I said, “Through Democracy”. In which he asked for me to elaborate. I shared that everyone on the team has a vote. I don't override that vote. Sometimes, the votes are not my choice, and it's okay. Then he responded, “I've never seen democracy work in leadership.” I simply said, “Well it does if you are consistent with the rules and expectations”.  But I'll never forget that, and it reminds me of something very important to me. It's important that your team members, whatever you call them- senior team, executive team, leadership team- It's important that they understand they have a voice because if they don't understand they have a voice, they don't have ownership.

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