The Special Sauce: Lessons in Leadership Development from the Sojourns Scholar Leadership Program

Introduction

Leadership matters.^1,2 Leadership is an equal measure of inspiration and action. Effective leaders must be able to articulate a brighter future and organize effectively to bring that vision to fruition. Skilled leadership ensures that a group, organization, institution, or system can adapt to change and hold true to core values while pursuing an inspiring vision. In this article, the members of the Advisory Board of the Sojourns Scholar Leadership Program (SSLP) reflect on the key aspects of the program that contributed to its success to help guide future leadership development in our field and beyond and encourage others to develop similar programs.

The first generation of leaders who pioneered the field of palliative care catalyzed advances in clinical services, science, policy, and workforce that have accelerated development of the discipline over the past 25 years. ³ As the field grows, there is an urgent need for new leaders to take us into the future at a time when, despite much success, the field of palliative care still faces many headwinds. Misunderstanding about palliative care remains widespread and health care professionals and the public still conflate palliative care with the end of life. Despite this confusion, demand for palliative care continues to grow and vastly outstrips supply with no simple solutions in sight. ⁴ Growth of palliative care services has been remarkable and yet in many parts of the country and around the world access is uneven or nonexistent. ⁵ Our science and steadily expanding evidence base, while also growing, is still in its adolescence with much more to be learned about how best to care for people with serious illness and their families and caregivers. Innovations in service delivery, education, interprofessional collaboration, policy reform, payment models, and rigorous research are critical for promoting access to high-quality palliative care.^6–12 All of these elements share in common the need for effective leaders.

In our growing discipline, many people from all professions find themselves recruited to leadership positions early in their careers and are stepping into broader leadership roles within their institutions, including as chief medical officers, chief nursing executives, chief academic officers, executive directors, division chiefs, and departments chairs. The growing demand for leaders in our field coupled with the need to prepare people for leadership roles in health care more broadly create an imperative to identify emerging leaders and help develop their skills to ensure the future of palliative care and integrate the values of palliative care across health care more broadly.

Responding to sector needs and a commitment to improve access to palliative care, in 2014 the Cambia Health Foundation (CHF) launched the SSLP to promote, support, grow, and nurture a new generation of leaders in palliative care who could take the field into the future. Scholars received grant support of $90,000 per year for two years, and their supervisor (e.g., director, chief, chair, dean, chief executive officers) had to commit to protecting 50% of their effort for two years to ensure sufficient time to complete their project and leadership development plan.

After recruiting 10 annual cohorts of 10–12 scholars, 108 people from across palliative care disciplines became Sojourns Scholars. The CHF completed a comprehensive evaluation of the program with input from scholars, advisory board members, and leaders in the field to highlight accomplishments of the scholars and evaluate the initiative (available on the CHF website). ¹³ In addition, as the SSLP winds down over the next four years, we wanted to reflect on the key factors that were essential to the success of the program, defined as scholars completing projects that impact the field, advancing in their career, and assuming greater leadership roles. While there are many components to the SSLP that align with best practices in leadership development programs as documented in the final report,^13–16 here we share what we and our scholars have identified as the three most important aspects of the SSLP program—the “secret sauce”—that were the keys to success and could help guide future initiatives in palliative care leadership development.

Recruit Great People

First among all the factors for success is recruiting great people. This idea may be so obvious as to beg explanation yet is critical for success and, therefore, essential to highlight. The goal of the SSLP was to identify emerging leaders: people who, if given the time, opportunity, and intentional support, would seize it to grow into outstanding leaders. The SSLP sought people with commitment, vision, communication skills, and a desire to lead. While there were no explicit criteria regarding exactly when in a career someone would qualify to join the SSLP, in general we sought people early in their careers yet with sufficient experience to be able to move into leadership roles.

The application, designed to identify these emerging leaders, had four core components. First, we asked candidates to propose a project that would serve as a platform for leadership development and improve palliative care. We realized that leadership is in service to a vision and a project provided an important opportunity for applicants to describe an inspiring vision and take action to get it done. Second, we had the candidate articulate their interest in and commitment to palliative care and their approach to leadership. Asking applicants to describe their investment in the field and understanding and style of leadership helped assess their potential as leaders in palliative care. Third, we asked candidates to describe a leadership development plan through which they would acquire additional skills. Through this process applicants could demonstrate self-reflection and insight, both key attributes of effective leaders, about their current skills and those they want to learn to grow as leaders. Finally, following review of the written application, we invited a group of candidates to interview with the Advisory Board, consisting of recognized, senior leaders in the field (described in greater detail below). The interview offered applicants an opportunity to provide additional details about their project, expand on their commitment to palliative care, and share personal stories.

The Advisory Board played a key role in recruiting applicants by reaching out to individuals to ensure breadth in geographic, institutional, and health professional distribution. Although the SSLP started with traditionally narrow criteria of applicants—nurses and physicians—after a few years we realized that leaders, especially in palliative care, can and do come from any discipline in health care. Expansion to all disciplines, including social work, chaplaincy, communications, health services research, pharmacy, psychology, and health care administration, ensured that we could draw from and support the broadest set of emerging leaders and made an important statement about who is a leader. We worked to create cohorts with representation across disciplines, institutions, and project types, though the main focus was always on the potential of the individual to grow into a national leader. We also sought to create the conditions for interprofessional leadership, support, and growth. This approach flattened some of the traditional hierarchy in health care and allowed for expanded growth for all members of the community.

Importantly, foundation staff provided support to applicants at every step in the process to increase their chances of success, including meeting with those who were not selected to provide feedback, encourage resubmission, or provide further encouragement. It is rare to receive such detailed, personalized feedback on an unsuccessful application, and this approach reflected a commitment to the individuals applying and our belief in their ability to succeed. In each year there were more highly qualified candidates that we could accept, and many people reapplied and succeeded on subsequent applications.

Provide Strong Program Leadership and Mentorship

As a leadership development program, SSLP sought out well-respected leaders to serve on the Advisory Board. The Advisory Board members provided vision and strategic direction as well as visibility for the program to the field at large. Working in close collaboration with CHF leadership and staff, the advisory board developed the criteria and selection process for scholars, reviewed applications and interviewed applicants, provided leadership and support during an annual two-and-a-half-day summit, served as role models of leadership in various settings, and provided mentorship to the scholars.

Mentorship by the advisory board was an especially important aspect of the program. Each scholar was assigned an advisory board mentor with whom they met frequently during the two years they were funded by the program and as needed and desired thereafter. Mentorship matches were intentional and often cross-disciplinary. The opportunity to meet with a senior leader in the field who is not at your institution offered support and insights that can be difficult for early-career professionals to find. The investment of time and interest by a senior leader was another way of demonstrating our belief in the scholars’ potential as leaders. In addition to meeting with the mentor to which they were assigned, scholars could reach out to any advisory board member for guidance and mentorship. As the program matured, many scholars became peer mentors to each other and to those in more recent cohorts. The commitment to mentorship as a vital part of leadership was woven into the SSLP.

In addition to the advisory board, the foundation personnel consisting of the CHF president and staff provided consistent, highly supportive leadership to the program. SSLP staff guided applicants through the process, gave detailed feedback on applications that were not successful at every stage of the process, and provided ongoing support to scholars during and after their funding period. The deep engagement of the CHF President in every aspect of the program elevated the prestige and visibility of the program and reflected its importance and the commitment of the CHF. In addition, SSLP staff were extremely responsive and available with the aim of helping every scholar succeed. Throughout the program, the goal of leadership of the SSLP at every level has been to model the type of kind, generous, visionary, service-oriented leadership we hoped others would emulate, centered on people and their success.

Create and Sustain a Supportive, Engaged Community

The most important ingredient in the secret sauce of the SSLP was the community of scholars, program staff, and mentors. We recruited 10 cohorts of up to 12 people, culminating in a community of 108. Ten to twelve scholars per cohort created a strong sense of community and belonging within each cohort and contributed to a robust, engaged, diverse, and highly functional and effective community. Among the most important factors of success of the SSLP is the connection between scholars committed to palliative care within and across cohorts and the community as a whole. The cohorts provided support and peer mentorship within their groups that continues in and outside the program. The interprofessional nature of the community further enhanced the collaborations and connections. An annual, in-person summit, converted to a virtual meeting for two years during the Covid pandemic, provided formal and informal opportunities to meet, mingle, learn, and connect. During the pandemic, frequent video meetings provided support during a highly stressful and uncertain time. The annual growth of the community added richness and depth and breadth of interests, geography, discipline, expertise, and projects. Importantly, we adopted the approach that once a part of the SSLP, scholars were always part of the community. All scholars were included in SSLP activities, invited to attend the annual summit for free, and participated as members of an online community for sharing opportunities, celebrating successes, and comforting grief. Each year between 74 and 83 scholars attend the two-and-a-half-day summit, reflecting the importance and value it provides. The members of the SSLP community care for each other across space and over time and report gaining tremendous meaning from being a part of this community.

As the community matured, scholars played a greater role in directing the activities of the SSLP, including the development of special interest groups and the design and content of the annual summits. Scholar engagement ensured that the program was meeting their evolving needs. In our tenth year, after selecting the final cohort of scholars, the community helped set the strategic direction advocating strongly and successfully to continue some aspects of the program for an additional five years in recognition of the tremendous value of this supportive community, especially for the more recently selected scholars. Scholars from early cohorts now serve in larger leadership roles across health care organizations, act as mentors to other scholars, and one scholar joined the advisory board. In surveys, scholars identify the community consisting of other scholars, the advisory board, and CHF staff as the single most important, meaningful, and helpful aspect of the program.

Looking Forward

Leadership is essential for advancing a cause, field, institution, or group and for making positive change in the world. Good leaders stand up, lean in, envision the future, and inspire people to act to bring the vision to fruition. They care first and foremost for the people they lead and commit to the vision they hope to achieve. Palliative care has been fortunate to have outstanding leaders with the vision to establish and grow a new field. As palliative care expands so does the need for leaders. Because our field recognizes and values the key roles of many disciplines across health care, we know that leaders come from all disciplines. We also know that leadership is learnable, built on a foundation of our native skills, and that each successful leader has a unique style and approach. We grow as leaders by modeling the characteristics we admire in others, rejecting those approaches we want to avoid, studying leadership, engaging with mentors and coaches, and most importantly, by leading. In the absence of and in addition to specific leadership development programs like SSLP, aspiring leaders can engage in leadership training programs offered by many institutions and professional societies and with leadership focused courses, coaching, and books. For those who want to lead, there is no substitute for stepping up and leading. The experience of leading is essential and is enhanced when coupled with guidance from senior and peer mentors and coaches. Leadership is a sacred responsibility to those we lead and the causes we champion to act with integrity, courage, and kindness and to serve others.

Conclusion

The CHF recognized the need for a new generation of leaders in palliative care and established the SSLP to develop, promote, and support them. After 10 years of recruiting scholars the program is in its closing stage. We found three key ingredients in the “secret sauce” that contributed to the success of the SSLP that we share in the hope that future leadership development programs in our field, in health care, and in any field can learn from the work we have done to achieve even greater success. ⁶ First and foremost, success depends on recruiting great people. One essential lesson we learned was the value in recruiting from all disciplines and among all stakeholders in the field. Second, a program must provide strong leadership and mentorship that models the approach, behaviors, and values you hope that future leaders will embrace. A key lesson is to treat people as you want them to treat others. Finally, and most importantly, success depends on building a community that is inclusive, welcoming, respectful, engaged, and empowered. Recruiting cohorts of 10–12 people ensured critical mass within and across cohorts and the program and seemed like the right size. For SSLP, the motto is “once a scholar, always a scholar” and the invitation to participate after the two years of funding ended, was an important commitment that sustained the community and allowed it to mature. Allocating the funding to make that level of ongoing participation possible was a vital part of the program. Margaret Mead is credited with the wisdom, “Never doubt that a small group of people can change the world. In fact, it’s the only thing that ever has.” The community of the SSLP—scholars, CHF staff, and advisory board—is the ultimate ingredient in the secret sauce that has helped to develop some of the leaders who are stepping up to bring our field and the care of people with serious illness into the future. We offer these insights from the SSLP to model future leadership development programs. We encourage other organizations including foundations, professional societies, and health care institutions committed to improving the care of people with serious illness to invest in the development of leaders in palliative care and health care more broadly to ensure that every person can live as well as possible for as long as possible.