Servant Leadership in Palliative Care

by Beth Fahlberg PhD, RN, CHPN and Robert Toomey, EdD, MA

Leaders are needed in palliative care who can provide the direction for current and future development. We recently wrote an article on Servant Leadership as a model for emerging Nurse leaders, which got us thinking about how Servant Leadership is a model that is also fitting for palliative care. There are many different models of leadership, yet the Servant Leadership model is particularly appropriate for palliative care.

Characteristics of servant leaders include: the ability to listen, empathy, healing, stewardship, commitment to the growth of others, and being skilled at building community.(1,2)

We recognize these characteristics in ourselves, and in the leaders who have shaped the field of Palliative Care. And while great strides have been made in advancing palliative care, as the IOM report states, there is much more work to be done “to achieve compassionate, affordable, sustainable, and effective care for all Americans”.(3)

These recommendations will not become reality without a concerted effort around palliative care leadership development. As stated in the ELNEC curriculum, “transformational leadership is critical to the development and innovation of palliative care.”(4)

Leadership is something that can be learned. It requires time, attention and mentorship. It is best developed when we have a conceptual model to guide us, such as Servant Leadership.

What is Servant Leadership?

Servant Leadership is a specific leadership philosophy and practice that, in short, is about serving first, then out of a serving approach, choosing to lead. Robert Greenleaf, former AT&T executive, coined the phrase ‘Servant Leadership’ in 1970 although this type of leadership has been around much longer than that.5 Some servant-leaders are people who are not well-known (can you think of quiet servant-leaders around you?). However, there are many other well-known servant-leaders. These include Jesus, Abraham Lincoln, Gandhi, Mother Teresa, Eleanor Roosevelt, Nelson Mandela and the Dalai Lama.

In palliative care, we see leaders emerging as they step up to meet needs. Soon, others follow and they find themselves in both formal and informal leadership positions. Rather than leading for power or recognition, they are leading to make a difference, so that those who are most vulnerable will get the care and support that is needed. This is Servant Leadership.

The study and practice of Servant Leadership is particularly well-suited to those who are emerging as new leaders, as the Servant Leadership Model provides a framework for their leadership development. At the same time, it can help those who have been leaders to become more effective and relevant. Greenleaf who described the ‘best test’ of Servant Leadership in the following way:

• ‘Do those served grow as persons?
• Do they, while being served, become healthier, wiser, freer, more autonomous, more likely themselves to become servants?
• And, what is the effect on the least privileged in society?’ (Greenleaf 1970/1977, emphasis original)

This approach to leadership is consistent with palliative care philosophies and practices, in which we become “healthier, wiser and freer” was we learn to connect with, respect and care for diverse individuals and families, often when they are more vulnerable than ever before.

We should encourage and nurture that desire to serve, and find ways to connect these new leaders with the mentors, resources and support to foster their growth. It is particularly important to help them when it gets tough, as the palliative care landscape is fraught with the potential for controversy, ethical dilemmas, moral distress and compassion fatigue. In addition, those skilled in palliative care often find themselves advocating in challenging situations involving their own families and friends. In light of these threats to palliative care leadership, emerging leaders need to be supported as they learn to respond to these challenges constructively, professionally and ethically, while caring for and receiving care for their own needs.

Each one of us can lead in our own spheres of influence, using our expertise, talents, resources and networks. Our growth and potential as leaders will be more effective if we:

1. Recognize what we do as leadership
2. Are mindful and reflective as we lead
3. Thoughtfully study leaders around us
4. Connect with effective leaders who can mentor us
5. Mentor emerging leaders, encouraging them to then mentor others

Applying Servant Leadership

Here are 5 ways to intentionally integrate Servant Leadership into your own work in palliative care: (1,6)

1. Develop and communicate your vision for palliative care, to inspire, motivate and engage others.
2. Listen and learn from those you are leading, so that you can address their needs, values and priorities, just as we do with patients and their families.
3. Invest in others’ growth and development
4. Give your power to others, but continue to have their backs.
5. Cultivate community through strategic relationships, collaboration, hard work and celebration.

As we have described in this article, we believe that Servant Leadership can help new, emerging and even established leaders in the field become more effective, relevant leaders, as they strive to implement the IOM recommendations to promote quality care for patients and families everywhere.

We welcome your thoughts about this in the upcoming #HPM tweetchat on Wednesday October 12, when we will discuss the following questions:

T1. What leadership models and practices have been used in palliative care? What has worked? What has backfired, and how?

T2. What does “serve” mean to you in the context of palliative care? Who do you serve and how? Can you think of an example when your serving turned into leading?

T3. Can you relate to the Servant leadership characteristics and practices? Do you think that this is already being implemented in palliative care? Where could this be implemented more effectively?

T4. Do you think Servant Leadership can be helpful in promoting palliative care leadership development?

References

1. Fahlberg BB, Toomey R. Servant leadership : A model for emerging nurse leaders. Nurs 2016. 2016:49-52.
2. Spears LC. Practicing servant-leadership. Lead to Lead. 2004;2004(34):7-12. doi:10.1002/ltl.94.
3. Institute of Medicine. Dying in America Improving Quality and Honoring Individual Preferences Near the End of Life.; 2014. http://www.iom.edu/Reports/2014/Dying-In-America-Improving-Quality-and-Honoring-Individual-Preferences-Near-the-End-of-Life.aspx.
4. End of Life Nursing Education Consortium. Advancing Leadership in Palliative Care Nursing. 2015.
5. Greenleaf RK. SERVANT LEADERSHIP – A JOURNEY INTO THE NATURE OF LEGITIMATE POWER AND GREATNESS. New York: Paulist Press; 2002.
6. Boone LW, Makhani S. Five necessary attitudes of a servant leader. Rev Bus. 2013:83-97. http://www.stjohns.edu/sites/default/files/documents/Tobin/vol33-num1-winter_2012-2013.pdf#page=85.

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Beth Fahlberg PhD, RN, CHPN, @bethfahlberg, is the program director for Palliative Care @ UW-Madison Continuing Studies, developing and teaching innovative primary palliative care education for healthcare professionals and Her healthcare expertise includes aging and chronic, advanced, and serious illness, with a specific focus on heart failure palliative care. She has used the servant leadership model for over 20 years to guide her own leadership development, and incorporates it in her palliative care continuing education programs.

Robert Toomey, EdD; MA (Servant Leadership), @sunsetweet, directs programs in leadership and management at the University of Wisconsin-Madison, Division of Continuing Studies. He created and directs the Servant Leadership Certificate, a 5-day noncredit professional development program. His doctoral dissertation was about leadership, leader development, and learning environments. Robert and Beth will be collaborating in Spring 2017 to develop and teach a new blended learning continuing education course called Applied Servant Leadership in Nursing and Healthcare. Facebook page: https://www.facebook.com/UWMadCSLMW.