John Mastrojohn on Enhancing End-of-Life Care

Marshall King: [00:00:00] Welcome to the Inspiring Good Podcast. This podcast is brought to you by the Community Foundation of Elkhart County, which serves a vibrant community in northern Indiana, known for its generosity and strong network of nonprofit organizations. I'm Marshall King, your co-host with Kevin Deary, a veteran nonprofit, CEO, who now coaches others.
Our guest today is John, Mastrojohn. Who serves as the President and CEO of Center for Hospice Care, leading the organization's mission to provide compassionate end of life care across Indiana previously had roles at Hospice of the Western Reserve and the National Hospice and Palliative Care Organization.
John, we're delighted to have you here. Welcome.
Kevin Deary: Thank you, Marshall. John, so good to have you here. You and I have gotten to know each other over the last year. I retired and you came, you moved in and took this job, and you came from, I believe, Washington, DC Yeah, actually most [00:01:00] recently from Cleveland, Ohio.
Cleveland. But you had worked at DC Correct. So tell me about why you chose to come here for hospital. Sorry for hospice care. Tell me how. 
John Mastrojohn: So I actually got to know the Center for Hospice Care when I was in Washington DC I worked for the National Hospice and Palliative Care Organization, and that's how I got to know the organization.
So had an opportunity to meet the previous CEO and also some of the leadership team members that, that work for Center for Hospice Care. So the organization was known to me. I had . Absolutely no plan on moving to Northern Indiana. But when the opportunity came and the more I talked to the board and talked to the search committee I knew this was the right decision and the right fit for me.
What drew you to palliative care? I'm a nurse by background and I worked, the first part of my career was in emergency services, quite honestly, another place where I thought I'd be the rest of my life, and it was through a graduate. At my graduate degree is in nursing. My . One, [00:02:00] one graduate degree in nursing.
And it was through that program that I was exposed to hospice care during a clinical rotation. And we were, the clinical rotation was a group of people nurses and others that were caring for dying AIDS patients and. Through that experience, I got to witness hospice care and it literally changed my life.
I love the care delivery that they were, the model that they were using the compassionate care that they were providing for the patient and to also the care that they were providing to the family members and . Again I saw that model and I've never looked back. I think it's absolutely the way to, to care for people at the end of life.
Kevin Deary: So specifically hospice versus palliative care. Can you, for those who don't really know, can you talk about the difference? 
John Mastrojohn: Sure. And I appreciate you asking because there's a lot of confusion between hospice and palliative care. Hospice is a form of palliative care. So palliative care is comfort oriented care.
And [00:03:00] the difference between hospice and palliative care is hospice is that form of palliative care that's specifically for people, for individuals that have approximately six months or less to live. That's how we define hospice care in the United States. In palliative care, you can receive comfort oriented care alongside of curative therapy and hospice care is comfort oriented only.
And again, there's that six months or less approximately that a patient will have to live. And that's based on a physician's prognostication. 
Kevin Deary: So you've had both clinical experience and now you have executive leadership. Yeah. Have you seen some parallels between the clinical care and the executive leadership?
One, you're working with a patient and a family. I. In other. Now on the executive side, you're working on the funding side, the, you're working out the insurances you're still working with family, but you're also working for, and hiring so many people into the organization. Can you talk about the executive leadership.[00:04:00]
John Mastrojohn: Sure. I think there are some parallels between the clinical care and also in leadership. For me, one of the things that I think is important in my role is that I did have that clinical background. Now that said, I've worked with a lot of hospice CEOs that don't have any clinical background and they're excellent at what they do for me.
The clinical background has been extremely helpful in understanding exactly what the clinicians experience, what it means to go out on call at three o'clock in the morning for a death visit or another type of visit to see someone. I think that gives me a little bit of street cred, if you will, with some of the clinical team members.
And it's also really helps me to understand really what they're experiencing in their day-to-day lives. 
Kevin Deary: So what have you seen coming here to Northern Indiana? And I think you have a pretty good size outreach too. You're in multiple counties. Can you talk a little bit about the. Regionally how many, how far out you go?
Sure. 
John Mastrojohn: Yeah. Center for [00:05:00] Hospice Care serves nine counties in Northern Indiana. So it's a fairly large geographic, area that we serve. Majority of our patients, of course, are in those areas that have a higher population. So we see more patients in St. Joseph County, Elkhart County but also in those contiguous counties surrounding and the
The thing that I think is important to understand too, and you asked the question about palliative care. We provide hospice services, but we also provide palliative care services, and we do that in a couple of different ways. We have an outpatient clinic where we provide palliative services. So just like any other clinic people come, they make an appointment, they see somebody there, typically a nurse practitioner.
We also have a community-based palliative care program that we call Kaleidoscope. And our staff members go out and they'll see those patients in the community like our hospice staff would 
Kevin Deary: in their homes or their in 
John Mastrojohn: their homes. They could be in a nursing facility, but [00:06:00] most of them are. Are in their own homes.
Kevin Deary: So you really are across the spectrum then on the community. Absolutely. From individual homes all the way to nursing homes, hospitals, palliative care, you're there. Correct. And you have your own facilities? 
John Mastrojohn: We do. We have two inpatient units. One is in Mishawaka and that is our bracker Bracken house.
And then we also have Esther's house, which is in Elkhart County. So those are our two inpatient units. 
Kevin Deary: How do people find out? About hospice and palliative care? Is it something that comes from their doctor once they are diagnosed? 
John Mastrojohn: It can, and most typically, Kevin, that's how it happens. Referrals made through a physician, but referrals can come from anyone.
So we have neighbors that will call and say, I'm really concerned about Mrs. Smith who lives next door. She seems to be declining. And those are some of the things that, I'm concerned about with her. They might give us some specific examples but the hospice team will always call [00:07:00] and speak to that individual's physician, get that referral from the physician, and then that gives us permission to go out and see the patient.
Of course, as long as they agree to it as well. 
Marshall King: John you're dealing with patients and families at incredibly tender times. You also have this national perspective, I think from working with the national organization. What are some of the hallmarks of outstanding hospice or palliative care that I.
That folks could, should look for as they're looking for what's being offered. It depends a little bit on the healthcare provider, who they work with sometimes, but what should somebody look for that signals that they're gonna be well cared for? That's 
John Mastrojohn: an excellent question, and I think it's a question that we get asked frequently.
What's, what differentiates a hospice, a good hospice from another hospice provider? And we know that. Quality of care right? Is really at the top of the list. And we ask people to take a look at the star ratings [00:08:00] for hospices. So there's, a variety of ways that they can do that. It's easy, honestly, the easiest ways to Google that, right?
And be able to see what the star ratings are. Find out. Most hospices in the United States are a. Four as a rating of four out of five. There are ways though to be able to then look online for comments that people might make about that hospice program. And of course, I think one of the most reliable ways is word of mouth and ask people if they've had experiences with a hospice program.
And that reputation, of course, goes a long way. 
Kevin Deary: And I have a scene where . People have adjusted their wills or to have memorials go to hospice just based on their experience with one employee. . Who was closest to them. And you, and I've just been totally blown away by the power of the relationship at the patient level.
Can you talk a little bit about the training and what kind of person do you look for? 
John Mastrojohn: One of the things that is absolutely a hallmark for hospice and palliative care [00:09:00] is compassion. So we're always looking for that compassionate caregiver, whether it's a nurse, social worker, or other member of the interdisciplinary team, I.
We often feel we hire for personality. We'll teach whatever we need to teach, right? Whatever those gaps are in knowledge, whether it's related to pain management, symptom control, understanding community resources, all those things are very teachable. What's not, of course, is that individual's compassion.
Really we talk about the people that have the heart for hospice care. Those are the folks that we're interested in hiring, and that's who we're looking for. 
Kevin Deary: And as I've gotten to know you, John, I've learned so much about hospice and palliative care and the amount of time it goes in to wrap your arms around the family.
The spouse, the children, the grandchildren. Can you talk a little bit about how palliative care in hospice embraces the, not only the patient, but the whole family? Sure. 
John Mastrojohn: And that is a hallmark really, of hospice care, is that. [00:10:00] We view the patient and the family as our unit of care. So I think we are, we're used to thinking about a hospital where our patient is that patient in room 3 0 1 a, right?
And that's how you think about care In hospice, we say no is it, is the patient and their family. We also say that family is how the patient defines family. So it is a very broad approach to how we do that. And we know that this experience of this individual dying has an impact on whoever those folks are that, that patient is referring to as their family.
So we see a patient, of course, we're looking at ways that we can help them and provide comfort. Could be through medication or other interventions. We're also looking at family members to say what are their needs? Are they tired? One of the things that's part of the Medicare hospice benefit is a respite benefit.
So if a family says, I've been caring for dad for, four months, [00:11:00] I'm exhausted, we can bring that patient into our inpatient facility and we can provide that respite care for them. 
Marshall King: John, I think one of the misconceptions about hospice is that . The end is imminent. You're a day or two away from dying or something like that.
I know just because of some family who work in healthcare that's not, that's a bit of a myth. . Talk about, tell us about that. Like I, what's the length of time that you think of when you think of hospice and palliative care? 
John Mastrojohn: It's a really good question, Marshall, because I think that is something that is so misunderstood.
Is that people, many people believe that someone needs to be imminently dying before they're ready for hospice. And again, we go back to the definition, which is a US definition that a person has approximately six months or less to live if the disease runs its normal course. Now we know that.
Determining how long somebody is going to live this science known as, prognostication. It's [00:12:00] very difficult to do. It is an inact, inexact science at best. So people say, it is a big of a guessing game, but there are things that we know that are really helpful to help us determine, exactly what that is.
But unfortunately, we often see patients for . Just days and sometimes hours before they die. What our responsibility is as a hospice provider is to help community members, physicians, and other healthcare professionals to understand hospice really isn't about brink of death care, but really helps patients much if we can get them sooner, right?
It helps. It helps us to. Control, pain or symptoms for a patient, and it helps us to implement some interventions for family members that can also be helpful. So we're always looking at ways that we can do that. I will tell you the average length of stay across the US is less than 30 days. And so that's a challenge.
And sometimes, like I said, it's hours. We measure [00:13:00] the time that we have a patient, not even days. 
Kevin Deary: What happens if there's not an open bed available? 
John Mastrojohn: So most of our patients are in their own home or another place of residence. So we have the inpatient units again, we have one in Elkhart, we have one in Mishawaka, but the majority of patients are in their own homes.
So we say for us, we're never too full because we can always, be able to provide staff to go to an individual's home. So that's helpful. 
Kevin Deary: How have you addressed the staffing levels? I know coming off of covid, the great resignation, just finding quality people to work is hard enough.
But to find people who have this tremendous amount of empathy and compassion how are you doing on staffing levels and what are you doing for to sustainability? 
John Mastrojohn: I will tell you, we are so fortunate. Covid was a challenge, not just center for hospice care, but every healthcare provider right across the country.
What we have witnessed [00:14:00] at Center for Hospice Care is that we did have several people that left during a period of time, and we know a lot of people left during covid, nurses, other healthcare professionals. We've been very fortunate that we've had a lot of those people come back. In fact, we . I was just informed.
We have a, an orientation on Monday. We have five new hires that are starting on Monday. Three of those are returning employees, so we're starting to see that happen, which is really helpful for us. We have not been challenged like some other organizations have, and we're very grateful for that. I will tell you, I think a big part of that is the culture of the organization and the fact that
We really do care about staff and we feel that we have to be compassionate leaders in order for our staff to deliver compassionate care.
Kevin Deary: How do you help your direct providers keep balanced? 
John Mastrojohn: It's a challenge. We provide resources for them, [00:15:00] right? So it's helpful for them, I think, to be able to talk to one another.
They rely on each other to do that. The supervisors can be very helpful, but I think the majority of them really find that support through other members of the interdisciplinary team. I worked for another hospice program years ago. We actually provided somebody to come in and provide that support. It was, she was a trained counselor and she was lovely and everybody really enjoyed her, but they said, we don't really need that because we need to rely on other team members.
They're the people who really understand. And I think that's where most staff get their support. 
Kevin Deary: Yeah, I think any frontline . Whether it's nursing, police, military, anybody who social workers that are in the field there is this bond that only somebody else who has gone through this can understand.
And you can lean on them and it probably helps them because in many times your family doesn't really understand true. Your friends don't [00:16:00] understand how could you do this job right? When actually how could you not? . So I, everyone I've come across, including yourself with hospice, I've just been very impressed with those grief counselors, those people who are providing frontline support and to know that they have families and sometimes children and.
They've got lives that they have to live. And but this is so much more than just a paycheck. This is a calling. I've not met anybody who has not worked in hospice or cancer wards who did not feel cancer. That's probably showing my age by saying the word ward, but cancer areas is because of being driven to it.
And I just think that is such a gift. . I would agree a little bit about executive leadership. Part of our inspiring Good podcast is taking the very best of some of the great leaders we have around here, including yourself. So glad you're here. Be [00:17:00] able to pass on to the next level of leadership that's coming at best practices.
And one of the things in executive leadership, especially in the nonprofit world, we get the privilege of working for a board and with a board. Can you talk a little bit about your experience of coming in and working with a board and also working for the board? 
John Mastrojohn: Sure. First of all, thank you for your nice words.
I will say, for me, I've been in leadership roles for quite a long time. This is my first . Job as CEO. So working with the board was new for me and it's been something that, I feel like I'm learning every day learning how to work with that board. But I think so much of what we do with staff, especially senior staff and others.
Is that creating that relationship and the open and honest communication? I feel the same thing is true for board relationships and really working with that board, being open, being [00:18:00] honest building that trust has been incredibly helpful for me. And really establishing, relationship with the board chair in particular I think is really helpful.
Having frequent communication. Helps. But I know it is something I continually am learning. But I think it is again, very similar to any kind of relationship is building trust. 
Kevin Deary: When you look at the skill sets that go into the role of as A CEO, having been now a retired CEO for a few years, and having done it for 30 years, we all have job descriptions.
We know what our job description says. What does it not say? 
John Mastrojohn: How long is this podcast? So I, I think there are a lot of things right, that it doesn't say, but most of it is around relationships and relationship building. I think that's what it comes down to so often, right? Or all of those things that you have to do.
You can't, one person can't do it all, so you really have to count on [00:19:00] those people that are around you. And I think that was something that I struggled with throughout . My career is trying to figure out, because I always thought I had to do it myself. Everything I had to do myself, and as I've grown and matured and I really discovered that it is through other people, that we're able to get things done. And the only way to do that is to develop those solid relationships. 
Kevin Deary: And I call that managing to the level of my incompetency. . Which I'm really good at. 
John Mastrojohn: Yeah. Put people around you 
Kevin Deary: that are better than you at something. 
We have our gifts, but we also have our areas of development.
We're always going to have those . But people around you who are gonna augment that. So you don't feel like you have to be everything to everybody. That's right. When you've been at the national level. , now you're at the local level. What are the similarities and differences between the national level and the local level?
John Mastrojohn: I think there, there are definitely similarities. One of the things that I think I learned at the national level was I had this perspective, [00:20:00] this national perspective, where I could see a lot of different hospice palliative care programs across the country. In fact, across the world, and. That experience was so incredibly helpful for me because you get to see the best of the best and the worst of the worst.
And I felt like I've learned from so many of them and I've been able to take a piece of something here, a piece of something else over here and be able to put some of those things together. That's been very helpful for me. A little hard. To make that transition from a membership organization, which is the organization I worked for in Washington DC to an organization that provides direct care.
But all of those experiences that I brought along with me, and especially meeting some of the most amazing CEOs in the country that has not only helped me build my knowledge base, but they continue to inspire me every day. 
Kevin Deary: And then you inspire those around you. 
John Mastrojohn: I 
Kevin Deary: hope so, because that's our job, right?
We [00:21:00] find that the CEO tends to be the fueling station for board members, for donors, for staff, for volunteers constantly fueling who fuels you. 
John Mastrojohn: It's interesting you say that because I reflect that right back to the people that you just mentioned, right? Like I feel I get filled up every day.
I. When I talked to staff in the organization we had a meeting yesterday with a patient's family and . They had some concerns about the care. We said let's talk about those concerns, because we really view all of those concerns and an opportunity to meet with somebody as a gift to help us to improve care.
And I think 20 years ago, I would've dreaded sitting down at that meeting. I. It was just the opposite yesterday. Again, I just, I looked at this as an opportunity to say, how can we learn from you? And that filled me up because I felt like I was taking something away from that meeting that I could now make improvements [00:22:00] for care for other people.
Especially 
Kevin Deary: when you, yourself as a CEO, it, it brings joy to my heart to hear a CEO say I got with the family as well. And not just sent to vice president or director, but I wanted to be at the table as part of the solution to hear right on how we could get better. I love when I hear that from a leader.
They want to, it's constantly getting better. It's quality assurance. What did we learn from this? How do you share that across your organization? Say you learn from one division or one situation, and how do you share that? 
John Mastrojohn: We do that through so one of the people just to stay on this example, I asked our director of nursing to participate in this conversation yesterday with the family, I thought, felt it was important and certainly she could answer questions for them and respond to some of their concerns differently than I could.
And, but I think when we learn from situations like that, that we take that back to the full leadership team and [00:23:00] we share some of that information with them so that we can all learn from these situations. We met, we meet as a leadership team once a week. We meet for a couple of hours and we talk about these things.
And I always say that's the two most important hours of my week is sitting with that team, having these kinds of conversations so we can all learn. 
Kevin Deary: I used to call that keeping the fingers on the pulse of the mission. Yes. 
And a CEO who doesn't keep their fingers on the pulse loses track real quick.
. And you're probably gonna have a significant issue down the road. As A-C-E-O-I found our times spent in people planning and processes. Or just constantly, right? People planning and processes. Just when the people thing seems to be working well and our team is doing great, we're busy planning, and then there's processes, right?
Things that we learn, things that we have to adjust, and then just constantly going back before between those and all of those are, can be very internal, but how do you push yourself externally out? [00:24:00] How do you get yourself out of the office and get yourself in a situation where you're an ambassador for the organization and then also making those other important connections and partnerships?
John Mastrojohn: Sure. I think it's critical, for CEOs to be able to do that. It's been a little bit of a push for me having come in about a year and a half ago. I've been very internally focused. Looking at the organization ways that we can really develop our strategy, looking at ways that we can improve our operations.
And it's an interesting question as it relates to timing, Kevin, because I think that's something for me now where I am pushing myself out more, being able to do that because I think it's important for any . Nonprofit organization for the CEO to be in the community, meeting with other community leaders, making those connections and hopefully building those relationships and
Collaborating on some projects. For example, we have one, I can't really talk about it just yet, but something that [00:25:00] we're excited about because we're, I'm talking to, we are talking to other community leaders of different ways that we can collaborate and work together. And that I think is the importance of really putting yourself out there.
You don't wanna announce it today on our I wish I could. Very good podcast. 
Kevin Deary: I wish I could. Next time. I understand next time. If you are looking at . Young professionals who want to be CEOs, what advice would you give them? 
John Mastrojohn: I think for somebody young it's important to say . You need to do the hard work, right?
You need to really just get in. You need to roll up your sleeves. You need to understand, so if we just use the hospice example, right? How does the organization work? How does an organization work? What does that look like at ? All different levels of an organization. And I think for anybody who was going to be able to do run again, any organization, but in a hospice program, you need to understand the full functioning of that.
And also to talk to people, talk to patients, talk to [00:26:00] families, right? To talk to people who've had those kinds of experiences so that you can really learn it from the bottom up. 
Kevin Deary: So I'm gonna leapfrog on the external and now we're gonna move into vision. So what's your vision? For the organization down the road.
John Mastrojohn: So we're looking at how we really are positioning ourselves to be the premier provider in the community. That's important for us. We feel that we stay very focused on our mission, right? We talk about we're hyperfocused on our mission, which is important for us, but we say the . The thing that differentiates us in the community, the market differentiator that we want to focus on more than anything is quality.
So that's important for us to think about quality. We are a four star hospice program and we are . In the process of what we're calling right now is our journey to Five star. What does that look like? And how do we create that five [00:27:00] star organization? And that's helpful for us to keep focused on a clinical perspective on how we do that, because that's how we're rated.
But that's not the. Only thing that we're focused on because we wanna be a five star hospice in every area of our organization, so we want to think about that and we continue to do that and we're driving that forward. Also thinking about how can we better serve. Patients and families in the community, and we look at our population of patients as anybody with serious advanced illness, then that's really who we're here to serve.
So what are things that people need? Can we talk to people in the community and find out what those needs are? That's in fact what we did with our Kaleidoscope program, which we started in June of last year, because we knew there was a gap. In services. So we're looking at ways that we can fill that gap.
So we continue to do that, but really our goal is to be able to provide those services that people need and do it in a way that makes the most sense for them. 
Kevin Deary: [00:28:00] I often explain my time working with youth for 40 years. . And 30 as CEO, as I was merely a gatekeeper, uhhuh for a season. But honestly, we will leave a fingerprint.
And what's your fingerprint gonna be? 
John Mastrojohn: I hope for our fingerprint, for Center for Hospice Care, right? Is that, that people look at the work that we've done and they know that it changed their difficult experience of losing a loved one and made that difficult situation as best as it could be.
And that I think is the fingerprint that we wanna leave.
Marshall King: John the British sociologist and writer Oliver Berkman talks about how we, all of us have roughly 80,000 weeks in our. In our lives, most of us will encounter death a handful of times, face to face during our lives before we leave [00:29:00] this earth as well. This is your work. You encounter this, maybe not as directly when you were providing clinical care, but this is your work.
What has death taught you about how to live 
John Mastrojohn: that? That's a really interesting question, Marshall, because I think it says all the time to me. It really helps me to understand on a daily basis that just what you said, right? That it, this is, we have a fixed amount of time and we have to make the best of it.
So live life to the fullest, right? In so many ways. I think that's so much of what hospice care has taught me, and we say, if you haven't learned that lesson in hospice care, then go to the back of the classroom, right? And just keep studying until . That becomes really clear to you. I think the other thing it has shown me is that it's so important to just be kind to people because our time is so limited and, I could be having a bad day, but it's gonna be important for me to be able to show that [00:30:00] kindness to someone else, to be compassionate to other people.
It's really a way in which I like to live my life. And I hope in some way, just a little bit of that, rubs off on other people as well. I mentioned to, to Kevin about compassionate leadership. It is something that we talk about all the time in our organization is how can we show that compassion to the people that we work with.
It's just really important for us to know. 
Marshall King: John, our last question today, what gives you hope? . 
John Mastrojohn: What gives me hope is when I sit in the leadership team meeting or I'm in our staff meeting and I look at the faces of the people that I work with. We have an amazing group of people and I know that they are there for the right reasons and.
They are going to continue on with this legacy of compassionate care and really helping the most vulnerable winner in our community, and that gives me hope [00:31:00] every day. 
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