In nearly every hospice organization I’ve worked with, there’s a version of the same story. The sales team and the admissions team started out aligned – same mission, same patients, same sense of purpose. Then the volume picked up, the pressure increased, and the cracks formed. A liaison felt dismissed when a referral got pushed back without explanation. A clinician felt overruled when a patient was admitted over her objection. And over time, those moments accumulated into something harder: A quiet assumption on both sides that the other team just doesn’t get it.
By the time most organizations recognize the problem, the distrust is already baked in. People have history. They’ve been burned. Addressing it requires more than a process fix – it requires acknowledging that the walls went up for a reason, and that rebuilding trust takes longer than breaking it did.
That said, it is possible. And it starts with a decision to stop treating this as a people problem and start treating it as a systems problem.
The tension is structural, not personal
Before anything else can change, both teams need to understand why they experience the same situation so differently. It’s not because liaisons don’t care about clinical appropriateness. It’s not because admissions clinicians don’t care about census or referral source relationships. It’s because each team is measured, coached and rewarded based on a different definition of success.
Liaisons are out in the field absorbing pressure from referral sources who want answers fast and expect a yes. Admissions clinicians are evaluating whether a patient is truly appropriate, gathering documentation, and managing compliance risk. Both are doing exactly what they were hired to do. The conflict isn’t a character flaw on either side – it’s what happens when two legitimate priorities collide inside a system that was never designed to reconcile them.
When you point fingers at the people, you miss the structure that created the conflict. The teams didn’t become adversaries on purpose. The system let them drift there.
Name what neither team knows about the other
One of the most effective things you can do is get both teams in a room – not to air grievances, but to share context. In my experience, this exercise almost always surfaces surprises.
Liaisons often don’t realize:
- How often incomplete referral information triggers delays that look like clinical foot-dragging but are actually a documentation gap
- What’s at stake from a compliance standpoint when a patient is admitted who doesn’t meet criteria, and who absorbs that risk
- How much clinical judgment is required even on referrals that seem straightforward
Admissions clinicians often don’t realize:
- How much relationship capital a liaison expends managing a referral source who’s been put on hold
- That “we’ll get back to you” without a timeframe can cost the organization future referrals
- How the cumulative experience of delays shapes whether a referral source calls your organization first or last
Naming the information gap isn’t about assigning blame. It’s about acknowledging that no one has the full picture, and that better outcomes come from combining what both teams know.
Leadership sets the conditions
Here’s something I’ve observed consistently: Siloed teams rarely stay siloed on their own. They stay that way because the structure around them reinforces it – separate meetings, separate metrics, separate accountability conversations. When leaders celebrate census wins without acknowledging the clinical team that made them possible, or escalate compliance concerns without looping in sales, they’re signaling (unintentionally) that these are still two separate teams with two separate jobs.
If you’re in a leadership role, the teams are taking cues from you. Unified metrics, shared accountability structures and visible cross-functional problem-solving aren’t soft culture work. They’re the conditions that make everything else possible.
Build the bridge before the next hard conversation
Don’t wait for a bad outcome or a frustrated referral source to force the issue. Create regular, structured touchpoints between sales and admissions before the pressure is on: a brief weekly huddle on active referrals, a shared definition of what a complete referral looks like, a clear process for gray-area cases that doesn’t require someone to be a hero or a villain to get a decision made.
The goal is to normalize collaboration, not just manage conflict. When teams have existing relationships and shared language before things get hard, they work through difficult cases differently.
Reframe what’s actually at stake
An eligible patient who waits too long or who never gets admitted because the process broke down – isn’t a neutral outcome. It’s a failure of the system. The patient and family deserved better. The referral source deserved better. The mission wasn’t served.
When both teams understand that this is the shared cost of staying siloed, it changes the conversation. It’s no longer sales versus admissions. It’s the whole organization versus a process that isn’t working. And that reframe matters, because people fight differently when they’re facing the same problem together instead of facing each other.
What it looks like when it’s working
When sales and admissions are genuinely functioning as one team, the day-to-day feels different. Liaisons call the admissions line with confidence, knowing they’ll get a straight answer and a realistic timeline. Clinicians flag eligibility concerns early, before relationships are strained, because they trust that the liaison can handle an honest conversation with a referral source. Gray-area cases get discussed, not decided unilaterally. And when a patient doesn’t get admitted, both teams understand why – and neither one is left explaining a decision they didn’t make.
That’s not a perfect system. But it’s a functional one. And it’s built on the belief that the person at the center of all of it, the patient, is better served when the people around them are working together.
Start with curiosity, not conclusions
Years of friction don’t reverse overnight. But they do start to shift when one person – a leader, a director, a seasoned liaison – decides to get curious instead of defensive. To ask: “What are you seeing that I’m not?” rather than “Why won’t you just work with me?”
That question, asked sincerely, is usually where the real work begins.
If your teams are working hard but pulling in different directions, the answer usually starts with an honest look at the system. Reach out at [email protected] or visit our GROTM Assessment page to schedule a diagnostic of current operations.
