I had an old boss who used to say, “neutral is reverse,” meaning that if you aren’t moving forward, you’re actually moving backward. Most hospice leaders know this, but when it comes to growth (or maybe put a little more gently, sustainability), some programs shy away from properly labeling what that sustainability team actually does.
Sales shouldn’t be a dirty word in hospice, but for many agencies there is an inherent awkwardness to the term and professional discipline of selling and marketing their services. They shy away from the label and even from the strategies that help them live out their mission.
And yet here we are, asking our liaisons to go out into the world and make the case to physicians, social workers, discharge planners and case managers that our agency is the right one. We give these liaisons business cards and territory maps. We track their referral numbers. We talk about pipelines and conversion rates. And it’s critical that we do this, but for someone who came up in hospice through nursing or social work or chaplaincy, that shift can feel uncomfortable at best and inauthentic at worst.
The problem is that the awkwardness has a cost, and that cost is measured in lives touched and better deaths provided.
When a liaison hesitates to advocate clearly for what their agency offers, the referral source defaults to whoever is easiest, loudest or most familiar. When a liaison can’t articulate the difference between two hospices serving the same hospital, the choice gets made on convenience rather than fit. And when the patient ends up with an agency that doesn’t have the after-hours staffing, the GIP relationships or the bereavement program that yours does, the family pays for that gap in their experience. Sometimes the patient pays for it in days they didn’t get to spend at home.
This is the reframe that hospice leaders need to be able to offer their teams, clearly and often: What we call “sales” in this sector is actually patient advocacy. The liaison who builds a strong relationship with a hospitalist isn’t closing a deal (ick). She’s making sure that when a frail elderly patient returns to the ED next month, there’s a clinician in that hospital who already knows what your agency can do, and who can have a confident conversation with the family about hospice as a real option, not a last resort.
A few practical reframes that leaders can use with their liaison teams:
- Selling versus educational advocacy. Most referral sources don’t intuitively understand what distinguishes one hospice from another, and many don’t have a clear sense of when hospice is appropriate in the first place. The liaison’s job isn’t to talk anyone into anything. It’s to make sure the people making referral decisions have accurate, current information about what’s available and what fits. That’s education, and it’s something clinicians already know how to do.
- Promoting your agency versus advocating for the patient’s best option. This is the reframe that tends to land hardest with mission-driven staff. If your agency offers something a competitor doesn’t, whether that’s pediatric capability, faster admissions, stronger veteran services, or a specific cultural or linguistic match, then not telling the referral source about that capability isn’t humility. It’s a failure to advocate for patients who could benefit from it.
- Closing versus removing barriers. Liaisons sometimes feel like they’re pressuring referral sources when they follow up on a pending referral or ask about a specific patient. In practice, most of those follow-ups surface a legitimate barrier: A family member who needs more information, a physician who wants to talk through prognosis, a social worker who isn’t sure the patient meets eligibility. The liaison’s persistence is what gets those barriers identified and resolved. Without it, the patient often doesn’t transition at all.
- Numbers versus stories. This one is for leaders themselves. If the only thing you celebrate in your weekly team meetings is referral count and conversion rate, you’re reinforcing the sales framing that can make mission-driven staff uncomfortable in the first place. Make room to tell the story of the patient whose family was grateful, the referral source who finally feels confident sending to your agency, the case where the liaison’s relationship-building paid off in real care for a real person. The numbers matter, but they’re not the point. They’re the trailing indicator of mission-enablement.
Hospice Will Always Be Unique
None of this is about turning a former hospice nurse into a pharmaceutical rep. The skill set hospice liaisons need is fundamentally different from traditional sales, and the best ones in this sector already know that. What they often need from their leaders is permission and language. Permission to advocate clearly for the agency they believe in, and language that lets them do that work without feeling like they’ve stepped outside their values.
The hospices that grow sustainably tend to be the ones where leadership has done this reframing work explicitly. They’ve made it normal to talk about referral development as mission work, because in a sector where almost 50% of eligible patients still die without ever accessing the benefit, or access it only in the final few days, it genuinely is that critical. The liaisons in those agencies aren’t more comfortable with sales. They’ve simply understood that it goes so much deeper than that term implies.
If your liaisons are working to find their footing as advocates rather than sellers, the GROTM Assessment can help surface what’s working, what’s blocking them, and where to focus first.
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.
