Margaret McNeil: Leading A Mission And Values-Based Children’s Hospice

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Margaret McNeil: Leading A Mission And Values-Based Children’s Hospice

We have Margaret McNeil. She’s the CEO of Canuck Place Children’s Hospice, where she leads a team of 140 staff and more than 400 volunteers. In 2017, Margaret was named the CEO of the Year by Business in Vancouver. We’re thrilled to have her as a part of the show. Margaret, thank you for being here.

Thank you so much, Doug.

One of the things that came up in our discussion was the importance of letting people know exactly what Canuck Place is. Could you tell us a little bit about that as we get started?

A lot of people have heard about Canuck Place and people know that we’re a pediatric hospice. When people think about hospice, they think about the end of life. A pediatric hospice includes that aspect to it. Yet, it’s very different in that we know children from the time that they’re first diagnosed with the condition that is progressive and life-threatening, where they’re not expected to live to age nineteen, until the time that they either die or they turn age nineteen. We know children and their families for very long periods of time. The average is about seven years. Most of the work that we do does not take place within the walls at the hospice. It takes place at BC Children’s, BC Women’s where our physicians and advanced practice nurses are the consulting team. It takes place in family’s homes. It takes place over the telephone when we’re supporting families. It also takes place within our two hospices.

We have our original hospice, which opened in ’95 in Vancouver and now we have a second hospice in Abbotsford, which we opened full-time in April of 2019. It is a different model of care. Another thing that distinguishes it is that you’ll never hear us use the word patient. We talk about children and we talk about families. The work here is child-centered and family-centered. We don’t look after the medical part of the child’s care, we look after the needs of the child in all aspects of their life. For example, we operate a school when the children are staying in the hospital for respite or pain and symptom management. We also have family suites so their siblings can also stay in. The kids go to school Monday to Friday. When school is out, we run programs around the province because we are a provincial service where Canuck Place families can gather and do everything else that all of our families do like go kayaking, go to the water slides, take kids to the Abbotsford Airshow because we believe that kids should be kids and families should be families. We want to make sure that they have as much opportunity for life as a family as they possibly can, knowing the eventual outcome for their child.

Given how intimate that connection with the children and their families must be, how do you find operating the two hospices or is the culture at the first site in Vancouver different than the newer site in Abbotsford?

The quality of care is the same in the two. Abbotsford is a purpose-built facility. It is on a campus of care with two other charities. Because it’s purpose-built, it has things like a suction built right in the walls where the building in Vancouver doesn’t have those physical attributes that make it easier to deliver care. The majority of our staff in Abbotsford are newer to the organization, it’s developing its own uniqueness. We have three locations. We have the two hospices plus a back office for our finance facilities, IT functions and HR. Each has its own flavor. What joins us is a connection. That connection is everything we do is connected to the care for the child and for their family.

As a leader, how do you make sure that the two sites operate as an integrated whole?

I’m going to make that three sites, Doug, because our back-office is as important to the organization as are the two hospices. We have an all-staff day once a year where we bring all staff together for both education and for time to socialize together. We have a Care for The Caregiver Committee because working in this environment requires qualities in staff that aren’t required in many other locations because we are in an environment where children die. The Care for The Caregiver Committee has representatives from all three sites that make sure that there are opportunities for staff to get together, get to know each other and look after each other. A small example is that the school for massage therapy brings in students on a once a week basis where kids and families get the opportunity to have supervised massage. If there are spaces leftover, those are for staff and volunteers. The Care for The Caregiver Committee is mindful of those things that are important to keep our staff and our volunteers whole in providing this challenging care that we provide.

On that challenging care and providing that, as well as your organization does, could you reflect maybe a little bit on how different this leadership position has been than other leadership or CEO roles that you’ve had in the past?

I’ve spent a lot of my career working in government-funded agencies and you’ve got a lot of infrastructure in those organizations. Canuck Place opened in 1995. We have licensed healthcare, but we started with the vision of an oncology nurse at BC Children’s who had volunteered at the first pediatric hospice in the world in Oxford, England. She came back to Canada and said, “We should start one here.” It was through her vision that Canuck Place came to being opened in ’95. When we opened, we had no government funding. Every dollar raised was directed towards care. We didn’t get any committed government funding until the late ’90s. We operated for close to five years without any government funding.

Even now, we are 60% donor-funded and 40% government-funded. The government funding goes towards those elements directly related to those services that are offset to the care that would otherwise be provided at BC Children’s. The children’s conditions that we look after are so rare and unusual about 190 different conditions. When we opened, the staff were small. Staff was involved in every single decision. We still have some of the same nurses and counselors who started with us many years ago. They want to be involved in every major decision that gets made. In the length of time that I’ve been here, we close to double the size of the organization. We’ve added a second building. We’ve doubled revenue. We’ve needed to develop business infrastructure that we didn’t need many years ago. Navigating that change has been quite a challenging one as the organization has grown and matured.

Some of the work that we’ve done here at The Discovery Group with adult hospices, one of the challenges that those organizations often face is that people that are providing care are good at it. They’re able to focus at the level of the individual and the level of the family, which can make it difficult sometimes for those same individuals to participate in the big picture, strategic planning and operations of the organization. How important is that sense of the big picture to your management team at Canuck Place?

It’s critical to the management team. At the staff level, you’ve described the nurses and counselors in a good way. They are highly values-driven. Their compassion, their desire to support families, to embrace life in every way around quality and safety of care and team are critical. With respect to the leadership team, I’d say that’s been part of the maturing of the organization is to make sure and help those staff grow and see the importance of that strategic vision. We have a good board of directors, I’m fortunate, that sees that bigger picture.

As we’ve had turnover within the leadership team, part of what I’ve done is made sure that we’re bringing in leaders who do have that broader vision, operational experience and maturity to make sure that bigger picture for the organization is key. There’s a term that I like a lot in leadership and that is that your number one team is not the team that you lead. Your number one team is the team that you’re a member of. To help the leadership team grow into seeing that their responsibility is not to their own team, but to the organization as a whole has been an important piece of growth in our leadership team.

How do you make sure that your management team has access to that big picture? What is it? From a tactical perspective, how do you make sure that on any given week or any given month or in a quarter that there is some time and there is some discussion about that big picture?

Our senior leadership team attends all of the board meetings. They’re always part of those discussions and our board meetings are every couple of months. They’re always part of the board meetings. At the committee level with the board, at least one, sometimes two senior staff members attend each of those committee meetings so that they see the bigger picture. We have an annual board retreat and the leadership team is part of that. From my perspective, we structure our agenda to focus on those strategic issues when it’s critical for those strategic issues to be a part of the agenda of the management team. We also have the indicators that we measure across the organization. Plus, we have departmental level indicators to make sure that both the departmental issues and the strategic issues are both a focus and equal importance to the leadership team.

You’ve mentioned your board a couple of times now so let’s spend some time talking about them. What percentage of your time would you say is dedicated to working and supporting the board?

I would say about 50%. It does vary sometimes depending on who the board chair is. Whether they’re an experienced board chair or less experienced board chair, the amount of change the board is going through. We’re going through some succession planning right now and making sure that we’re in good shape, not only for now but for the future. That is taking additional time. I’d say on average about 50%. One of my big learnings in coming into this role was that in previous roles you have reported to CEOs and I’ve attended board meetings. I’ve been a board member, I am a board member of WorkSafe as well, which gives me another lens to be able to bring into this role here. I thought I had one boss and that was the board chair. I learned quickly that I have sixteen bosses because I need to have a relationship with each of our board members. Each of them brings something unique and valuable to our board. Creating, maintaining, sustaining and growing those relationships is incredibly important for me in order to have effective relationships with the board as a whole.

How involved in fundraising that 60% of your budget is the board?

That is something that has been largely left to staff. We have had a couple of board members who have deep connections within the community. They have brought a different flavor in the last number of years to the board because we need people who have deep healthcare experience. We need people with a strong financial background, investment knowledge and business background and governance experience. Because we are 60% donor-funded, those two board members that we have had in the last number of years have brought forward the importance of having philanthropic influencers and community connectors on our board. We are looking at strengthening our board by ensuring that we have those community connectors as an ongoing fixture on our board because it is important to what we do and being able to manage the care delivery within the organization.

On fundraising, you have a very active donor base. How much of your time do you spend directly interacting with donors to the organization?

I would say about 25% to 30%. The reason I give it that range is that there are some donors, individual donors that I’m very involved with. People who are involved in philanthropy know that it is relationship-based. There are those donors that I am deeply connected with and deeply connected to. I have a bigger role with those donors than I do with some of our other donors where I have a personal relationship. It might be a smaller donor, smaller in terms of their financial contribution because I have a personal relationship.

Every time they are kind enough to give a gift to the organization, I make sure that I reach out because that personal touch in that relationship is important. Also, we have a number of donor stewardship events. I am at all of those donor stewardship events to the best of my ability. Because seeing the CEO and hearing directly from the CEO of the organization knowing that they are connecting with their ability to give and what they believe in the mission of our organization is critical. That’s another important touchpoint for me with both corporate donors and with individual donors.

Can you tell us a story about a time when you learned something about the organization from your conversation with a donor?

There are a number of stories there. If there’s a theme around that, it would be that what’s important to every donor matters. There’s one donor that I’m thinking about who loves data and wanted to know about the percentage that we spend on admin, our percentage of money being spent in different categories. That was the key to that donor. We have other donors who have unless you are deep in conversation with someone and have a trusting relationship, they may not tell you things. We do have a number of donors who have had their own personal tragedies in their own families, whether it’s directly related to Canuck Place or not directly related to Canuck Place if it’s related to them or one of their children. It is seeing the work that Canuck Place does, how we do it and how we wrap our arms around a family as a family unit to support them in this incredibly challenging journey.

Having a donor tell me their own personal story is one that moves me every single time and helps me better understand their connection to our organization. They may well not have had the experience of having an organization, wrap their arms around them and support them through an incredibly challenging time. Whether it be with counseling support, whether it be with the necessary medical and nursing care, whether it be with allowing them time to be a family, whether it is an opportunity to give them a chance to remember they’re a child. All of those things are so incredibly important and deeply meaningful for donors. Some of those donors are also corporate donors. I also think that some of our corporate donors have a personal connection. It’s through that relationship that we get to learn about that. That is such a precious gift that they choose to share. It is meaningful to me every single time I hear a story.

It is amazing how powerful donor interactions with the organization or donor stories can be to motivate people working in those organizations. In an organization where the mission is front and center every day, I can’t look away. Everyone that comes to work there knows why they’re there. Does that pose unique challenges for leading change in the organization?

The challenge is that we are a strong values-based organization. There’s a budgetary decision that needs to get made and you’re highly driven by values. When somebody who’s more leaning towards weighing the pros and cons and looking at a strategy and the best decision for the organization. If you make a decision that seems to not align with values, everybody holds up their values cards and their values cards might be different and saying, “This doesn’t work for me.” This is an organization because we have people who have been here for a long time. They like to express their opinions about things. That comes with pluses and minuses. The bigger plus is that it allows us to engage in a conversation with our staff about why we’re making the decision that we’re making, show them where the values alignment is and how it helps the future and the sustainability for the organization.

A motivated and engaged staff group like that is necessary for the level of care and support that the organization provides. To whom do you look when you’re struggling with a question as a leader of the organization?

I’ve got a wonderful leadership team. It depends on what the nature of the question is. If it is one that I can bring to the leadership team, I bring it to the leadership team and I say, “This is the issue. This is the background. This is what I’m thinking. Give me your best advice. If you were in my shoes, what would you do?” We engage as a leadership team with a management consultant on a once-a-year basis. We’ve used that in a couple of ways. One is to let our staff know this is a normal thing. It is a useful thing that all teams need to do is take time to step back, reflect and see how we’re doing and ways that we can grow and develop us as a leadership team better.

There’s an exercise that we often use called alligators in advice. This is my alligator and the team can give me advice. I can follow it or not follow it. I’ll sometimes turn to my board chair or a couple of my board members who have experience in that area. If it’s something that is one where I want the independence of other people who do the same work is I’ve got what I call my 411 list of a group of other leaders in similar roles within the community that I’ll reach out to. When we call each other, we all know that it’s a confidential call. We have deep trust. We can reach out and say, “This is what I’m dealing with right now. Have you had this experience? What did you do so that we lean on each other for that advice?”

These jobs as CEO, you can’t always talk to your management team about the issues or you can’t give the full spectrum of the issue to the whole team. It can be quite isolating. It’s great that you’ve found a group that you can ask those questions and get that feedback.

My board has been incredibly supportive of me having an executive coach. That’s another place that I can reach out to also. The nature of the conversations is always going to be confidential. The peer-to-peer relationships to me are ones that I value. You can’t necessarily talk to your staff, you can’t necessarily talk to your board. You have to have those safe places where you can reach out.

How do you know when it’s time to bring in the board or at least let the board chair know that something isn’t going according to plan?

Our board is at this point a hybrid board between a governance board and an operating board. When we had a discussion about a particular direction that we’re taking, there’s agreement about it at a board meeting. It doesn’t go that way. I believe in the world of no surprises. I would give the board chair a call and we would have a conversation usually about the strategy that I’m planning to take or to seek advice about direction. To say, “Is this something?” because it is significant that we need to take it back to the board for some further discussion about it.

Let me give you a real-life example. When I joined the organization back in 2012, we were about halfway through the construction of our building. There was no operating budget. Somehow the project got approval for the construction but had never looked at an operating budget. In 2012, we were looking to operate the building in fairly short order and didn’t have the necessary funds. To me, that’s clearly a board issue. It’s not something that I’m going to be able to solve by myself. There were deep implications if I had not brought the board into that discussion because we would have had a building that we weren’t able to operate. We had donors who had contributed to the construction and they’re expecting to see the building open and fully operating. If we weren’t going to be in a position to be able to do that, it was one that I needed to bring the board chair and the full board into discussions about the strategy as to how we were going to go forward.

I’m sure there were many weeks, months and potentially years of work ahead. At what point did you realize, “This is going to be okay,” as it relates to your relationship with the board?

To me, the issue about transparency and the issue about honesty, the approach of being straight forward, being solution-focused and showing the board that there is a way through may not be particularly smooth. There is a way of getting the board’s advice. The board gave me a tremendous amount of good advice in thinking through how we were going to move forward with this issue are the hallmarks. There’s not much in life that you can get through without transparency, honesty and humility. To me, there was no fault-finding. There was no need for blame. There was nothing there. This is a situation that we find ourselves in now. There’s another expression that I like very much, “It’s not what happened. It’s what you do about what happened.” This was about what we did about what happened.

One of my great board chairs in my time as CEO, he would say it all the time, “It’s all in the art of the recovery.” He may have wished we weren’t giving him as many opportunities to use it as we did, but that is focusing on let’s solve this problem rather than admiring the problem. That’s good advice for everyone. Looking back, you had been around leadership tables, you’d been at board meetings, you are a board member. What was the biggest difference between being a senior leader in an organization and being the CEO?

When I think about being a senior leader, a VP, a regional director, an executive director and other roles, I take the work home differently now. Previously, for example if I would be away on vacation, I knew that my CEO had my back, was fully briefed about what was going on. If things happen, I was confident that they were going to be handled. Not that I didn’t think about the organization in a senior role, but the role as CEO is with me 24/7. It doesn’t matter where I am or what I’m doing. I’m always vigilant to what is going on within the organization. I feel that responsibility in a strong way. Not that I am and my business card because I always believe that everybody needs to have a full life as much as our families need to have a full life. The buck stops here and the buck stops with me. It stops with me, both with my senior leadership team and it stops with the board of directors. That to me is the crux of what the difference is.

That’s a clear line that you’d probably go back and forth over as the months and years go on. What advice would you give to someone who is about to become CEO? Maybe not for the first day, but as they’re coming into their first CEO role. What advice would you give maybe you wish someone had given you?

If there’s an opportunity to talk to people who have been in similar roles and needs similar transitions, take that time. British Columbia is a relatively small province. If you’ve been in certain sectors, people know each other. When I was looking at the role here, I tapped into my network and knew people who had made the transition from similar sectors within the health sector or within the social housing sector. I spent time with those people about making the transition and things that I should pay attention to. That was time well-spent. If the individual has time that they can find a mentor in a CEO role and I have had the good fortune to mentor a number of people through the SFU MBA program, Vantage Point and Simon Fraser nonprofit program to be able to have somebody mentor you informally.

Also, tell you what you don’t know because there are things that come up that you don’t know are going to come up and to invite with curiosity those questions. Whether you know what to question or you want to find out about how something works, ask and reach out. People are generous with their time. We all want to see the sector flourish and the sector be successful. It’s in everybody’s interest to share what they know and open their hearts, their minds, their experience, their knowledge and their successes and failures to be up in commerce. Because when I’m no longer in this role, I want to see the organization continue to thrive. This sector to me is important. We have the private sector, the nonprofit sector and the public sector. The nonprofit sector to me is the one that ensures we have a good civil society. The more leaders that we can do to help support that to continue to be strong and grow, we should take advantage of.

I want to touch on a couple of points that you made that are valuable and I hope our audience will take away. One, the answer to many of the questions I asked you, you started with as a values-based organization. You brought it back to the values of the organization time and time again, which is admirable and critical for developing the strength of an organization and to have the success that you’ve had in making Canuck Place all that it is. The second thing that came through a lot was referencing being direct, open and transparent with families, children, your team, the board and donors, being able to speak with the same voice in whatever room, with data-driven, when the donor asks for it. Mission values-based when donors ask for something else, it’s important to maintain integrity as a leader and coherence of your message for your team. Finally, I appreciated your sense of what the sector can mean in our civil society. Thank you very much for all that you do at Canuck Place. Thank you very much for being on the show.

It’s been a pleasure, Doug. Thank you very much.

Important Links

• Canuck Place Children’s Hospice
• WorkSafe
• CanuckPlace.org

About Margaret McNeil

Margaret McNeil is Chief Executive Officer of Canuck Place Children’s Hospice and leads 140+ multi-disciplinary employee team and over 400 volunteers.

Committed to community, Margaret is a current member of the Board of WorkSafeBC, an Executive Mentor with the SFU Beedie School of Business. She is a former Director of the Minerva Foundation for BC Women and Canadian Cancer Society of BC & Yukon. Margaret, a Registered Nurse, holds a Bachelor of Science in Nursing from McMaster University, and a Master of Science in Nursing, in Community Health, from Case Western Reserve University in Cleveland, Ohio. She has also completed the Executive Program at Queen’s University in Kingston, Ontario and recently completed the Corporate Directors’ Program associated with the Conference Board of Canada and the DeGroote School of Management.

She comes from a background in the public sector.  In previous roles, she was the VP of Operations at BC Housing, led the Mental Health and Addictions program at Vancouver Island Health Authority, and has led a variety of policy initiatives and programs for various aspects of health including home and community care in BC.

In 2017, Margaret was awarded CEO of the Year from Business in Vancouver in the Non-Profit category.