Finally, after 16 years of trying to tie the knot, Ohio city's two acute-care hospitals have put half a century of competition behind them

It was a long, dramatic courtship. Finally, after 16 years and two frustrating tries, Springfield, Ohio's two acute-care hospitals have completed their merger, ending a half-century of competition. City leaders call the deal a testament to the two hospitals' boards and leaders. A. David Jimenez, left, an executive at Catholic Healthcare Partners, says that ultimately, it is the community that must come first.     

A synergy of values. Catholic healthcare leaders must implement their organization's mission and model its values

Catholic organizations need to select, develop, and retain healthcare leaders who dedicate themselves to carrying on the Church's healing ministry and the work begun by those who have preceded them. Persons entrusted to carry on Jesus' healing mission perform their duties out of a sense of commitment to the ministry and a love for the persons with whom they work and whom they serve. They recognize a synergy between their own values and the values of the healthcare organizations they lead. Dedication to leadership in Catholic healthcare can be viewed from three perspectives: the Bible and selected documents of the Catholic Church; the transfer of responsibility for Catholic healthcare from religious congregations to evolving forms of sponsorship; and the implications for the selection, development, and retention of healthcare leaders, both lay and religious. Servant-leadership is an integral part of the religious tradition that underlies Catholic healthcare. As cooperation increases between healthcare providers, third-party payers, employers, and other healthcare agents. Catholic healthcare organizations are challenged to reassert a mission and values that will enable healthcare in the United States to be delivered both compassionately and competently.     

Catholic Health Initiatives at 10

The summer of 2006 marked the 10th anniversary of the formation of Denver-based Catholic Health Initiatives (CHI). Formed in 1996 as the result of the merger of three Catholic health care systems, and soon joined by a fourth, the system integrated a diverse collection of health care facilities previously sponsored by 12 different religious congregations. It was the first Catholic health system to give laity a sponsorship role in its facilities. CHI's facilities are sponsored by a public juridic person (PJP), the Catholic Health Care Federation (CHCF). The same people who sit on the system's board also constitute CHCF. They are thus responsible for both governance and sponsorship. CHI was the first Catholic health care system to give laypersons a sponsorship role in its facilities. Establishing the PJP was a long and complex task. Eventually, the church determined that CHI's PJP should be pontifical, accountable to the Congregation for Institutes of Consecrated Life and Societies of Apostolic Life in Rome. CHCF in 1991 became the first PJP in health care in the United States. CHI's staff, led by its first president and chief executive officer, Patricia Cahill, quickly took steps to help the new system begin to coalesce, establishing a single, systemwide pension plan, debt policy, and so forth. Also challenging was the creation of a systemwide new culture. An essential step in the development of CHI's culture was the involvement of employees in the identification of its core values: reverence, integrity, compassion, and excellence, The creation of CHI's Mission and Ministry Fund also helped give the system an identity. This fund provides grants to programs that take an innovative approach to building healthy communities, a goal expressed in CHI's mission and vision statements. The people who created CHI and nurtured it during its first decade give it high marks for faithful adherence to its mission. Even so, they acknowledge that there is always more work to be done.     

The influence model of sponsorship. A Catholic hospital is now part of the "Mayo Clinic"

Saint Marys Hospital was founded in Rochester, MN, in 1889. Constructed by the Sisters of St. Francis, it was staffed by physician members of the local Mayo family. The Mayo practice grew into an association of many physicians and medical residents who later began to staff Rochester Methodist Hospital also; the three healthcare institutions became collectively known as the "Mayo Clinic." By the mid-1980s, billing was so complex for the three still-independent facilities that their leaders decided to integrate more formally. This was done in three phases and resulted in the creation of a single institution known as the Mayo Medical Center. From Saint Marys' standpoint, the facilitating document in this process was a "Sponsorship Agreement" whose purpose was to maintain the sponsor's interests and obligations in the integrated structure. A Sponsorship Board was created to continue the hospital's Catholic tradition, including maintaining its chaplaincy, chapels, religious symbols, and special funds. The Sponsorship Board views the new environment as a special challenge. Its members know that Catholic sponsorship: Comforts patients, who realize they are in the hands of people motivated by the Christian ethic Creates an atmosphere in which patients and their families can seek the spiritual support that often aids healing Strengthens a sense of community among physicians, hospital staff, and administrators The Sponsorship Board hopes the sponsor's influence may come to affect the whole Mayo Medical Center, bringing patients, family members, and staff an "added dimension" of care.     

A closer look at lay sponsorship. A CHA survey reveals some problems with two established models

The private association of the Christian faithful (PACF) and private juridic person (PJP) are two lay sponsorship options for healthcare organizations that find traditional sponsorship unavailable. Today two questions relate to these models: Are the PACF and the PJP still realistic and attractive models of sponsorship? Can Catholic identity be maintained in them? Last summer CHA surveyed the seven member organizations that use either the PACF or the PJP as sponsorship models. In addition, CHA conducted four site visits, which corroborated the survey findings. Most respondents said their organizations had adopted the lay model as a means of remaining Catholic after their original sponsors withdrew. Most said they had a good relationship with the local diocese, although formal meetings with the diocesan leaders were infrequent. Each organization had a clearly articulated mission and reinforced their mission and values in various ways. Leadership development appeared somewhat weak. Some respondents spoke favorably of the PACF and PJP models of sponsorship, but others saw limitations, including isolation, lack of clarity in reporting mechanisms between the organization and the diocese, and lack of board education about the models. Even those who saw a future for lay sponsorship on the PACF and PJP models said that, although it is important for Catholic healthcare to develop lay leadership, these models are not promising steps in that direction.     

Partnerships for the future. A new vision for the Catholic healthcare ministry

Collaboration among healthcare providers will help them more effectively meet the needs of their communities in the 1990s. San Francisco-based Catholic Healthcare West (CHW), formed in 1986, strives to provide high-quality healthcare by collaborating with Catholic and non-Catholic providers. CHW leaders believe that Catholic providers make ideal partners; however, they have found that Catholic healthcare providers often must look outside the Catholic healthcare ministry to find these partnership opportunities in order to remain viable and effectively carry out their mission. Besides system-to-system or hospital-to-hospital linkages, collaboration is also achievable with other types of healthcare providers, such as physicians. In collaborations between Catholic and non-Catholic healthcare providers, Catholic providers must strive to maintain their Catholic identity. When evaluating potential partners, they must consider issues such as corporate culture, organizational compatibility, and sponsor influence. CHW leaders believe that for any merger or affiliation to be successful, it must clearly produce market and financial advantages for the new partnership and offer the community a significant improvement in quality of care and services.     

Catholic identity: realized in conversation

Catholic literature leaders must constantly engage the Catholic tradition, because it provides the framework for everything we do. The way they can do this is through conversation--discussion about the profound values and philosophical and theological assumptions that are at the heart of our ministry. Yet many healthcare boards and senior managers do not engage in such conversations. This is a serious omission, with potentially serious consequences. Too often mission and pastoral care values are regarded as separate from the business aspects of a healthcare organization. If we are to understand and integrate our mission into our healthcare work, this must change. The entire organization must make a commitment to foster an understanding of Catholic identity through conversation. As important as the dialogue is, some Catholic healthcare leaders let obstacles prevent them from delving into Catholic identity. They may not understand it, or they may be deterred by our cultural tendency to regard religion as personal, not part of the business realm. Some may be embarrassed, uncomfortable with abstraction, or reluctant to spend the time required. To encourage the conversation among Catholic healthcare leaders, we may take a lesson from our counterparts in Catholic education, who struggle with the same questions. A model Catholic university, where Catholic values are incorporated at all levels, may be a model for Catholic healthcare.     

Congregation transfers its healthcare system. Franciscan Sisters of Little Falls list critical factors for a successful transfer of sponsorship

In 1993 the Franciscan Sisters of Little Falls, MN, transferred ownership and sponsorship of their 12 healthcare facilities to Catholic Health Corporation of Omaha. The sisters had had two goals from the start of the process: To transfer the facilities to another Catholic system, and in such a way that both members of the religious institute and the facilities' personnel would "own" the decision To complete the transfer with minimal upheaval in facility operations The sisters accomplished both of these goals. They attribute their success to prayer and several critical factors. First, having pondered their healthcare ministry in light of their Franciscan tradition, the sisters decided that a larger system could better meet their facilities' needs. Second, they developed a set of criteria for the new sponsor, including the requirement that it be both Catholic and dedicated to rural healthcare. Third, the sisters became willing to take the risks a transfer involved for both their congregation and the 12 facilities. Fourth, the sisters clearly communicated their decision to everyone affected by it. Fifth, they sought the help of experts in making the transfer. Sixth, they worked hard to create trust, so that all involved--including those who would lose their jobs--took ownership of the transfer decision. After completion of the transfer, each of the facilities held a ritual celebrating the friendships and respect built over the long years the Franciscan Sisters were their sponsors. The sisters held their own ritual of commemoration. They continue their ministries in health, education, social services, and pastoral care.     

Alternative agendas. System priorities for the 1990s will differ from those of the last decade

The Sisters of Charity Health Care Systems (SCHCS) was established in 1979 in response to changes in the U.S. healthcare system and to new needs of sponsors and Catholic healthcare facilities. However, the agenda that SCHCS leaders (and leaders of other systems) set at that time must now give way to an agenda that will address the new challenges and responsibilities facing the Catholic healthcare ministry in the 1990s. In its first decade of existence, SCHCS established and fulfilled a number of goals: It strengthened governance relationships, helped systems and sponsors better identify with local communities, enabled facilities to steward resources more effectively, and facilitated members' understanding of mission and sponsorship values. In the 1990s, however, systems will have to create more opportunities for regional, collaborative, and networking relationships among member facilities and between members and non-members. To achieve this, they will have to reevaluate their structures, find ways to faciliatate collaboration, make resources available to institutions outside the system, and develop an overall philosophy that enhances both the fiscal and spiritual well-being of member facilities.     

Revitalizing the ministry

The twentieth century's last decade presents religious institutes with a golden opportunity to confront the dilemmas surrounding sponsorship. Sponsors can develop a number of strategies to allay current anxieties and to transform potential crises into advantages. One is to revitalize the corporate mission by basing it on professed values rather than on existing structures. Institutes can also articulate their mission by building networks that encourage cooperation between those involved in traditional services and those in alternative services. Strengthening collaboration with the laity is also critical. Sponsorship forums are one way to promote mutual understanding and reflection. In addition, involving lay leaders in planning and decision making will broaden their understanding of issues that affect the healthcare institution. Finally, with the laity assuming a greater share of responsibility in Catholic healthcare, many institutes will have to develop strategies that allow them to "let go." The process will require inner transformation. Recognizing the institute's contribution to the development of the Catholic healthcare ministry can help members accept the need for change. Actively planning for the changes will also help members cope with them.     

Serving our communities better. Guidelines for planning and developing integrated delivery networks

In 1994 the Daughters of Charity National Health System-East Central (DCNHS-East Central) adopted 11 guidelines to help corporate staff and local leaders plan and develop integrated networks. Guideline 1 emphasizes needs-based strategic planning. Guideline 2 focuses on the community-based network planning process, recommending a team approach and ongoing communication with the local ordinary. In guidelines 3 through 5, the DCNHS-East Central Board of Directors spells out key issues that must be covered in proposals ultimately presented for governance action. Guideline 6 presents three core elements that should characterize all CBNs in which DCNHS-East Central institutions participate. Guideline 7 emphasizes that all CBN proposals and agreements must be clear with respect to the Catholic identity of DCNHS-East Central institutions. Guidelines 8 and 9 require that proposed changes to traditional policies and management practices be explicit in CBN proposals. The tenth guideline requires that all CBN proposals indicate an explicit evaluation function. The final guideline underscores that regardless of the strategic fit or how well a CBN is designed, it is unlikely to succeed unless both internal and external relationships are based on a solid foundation of honesty, mutual respect, and trust.     

Public juridic person ensures Catholic presence. How one Catholic healthcare system assumed a lay model of sponsorship

To ensure that the Catholic healing presence remained in the communities it has served for many years, the United States St. Joseph Province of the Sisters of Charity of Montreal (Grey Nuns) is transferring its healthcare institutions to a lay model of sponsorship. The new arrangement makes Covenant Health Systems (CHS) a public juridic person of pontifical right sponsoring the U.S. Grey Nuns' healthcare organizations. In addition to extensive education and communication efforts aimed at all its constituencies, CHS needed to pass through several stages before it could become a public juridic person. Approval had to be obtained from the Grey Nuns Provincial Administration and General Administration (in Montreal). Proposed statutes and bylaws had to be drafted. The CHS Board of Directors had to sign a letter of intent, indicating its willingness to accept these responsibilities of sponsorship. The Congregation for the Institutes of Consecrated Life and Apostolic Societies approved the request for public juridic person status. CHS and the Grey Nuns will take a year to implement the transfer, which will be official on October 24, 1996. CHS will continue to operate in a manner consistent with the teachings of the Catholic Church by complying with the Ethical and Religious Directives and by maintaining contact with local ordinaries.     

Catholic healthcare's future. Ten models for competition and capitation

In the next five years, Catholic providers must select strategies that will involve affiliations, acquisitions, and consolidations with Catholic and non-Catholic partners. At least 10 options are available to meet the long-term trends of managed care, competition, and capitation. Vertical integration allows comprehensive patient care. Multisponsor management can help religious institutes expand their market share. Systems and one-hospital sponsors can affiliate their facilities to form Catholic networks. Community-based not-for-profit networks can include both Catholic and non-Catholic organizations bound by contracts and joint ventures. Joint ventures provide the benefits of integration to Catholic providers, who must be willing to commit substantial capital to create HMOs and other networks with non-Catholic partners. Acquisition of facilities and regional and statewide expansion can strengthen a Catholic system's market position in the face of declining acute care hospital services. Catholic/non-Catholic mergers risk consolidating and closing facilities but need not erase Catholic identity. Cooperation between affiliation and merger, or "co-opetition," involves creating new legal territory for Catholic/non-Catholic consolidation. Divestiture may be an ultimate strategy, but Catholic sponsors must proceed with caution in their dealings with plentiful buyers. Catholic facilities and systems are joining with Catholic Charities, other providers, and local agencies to create networks.     

Helping patients receive medical benefits. Collaboration between hospitals and legal services assists providers and low-income Kansans

In Kansas, legal services lawyers have teamed up with Catholic healthcare administrators to help uninsured and underinsured hospital patients receive healthcare benefits from programs for which they may be eligible. The project--Hospital Patient Assistance Program--provides comprehensive assistance in establishing a patient's eligibility for medical benefits. Hospital participation in the program is simple. When business office or admissions staff discover that a self-pay patient has been registered with the program, they refer the patient to Kansas Legal Services; Inc. (KLS). KLS staff members try to determine if the patient is eligible for benefits from any of a number of programs, including Medicaid, Medicare, and Crime Victims Assistance. If KLS finds no programs for which the patient is eligible, it does not accept the case and notifies the hospital. Hospitals participating in the program have found that many accounts they previously wrote off as not collectible can be paid. Since the program began in 1990, participating hospitals have realized almost $8 million in payments from various benefit sources.     

A model for future healthcare leadership. CHA's competency study provides a practical tool for leadership development

The Catholic Health Association's (CHA's) study "Transformational Leadership for the Healing Ministry: Competencies for the Future" is a powerful tool for the identification and development of leaders in Catholic healthcare. The study can help executives measure their own performance against a standard of excellence and establish goals to improve their performance. Trustees can use the study to establish policies for identification, assessment, development, and career planning for senior executives. Sponsors might consider the competencies as they intensify collaboration in ministry with lay colleagues by encouraging leadership development or as they participate with trustees in the selection of executives. The model presented in CHA's study is dynamic and adaptable to the leadership needs of various organizations. It should not yield a homogenized view of the "ideal" leader in the Catholic ministry. Nor should it encourage elitism or invidious comparisons between leaders or organizations.     

广东省医院检验检查结果互认现状调查

目的了解广东省医院检验检查结果互认现状。方法对广东省11个市区的38所二级及三级医院的医务人员进行问卷调查,并对广东省卫生厅及广东省临床检验中心领导进行访谈。结果68％的医务人员认为检验检查结果互认程度中等,72％的医务人员认为互认过程基本顺利,过半数的医务人员认为互认能够带来积极影响。临床检查及诊断标准不统一是阻碍互认的关键因素,利益问题是阻碍互认的重要因素,法律风险的阻碍作用也不可忽视。     

Health-related message boards/chat rooms on the Web: discussion content and implications for pharmaceutical sponsorships

This content analysis study examined health-related message boards to better understand who is using this on-line health information and support device and what topics they are discussing. Besides needing to understand this support and coping mechanism for individuals, this has become an increasingly important topic for health communicators to understand because the Health and Human Services' (HHS) Inspector General recently gave permission to a pharmaceutical manufacturer for sponsorship of a disease management chat room. Very little research has been done on the content of these message boards/chat rooms. Key findings include that the most commonly discussed medical topics were medical treatments and drugs (often specific brands) and that these boards are clearly important sources of information and emotional support. Implication and future research are discussed.     

Preserving Catholic identity in mergers--an ethical and Canon Law perspective

A merger or joint venture between a Catholic healthcare facility and a non-Catholic healthcare facility that provides procedures the Catholic Church believes to violate moral principles raises a number of issues to be considered by diocesan bishops. The 1983 Code of Canon Law provides bishops with guidelines to help establish the Catholicity of a Catholic hospital that has affiliated with a non-Catholic hospital. The diocesan bishop exercises his authority through a threefold ministry of teaching, sanctifying, and governing. These ministries stand as a reminder of his decision-making authority in matters that affect the spiritual state and growth of those entrusted to his care. Catholic identity, as it is presented in the Code of Canon Law, can be determined through the presence of a relationship between an institution and ecclesiastical authorities, the legal establishment of the entity, and a degree of control that the Church exercises over the institution. When evaluating a possible merger of joint venture between a Catholic hospital and a non-Catholic hospital that is performing procedures not in accord with Catholic Church teaching, the diocesan bishop must consider what limits must be observed. The good effects of the affiliation must be intended and direct, and the harmful effects must be perceived as unintended and indirect. The difficulties in determining and protecting the identity of Catholic hospitals in possible mergers or joint ventures should not prevent facilities from considering alternative forms of corporate structures. The Code of Canon Law and the Church's ethical teachings provide guidelines to ensure these possibilities.     

Health-Related Message Boards/Chat Rooms on the Web: Discussion Content and Implications for Pharmaceutical Sponsorships

ABSTRACT

This content analysis study examined health-related message boards to better understand who is using this on-line health information and support device and what topics they are discussing. Besides needing to understand this support and coping mechanism for individuals, this has become an increasingly important topic for health communicators to understand because the Health and Human Services' (HHS) Inspector General recently gave permission to a pharmaceutical manufacturer for sponsorship of a disease management chat room. Very little research has been done on the content of these message boards/chat rooms. Key findings include that the most commonly discussed medical topics were medical treatments and drugs (often specific brands) and that these boards are clearly important sources of information and emotional support. Implication and future research are discussed.     

"Good help" in St. Petersburg

Founded in 2001 by representatives of seven local organizations, the Refugee Healthcare Partnership (RHP) provides necessary health services and meaningful employment opportunities for refugees in the Tampa Bay, FL, area. Spearheaded by Catholic health care organizations and Catholic Charities of the Diocese of St. Petersburg, the RHP was made possible initially by funding from the Bon Secours Mission Fund of Bon Secours Health System, Marriottsville, MD. Florida leads the nation in granting lawful permanent resident status to refugees and asylum seekers. Like the rest of the country, Florida has a shortage of long-term care nursing personnel. RHP leaders believed that by training refugees to become certified nursing assistants (CNAs) they could ease the local CNA shortage and provide refugees jobs with health insurance. Soon thereafter, RHP leaders recognized that to be successful they would have to provide services to teach refugees English. The RHP worked with the Pinellas Technical Education Centers (PTEC) to form the Pinellas Refugee Education Program (PREP). Funded by the Florida Department of Children and Families and the U.S. Department of Health & Human Services, PREP assists refugees to learn English and to train for jobs, including careers outside of health care. To help RHP clients prepare for CNA classes at PTEC, a "medical orientation" course was developed to give refugees familiarity with medical terms and with long-term care practices in the U.S. In less than four years, the RHP has served more than 260 clients. The RHP continues to offer its clients needs assessment; placement in health-care related, entry-level training programs; mentoring programs; and referrals to medical services. The original seed funding from Bon Secours has now been superseded by a substantial grant from the state.