Healthy communities: good mission, good sense. Holistic approach is the key

Catholic healthcare's mission is keeping people healthy, and providers must listen closely to determine their needs in these fast-paced, stressful times. In a society preoccupied with technology and acute care, which has the least overall impact on people's health, providers must implement more preventive strategies. The shift to promoting community health will require diverse, creative approaches. Catholic facilities must offer holistic healing, becoming community resources for children and the elderly. Religious institutes also must prepare for the laity's increasing role in the ministry. Providers must develop initiatives that define Catholic healthcare, such as the Welfare-to-Work Program in St. Louis, which offers women employment opportunities and benefits as a starting point to gain control of their lives. With increased school collaboration, nurses can help children develop good health habits. The guiding vision must be the health of the whole person and the community. Catholic providers must restore public trust and confidence by emphasizing person-centered healthcare. Only by becoming an integral part of the community can Catholic healthcare make a difference in people's lives.     

Social justice in a time of crisis. Catholic tradition offers creative ideas for solving the problems of healthcare costs and access

In this moment of crisis, Catholic healthcare leaders must seek root causes and thorough solutions to the pressures of rising costs and the grave question of access to healthcare. The first question is whether the system can be fixed or if a more radical approach is needed. To reach a solution, government, business, hospitals, and physicians must sit down at a common table to debate the issue. In 1981 the bishops outlined a series of values or principles that should characterize the U.S. healthcare system, including treating the whole person and providing access for all. These values have characterized Catholic healthcare facilities in the past decades and should not be lost in the present crisis and in the decisions being made for the future. Today, Catholic healthcare leaders have a broadened understanding of Catholic identity and the need to continually probe what that means. They realize Catholic identity is more than a few moral codes; it is a broader concern about the way in which healing takes place. Another gain is the development of lay vocations, but these are often restricted and should be more fully developed. In conjunction with this concept, we need to see hospitals as belonging to the whole Church in terms of its mission and thus the responsibility of the entire body of believers. Finally, a new image is needed concerning how care is provided. We need to bring prevention and care closer together, preventing duplication of major services and making certain basic services available to all.     

Offering salvation. Ascension, equity firm forge deal they say could save Catholic hospitals

As more Catholic hospitals have become acquisition targets by for-profit companies, the nation's largest Catholic system wants to keep more facilities in the fold. Ascension Health has teamed with a private-equity firm to do just that. But "can a for-profit enterprise that is owned by a private-equity firm pursue and live the ministry of Jesus in providing healthcare?" asks Seton Hall law professor Kathleen Boozang, left.     

Merging with for-profits: flawed strategy. Such affiliations benefit neither the Catholic hospital nor society

Some Catholic healthcare organizations, seeking new sources of capital, are eyeing mergers with for-profit systems. However, such mergers raise questions about their effects on both the mission of particular Catholic institutions and the well-being of society at large. For-profit organizations are driven by the pursuit of profit. They market ?products.? This pursuit naturally shapes their decision-making rationales, employee relations, and business priorities. Not for-profits, on the other hand, provide ?public goods?--goods that for-profits either will not provide or will not provide adequately--and this mission shapes their priorities, decision making, and employee relations differently. What is more, economic power is unequal between the two kinds of organization. Since not-for profits are seeking capital when they merge with for profits, they usually do so from a position of relative disadvantage. When conflicts arise, the for-profit partner generally prevails. The not-for-profit partner then finds itself, not merged with, but acquired by the for-profit. Throughout U.S. history, not-for-profits have performed a function neglected by both government and private companies. Now, in the 1990s, the whole social welfare framework of our society is under attack. A moral-political crisis questions the very concept of the voluntary sector. If Catholic healthcare organizations allow themselves to be swallowed by for-profits, who will care for the voiceless and the vulnerable?     

Not-for-profits up for grabs by the giants

Continuing the consolidation in healthcare, hospitals that for decades have been the cornerstones of the not-for-profit sector--teaching facilities, Catholic hospitals and other church-affiliated institutions--are for the first time considering deals with for-profit chains.     

A dynamic force for change. The common good provides the rationale for a healthcare system for all

In advocating for a reformed healthcare system, the Catholic healthcare community has claimed that responsibility for the common good is of the highest ethical importance. Yet to many the concept of the common good remains elusive. As the common good evolved in Catholic social teaching, it grew to include its anthropological origins, the principle of subsidiarity, and the virtue of solidarity. Above all, it is characterized by justice and refers to a social order that reflects peace, unity, and harmony. As an organizing principle for civil governments, the common good calls on them to foster societies that provide spiritual, cultural, political, and economic conditions in which all persons can realize their human dignity. By viewing healthcare and the right to security in case of sickness as among the particular goods that make up the societal common good, Catholic social teaching provides the rationale for a just healthcare system on a national level. In addition to advocating for a national healthcare system designed to serve the common good, Catholic healthcare entities must evaluate their own programs and services in light of the common good and examine proposed initiatives with other providers, especially for-profit organizations, in that context, as well.     

A new role for the Church. Dioceses should do more in providing care for dependent and dying persons

In 1988, with the publication of Catholic Health Ministry: A New Vision for a New Century, the Commission on Catholic Health Care Ministry called on the Church to redefine its healing mission in society. Unfortunately, despite various efforts, the Church has not yet fully articulated a shared vision of Catholic healthcare, healing, and support. Healing human brokenness has always been the Church's work in the world, whether the brokenness be physical, emotional, intellectual, moral, or spiritual. The Church, having a broader definition of brokenness than that of the larger healthcare system, must sometimes act as a countercultural critic of that system. Two of the great challenges facing healthcare today are providing care for dependent persons (people with chronic illnesses and older people) and for dying persons. In both cases, much more coordination of the various actors is needed. The Church could ensure that this coordination is carried out. In each diocese, the bishop should organize a pastoral health and social service planning group to assess community needs and apply Church resources to them. Local Catholic healthcare providers and social service agencies should develop a corporate culture of healing and support. Parishes should accept the idea that healing and supporting frail people are integral parts of parish life.     

An innovative way to continue the ministry. A Catholic multi-institutional healthcare system achieves public juridic person status

Members in a Catholic multi-institutional healthcare system that has been established as a public juridic person know their missions will be carried on even if they must leave the healthcare field. The establishment of a public juridic person was a goal of the Catholic Health Corporation (CHC), Omaha, since it began in 1980. The juridic person was to be named Catholic Health Care Federation (CHCF) in order to distinguish the canonical juridic person from the civil law corporation. It took many years to determine which competent authority was the most appropriate to grant CHCF public juridic status. The Congregation for Institutes of Consecrated Life and Societies of Apostolic Life (CICLSAL) was deemed the appropriate authority. CICLSAL established CHCF as a public juridic person on June 8, 1991. CHCF's member religious institutes are the same as CHC's. But CHCF is the canonical sponsor for two owned facilities and manages a third community-owned facility. The religious institutes remain the sole canonical sponsor for their own facilities; however, they jointly sponsor three facilities through CHCF. Public juridic person status is a way for CHCF to continue Christ's healing mission.     

Healthcare and social responsibility. The revised directives clarify the Catholic position

The Catholic Church participates in the U.S. healthcare system by reason of its contribution to the common good of society. To facilitate this, the Ethical and Religious Directives for Catholic Health Care Services set forth certain normative principles. Catholic healthcare is dedicated to promoting human dignity and the sacredness of life; it has an "option for the poor"; it seeks the common good, cooperating with other providers toward that end; it prohibits abortion, in vitro fertilization, contraceptive sterilization, and assisted suicide procedures in free-standing Catholic healthcare institutions. This article focuses on the directives in Parts 1 and 6 of the ERD. Directive 2 calls for mutual respect among care givers. Directive 3 discusses ways to care for people "at the margins of society." Directive 4 describes the medical research permitted in Catholic facilities, and Directives 5 and 9 suggest how such facilities can best perpetuate their Catholic identity. Directive 7 mandates that Catholic facilities treat employees justly. Directive 8 says that such facilities must observe canon law in transferring sponsorship or in founding, closing, or selling an institution. Directive 68 suggests that the bishop be involved in a proposed partnership that may infringe upon Catholic identity. Directive 70 urges Catholic facilities to avoid scandal, and Directive 69 warns that some forms of cooperation are unethical even when scandal is not present.     

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.     

An opportunity for positive change. We have the history, experience, and will to preserve a Catholic presence in healthcare

The charitable acts of women religious in response to the needs of the communities in which they settled is one of the great chapters in the history of the Church in America. But in the past two decades providers have had to contend with extraordinary changes in the healthcare environment. The Catholic healthcare mission was rooted in concern for the poor. Should Catholic healthcare providers withdraw from this field in which they have had such a significant presence and have contributed so much, or be driven from healthcare by the fiscal consequences of fidelity to mission? Instead, through its reform proposal, the Catholic Health Association has recommended that Catholic providers become advocates of change. However, even if change, such as universal access to healthcare, is achieved, we shall still have a society in which there will be many poor people. The challenge will be to see that healthcare for the poor does not become poor healthcare. Although the changing urban environment presents enormous challenges to providers, the Catholic healthcare ministry is a significant presence in urban areas. Widespread poverty accompanied by behavioral problems and social breakdowns are significant factors affecting healthcare and healthcare costs. Drug addiction; AIDS; teenage pregnancy; homelessness; the deterioration of the family; and generations of unemployment, anomie, abuse, and violence, which are often most acute in concentrated neighborhoods of poverty, challenge the ability of Catholic hospitals to meet their community's needs. Catholic providers today have a real opportunity to bring about positive changes in healthcare. They have the history, experience, and will to preserve a Catholic presence in the provision of healthcare.     

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.     

Meeting mission challenges in IDNs. Through integrated delivery networks, organizations can continue their ministry and extend its reach

Whatever the final shape of healthcare reform, providers and sponsors are already collaborating with each other in various network arrangements. As they pursue these arrangements, they are asking questions about their role in a reformed system and whether the networks they participate in will strengthen their mission and ministry. Documents published about five years ago by the Catholic Health Association (CHA) and the Commission on Catholic Health Care Ministry provided the rationale for CHA's proposal to form integrated delivery networks (IDNs) as part of a national healthcare reform plan. The documents called for a continuum of care with comprehensive community- and institution-based services and challenged Catholic healthcare leaders to work for a healthcare system that guarantees access to the needy and most vulnerable in society. The central task for administrators today is to determine whether participating in an IDN enables Catholic healthcare providers to fulfill their original mission and purpose. To determine this, organizations must clarify their mission and evaluate their beliefs. They must also develop a shared vision of motives and goals among everyone with whom they collaborate. IDNs' success in furthering the healthcare ministry will depend on leaders' ability to ensure that new corporate cultures which arise in cooperative ventures and arrangements support Catholic values and mission. In making the transition to a new environment, leaders should remember that aspects of IDNs support many of the goals of the Catholic healthcare ministry.     

Network integration. A new vision for Catholic healthcare systems in the 1990s

The 1990s will be the decade of network integration for many of the nation's healthcare organizations. Catholic healthcare systems will have to refocus on local and regional healthcare delivery. To succeed in local and regional markets, the systems will have to offer various levels of care through numerous types of providers, share services among facilities, cooperate with secular organizations, and build stronger affiliations with local parishes. Managing this change (from offering fragmented healthcare services to offering integrated services) will be a major challenge facing organizations in the decade ahead. They must develop a clearly articulated vision to provide stability during this time of rapid change. To meet the challenges of the 1990s, Catholic healthcare systems will have to determine the types of functional sharing that will be beneficial at the local level, divest and transfer sponsorship of facilities that burden the system's mission, and expand the activities of the laity.     

Healthcare reform's moral, spiritual issues. The problems are not just political

Although President Clinton's proposals were defeated in 1994, healthcare reform is an issue that will not go away. But it is an especially complex issue because it is moral and spiritual as well as political. Catholic social teaching could help free us Americans from our confusion on the topic. For example, the Catholic ideas of justice, subsidiarity, and the common good could help us address the crux of the healthcare reform debate, which questions the fairness of forcing more fortunate people to provide healthcare for those who are sick and poor. Catholic social teaching tells us that our healthcare decisions must be made not only on the basis of what is good for me but what is good for us as a community. By the same token, we might find that several specifically spiritual ideas are helpful. Christianity says, for example, that sickness can be a gift because it is a window on immortality for us; that we should not prize life above all other values; and that friendship--including the civic friendship involved in healthcare--is a way we can enter full friendship with God. These moral and spiritual ideas lead us to certain political conclusions: Healthcare reform should be politically realistic, relatively simple. and inclusive. Because healthcare is a good like no other, it can be a powerful occasion for realizing God's own compassion, healing, and justice.     

Years of transition. Internal developments under Fr. Schwitalla, 1928-1947

Dedicated to helping Catholic hospitals keep pace with rapid changes in the healthcare field, CHA flourished under the leadership of its first president, Rev. Charles B. Moulinier, SJ, who served from 1915 to 1928. The second in a series of Health Progress articles on the Catholic Health Association's history (March 1990) recounted Fr. Moulinier's efforts to expand CHA's role as a national organization serving Catholic hospitals. This article describes the work of Rev. Alphonse M. Schwitalla, SJ, to reorganize CHA and to develop a program for evaluating Catholic schools of nursing. In May, a fourth article will focus on CHA's developing relationships with other national Catholic organizations and its expanded role as an advocate of healthcare policy reform.     

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.     

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.     

Persistence and pain. Women and healing in the Gospel offer insights to Catholic healthcare providers

Scripture can enlighten us on the difficult times Catholic healthcare providers face today. Two stories from Mark's Gospel offer helpful insights to persons engaged in the institutional context of healing. These stories are of the woman with the "flow of blood" (Mk 5:25-34) and of the Syro-Phoenician woman (Mk 7:24-30). The women were determined to receive the healing they needed. They went for it, and got it, despite considerable obstacles. I suggest five insights we might draw from these two narratives of healing. These women were persistent. Sometimes it takes a great deal of persistence to find God in all the ordinariness, the numbing everydayness we encounter in our daily work. Like these women, the healing you seek for those you care for takes place in a hostile world. Catholic healthcare institutions themselves face some hostility from other institutions. The stories remind us that we must feel our own pain and that of others. The capacity to hurt and to feel the hurt of others helps us persevere in the face of this hostile world. Both women did what others could--and should--have done for them. Each of these women found in herself a place of strength she could draw on. This place of strength is the presence of God. I hope that Catholic healthcare providers are aware of God's presence in them and in those to whom they minister. I hope they work against the "quick-fix" mentality of much of modern healthcare and modern consumerism. Catholic healthcare recognizes the sacramentality of life on earth, struggling always to find the God who is revealed where we least expect her.     

A growth opportunity. Catholic hospitals can improve their mission and margin by developing rehabilitation services

Developing rehabilitation services should be an attractive diversification strategy for Catholic hospitals during the 1990s. Although the number of inpatient rehabilitation providers more than doubled during the 1980s, many markets remain underserved. Rehabilitation units can enable facilities to generate revenues and, at the same time, better serve the community. A number of other factors make creating rehabilitation programs a sound venture: Hospitals can choose from among a variety of product lines when deciding which services to include; reimbursement mechanisms are at present favorable to rehabilitation; businesses are making increasing use of these services; the segment of the population that most often requires rehabilitation services is growing; and many acute care hospitals have a ready-made source of rehabilitation referrals in their occupied beds. For Catholic healthcare facilities now offer teritary or subspecialty programs and have developed sophisticated ancillary services, they are well placed to add rehabilitation programs.