Mission in a time of transition. Mission leaders' unique skills can help CEOs prepare their organizations for integrated delivery

To get a perspective on how the mission role has evolved over the past few years, the Catholic Health Association surveyed a sample of mission leaders at Catholic acute care facilities throughout the United States. Most respondents (86 percent) were women religious, and the majority had advanced degrees in some area of religious studies. They indicated that an ideal education for a mission leader would include preparation in theology, ethics, or spirituality, as well as business or healthcare administration. The majority of mission leaders answering the survey ranked themselves high in their ability to influence their organization's chief executive officer. They consistently identified their key role as integrating values and mission into the daily life of the organization. The majority of respondents (95 percent) said they were responsible for mission in acute care. Other important areas of responsibility included home care, hospice, long-term care, and outpatient care. Most respondents reported extensive involvement with the ethics function at their facilities, and they also had an active and vital role in continuous quality improvement efforts. Mission leaders felt their skills uniquely qualify them to assist organizations making the transition to integrated delivery. Their experience in collaboration, communication, and team building can be crucially important as organizations adjust to the demands of a new delivery system.     

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.     

Medicare/Medicaid restructuring. Challenges and opportunities of managed care

The restructuring of the Medicare and Medicaid programs poses significant operational, legislative, and mission challenges for the Catholic health ministry. This report highlights meetings held in Chicago and Philadelphia in November and December 1996 to prepare healthcare leaders for the changes that are coming. The meetings were two of seven held across the country last fall. Cosponsored by the National Coalition on Catholic Health Care Ministry, the Catholic Health Care Association (CHA), and Consolidated Catholic Health Care, these regional conferences were part of New Covenant, a process to strengthen the Catholic presence in healthcare through regional and national collaborative strategies. The meetings blended operational and mission concerns. On the first day, speakers reinforced mission as the ministry's foundation and market advantage, and they defined opportunities and strategic responses to the restructuring of the Medicare and Medicaid programs. The second day's sessions moved into collaborative strategies for dealing with Medicare and Medicaid changes. The day concluded with CHA's public policy proposals related to these programs' restructuring.     

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.     

Protecting children's health. CHA's immunization program helps organizations increase vaccination rates in their communities

In response to the increasing outbreaks of vaccine-preventable diseases in the United States, the Catholic Health Association (CHA) has developed a new resource to help its members launch programs that will increase immunization rates among children in their service area. Vaccines are the building blocks of basic primary care. But society and the healthcare system have erected barriers that prevent children from being fully immunized. Impediments include missed opportunities, cost barriers, and facility and resource barriers. Catholic healthcare providers can help eliminate these barriers and ensure that all children in their service areas are vaccinated by assessing their immunization resources, seeking out unvaccinated children, and collaborating with community organizations and agencies. CHA's immunization campaign will guide Catholic healthcare providers as they protect children from preventable diseases. Immunization may help reduce the costs of emergency and acute care for conditions that could have been prevented.     

"Do good and talk about it". A CHRISTUS health study emphasizes the importance of telling our stories to the public

In a time of public scrutiny, it is paramount that Catholic health care organizations examine their commitments to their communities and effectively communicate community benefit activities to stakeholders-employees, physicians, patients, and the public. CHRISTUS Academy, a leadership development program at CHRISTUS Health, Irving, TX, conducted two studies regarding community benefit. The first researched community benefit practices at more than 20 highly respected, tax-exempt CHA- and VHA-member organizations, comparing them with the practices of about 40 publicly traded, for-profit organizations. The primary conclusion was that community benefit is not just about measuring the numbers-it is also about "telling the story." Unlike the for-profit organizations, tax-exempt health care organizations tend to struggle with adequately measuring and reporting their community contributions. In a second study, the academy surveyed CHRISTUS Health's employees and physicians regarding their knowledge of the system's commitment vis-à-vis identifying and meeting community needs. The vast majority said the system is important to the community and is actively involved in understanding and meeting the needs of the community. However, they also ranked the system lower in terms of working with other community organizations, being a leader in community health, and being known for sponsoring volunteer activities. These lower rankings indicate that the community benefit activities are not well publicized or known within the organization. Catholic health organizations must take an active approach in communicating their work to the public, the media, and each other. In doing so, they fulfill an integral part their mission.     

Covenant model of corporate compliance. "Corporate integrity" program meets mission, not just legal, requirements

Catholic healthcare should establish comprehensive compliance strategies, beyond following Medicare reimbursement laws, that reflect mission and ethics. A covenant model of business ethics--rather than a self-interest emphasis on contracts--can help organizations develop a creed to focus on obligations and trust in their relationships. The corporate integrity program (CIP) of Mercy Health System Oklahoma promotes its mission and interests, educates and motivates its employees, provides assurance of systemwide commitment, and enforces CIP policies and procedures. Mercy's creed, based on its mission statement and core values, articulates responsibilities regarding patients and providers, business partners, society and the environment, and internal relationships. The CIP is carried out through an integrated network of committees, advocacy teams, and an expanded institutional review board. Two documents set standards for how Mercy conducts external affairs and clarify employee codes of conduct.     

The transition to regional networks. Changes in reimbursement and approaches to care favor cooperative arrangements among providers

As costs escalate and the delivery system becomes more fragmented, organizations throughout the United States have begun to call for basic reform of the healthcare system. Several national organizations, including the American Hospital Association and the Catholic Health Association, have presented working proposals advocating coordinated regional healthcare delivery systems. The proposed networks would provide a full continuum of services from prevention through aftercare and long-term care, and from primary through tertiary care. In the past few years, providers themselves have begun to see the value of cooperative efforts. Collaborative ventures such as group purchasing and sharing mobile equipment have increased as hospitals look for ways to reduce costs and control overhead. Mergers and affiliations are also becoming more common. As they develop, different networks will allow for various kinds of interrelationships among components. In general, these systems will provide high-volume, low-cost services at a number of sites and low-volume, high-cost services at a central location. Secondary and tertiary campuses will focus increasingly on specialty care, and as volume increases at primary campuses, secondary and tertiary organizations will establish more primary affiliations. To make the transition from a competitive to a cooperative healthcare delivery system, providers will have to reexamine their mission and values and, in many cases, refocus their vision of the future.     

Health care and the global community

Catholic health systems and facilities, to fulfill their commitment to the healing ministry of Jesus Christ, are called to serve society's most poor and vulnerable people. This calling applies to people in need not only locally but also internationally. Individuals and organizations providing aid in foreign lands will face many challenges. Yet if they believe that they can use their expertise to benefit people in need, they can accomplish their goals. Some guiding principles are instructive for those undertaking international outreach efforts: Partners must commit themselves to a common mission; the effort must focus on empowering aid recipients; participants in the effort-donors and recipients alike-can experience transformation; and health and well-being must be central to the work. The Catholic Consortium for International Health Services (CCIHS) has experience in following these principles to bring about change. The consortium can help ministry organizations achieve their international outreach goals.     

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.     

Program helps nurses develop spiritual care skills

Recognizing the registered nurse's (RN's) important role in providing spiritual care, the Catholic Health Association of Wisconsin has created a program to prepare nurses to identify and respond to patients' spiritual needs. The program features instruction in theological and ethical issues and a three-month practicum, during which nurses evaluate their abilities to incorporate an awareness of spirituality into professional practice. A patient questionnnaire enables an objective measurement of the program's effect on nurses' care-giving skills. The program's ultimate goal is to formalize the RN's role as a member of the spiritual care team in the Catholic health care facility. The program represents not only an opportunity to contribute to the RN's professional growth but also to advance the Catholic health care mission.     

Mentoring mission leaders of the future. Program prepares laity for ministry leadership

As religious sponsors increasingly relinquished their CEO positions throughout the 1980s and early 1990s, they established mission integration positions-staffed primarily by women religious-to help ensure the Catholic identity of their facilities. Now that role, too, is undergoing change as sponsors seek to empower the laity in their organizations with responsibility for carrying on the Church's healing mission. At St. Vincent Hospitals and Health Services in Indianapolis, the Daughters of Charity of St. Vincent de Paul, the organization's sponsor, has developed a mentoring program to train the laity in the roles and responsibilities involved in mission. The year-long program has 11 modules that present theory on such topics as ethics, spirituality, the sponsor's history and charism, and the relationship of the healthcare organization to the Church. Participants also attend committee meetings, complete a mission integration project, and gain practical experience in mission-related activities.     

Clean air works: the Boston experience.

NACCHO supports local public health agencies across the country in their efforts to implement smoke-free workplace ordinances in their communities. As the national voice of local public health, NACCHO also strives to strengthen and improve the health of our nation's communities through the tobacco prevention and control project. NACCHO provides a variety of tobacco-related tools and resources through its Web site (www.naccho.org), including the Tobacco Prevention and Control Learner's Guide; Smoke-free Policy Guidelines, a series of fact sheets co-authored by the Association of State and Territorial Health Officials (ASTHO) and the National Association of Local Board of Health (NALBOH); the Model Practices Database; Program and Funding Guidelines for Comprehensive Local Tobacco Control Programs, a document outlining the 7 components of a good tobacco control program; resources on social justice; NACCHO's Foundation Funding Guide, an online resource for local public health associations looking for grants from foundations; and links to other organizations. NACCHO also works to influence the development of integrated tobacco-related policy initiatives and their enforcement at the national and local level.Featured in this issue of the Journal of Public Health Management and Practice is an example of a success story of one of NACCHO's members in the area of smoke-free ordinances.     

Prevailing issues in long-term care. CEOs see urgent need for adequate funding and better communications among Catholic organizations

The ongoing crisis in long-term care has forced administrators and chief executive officers (CEOs) to reassess their position within the U.S. healthcare system and define their response to the challenges they face. This article identifies the issues that Catholic long-term care CEOs find most pressing based on two recent opinion surveys conducted by the Catholic Health Association (CHA). In the area of management and governance, the subject of a 1990 CHA survey, respondents rated as their top concern the inadequacy of funds to treat chronically ill elderly persons. Other important issues included threats to the tax-exempt status of healthcare providers, availability of healthcare for the poor, and scarcity of nursing staff. Respondents to a 1991 survey that focused on collaboration within the Catholic healthcare ministry cited the lack of a forum for communications as the greatest hindrance to collaborative enterprises. A lack of available time to pursue and develop collaborative projects and the absence of compelling reasons to collaborate with other Catholic organizations were also identified as important issues. Overall, the consensus among long-term care CEOs was strong on the importance of certain management and governance issues and on the need for Catholic organizations to work together more closely.     

Qualität in Prävention und Gesundheitsförderung

Following the principles of participatory health research, a collaborative study was conducted by the German Federal Association for Prevention and Health Promotion (BVPG) and the Institute for Social Health at the Catholic University of Applied Sciences Berlin (KHSB). The purpose of the study was to create a framework for the members of the BVPG for taking joint action on developing the quality of health promotion and prevention measures. The 129 members of the BVPG are mainly nongovernmental organizations responsible for the implementation and coordination of prevention and health promotion interventions at the state and national levels. One of the explicit goals of the BVPG is to support the development of quality in prevention and health promotion. A theoretical sample was drawn of 14 member organizations to participate in individual interviews and a Delphi process to gather data on their current quality development practice, their need for further support, and their ideas for a common framework. Selected results from the interviews and the proposed framework are presented here.     

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.     

Planning for community benefit. A seven-step process helps providers define and address important needs

The Catholic Health Association's (CHA's) Standards for Community Benefit ask Catholic healthcare organizations to show their commitment to addressing community needs. The standards call on providers to stress the importance of community service in a variety of contexts--from their statements of philosophy and values to the decisions made in their board and executive staff meetings. At the heart of the Standards for Community Benefit is the requirement that an organization's governing body adopt a community benefit plan. The community benefit plan can help orient staff, physicians, and volunteers to the facility's charitable role. A provider can also use a completed plan to elicit community members' views on the organization's interpretation of community needs, its priorities, and performance. Not-for-profit healthcare organizations can prepare a community benefit plan by completing the following steps: Restate the organization's mission and commitment Define the community being served Identify unmet community needs Determine and describe the organization's leadership role Determine and describe the organization's community service role Seek public comment on the plan Prepare a formal, written community benefit plan.     

Mission "in the trenches". A Texas system practices what it calls "co-ministry"

As responsibility for mission shifts from religious to lay leadership, sponsor-secular partnerships and new models of governance help to ensure that Catholic health care facilities continue the healing ministry of Jesus. By appointing lay mission directors and developing programs that support the work of health care professionals and associates "in the trenches," the sponsors of Catholic health care facilities are embedding particular values and behaviors in their organizations. The miracle of Catholic health care invites women and men of different faith traditions to participate in and contribute to the values, culture, and mission of the Catholic health ministry. Mission "in the trenches" is longer reserved solely for sponsors and religious congregations. By establishing and recognizing the essential services provided by interdisciplinary spiritual care teams and empowering patient caregivers with the knowledge and tools necessary to fulfill their specific responsibilities, the healing presence of God is made known to those who seek our care and observe our actions.     

"Like shining from shook foil". A "virtuous organization" is prepared to treat both the body and the soul

The Catholic health care ministry is about mission, and the role of organizational ethical reflection is to encourage people in the ministry to think about the institutional performance and practice of medicine within a ministry of the Catholic Church. By engaging a creative process that identifies the needs of people served by Catholic health care, institutions are able to mediate the healing and redeeming power of Jesus, thereby creating virtuous organizations. To depict the mission of Catholic health care as an extension of the healing ministry of Jesus is to evoke explicitly Catholic theological language, and such language is appropriate because Catholic health care is a ministry of the Catholic Church. The church itself is the embodiment of the healing and redeeming ministry of Jesus, and the institutional ministries it has created over time need to bear witness to this fundamental reason for their existence.     

A focus on common needs. CHA's physician-facility project looks at future directions in healthcare

Physicians and administrators of healthcare facilities lack integrated planning and decision-making processes, trust and confidence in each other, and a professional sense of satisfaction. A focus on common needs and interests is necessary to get the relationship on the desired track in the future. In 1989 the board of directors of the Catholic Health Association (CHA) created a special study group to review and develop recommendations on the relationships between physicians and healthcare organizations. The study group has addressed issues causing stress in these relationships, future changes in healthcare delivery that could affect these relationships, support CHA might provide, and ways to promote emphasis of these relationships and related issues among CHA members. The study group decided that collaborative planning and decision making will be the keys to getting to the desired future. This integration must go beyond shared planning activities and involve some degree of shared economic risk. The study group's final report, to be disseminated in spring of 1992, will identify key issues that significantly affect the physician-facility relationship, include resource materials to assist local organizations in assessing that relationship, and recommend ways to change the relationship through education.