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.     

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.     

Evangelization through institutional sponsorship. Education and experience in the congregation's tradition can move the laity to full partnership in the ministry

Sponsors' efforts to empower lay leaders to carry on the Catholic healthcare ministry can be understood as a process of evangelization, or the proclamation of the Gospel to Christians and non-Christians in order to awaken and nourish faith. By involving the laity in the operation of their institutions, sponsors assume an evangelizing posture. To ensure the continuation of their ministry, sponsors share with the laity their history, charism, and values. They thus set a standard on which institutions can base their own mission and values. Catechetics, or religious instruction, is another aspect of evangelization. For sponsors, catechesis takes place through governance and mission integration activities. The sacraments are also important to evangelization. Through prayer before a board meeting, the use of paraliturgy during the commissioning of new board members, or the eucharistic liturgy, sponsors raise people's awareness of the sacred even in the midst of workplace routine. Sponsors themselves need continual evangelization. As congregations help the laity carry out the Church's healing mission, they are also called to examine how they sponsor.     

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.     

After the shaking stops. Catholic healthcare workers should prepare for seismic changes

In an attempt to cap spiraling costs and remain competitive, both providers and insurers are going through a frenzy of consolidation. Experts are predicting these changes: The integrated delivery system (IDS) will be the prevailing type of healthcare organization. There will be fewer acute care beds and fewer hospitals. Hospitals will be subsidiary to IDSs. Catholic and non-Catholic providers will join together to form IDSs. Regional IDSs will join statewide networks. The Catholic healthcare ministry can survive in such an era of consolidation if its leaders (1) collaborate with others on a basis of shared values, (2) have a well-defined mission, (3) provide holistic care, and (4) ensure that the organization remains true to its mission and demonstrates core values in its decisions and behaviors. Sponsors will need to find ways to share management of IDSs with non-Catholic organizations; to collaborate in the formation of regional and statewide IDSs; to urge other Church leaders to support social justice, human dignity, and community service; to be mindful of the stresses these changes will place on physicians and employees; to encourage dialogue about other changes in religious life; and to prepare laypersons to be their successors in the leadership of Catholic healthcare.     

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.     

Making mission possible. A response to Rev. Richard A. McCormick's article on the preservation of Catholic hospitals

In "The Catholic Hospital Today: Mission Impossible?" (Origins, March 16, 1995, pp. 648-653), Rev. Richard A. McCormick, SJ, STD, questions whether Catholic hospitals can continue their missions in a society with so many factors and influences that seem to oppose efforts to perpetuate the healing ministry of Christ. As Fr. McCormick states, the matrix of good medicine is centered on the good of the individual. But too often, the patient has been considered an individual isolated from others. The rights of families, people who belong to the same insurance program, and the society funding much of healthcare must also be considered. Fr. McCormick points out that an obstacle to the healing mission arises because healthcare is often treated as a business instead of a service. If not-for-profit healthcare facilities come to exist for the well-being of the shareholders, as do for-profit healthcare facilities, then a perversion of values results. This should lead us to renounce for-profit healthcare and the behavior that some Catholic health organizations have borrowed from the for-profit sector. In addition, Fr. McCormick calls attention to our society's denial of death and tendency to call on medicine to cure personal, social, or economic problems. This denial-of-death phenomenon helps us realize the need for the mission of Catholic hospitals. Continuing the mission of Catholic hospitals will require the attention of all involved in them-physicians, trustees, nurses, administrators, and ancillary personnel. These healthcare providers must not be distracted from the mission by joint ventures and economic issues.     

From ministry to market. Catholic healthcare can survive in an age of commercialization

Large, for-profit healthcare corporations now dominate hospital and physician services in many parts of the nation. Such organizations are under unrelenting pressure to produce profits; news stories show that these pressures can lead for-profits to engage in questionable, even illegal activities. Also, for-profits are unlikely to provide much care for the poor and uninsured. Unfortunately, Catholic providers have several disadvantages when competing with for-profits, and one is the fact that they do provide care for the poor. Catholic providers are handicapped also by: Problems with their geographic locations. Difficulties in creating partnerships with physicians. Lack of access to capital. Loss of political influence. On the other hand, Catholic healthcare providers have several advantages over for-profits. Among them are: A reservoir of public goodwill. Experience in forming networks The potential for prudent growth. A common vision. Access to Church pulpits. The influence of women and men religious Given theses advantages, Catholic health ministry leaders could boldly restructure their own organizations, and, in doing so, mitigate the commercialization of healthcare in the United States.     

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.     

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.     

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.     

"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.     

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.     

Tradition and transformation. Sponsors forge relationships to revitalize the Catholic healthcare ministry

In September 1992 seven leaders of institutes of women religious met in St. Louis to discuss the challenges facing sponsors of Catholic healthcare. One woman religious from the Catholic Health Association also joined in the roundtable conversation. The discussion ranged over a variety of topics but invariably returned to one question: Given the current situation in healthcare, how can sponsors use their leadership to foster relationships that ensure the continued vitality of the Catholic healthcare ministry and promote a just and rational healthcare system?     

Can the ministry collaborate to form the "next generation" of sponsors?

In looking to the future of sponsored ministry of Catholic institutions, the formation of future sponsors--both religious and lay alike--is an important issue. As this ministry continues to evolve, and sponsoring groups determine how best to prepare new sponsors, might it not be time to think about how to pool the ministry's collective wisdom on formation? Sponsors act not only in the name of the health care institution (or other ministry) but on behalf of the faith community engaged in continuing the compassionate healing ministry of Jesus. In Catholic ministry, and particularly health care ministry, sponsors carry out their responsibilities through a multiplicity of organizational relationships. Just as structures differ, so too do criteria that guide who will be called to join a sponsoring group. There are several core elements that are incorporated in the majority of sponsor competency sets. Elements identified by a committee of ministry members, and reviewed by hundreds of sponsors and other ministry leaders are: mission oriented, animated, theologically grounded, collaborative, church related, and accountable. If one is looking at the potential for convening dialogues about possible areas of collaboration in formation, these core elements, with examples of how they are lived out, may offer an outline of areas new sponsors might need to learn more about for their personal and professional development. Our Catholic health ministry depends on leaders who can create and steward organizational cultures that incarnate Jesus' healing. The possibilities for collaboration in the formation of future sponsors are endless, but there are challenges. If you are a member of a sponsor body/council/corporate member in Catholic health care, and are interested in nominating potential persons to take part in a representative group that would discuss possibilities for collaboration in sponsor formation, please go to www.chausa.org/sponsorformation and complete all sections of the nomination form.     

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.     

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.     

A "second generation" of ministry leadership

Catholic health care leaders differ from others in the field in that "they are expected to serve as Jesus served, teach as Jesus taught, and lead as Jesus led, in order to heal as Jesus healed." The Catholic health ministry today is led largely by laypeople-what might be called the "first generation" of lay leaders. This first generation was privileged in that it was tutored by and worked alongside women and men religious. Those religious are now mostly gone from the ministry, and that first generation of lay leaders will also be retiring in the not too distant future. Leadership will then pass to a "second generation," laypeople who have not worked alongside religious. How is this new generation to learn "to heal as Jesus healed"? Catholic Health East (CHE), Newtown Square, PA, has developed a program explicitly directed at the recruitment and development of second-generation leaders. In its efforts to fill a position, the system first assembles a preferred-candidate profile, based on 15 competencies, including seven core competencies. CHE then employs a recruitment process based on behavioral event interviewing. All involved stakeholders participate in the interviews.     

What separates outstanding from average leaders? A study identifies leadership competencies and implications for professional development

As the healthcare crisis mounts, healthcare organizations must be managed by especially competent leaders. It is important for executives to assess and develop the competencies necessary to become "outstanding" leaders. In our study of leadership competencies among leaders of religious orders, we found that outstanding and average leaders appear to share characteristics such as the ability to articulate their group's mission, the ability to act efficiently, and the tendency to avoid impulsive behavior or excessive emotional expression. Outstanding leaders, however, differed from average leaders in seemingly small but significant ways. For instance, nearly three times as often as average leaders, outstanding leaders expressed a desire to perform tasks well--or better than they had been performed in the past. The study also assessed how members of religious orders perceived their leaders. In general, they tended to rate leaders of their religious institutes as transformational leaders--leaders who welcomed doing things in a new way and inspiring their own staffs to search out new ways to provide services.     

Preserving the mission. Sponsors and lay leaders must collaborate to maintain the Church's presence in healthcare

As the number of women and men religious involved in healthcare decreases, the Church faces the task of sustaining and expanding its institutional presence in the healthcare world. Both the Gospels and Church teaching support the claim that the Church should be involved in social institutions such as healthcare. Documents such as the Second Vatican Council's Pastoral Constitution on the Church in the Modern World stress the Church's concern with the impact of God's kingdom on all dimensions of human life. Pope Paul VI's Evangelization in the Modern World clearly affirms that the Gospel cannot be complete until it is interrelated with social life. Jesus' ministries of teaching and humble service are also paradigmatic for Catholic healthcare. To preserve and extend its institutional presence, Catholic healthcare will have to meet a number of challenges in the coming years. Catholic healthcare facilities must be prepared to relinquish their autonomy and work with others, providers will have to become attuned to what is distinctively Catholic about their facilities, and the Church must commit itself to preparing lay leaders for the Catholic healthcare ministry.