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.     

The notion of grace

Catholic Healthcare West (CHW), San Francisco, which either sponsors or participates in three separate leadership development programs, sees the formation of new ministry leadership as a matter of the first importance. For the past four years, CHW has participated in CHA's Ecclesiology and Spiritual Renewal Program for System Leaders, the annual pilgrimage to the Vatican City in which ministry executives, board members, and sponsors get an opportunity to learn about the church's institutional structure and immerse themselves in its spiritual atmosphere. In 2002 the system established its CHW Learning Institute, which offers all employees training in leadership, clinical, governance, and employee development. Among other things, the institute has developed CHW's Competency Standards for Leadership. In 2004 CHW, with four other Catholic health care systems in the western United States, created the Ministry Leadership Center, Sacramento. This spring, 49 CHW managers were among the students enrolled in the center's inaugural classes. Among other subjects, they studied the distinctive competencies-intellectual, affective, and spiritual-required to lead a health care ministry in its operations and governance.     

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.     

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.     

Loyalty in managed care: a leadership system

Healthcare executives are given a comprehensive and integrated ten-step system to lead their organization toward stabilizing a financial base, improving profitability, and differentiating themselves in the marketplace. This executive guide to implementing loyalty-based leadership can be adapted and used on an immediate basis by healthcare leaders. This article is a useful resource for healthcare executives as they move to make loyalty an organizational resource. Effectively managing the often-fragmented forces of loyalty can produce a healthier bottom line and improve the commitment among key stakeholders within a managed care environment. A brief loyalty-based leadership practices survey is included to serve as a catalyst for leaders and their teams to strategically discuss loyalty and retention in their organization.     

Community benefit: what it is and isn't

"Community benefit" is the measurable contribtution made by Catholic and other tax-exempt organizations to support the health needs of disadvantaged persons and to improve the overall health and well-being of local communities. Community benefit activities include outreach to low-income and other vulnerable persons; charity care for people unable to afford services; health education and illness prevention; special health care initiatives for at-risk school children; free or low-cost clinics; and efforts to improve and revitalize communities. These activities are often provided in collaboration with community members and other community organizations to improve local health and quality of life for everyone. Since 1989, the Catholic health ministry has utilized a systematic approach to plan, monitor, report, and evaluate the community benefit activities and services it provides to its communities. This approach, first described in CHA's Social Accountability Budget, was updated in the recent Community Benefit Reporting: Guidelines and Standard Definitions for the Community Benefit Inventory for Social Accountability. By using credible and consistent information, health care organizations can improve their strategic response to demands for information that demonstrates their worth.     

The modern association. Preserving a Catholic presence in the U. S. healthcare system

A leader in U. S. Catholic healthcare since 1915, CHA has helped Catholic hospitals meet the challenges of the standardization movement, the Depression, and two world wars. The fifth Health Progress article on CHA's history (June 1990) described the association's postwar emergence as a service organization under the leadership of Rev. John J. Flanagan, SJ. This article, the last in the series, charts CHA's response to the revolutionary changes within Catholic healthcare brought about by the Second Vatican Council and the passage of Medicare. It recounts the struggles within the U.S. Catholic healthcare community to sustain its Catholic identity, as well as the community's increased presence as an advocate for a just healthcare system. In the spirit of the institutes of women religious who established the Catholic healthcare ministry in the United States, CHA enters the 1990s committed to advocating for universal access to healthcare and enhancing its members' ability to serve the poor and vulnerable.     

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.     

A journal of community. Catholic healthcare providers' presence is necessary to sustain a values-based system

Catholic healthcare leaders must use all their will and creative imagination to find a way to maintain a significant Catholic presence in healthcare. Catholic healthcare leaders across the nation are acquiring, consolidating, and merging hospitals; forming alliances and networks of integrated services; and bringing together Catholic healthcare systems on a regional and local basis. The next few years are critical for Catholic sponsors of healthcare services. The unique challenge is to pursue the development of a Catholic network that would include a wide range of health, mental health, home care, long-term care, social, and housing services. The key ingredient to making networks happen will be leadership, and I think CHA and sponsors rightly emphasize the need for continuing leadership formation and development of trustees and executives in Catholic healthcare. A united effort by Catholic healthcare providers could have a penetrating influence on the overall development of healthcare in this nation. Now is the time to exercise imaginative leadership; to reach out to the existing Catholic and community-based providers of health and human services; and to create networks that can provide a continuum of accessible, high-quality, values-based, and cost-efficient services.     

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.     

Managing change. A step-by-step process helps sponsors implement change smoothly

During the past six years the Catholic Health Association (CHA) has developed and modified a process to help leaders evaluate and implement merger, cosponsorship, and sponsorship transfer decisions. CHA's highest priority in these efforts has been to keep Catholic healthcare facilities under Catholic sponsorship, control, and management. Proposals to change sponsorship arrangements usually originate with sponsoring institutes, whereas local boards generally initiate merger proposals. In either case, it is critical that all interested parties--such as sponsors, boards, administrators, medical staff, employees, and the local Church--be involved in the decision-making process at some point. Once leaders have decided on a course of action, they should appoint a task force to implement the proposal. The board, administration, and medical staff will all have important roles to play in the implementation process. Another important step is to establish criteria for evaluating candidates for a proposed merger or sponsorship transfer. Leaders should ensure that people affected by the transaction have an opportunity to give input and to grieve their loss. After leaders have selected a candidate, they must negotiate the details of the agreement and take the necessary legal steps to complete the transaction. It is imperative that a facility secure outside legal counsel to help it through this stage.     

The role of leadership in creating a diversity-sensitive organization

The opportunity for personal growth that a focus on DSO development offers leaders is compelling, as it provides and requires new experiences and new ideas. Seasoned healthcare executives and their organizations are offered the opportunity for renewal-to see things in a new light and experience the organization, the service area, and each other differently. Researchers at the Gallup Organization, based on studies of more than 50,000 leaders in diverse industries, have identified the following seven demands of leadership: visioning, maximizing values, challenging experiences, mentoring, building a constituency, making sense of experience, and knowing one's self (Conchie 2004). To meet these demands with courage and conviction in the context of diversity is, perhaps, the ultimate healthcare leadership challenge in the foreseeable future.     

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.     

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.     

Lessons of experience: Key events and lessons learned of effective chief medical officers at freestanding children's hospitals

As the healthcare environment changes, physician executives who are effective leaders and agents of change are needed. Healthcare organizations that are successful at developing effective physician leaders will be at an advantage. This article examines how physician leaders develop on the job. Such knowledge and insight can be useful to healthcare systems looking to develop a new physician leadership development program or improve an existing one. This study identified that learning from other people (e.g., mentors, role models, bosses) and key events involving hardships are valuable means in developing leadership acumen for chief medical officers (CMOs) at freestanding children's hospitals. Most of the hardships CMOs reported were a result of mistakes made when they were trying to institute change. CMOs reported a disproportionately low number of learning events from developmental job assignments. This finding may indicate a lost opportunity on the part of healthcare organizations in developing leaders. The most frequent lessons learned pertained to handling relationships, interpersonal skills, and executive temperament. Skills in handling relationships and interpersonal skills were best learned through business mistakes made in dealing with others. Lessons in executive temperament, self confidence, and handling adversity were most often learned from role models and bosses. These findings indicate that physician leadership development initiatives should intentionally and systematically incorporate job assignments, role models, and mentors.     

Our essential journey. A Denver system decides to "grow" its own leadership

Last year Provenant Health Partners (PHP), a Denver healthcare system, decided it would begin to "grow" new lay leaders. The idea was to allow PHP personnel to self-select themselves as potential leaders and to guide their development so their daily work would come to reflect the system's heritage and values. PHP is part of Sisters of Charity Health Care Systems (SCHCS), based in Cincinnati. As a foundation for its project, PHP had its senior and middle managers participate in SCHCS's Values in Leadership program, which increases leaders' awareness of their role as stewards of Jesus' healing ministry and encourages them to develop effective skills based on their sponsor's core values. PHP then formed an 11-person leadership development planning team representing its three hospitals and various system departments. The team drafted a plan which encourages PHP leaders and potential leaders to develop leadership skills with the aid of feedback from their colleagues. PHP is currently fine-tuning the plan in a pilot project. In addition to using the plan to develop leaders, the system is considering adapting it for use in employment screening, intraorganizational promotion, and the allocation of educational funds.     

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.     

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?     

Mission-driven market strategies: lessons from the field. A study of six successful Catholic systems finds mission and values clarity more relevant than ever

Convinced that Catholic organizations might have special strengths for succeeding in price-competitive markets, the Catholic Health Association, with the assistance of a national membership advisory committee and The Lewin Group, Fairfax, VA, studied six healthcare organizations that are successfully meeting the challenges of difficult environments. Based on more than 100 interviews and assessments of the environments in which these progressive mission-driven organizations operate, the researchers identified strategies that can assist other faith-based health organizations. The Lewin Group's Kevin J. Sexton, who led the research team, explained that "the study examined how the organizations embraced their mission and used their values in three areas: linkages with other organizations, linkages with physicians, and strategies for balancing delivery and insurance." CHA's executive vice president William J. Cox said the study sites were selected to obtain a range of marketplace, sponsorship, and structural experiences. "We wanted to learn how Catholic organizations responded to environmental forces with strategies that were grounded in mission," Cox said. CHA has published the study in a resource packet that describes the five major findings, profiles the cases, and provides Best Practices Checklists--specific pointers to guide organizations in their efforts. The following study excerpts provide a brief overview of the findings and a sample of the Best Practices Checklists. To obtain the complete resource, Mission-Driven Market Strategies: Lessons from the Field, call the Catholic Health Association at 314-253-3458 (for more information see the advertisement on p. 62).