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.     

Development of a service organization. CHA (Catholic Hospital Association) from post-World War II through Vatican II

Having weathered the Depression and war years, CHA in the late 1940s looked forward to a new era in Catholic healthcare. The third and fourth articles of Health Progress's six-part history of CHA described how Rev. Alphonse M. Schwitalla, SJ, led the association through one of the most difficult periods in U.S. history. This article follows CHA's development into a modern service organization under the leadership of Rev. John J. Flanagan, SJ. The series' final installment, which will appear in the July-August issue, describes how CHA has modernized its services and structure in the past two decades to help its members adjust to a turbulent environment.     

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.     

Values and vision--CHA's plan for healthcare reform is based on two unique perspectives

The Catholic Health Association (CHA) Leadership Task Force on National Health Policy Reform has offered a proposal that, if enacted by Congress, would result in profound changes in the way providers deliver healthcare in the United States. The proposal would result in fewer acute healthcare facilities, challenge some acute care facilities to provide additional services and require each Catholic healthcare provider to collaborate with Catholic providers and others. Two features distinguish CHA's plan from the many other healthcare proposals that have been offered. First, CHA's plan is rooted in six tenets of Catholic healthcare. Second, the plan primarily focuses on client-centered delivery reform rather than on financing issues as other proposals have done. The task force believed it first had to create a vision of what the nation's future healthcare delivery system should look like. The task force decided that providers must do a better job of meeting clients' healthcare needs. To be a credible leader in the healthcare reform debate, the task force believes that CHA must offer a plan that primarily focuses on the needs of people and, second, controls costs effectively.     

Counting community benefits. CHA survey reveals members' commitment to providing care for the poor and other community services. Catholic Health Association

In its 1990 National Community Benefits Survey, the Catholic Health Association (CHA) found that in recent years Catholic hospitals increased the amount of uncompensated care they provided, despite growing fiscal constraints. CHA also found that, in the two years since it introduced the Social Accountability Budget, 60 percent of Catholic healthcare facilities have used either CHA's process or a similar structured approach to reinforce, measure, and plan their contributions to the community. Of the hospitals that responded to the survey, 91 percent provided nonbilled services targeted to low-income populations in 1989, more than 75 percent provided free or discounted services to other populations with special needs, and about 82 percent made free or discounted services available to the broader community. In addition, the majority of Catholic facilities can now more accurately report the dollar value of the uncompensated care they provide. In Illinois 31 of the state's 52 Catholic hospitals were able to quantify the value of the benefits they provide to the poor and the broader community. Moreover, facilities and systems throughout the nation are intensifying their efforts to plan and coordinate programs to meet community needs and the needs of the poor.     

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.     

Accessibility and the Canadian health care system: squaring perceptions and realities

The 1984 Canada Health Act (CHA) is the major piece of Federal legislation that governs health care accessibility in the provinces and territories. According to the CHA, all provinces and territories in Canada must uphold five principles in order to receive federal funding for health care (universality, comprehensiveness, portability, public administration, and accessibility). In Canada, there are competing views among policy makers and consumers about how the CHA's principle of accessibility should be defined, interpreted and used in delivering health care. During the 1990s, the health care perceptions of Canadians and their health care behaviours were measured through both public opinion polls and Statistics Canada's National Population Health Survey (NPHS). The goal of this paper is to examine perceptions of accessibility in public opinion polls and actual accessibility as measured through the NPHS. Public opinion polls demonstrate that while Canadians want to preserve the principles of the CHA, a majority of Canadians are losing confidence in their health care system. In contrast, the results from the NPHS reveal that only 6% of Canadians aged 25 years and older have experienced accessibility problems. Among those who report access problems, the barriers to accessibility are linked to specific socio-economic, socio-demographic and health characteristics of individuals. We discuss these findings in the context of the current debates surrounding accessibility within the CHA and the Canadian health care system.     

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.     

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.     

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).     

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.     

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.     

Immunization against Brucella infection: 8. The response of Cynomolgus philippinensis, guinea-pigs and pregnant goats to infection by the Rev I strain of Brucella melitensis

Experiments have been carried out on monkeys, goats and guinea-pigs to define as closely as possible the degree of attenuation of the Rev I strain of B. melitensis. Earlier studies had conclusively demonstrated the effectiveness of the strain as an immunizing agent of the three animal species and had suggested that the degree of attenuation was such as to warrant limited study in humans. Results of such a limited study suggested more intensive measurement of the virulence of the strain in other stocks of animals as well as in individual animals rendered increasingly susceptible. A comparison of Rev I with B. abortus, strain 19-BA, and with a fully virulent strain of B. melitensis in guinea-pigs confirmed that the BA strain was more attenuated than Rev I. Cynomolgus monkeys were effectively immunized by Rev I and showed temporary signs of generalized infection. Human isolates of the Rev I strain were striking in the temporary infectivity possessed by rough colony types.     

CHA Evaluative Criteria: strengthening commitment to the apostolate

CHA's Evaluative Criteria helps facilities determine the breadth of their Catholic focus and character. It is the best response Catholic health care facilities can make to the issue of quality of care.     

CHA 2000 recommendations: a guide to the future. Catholic Health Association

The following is an excerpt of the CHA 2000 Task Force Final Report and Recommendations, approved by the Catholic Health Association (CHA) Board of Trustees at its April meeting. The recommendations for the future of CHA were presented to the CHA membership at the annual business meeting at the Joint Assembly of the Catholic Health Associations of Canada and the United States, June 10 in Montreal.     

Culturally-Relevant Online Education Improves Health Workers’ Capacity and Intent to Address Cancer

To address a desire for timely, medically-accurate cancer education in rural Alaska, ten culturally-relevant online learning modules were developed, implemented, and evaluated with, and for, Alaska’s Community Health Aides/Practitioners (CHA/Ps). The project was guided by the framework of Community-Based Participatory Action Research, honored Indigenous Ways of Knowing, and was informed by Empowerment Theory. Each learner was invited to complete an end-of-module evaluation survey. The survey asked about changes in intent to share cancer information with patients as a result of the module. In 1 year, August 1, 2016–July 31, 2017, 459 surveys were completed by 79 CHA/Ps. CHA/Ps reported that, because of the modules, they felt more knowledgeable about cancer, and more comfortable, confident, and prepared to talk about cancer with their patients, families, and communities. All learners shared that because of the modules, they intended to talk with their patients more often about cancer screenings, tobacco cessation, physical activity, or nutrition. These findings suggest that the application of this collaboratively developed, culturally-relevant, health promotion intervention has supported increased CHA/P capacity and intent to interact with patients about cancer. In the words of a learner: “Doing all these courses makes me a ton times more comfortable in talking about cancer with anyone. I didn’t know too much about it at first but now I know a whole lot. Thank you”.     

Community health assessment: driving the need for current, easily accessible population health data.

Community health assessment (CHA) is a core public health function. Community health assessment is a term that describes both a process and its tangible products, such as a community health profile or other types of reports on the status of the community's health and existing influences on its health, including the extent and nature of health-related resources. Assessment has enabled a better understanding of the community's health, and this has impacted public health decisions. The authors use the framework for community health improvement proposed in 1997 by the Institutes of Medicine to show how CHA is part of the community health improvement process. Community health assessment drives the need for current, easily accessible population health data. The importance of Web-based data query systems, the focus of the other articles in this special issue, can be best understood within the broader context of CHA. Selected case examples of how Web-based data query systems have impacted the CHA process in three states are highlighted.     

A voice against physician-assisted suicide

In the early hours of November 14, 1996, Card. Joseph Bernardin died of pancreatic cancer. The Archbishop of Chicago approached death not in fear but as a "transition from earthly life to life eternal." One of his last public acts was writing a letter to the U.S. Supreme Court. He asked the justices to reject arguments that the dying have a right to physician-assisted suicide. In two powerful and poignant pages, the cardinal concisely summarizes the legal and policy arguments against legitimizing the purposeful facilitation of death by healthcare providers. CHA attached his letter to the amicus curiae brief it filed with the U.S. Supreme Court in Vacco v. Quill and Washington v. Glucksberg, the two physician-assisted suicide cases to be decided by the Court this term (see "CHA Amicus Curiae Brief on Physician-Assisted Suicide," p. 36). In this article we provide context for the thoughts expressed in Card. Bernardin's letter, excerpted below, and describe how this letter makes a persuasive legal argument against physician-assisted suicide.     

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.     

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.