The theology of community benefit. Our tradition obliges us to reach out beyond our hospital walls

The Catholic health ministry's concern for communities stems from the church's belief that human dignity is most fully expressed and recognized within the context of community. We humans are social beings by our very beings, and unless we involve ourselves in relationships with others, we fail to develop our innate human gifts. We who serve Catholic health care recognize that Jesus had a special affection for and ministry for the poor and vulnerable. Our church calls on us to provide service and advocacy for people whose disadvantages put them at society's margins. This obligation arises from the fact that all people--the healthy and the sick, the rich and the poor, the well-educated and the untaught--are children of the same loving God. Sharing that God, we are our "brother's keeper."     

"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.     

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.     

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.     

Toward a theology of limits. Seen in the right way, limits can enlarge the range of human possibility

Many in healthcare bemoan the limits-on, for example, budgets, patient autonomy, and life-prolonging interventions--of the 1990s. But limits can enhance, as well as constrict, human possibilities. Genesis reminds us that being limited is part of being human. Without limits, we would not need to become responsible. We would not need compassion, reconciliation, healing, prudence, risk, or trust. Hopes and dreams would be irrelevant. We would be paralyzed by indifference. The Bible also tells us that God is self-limiting. The New Testament describes God's self-limiting Incarnation as Jesus of Nazareth. The theology of Incarnation says that God works not in spite of human structures, experiences, and limits, but through them. The doctrine of the Trinity shows that God's own identity consists in relationship. It is from the perspective of community that one sees modern humanity's greatest ethical challenges. If we of the Catholic ministry are to be at the healthcare table, we must be willing to compromise. And we must be at the table if our values of inherent human dignity, social justice, and care for society's outcasts are to have a voice.     

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.     

Spirituality in the Catholic workplace. Does it differ from the now-fashionable versions found in other organizations?

"Spirituality in the workplace" has become something of a fad in corporate America as companies seek to find a balance between their employees' personal beliefs and the bottom line. Does this newfound spirituality-meets-margin differ from the spirituality traditionally observed in faith-based organizations? Often secular organizations, in an attempt to be as non-offensive and inclusive as possible, adopt an all-or-nothing approach to workplace spirituality. This can translate into a celebration of every religious belief system or a "New Age" appeal to universal human values. Spirituality in a Catholic health care workplace differs, however. It is quite specific in that it focuses on the healing ministry of Jesus Christ. It is precisely this healing ministry that nurtures the spirituality found in Catholic health care organizations and differentiates it from its secular counterparts. Although nurturing spirituality in the Catholic health care workplace can be seen as the job of each person involved, from sponsor to caregiver, chaplains serve an integral role. Their unique perspective and training can be crucial to successfully fostering an organizational culture based on the values that Jesus portrayed in the Gospels.     

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.     

Tradition in transition. What it means to be a Catholic healthcare facility today

Until recently we rarely questioned whether Catholic healthcare facilities would remain Catholic. New types of business ventures, however, have changed this. More important, the traditional elements that identified a facility as Catholic no longer seem enough to sustain the ministry. What are the distinct qualities that identify a healthcare facility as Catholic? Three elements are crucial to successfully defining any identity: distinctiveness, relatedness, and richness. To determine the meaning of Catholic identity, we must look at these elements from the perspective of the changes occurring in the Catholic Church and in healthcare in the United States. In light of this we can identify distinctive features that characterize U.S. Catholic healthcare. These components include understanding healthcare as a ministry, being guided by Church teachings, collaborating with others, participating in care for the world community and the poor, giving holistic care, promoting self-determination, and respecting and protecting human life while accepting suffering and death. Only in their totality, however, can these components set forth a vision rooted in our past that speaks to the realities of the present and calls us forward to a future where greater justice will reign.     

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

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

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

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

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.     

Does Canon Law speak of sponsorship of Catholic works?

Though the term "sponsorship" is not used in the Code of Canon Law, it is generally accepted today that "sponsorship" entails the use of a particular name and the exercise of certain responsibilities that arise from this use. A person's good name--whether the "person" is an individual or a group--is of primary importance today; and sponsorship responsibilities are exercised in relation to what the name stands for. In the case of church ministries such as the Catholic health ministry, the term refers to works undertaken in the name of Christ, on behalf of the Catholic Church. Traditionally, sponsorship had emphasized a position of corporate strength and independence through ownership and control via reserved powers. Today, as new relations are established with other providers, a presence is required that relies more on the ability to influence. Sponsorship in canon law entails a relation to the threefold mission and ministry of the church: to teach, to sanctify, and to serve God's people. Undoubtedly, health care fits in among these elements of ecclesial service. It has generally been held that for a work to be identified as "Catholic," it must, in one way or another, be related to a juridic person in the church, such as a diocese, a religious institute, one of the institute's provinces, or even one of its established houses (canon 634). There could also be situations in which no formal juridical person is involved and yet the work is considered to be "Catholic." Lately, new entities established specifically for sponsorship purposes have been recognized either by bishops or by the Holy See. These entities, usually known as "public juridic persons" (but sometimes also called "foundations") assume the sponsorship responsibilities previously assumed by a religious institute (or one of its parts) or a diocese. In some instances, these entities also assume all the ownership and property rights previously held by the original institute or diocese.     

How to approach Catholic identity in changing times. Catholic Health Association of the United States

The Catholic healthcare ministry is at a challenging moment in its history. Not only is the ministry called to continue to be authentic to its own self, but the ministry also has the opportunity to communicate the richness and universality of its values to others. In response to our members' genuine concerns, the Catholic Health Association of the United States (CHA) has prepared this document to support our members in the expression of their Catholic identity in new forms of healthcare service.     

Theology links Christian ministry with God's call

Catholic health care ministry originates in and is shaped by the theme of call in the Old and New Testaments. To be specifically Catholic, health professionals and facilities must define their ministries according to the values expressed in this theological tradition. Sponsorship. The opportunity to provide health care enables religious communities to contribute to God's ongoing creation process and to reiterate Christ's call to minister to others. Although health care facility sponsorship thrusts religious communities into the arena of big business, the abandonment of the health care mission could be considered a betrayal of evangelical values. Quality of life. The implicit concern for human dignity that distinguishes Catholic health care facilities should be evident in personalized patient care, just working conditions, and a commitment to healing in the civic community. Stewardship in ethics. The development of business policies and procedures and institutional responses to social change should be carefully considered in light of the Catholic understanding of loving covenant and the Christian way of life. Shared ministry. Health care facilities have played a leading role in implementing the Second Vatican Council's vision of ministry. Sponsoring communities' continued willingness to share responsibilities with laity will be imperative in meeting the health care demands of the future.     

The application of faith-based principles. Mission leaders can facilitate an organization's cultural transformation

Cultural factors account for a high percentage of the less-than-successful mergers, partnerships, and joint ventures that are taking place in today's healthcare marketplace. Culture is found wherever people live and work together in relative stability. Those in the Catholic healthcare ministry are in need of faith-based wisdom to deal with the challenges of cultural transformation. Five principles may be helpful: Take time as a team to return in a reflective way to the wellsprings of our ministry. Remember that this is a three-way undertaking--you, your co-workers, and God. Remember that to hear God speak to us, to recognize God's presence, we need to keep ourselves centered and deeply attentive. Help one another sort out motivations and maintain a clean heart. Appreciate the affective potential in the cultural elements of symbol, myth, and ritual. Using these principles, leaders can begin to focus on how they can positively affect culture change through the following conceptual model of culture: The symbolic dimension of symbols, myths, and rituals. The dimension of espoused beliefs, purpose, and values. The mini-expressive dimension of revealing everyday comments and behaviors. The hidden dimension of sentiments, convictions, and commitments.     

Can we still hear the call? What it means to be Catholic

Despite the drastic changes occurring in the world today, certain elements of the Catholic tradition and communion can make the transition into a world colored by merger and shaped by governmental concerns for the general, not the particular. If Catholic particularism to many degrees and in many ways has been lost, the "loss" occurred before, apart from, alongside, and in many ways independent of merger and governmental contexts. "We gave it away." These are days for retrieval. The Catholic response to "the call" has been complicated by the following forces: bureaucratization of the world, acceptance of the terms of a liberal (i.e., "open") society, pluralism, and governmental involvement. These factors are formidable, and they do change contexts for response to the call. But they need not stifle the response. The following are some of the elements in "the call" that the Catholic "we" can hear and respond to, while they are also graspable and transmittable by non-Catholics in merged, governmentally related institutions and associations: Catholicholism, concern for the soul, a sacramental view, attention to human dignity, the quest for meaning, the value of ritual, human exemplarity, responsibility to community, the call to justice, and a special ethos. This sampling of elements could be debated within Catholic and in pluralistic contexts. But rather than debate, I would picture a value in conversation in each institution, system, association, or network. This conversation involves Catholics and non-Catholics alike.     

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.     

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 stewardship challenge: reconciling faith and finances

As financial constraints have tightened in recent years, Catholic health care facilities have undergone the double pressure of having to safeguard the integrity of their Christian mission while maintaining economic viability. The conflict between faith and finances, however, represents a tension that has been felt since Biblical times. The dichotomy between ministry and money can be traced from Scripture's admonition that money is the root of all evil, through the Manichean heresy of the early Church, right up to the conflict that today's sponsoring congregations experience in seeking to reconcile multimillion-dollar budgets with their efforts to maintain a simple life-style and raise the existence level of the poor. Mission integrity and fiscal viability are not irreconcilable, however. Effective management can advance, not impede, the mission's cause. Sound business decisions need not exclude social or mission values. Indeed, ministry and management are united in the Gospel message of stewardship. The Gospel itself abounds in management lessons, perhaps the clearest of which is the parable of the talents, in which we are told to manage our gifts wisely so that they are actually increased and not just maintained. Numerous contemporary Church documents also suggest that the multimillion-dollar services that we have inherited and developed must continue to be managed well so that their yield, ministerial and financial, is increased. To resolve much of the misunderstanding within sponsorship groups and health care facilities, an action agenda is needed: The nature of work must be given prayerful reflection, so that it can be understood as a sharing in the creative act of God and as a part of each person's spirituality. Moreover, an institution should be viewed and managed as a positive power base and educational center for developing and advancing positions consistent with the Gospel. Institutional policies and procedures, of course, should be made to reflect this new understanding of the management-ministry relationship. Considerations of ministry, economy, and quality should be included in mission statements and philosophies, and financial officers and mission personnel should be challenged to integrate fiscal viability with mission integrity. Finally, a model for ethical decision making should be developed and adopted so that both orientations--ministry and management--are harmoniously balanced in the institution's decisions.