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.     

Church law's role in collaborations. Principles to guide Catholic healthcare providers contemplating new arrangements

To ensure the success of collaborative arrangements between Catholic and non-Catholic organizations, Catholic providers are advised to look at Church law in canonical and civil documents and at the role of Church law in arrangements between parties. First, Catholic healthcare providers should identify persons subject to Church law as they become engaged in apostolic activities such as providing healthcare on behalf of the Church. They need to distinguish among physical persons, moral and juridic persons, and associations of the faithful and other persons. To verify whether a party is a juridic person, Catholic healthcare providers must turn to historical documents. When cooperative arrangements are made between parties, they must consider a number of elements of Church law if the work is to remain Catholic. These include acquired rights and obligations, administration of temporal goods, observance of moral teachings, and respect of applicable legislation. The law places no limits on the types of arrangements that religious institutes can enter into. However, when cooperative arrangements are being considered between Catholic and non-Catholic religious institutes, the moral issues involved must be taken into consideration. In such arrangements all parties should clearly determine beforehand common purposes, structures, and rights and obligations involved, so that there will not be any misunderstandings along the way.     

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 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.     

Building true collaborations. A senior support network illustrates a successful partnership of healthcare and social service providers

The relationship between Catholic Social Services (CSS) of the Diocese of Scranton and Mercy Health Partners--Northeast Region, which joined forces last year to develop a senior support network for residents of Wilkes-Barre and the Borough of Kingston, PA, illustrates how collaboration grows out of cooperation and coordination of services. The network is a project of the Neighborhood-Based Senior Care National Initiative, which works to develop collaborations between Catholic health systems and Catholic Charities agencies to help poor communities meet the needs of aging persons. Barriers to successful collaboration may stem from cultural misunderstandings, differences in organizational stability and decision-making processes, attitudes toward money, and even professional vocabularies. Organizations that trust and respect each other can overcome these barriers. The Wilkes-Barre project began simply, but its success established a pattern of cooperation between CSS and Mercy Health Partners, which led to further coordination of referral programs, development of community health profiles, and cross-organizational training. After nine months on the Wilkes-Barre project, CSS and Mercy Health Partners are now developing a Program of All-Inclusive Care for the Elderly (PACE). Effective collaboration between healthcare providers and social service agencies is a long, sometimes difficult, process that requires organizational commitments of time and resources. Organizations must not yield to the temptation to take shortcuts to achieve short-term gains.     

Social justice in a time of crisis. Catholic tradition offers creative ideas for solving the problems of healthcare costs and access

In this moment of crisis, Catholic healthcare leaders must seek root causes and thorough solutions to the pressures of rising costs and the grave question of access to healthcare. The first question is whether the system can be fixed or if a more radical approach is needed. To reach a solution, government, business, hospitals, and physicians must sit down at a common table to debate the issue. In 1981 the bishops outlined a series of values or principles that should characterize the U.S. healthcare system, including treating the whole person and providing access for all. These values have characterized Catholic healthcare facilities in the past decades and should not be lost in the present crisis and in the decisions being made for the future. Today, Catholic healthcare leaders have a broadened understanding of Catholic identity and the need to continually probe what that means. They realize Catholic identity is more than a few moral codes; it is a broader concern about the way in which healing takes place. Another gain is the development of lay vocations, but these are often restricted and should be more fully developed. In conjunction with this concept, we need to see hospitals as belonging to the whole Church in terms of its mission and thus the responsibility of the entire body of believers. Finally, a new image is needed concerning how care is provided. We need to bring prevention and care closer together, preventing duplication of major services and making certain basic services available to all.     

An opportunity for positive change. We have the history, experience, and will to preserve a Catholic presence in healthcare

The charitable acts of women religious in response to the needs of the communities in which they settled is one of the great chapters in the history of the Church in America. But in the past two decades providers have had to contend with extraordinary changes in the healthcare environment. The Catholic healthcare mission was rooted in concern for the poor. Should Catholic healthcare providers withdraw from this field in which they have had such a significant presence and have contributed so much, or be driven from healthcare by the fiscal consequences of fidelity to mission? Instead, through its reform proposal, the Catholic Health Association has recommended that Catholic providers become advocates of change. However, even if change, such as universal access to healthcare, is achieved, we shall still have a society in which there will be many poor people. The challenge will be to see that healthcare for the poor does not become poor healthcare. Although the changing urban environment presents enormous challenges to providers, the Catholic healthcare ministry is a significant presence in urban areas. Widespread poverty accompanied by behavioral problems and social breakdowns are significant factors affecting healthcare and healthcare costs. Drug addiction; AIDS; teenage pregnancy; homelessness; the deterioration of the family; and generations of unemployment, anomie, abuse, and violence, which are often most acute in concentrated neighborhoods of poverty, challenge the ability of Catholic hospitals to meet their community's needs. Catholic providers today have a real opportunity to bring about positive changes in healthcare. They have the history, experience, and will to preserve a Catholic presence in the provision of healthcare.     

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.     

Not-for-profits' role in a reformed system

As head of the White House task force that helped to craft President Bill Clinton's healthcare reform proposal (the Health Security Act), First Lady Hillary Rodham Clinton demonstrated her determination that reform result in a system that has caring and service at its center. In an address a year ago at the Catholic Health Association assembly, she stressed the administration's goal of providing the security of healthcare coverage to everyone in the United States. Saying the current complex, disjointed system "fragments the care people receive," the First Lady applauded programs that reach out to underserved populations and strengthen the country's healthcare infrastructure. In this interview with Health Progress, Mrs. Clinton discusses tough issues in achieving the system she envisions and the role of Catholic healthcare organizations in a reformed system. Here are her remarks.     

Guidance for a failing system. Catholic social teachings provide the needed principles

Catholic healthcare has traditionally relied on four major ethical principles--nonmaleficence, beneficence, autonomy, and justice--to address conflicts between various goods. However, all healthcare now finds itself facing great changes. "Principleism" is too limited to guide the Church's health ministry through the current crisis. But the Church possesses a body of social justice teachings that may provide healthcare with the necessary guidance. Eight inseparable but distinct themes are found in the social teachings: human dignity, human solidarity, the option for the poor, the common good, human rights, social justice, stewardship, and liberation. The eight themes are here applied to five critical healthcare issues: the patient-physician relationship, the right to choose, healthcare as a communal good, rationing and limits, and work and its implications. The Church's social teachings may provide us with a basis for a structural reexamination of healthcare--including Catholic healthcare. In that analysis, we may find that Catholic healthcare has developed practices and standards that are at odds with its own teachings. Such an analysis will be painful, but it must be done.     

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.     

Care of the dying: a Catholic perspective. Part II: Social and political context--Catholic providers must exemplify a caring community. Catholic Health Association

Fears of abandonment and isolation in an institution have increased the public demand for euthanasia and assisted suicide. To quell this movement, Catholic healthcare providers must provide a caring community where patients and care givers enable each other to confront the fear of death and find support in living with human limitation. To begin to address the social and political dimensions of issues about the end of life, Catholic healthcare providers must use clear and consistent definitions of the terms used to describe these issues, such as death with dignity, right to die, euthanasia, allowing to die, and assisted suicide. By acknowledging the influence of the media in forming attitudes and opinions, healthcare institutions can seize opportunities for public education on fundamental human and religious values. The first effort has to be directed toward educating members of the media. The Catholic Church supports the concept of advance directives, which provide an opportunity for people to express their values and the ways they would expect those values to be honored in decisions about medical treatment. Courts' role in resolving decisions about treatment should be limited. Patient self-determination is best exercised when a patient (or surrogate), in consultation with a physician, decides what is best. Catholic healthcare institutions should advocate for legislation that fosters an appropriate balance between protecting a patient's right to self-determination and the state's interests to protect life. At the same time, institutions' advocacy efforts should demand sufficient resources for holistic care for the dying.     

"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.     

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.     

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.     

Medicare/Medicaid restructuring. Challenges and opportunities of managed care

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

A dynamic force for change. The common good provides the rationale for a healthcare system for all

In advocating for a reformed healthcare system, the Catholic healthcare community has claimed that responsibility for the common good is of the highest ethical importance. Yet to many the concept of the common good remains elusive. As the common good evolved in Catholic social teaching, it grew to include its anthropological origins, the principle of subsidiarity, and the virtue of solidarity. Above all, it is characterized by justice and refers to a social order that reflects peace, unity, and harmony. As an organizing principle for civil governments, the common good calls on them to foster societies that provide spiritual, cultural, political, and economic conditions in which all persons can realize their human dignity. By viewing healthcare and the right to security in case of sickness as among the particular goods that make up the societal common good, Catholic social teaching provides the rationale for a just healthcare system on a national level. In addition to advocating for a national healthcare system designed to serve the common good, Catholic healthcare entities must evaluate their own programs and services in light of the common good and examine proposed initiatives with other providers, especially for-profit organizations, in that context, as well.     

The mission imperative: our foundation and market advantage

Simply put, MISSION means being sent as Jesus was sent to be a presence of radical healing in the world on behalf of the kingdom of God. Our capacity to sustain Catholic healthcare as a ministry of the Church depends on our realization that all our activities must flow from the core of who we are, that is, from our spirituality. Thus MISSION requires certain attitudes and behaviors, including that we reach out to all persons in need, that we be immersed in the world, that we be prophetic, and that we express the kind of love that led Jesus to give his life. As ministry, we must provide witness as well as service because of the call to be MISSION in the world is also the call to build up the kingdom of God within. Several basic committees lie at the heart of who we are: supporting the dignity of all persons, caring for the poor and vulnerable, building up the common good, and practicing responsible stewardship. Changes within the environment and within the ministry itself present some potential perils but also great opportunities. For example, although managed care, when misused, is a flawed system, it is also has possibilities that are very consistent with ministry values and commitments, forcing us to look at the needs of communities, not just individuals. The requirements of MISSION should also be understood as ways to gain market advantage. Unless we have sufficient advantage in the markets where Catholic health ministry is present, our capacity to effectively transform the present reality on behalf of God's kingdom will be limited.     

Healthcare and social responsibility. The revised directives clarify the Catholic position

The Catholic Church participates in the U.S. healthcare system by reason of its contribution to the common good of society. To facilitate this, the Ethical and Religious Directives for Catholic Health Care Services set forth certain normative principles. Catholic healthcare is dedicated to promoting human dignity and the sacredness of life; it has an "option for the poor"; it seeks the common good, cooperating with other providers toward that end; it prohibits abortion, in vitro fertilization, contraceptive sterilization, and assisted suicide procedures in free-standing Catholic healthcare institutions. This article focuses on the directives in Parts 1 and 6 of the ERD. Directive 2 calls for mutual respect among care givers. Directive 3 discusses ways to care for people "at the margins of society." Directive 4 describes the medical research permitted in Catholic facilities, and Directives 5 and 9 suggest how such facilities can best perpetuate their Catholic identity. Directive 7 mandates that Catholic facilities treat employees justly. Directive 8 says that such facilities must observe canon law in transferring sponsorship or in founding, closing, or selling an institution. Directive 68 suggests that the bishop be involved in a proposed partnership that may infringe upon Catholic identity. Directive 70 urges Catholic facilities to avoid scandal, and Directive 69 warns that some forms of cooperation are unethical even when scandal is not present.     

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.