Catholic Health World - November 1, 2023

Latino health executives’ summit 2 Best practices in health equity 2 Quints and mom go home 3 PERIODICAL RATE PUBLICATION

NOVEMBER 1, 2023 VOLUME 39, NUMBER 17

AHA program enables hospitals to assess then bolster health equity efforts

Pope’s new climate warning says world may be near

‘breaking point’

A sweeping report the Department of Health and Human Services released earlier this year on the health of people in the U.S. revealed serious disparities: Black Americans are more likely than those in other racial and ethnic groups to die of heart disease. They also have higher cancer mortality and die of HIV at higher rates. Hispanic and non-Hispanic Black adults have higher unmet needs for medical care due to costs than do non-Hispanic white adults.

The American Hospital Association says there long has been widespread acknowledgment of such disparities by stakeholders across the U.S., including health care systems and facilities and government health agencies, and many of these stakeholders have been working to address the disparities. The efforts have not always been consistent and cohesive across the nation, so broadscale change has been difficult to achieve.

In response, the association has developed a Health Equity Roadmap, a comprehensive set of resources and tools for hospitals to use to assess how well they’re addressing inequities and disparities, devise a plan to bolster that work and then implement the plan. AHA provides Continued on 4

The Health Equity Transformation Assessment: the six levers of transformation

Douglas R. Clifford/Tampa Bay Times via AP

By JULIE MINDA

Rescue workers wade through a tidal surge on a highway while looking for people in need of help after the Steinhatchee River in Florida flooded following the arrival of Hurricane Idalia in August. Climatologists expect severe weather incidents to increase as global warming worsens.

Focus on climate resiliency, planning experts urge

By VALERIE SCHREMP HAHN

To address the risks climate change poses to medical facilities, to care providers and to the communities they serve, health systems need a climate resiliency plan, advises Christina Vernon Sanborn.

“No organization is exempt from climate threats, so everyone has a need to think about how climate is going to impact their ability to deliver care,” said Sanborn, associate principal and senior decarbonization specialist at the environmental engineering firm Mazzetti. “Proactive planning, as with all things, reduces the cost

In a dire new statement on the perils of climate change, Pope Francis names health care as one of the areas that will feel its impact.

The pope’s exhortation, Laudate Deum, repeatedly refers to the climate crisis and notes that some aspects, such as the increase in ocean temperatures and the decrease in arctic ice sheets, are “already irreversible.”

Pope Francis references the concerns he raised in his 2015 encyclical Laudato Si’. That earlier statement presented a broader look at environmental concerns and called for people to engage in a “renewed dialogue” on caring for and preserving God’s creation.

“Yet, with the passage of time, I have realized that our

Continued on 6

Continued on 6

By LISA EISENHAUER

St. Mary center helps people with HIV or AIDS to not just survive, but thrive

CULTURALLY APPROPRIATE PATIENT CARE

DIVERSE REPRESENTATION IN LEADERSHIP AND GOVERNANCE

EQUITABLE AND INCLUSIVE ORGANIZATIONAL POLICIES

COMMUNITY COLLABORATION FOR SOLUTIONS

By JULIE MINDA

COLLECTION AND USE OF DATA TO DRIVE ACTION

SYSTEMIC AND SHARED ACCOUNTABILITY

Ramon “Ray” Ramirez was an executive at the Marshall’s department store chain, privately insured and healthy in the 1990s when his life drastically changed in the mid-1990s. His boyfriend died by suicide, then Ramirez fell ill and was diagnosed with human immunodeficiency virus, or HIV, the virus that can lead to AIDS. His illness progressed to the point that he was unable to maintain his job.

“I found myself ill and alone,” he says, “and I discovered I needed help on so many different levels.”

Remembering his boyfriend’s positive

Source: equity.aha.org

Statement heightens concerns raised 8 years ago in encyclical Laudato Si’

Continued on 7

Cancer recovery in the limelight Patients of Mercy Medical Center took part in a lively talent show to demonstrate that there is much to celebrate and enjoy after surviving cancer. Here, Dr. Armando Sardi, medical director of the Institute for Cancer Care at Mercy Medical Center in Baltimore, performs magic tricks to kick off the September show.

His treatment protocols for advanced cancer have enabled many patients to survive many years, despite their initial poor prognoses.

Story on 8

2 CATHOLIC HEALTH WORLD November 1, 2023

Latino health care executives tout diversity, mentorship, sponsorship

By LISA EISENHAUER

SEATTLE — The importance of diversity in the executive ranks of health care and the value of having and being mentors and sponsors were recurring topics at the annual leadership summit convened by the National Association of Latino Healthcare Executives.

The theme of the summit held in midSeptember was “moving the needle.”

Many speakers discussed the need for health systems to embrace diversity, equity and inclusion so that they have staffs and executives whose races, ethnicities and cultures mirror those of the people outside their doors.

“We need to represent at every level of the organization the patient population that we’re serving,” Marcos Pesquera said during his remarks. “That is not any kind of discrimination whatsoever. We want to represent because there’s plenty of proven research that says that congruency matters and trust grows a lot quicker.”

Pesquera, system vice president for community health and chief diversity officer at CHRISTUS Health, is president and chair of the association, which has grown to almost 3,000 members and 17 chapters since its founding in 2005. Five of those chapters were added just this year.

‘It was not easy’ One of the association’s goals is to increase the number of Latinos in executive health care posts beyond the current 2%.

Naydu Lucas, chief nursing officer at two Northern California hospitals, Providence St. Joseph Hospital Eureka and Providence Lucas Redwood Memorial Hospital in Fortuna, was part of a panel discussion about how Latina leaders are making

Marcos Pesquera, right, system vice president for community health and chief diversity officer at CHRISTUS Health, chats with Noel J. Cardenas, an executive at two hospitals in Houston, during a session of the leadership summit convened by the National Association of Latino Healthcare Executives. Pesquera is president and chair of the association.

their voices heard.

Lucas talked about the challenges she faced after she decided to transition from finance to health care at the age of 30 and to build a new life in the United States, far from her native Colombia. One of the challenges, she said, was that her accented English led to her being dismissed as not capable of handling a leadership role.

She nevertheless went on to get a doctorate in nursing practice and within eight years had reached her goal of becoming a chief nursing officer.

“It was not easy at all,” she said. “There was a lot of discrimination through the way and a lot of being held back, but I had the power of conviction that I’m going to succeed in this country.”

Lucas credited two people in particular with guiding her as she climbed the ladder. One of them was a clinical leader who helped her develop management skills so she could move to the next level of her

career. The other was Ron Rehn, a chief administrative officer within Providence, who inspired her to stay with a missiondriven system that shared her values.

Nowadays Lucas mentors many people herself. She even signed up to be a mentor at the summit. She urges her protegees to be optimistic, even if they face discrimination.

“I keep repeating over and over: If one door closes, another one better will open and just keep trying. Never, never, never give up,” Lucas said.

Inspired to touch lives Geraldo Flores, senior vice president and chief nurse executive at CHRISTUS Health, joined a panel discussion of how insights become opportunities. Flores shared how a cut hand prompted a trip to an emergency room at a Sisters of Mercy hospital in Laredo, Texas, when he was a teenager. While there, he saw the medical staff resuscitate a patient in cardiac arrest.

“And as I watched the entire team work on this man, I was totally brought into the process,” recalled Flores, who at the time was a high school dropout. “I didn’t care about my hand anymore.

What I was thinking is, what an incredible opportunity to Flores touch lives, what an incredible opportunity to serve.”

Flores said he found mentors as soon as he stepped into a nursing assistant position.

He credited them for guiding him along a path that eventually led to a doctorate in nursing practice and an executive post.

An important aspect of his mentors was that they shared his Latino culture and his values, Flores said. “There were things that I needed to overcome that would encourage me to follow my dream, and sometimes that meant even sacrificing some of what we value so much in the Latino culture, which is time with our families,” he explained.

His best advice to others who want to follow his footsteps, Flores said, would be: “Stay true to yourself. Be authentic.”

‘We are familia’ Pesquera enumerated the pillars of the Latino executive association’s mission — capacity building, growth, strategic alliances, and advocacy and policy — during a discussion that covered some of the highlights of its 18-year history. To further that mission, he said, will require grooming new leaders.

“We have to continue to turn around, sponsor, mentor and help the pipeline, while not forgetting in the midst of our focus and our seriousness about the work that we’re doing, we have to have fun,” he said. “And we are familia, so don’t forget about your culture in the process.” leisenhauer@chausa.org

CHA video series spotlights best practices toward achieving equity

By LISA EISENHAUER

As part of its Confronting Racism by Achieving Health Equity pledge, CHA is compiling short taped “webisodes” that spotlight best practices developed across the Catholic health ministry to advance equity and address disparities in health care.

The best practices webisodes comprise a micro-learning series that shares specific approaches that CHA members are taking to see that those they serve have access to exceptional health care and that internally they are promoting diversity, equity and inclusion. The length of each video is at most 12 minutes. Anyone can access the videos at wearecalled.org.

The pledge is part of the anti-racism We Are Called initiative CHA launched in 2020 to respond to racial- and ethnicity-related injustice and inequities across the country and to renew the ministry’s commitment to honoring the dignity of all persons. Over 90% of CHA members joined the pledge to pursue policies and programs for systemic change to achieve health equity.

Kathy Curran, CHA senior director of public policy, and Dennis Gonzales, CHA senior director of mission innovation and integration, are leading the We Are Called initiative. The two, along with Josh Matejka, CHA director of creative services, are collaborating to create the best practices webisodes.

Curran said the idea for the learning series sprang from a talk Erica Torres, system vice president of mission integration at PeaceHealth, gave at a meeting of the CHA board committee focused on diversity and health disparities.

“Afterwards, we thought, wouldn’t it be great if we could find a way to share more

In a We Are Called best practices webisode that focuses on the equity work being done by Mercy, the system’s Pathway to Employment program is one of the initiatives discussed. The program is an employment-based internship model for students with disabilities.

broadly the work PeaceHealth is doing within the membership and find a way for other members to highlight what they are doing?” Curran said during a webinar Sept. 27 hosted by CHA to discuss the series and how members can add their own webisode.

Torres is featured in one of the three webisodes that are already online. In it, she discusses how PeaceHealth is “actively working Torres on becoming an anti-racist organization.” It’s doing that, she said, by creating a strategy that hardwires diversity, equity and inclusion into its practices in the same way as safety is now. That strategy includes putting DEI under the purview of its mission integration department.

“Explicitly linking DEI to our mission will ensure that every aspect of what we do — how we recruit, hire, promote and retain employees; how we conduct our business

operations; how we incentivize and hold our leaders accountable and how we provide clinical care — is rooted in dismantling racism and eliminating health disparities,” Torres says in the video.

Another video spotlights the work Avera Health is doing through its Community Health Resource Center in Sioux Falls, South Dakota. The center focuses on serving the region’s immigrant and refugee populations. The third video showcases Chesterfield, Missouri-based Mercy’s decision to add belonging as a focus in its practices along with diversity, equity and inclusion.

It includes a description of Mercy’s Pathway to Employment program, an internship model for people with disabilities.

Matejka explained that CHA has simplified the process of creating a video and will work with any member interested in adding one to the series. To express an interest and get how-to details, email WeAreCalled@ chausa.org.

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November 1, 2023 CATHOLIC HEALTH WORLD 3

‘Grateful’ family home after delivery of rare quints, weeks at Phoenix’s St. Joseph’s

By JULIE MINDA

After moving from Washington state to Phoenix to become a patient of a doctor who specializes in high-risk multiplebirth pregnancies, a woman delivered five healthy babies this summer at Dignity Health St. Joseph’s Hospital and Medical Center.

On June 4, Stephanie Freels delivered quintuplets by emergency cesarean section at 27 weeks’ gestation, the hospital announced in a release. The births put Stephanie and her husband, Graham, in an exclusive set. In 2020, only 29 of the more than 3.6 million births in the U.S. were quintuplets or higher-order multiples, according to the Centers for Disease Control and Prevention.

The couple are among many who have sought out the care of Dr. John Elliott, a perinatologist who practices at St. Joseph’s.

The Freelses’ four girls and one boy weighed hardly more than 2 pounds each at birth. Pregnancy, birth and perinatal care of high-order multiples are all considered to be a greater risk than for individual and twin births.

For weeks, the infants — Adelyn, Eliana, Linnea, Fisher and Harper — lived in the nursery intensive care unit, which St. Joseph’s calls the NyICU, receiving around-the-clock care until they were healthy enough to leave the hospital. The last Freels baby was discharged after 76 days.

“We are so grateful to have all of our children home with us,” Stephanie said in comments shared by the hospital. “So many people have prayed for us and our family throughout our journey and NyICU experience. We are so grateful that so many prayers have been answered and we are looking forward to creating new memories as a family of seven.”

Andrea Hassler said families “travel from all over the country to deliver their babies at St. Joseph’s and receive world-class care for their newborns,” including at the NyICU. Hassler is St. Joseph’s nursing director of

Stephanie Freels cradles her quintuplets, who were born at Dignity Health St. Joseph’s Hospital and Medical Center in Phoenix June 4.

women and infant services.

More multiple births While quintuplets are indeed a rarity, according to a June 2021 bulletin from the American College of Obstetricians and Gynecologists, the incidence of multiplebirth pregnancies in the U.S. “has increased dramatically over the past several decades.”

The bulletin said the increase has been attributed to the fact that women are having babies at older ages and more women are using assisted reproductive technology, such as in vitro fertilization. Both factors can increase the likelihood of having multiple babies at once.

That bulletin said “a number of perinatal complications are increased with multiple gestations, including fetal anomalies, preeclampsia, and gestational diabetes. One of the most consequential complications encountered with multifetal gestations is preterm birth and the resultant infant morbidity and mortality.”

Phoenix-based Elliott specializes in addressing the risks that can come with higher-order multiple pregnancies. He has delivered more than 2,000 sets of twins, 700 sets of triplets, 109 sets of quadruplets and 23 sets of quintuplets over the course of his four decades in practice, according to a biography at Valley Perinatal Services, the high-risk pregnancy specialty group that employs him.

Many of Elliott’s patients deliver at St. Joseph’s, where the NyICU cares for nearly 800 premature babies annually. The unit specializes in complicated pregnancies and infants with serious conditions, including cardiac concerns, congenital abnormalities, prematurity, respiratory issues and concerns necessitating surgery.

Terrifying moment Graham and Stephanie Freels had wanted to be parents from the start of their 2017 marriage, but Stephanie experienced multiple medical issues that prevented

it. They learned late last year that Stephanie was pregnant. A January ultrasound revealed they were expecting quintuplets.

Viewing five heartbeats on an ultrasound monitor the following week, was “one of the craziest moments of our lives,” said Stephanie.

Knowing the risks of carrying multiples, Graham researched online to locate the right doctor to treat Stephanie and the babies. He learned about Elliott. Following a consultation with the physician and his team, the couple made their temporary move.

Near the end of her second trimester, Stephanie reported to St. Joseph’s in considerable pain, and Elliott’s team determined she was dilated to the point that an immediate delivery was necessary.

During their early-morning birth, each baby had a team of neonatologists, nurses and respiratory therapists in the operating room to provide them with the immediate care they needed after birth.

Graham recalled that he was “absolutely terrified” that morning, but, he said, “God was with our family through it all as St. Joseph’s amazing medical team cared for Stephanie and helped us welcome our five beautiful children.”

During the babies’ two-plus months in the NyICU, their parents visited them and watched in excitement as they grew and gained strength. Stephanie and Graham celebrated milestones, such as when the babies were strong enough to take a bottle.

Stephanie said, “One of the best moments of our NyICU journey was being able to hold all five of my babies for the first time. I was so emotional leading up to the moment I could finally hold all of them in my arms after carrying them in my belly. It was a moment I will forever cherish.

“I am so thankful to the NyICU nursing team for giving me this experience,” she said.

Visit chausa.org/CHW to learn about additional quints born at St. Joseph’s. jminda@chausa.org

SSM Health to build replacement children’s hospital in St. Louis

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SSM Health unveiled plans and the design for its new SSM Health Cardinal Glennon Children's Hospital at an event in September.

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By LISA EISENHAUER

ST. LOUIS — With St. Louis Archbishop Mitchell T. Rozanksi offering a blessing and children who have been patients scooping ceremonial shovels of dirt, SSM Health announced on Sept. 28 plans to replace SSM Health Cardinal Glennon Children’s Hospital in St. Louis.

The new 14-story tower will be just down the street from the existing hospital, southwest of downtown. It will stay on the same campus as SSM Health Saint Louis University Hospital, which moved to a newly built tower next to its old one in 2020.

SSM Health, based in St. Louis, expects the construction of the children’s hospital to be completed in 2027. The new hospital

will have 200 inpatient beds, five more than the current hospital. SSM Health did not release an estimate of the project’s cost or details on plans for the current hospital.

Laura Kaiser, SSM Health president and CEO, noted that when Cardinal Glennon opened in 1956 it was the nation’s first freestanding not-for-profit Catholic pediatric hospital. “The opportunity to design a new facility in present day allows us to create spaces that better support children and their families with complex medical conditions,” she said.

The new hospital will offer expanded and enhanced services, including in neonatal intensive, cancer, cardiology and dialysis care. It will continue as an academic medical center affiliated with the Saint Louis

University School of Medicine.

Two of the speakers extolling plans for the new hospital at the groundbreaking were 14-year-old Jimmy Williams and his mother, Shana. Jimmy underwent a heart transplant at Cardinal Glennon four years ago, a surgery that he said gave him “a second chance at life.”

His mother praised the hospital’s caregivers, who she described as a second family, for the compassion and encouragement they showered on the family. “This hospital will mean so much to countless children and their families,” Shana Williams said. “It will continue a legacy of saving lives, just as it did for my Jimmy.” leisenhauer@chausa.org

4 CATHOLIC HEALTH WORLD November 1, 2023

Health Equity Roadmap materials and support for this process.

Leon Caldwell, AHA senior director of health equity strategies and innovation, said “patients are at risk of harm” because of inequity.

“We’re at an inflection point,” he said.

Caldwell, who is one of eight staff members at AHA’s Institute for Diversity and Health Equity, added, “There are generations of Americans who have seen the disparities, seen the inequities and sat still because they were culturally, racially and economically segregated.” But now, he said, “you have generations — a newer generation — that have closer proximity to each other. That allows them to ask questions around fairness and justice and equity in ways that the previous generation did not.”

This sort of introspection happening nationally, he said, has inspired the type of equity work AHA and its member hospitals are pursuing.

The roadmap initiative complements an effort CHA launched in late 2020, its Confronting Racism by Achieving Health Equity pledge and the related We Are Called initiative. Ninety percent of CHA members have committed to that pledge.

Evolving response Joy Lewis is AHA senior vice president of health equity strategies and executive director of AHA’s Institute for Diversity and Health Equity. AHA, CHA and other associations formed that institute. AHA now operates it.

During a recent CHA podcast, Lewis said the roadmap work builds upon previous AHA activity. That includes AHA designating the institute to coordinate the association’s health equity work. The institute initiated in 2011 a National Call to Action to Eliminate Health Care Disparities and in 2015 issued a #123forEquity Pledge to Act that grew out of the call to action. More than 1,700 hospitals and health systems signed that pledge to take action to eliminate health care disparities.

Caldwell said that since the signatories lacked dedicated resources from AHA to move beyond the pledge, they ended up “kind of going back to homeostasis.” To address the need for guidance in health equity work, AHA secured funding from the Robert Wood Johnson Foundation to build out the roadmap over the last two years.

AHA bills it as a national initiative to drive improvement in health care outcomes, health equity, diversity and inclusion. AHA launched the roadmap in March 2022.

To begin the roadmap, a hospital enrolls online in the Health Equity Transformation Assessment and then completes that assessment electronically. AHA recommends that the form be completed within 45 days of signup. Information that hospitals provide to AHA through this process is kept confidential. It is only used for selfassessment, not for AHA to compare hospitals against one another.

Upon completion of the assessment, AHA provides facilities with a profile containing the results. The profile is structured around six “levers of transformation” that AHA has identified as critical to implementing change around equity. The association also provides links to “transformation action planners,” which are resources to guide action and changes. Facilities completing the roadmap can join a virtual community AHA created for hospitals to support each other in the work.

Pilot, then launch As of the middle of September, about 35% of AHA member hospitals had signed up to take part in the roadmap and had been sent the assessment to complete.

More than a dozen CHA member systems representing more than 300 hospitals have

AHA’s Institute for Diversity and Health Equity

From page 1

American Hospital Association members take part in a Health Equity Innovation Summit in May in Wynnewood, Pennsylvania. AHA summits advance work related to diversity, equity and inclusion. The association has produced programming called the Health Equity Roadmap to help hospitals advance work related to health equity.

Leon Caldwell

roadmap has the potential to be “transformational; a catalyst for each individual (at Trinty Health facilities) to reach their full potential.”

He said that while staff of Trinity Health hospitals have done laudable work furthering the system’s mission to “provide the most comprehensive, compassionate and quality care possible ... it’s critical that we build on that good work and make conscious efforts to deliver care that is free from bias and inequities and be respectful of cultural values and beliefs.”

He said the roadmap “provides the guideposts to not only ensure we are meeting those goals, but to gain support from peers to continually evolve and do even better.”

signed on as intending to take part.

St. Mary’s Health Care System in Athens, Georgia, which is part of Livonia, Michigan-based Trinity Health, was among AHA members that piloted the roadmap before the tool’s launch.

And now, the hospitals that are part of another region, Trinity Health Mid-Atlantic, have completed the 24-page assessment that is part of the roadmap. This work involved leaders from the region’s three Pennsylvania hospitals and one Delaware hospital, including presidents; chief human resources officers; and executives in quality and compliance, health informatics, community health and well-being, and diversity, equity and inclusion. As Catholic Health World went to press, the region had just received and was evaluating the assessment results.

James Woodward, president and CEO of Trinity Health Mid-Atlantic, said the

Blueprint CommonSpirit Health has signed on to take part in the roadmap and is coordinating its facilities’ participation.

Wright Lassiter III, CommonSpirit CEO, is an AHA board member and the association’s immediate past chair.

“CommonSpirit fully supports use of the AHA roadmap as a valuable tool to create pathways to improved health outcomes and increased community impact,” Lassiter said.

Rosalyn Carpenter, CommonSpirit’s senior vice Lassiter president, chief diversity, equity, inclusion and community impact officer, is on the advisory council for AHA’s Institute for Diversity and Health Equity.

Carpenter said in their roles with AHA, she and Lassiter have provided much support for, influence on and input into the cre-

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ation of the roadmap.

Gaye Woods, system vice president of equity and inclusion, said CommonSpirit facilities long have been working to eliminate disparities and inequities, as those aims are integral to their mission. Around 2020, CommonSpirit refocused and reenvisioned that work. It created and has been pursuing a health equity blueprint that is centered on five priority areas. Woods said this preexisting effort of CommonSpirit is very much aligned with what the system now is pursuing at the same time, as a signatory to AHA’s roadmap work.

“This work is very interconnected, and there is great overlap in our shared commitments,” she said.

Woods added that health inequity and disparity are “an urgent issue that the pandemic amplified.” She noted that with the Joint Commission and some federal agencies expected to look at health equity in new ways, and with the topic so central to the Catholic health mission, this is a perfect opportunity “to address this in a faithbased way.”

She said, “This work is just an extension of what was started a long time ago, an extension of who we are. And I’m proud that CommonSpirit has taken a real stand of courage. We’re advancing health equity, and that to me is powerful work that I want to be a part of.” jminda@chausa.org

Roadmaps to Health Equity | AHA’s Lewis and Caldwell discuss the roadmap work on CHA’s Health Calls podcast.

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November 1, 2023 CATHOLIC HEALTH WORLD 5

CommonSpirit’s five-pillars approach ‘is about creating equity for all’

By JULIE MINDA

While CommonSpirit Health and its predecessor organizations have been undertaking work to address health inequities and disparities for decades, the system has been organizing that work in a new way since the early days of the COVID-19 pandemic.

Now, CommonSpirit Health is approaching health equity throughout the 140-hospital system by centering it around five priority areas, or pillars: getting its own house in order, getting the data element right, healing people with whole-person care, partnering with others in the work, and advocating for social justice, especially when it comes to health care access.

Rosalyn Carpenter, senior vice president, chief diversity, equity, inclusion and community impact officer, said the work in this area at CommonSpirit “is about creating equity for all.”

Gaye Woods, system Carpenter vice president of equity and inclusion, said the effort is based on the recognition at CommonSpirit that hospitals need to pivot from how they’ve approached this work in the past. Focusing on “health equity can be such a driver of improvement and transformation,” she said.

This CommonSpirit work is along similar tracks to the Health Equity Roadmap that the American Hospital Association launched last year and the We Are Called initiative that CHA launched in late 2020.

stood when it came to health equity. This included an assessment of gaps and opportunities. The office also put forth a blueprint for scaling programming to address those areas.

Starting baseline CommonSpirit was formed in 2019 when Catholic Health Initiatives and Dignity Health combined to form a single ministry. Just over a year later, CommonSpirit “leveraged the moment” during the pandemic’s early days when numerous voices in society were decrying the racial and ethnic disparities that the pandemic had laid bare, said Carpenter. CommonSpirit embraced that moment as the impetus to develop what would become its five-pillar approach, she said.

Much of the work has been driven by the Office of Diversity, Equity, Inclusion and Belonging that Carpenter heads.

That office began by engaging numerous groups at the corporate and local levels at CommonSpirit, including leaders in strategy, communications, population health, community health, advocacy, transformation, information technology, quality, human resources and philanthropy.

Based on input from those discussions, Carpenter, Woods and others in the diversity and inclusion office articulated a baseline understanding of where the system

Building momentum Woods has been leading much of the ensuing work. An early focus has been standardizing methods of collecting patient data to incorporate best practices. Solid data can help health care facilities to more precisely and accurately identify areas of inequity, said Woods.

She also has been supporting CommonSpirit’s Woods local ministries as they identify ways to address inequity, forge partnerships that advance health equity, and work to replicate and tailor best practices from other CommonSpirit ministries that have developed successful practices.

Some of the momentum has come in the areas of chronic disease management for vulnerable populations, workforce diversity initiatives, community partnerships and restorative justice around the social determinants of health, said Woods. She explained that in this case, restorative justice has to do with ameliorating inequities around vulnerable people’s access to hous-

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ing, transportation, education, nutrition and social services, for example.

Collaboration and kindness Some of the high-profile work that CommonSpirit has made progress on through its health equity pillars includes: A 10-year, $100 million collaboration between CommonSpirit and the Morehouse School of Medicine. Their More in Common Alliance is focused on increasing the number of clinicians who are Black or from other underrepresented populations.

The Race to Zero environmental campaign through which CommonSpirit is pushing to achieve net-zero greenhouse emissions by 2040.

A partnership begun in 2022 between CommonSpirit and Charles R. Drew University of Medicine and Science to address the national nursing shortage and to diversify the nursing workforce. Related initiatives include faculty resources, mentorship efforts and pipeline programs.

The late 2022 launch of the Lloyd H. Dean Institute for Humankindness & Health Justice. This institute is focused on advancing health justice through research, diversification of the health care workforce and funding for healthier communities.

In mid-2022, CommonSpirit was a founding member of the Partnership to Align Social Care. This partnership unites health care providers, community-based organizations, health plans, national associations and federal agencies to improve how social care is delivered. CommonSpirit provided a grant to the partnership. Other funders are the Robert Wood Johnson Foundation, Elevance Health, Kaiser Permanente, United HealthCare, and the Archstone Foundation.

Efforts to remove inappropriate racebased algorithms used in the early diagnosis of chronic kidney disease. Building upon work begun in some of its Arizona facilities, CommonSpirit has been trying to improve chronic kidney disease outcomes for people of racial minorities, especially Black people. CommonSpirit physicians and others have been working with the National Kidney Foundation, the American Society of Nephrology and others to change the way race is considered when kidney function is assessed. The previous marker included a race-based adjustment that overestimated kidney function in African Americans and led to later diagnosis, lower prioritization for transplant and poor health outcomes, for Black patients.

CommonSpirit has updated its lab testing protocols accordingly.

More information on the work is available at commonspirit.org/what-we-do/ advancing-health-equity. jminda@chausa.org

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Catholic Health dedicates new Lockport Memorial Catholic Health’s new Lockport Memorial Hospital was blessed and dedicated at a ceremony Oct. 4 led by Bishop Michael W. Fisher of the Buffalo, New York, Diocese.

Catholic Health announced plans to build the hospital in Lockport nearly three years ago to ensure more than 80,000 residents would continue to have access to quality health care following the closure of Eastern Niagara Hospital.

The 60,000-square-foot facility is a campus of Mount St. Mary’s Hospital in Lewiston, New York. The hospital features an 18-bed emergency department; 10-bed inpatient unit that can expand to 20 beds; diagnostic imaging and laboratory services, including blood draw; and medical offices for primary care, women’s health, and specialty care services, which were slated to open by the end of October.

6 CATHOLIC HEALTH WORLD November 1, 2023

Pope’s statement From page 1

Collective voice The exhortation came out on Oct. 4, the feast day of environmental patron St. Francis of Assisi.

“Those of us who serve in Catholic health care must use this motivation to push more urgently for changes in how we live and work and heed Pope Francis’ call to ‘bring about large processes of transformation rising deep with society,’” Sr. Mary Haddad, RSM, president and CEO of CHA, said in a statement. “As a leading ministry of the Church in the United States, we will continue to raise our collective voice to call for bold change in environmental policies and practices that are critical to promoting human flourishing.”

If the global health care sector were a country, it would be the fifth-largest greenhouse gas emitter on the planet, according to the nonprofit Health Care Without Harm.

The biggest contributor to the global health care carbon footprint is the United States, accounting for 27%, the organization says.

Dr. Rod Hochman, president and CEO of Providence St. Joseph Health, also

Climate webinar From page 1

and improves recovery times when disruptive events do occur.”

Sanborn and two others with expertise in climate change resiliency planning shared their insight during a CHA webinar Sept. 20.

The three offered advice and encouragement on Sanborn how the health care sector can respond to global warming and its impacts, such as heat waves, flooding, wildfires and drought. The webinar was part of CHA’s observance of the Feast of St. Francis, known as the patron saint of ecology.

Single biggest threat Sanborn noted that the United Nations has identified climate change as “the single biggest health threat facing humanity” and has said that the risks of a warming planet are disproportionately felt by the most vul-

Rick Bowmer/Associated Press

responses have not been adequate, while the world in which we live is collapsing and may be nearing the breaking point,” the pope writes in the new statement.

He adds: “In addition to this possibility, it is indubitable that the impact of climate change will increasingly prejudice the lives and families of many persons. We will feel its effects in the areas of healthcare, sources of employment, access to resources, housing, forced migrations, etc.”

A man walks through wildfire wreckage in Lahaina, Hawaii, in mid-August. The wildfires on the island of Maui left about 100 people dead. Climate change is a key driver in increasing the risk and extent of wildfires in the United States, according to the National Oceanic and Atmospheric Administration.

Remaining hopeful In his reflection, Pope Francis expresses hope for agreement among world powers to transition from fossil fuels to renewable energy sources at a climate conference in the United Arab Emirates later this year. He notes that a summit in 1992 led to the adoption of a U.N. treaty for a framework on climate change.

“This Conference can represent a change of direction, showing that everything done since 1992 was in fact serious and worth the effort, or else it will be a great disappointment and jeopardize whatever good has been achieved thus far,” he writes.

Pope Francis waited until the final line of the letter to point out that Laudate Deum means “Praise God.” “For when human beings claim to take God’s place,” he explains, “they become their own worst enemies.”

responded to the pope’s message. “At Providence, we believe health is a human right and understand that the effects of climate change are most disproportionately felt by marginalized populations around the world,” he said.

Hochman noted that his system is striving to become carbon negative by 2030.

The Catholic Climate Covenant applauded Laudate Deum. The group, which is a collaboration of 20 national Catholic organizations working to reduce environmental harm, said in a statement that it was “particularly moved” by the pope’s focus on the climate crisis.

“Pope Francis’ message is a powerful reminder of the values that guide us: respect for the life and dignity of every person, soli-

darity with the poor and vulnerable, and stewardship of the earth which sustains us all and upon which we are all dependent for our very lives,” the group said.

nerable and disadvantaged.

She also pointed out that a federal agency has created a pledge around addressing climate change. That pledge from the U.S. Department of Health and Human Services’ Office of Climate Change and Health Equity calls for signatories to drastically reduce greenhouse gas emissions by 2030 and for them to create and release a resiliency plan by the end of this year. Health systems encompassing more than 800 hospitals already have signed the pledge. Many of the signatories are CHA members, including Ascension, CommonSpirit Health, Providence St. Joseph Health and SSM Health.

A good climate change resiliency plan, Sanborn said, should be driven by an evaluation of the threats to a health system — its business operations, facilities and staff — as well as to the communities served, with a particular focus on vulnerable residents.

The plan should cover preparing for those threats, absorbing their impacts, recovering after a disruptive event and adapting to change, she added.

“In the end, the goal is to have not just a document, but a living document that is continuously adapting to new information and takes into account all of the human and physical systems that you’ve evaluated,” Sanborn said.

“It’s good to keep in mind the real objective,” Marchman said, “which is to develop more resilient systems — that is, to develop the kind of systems that can not only bounce back, but maybe in some cases even thrive in adverse conditions.”

Five steps Patrick Marchman, principal with consulting firm KM Sustainability, went over five steps for health systems to create a framework for how they will adapt to and build resiliency to the impacts of climate change. The first four Marchman steps are: Understand exposure.

Assess vulnerability and risks.

Investigate options.

Prioritize and plan.

Marchman stressed that health care systems don’t have to start from scratch in their planning. He noted that nationwide there are thousands of existing plans that touch on potential aspects of climate change, such as flooding and emergency preparedness, from various jurisdictions and organizations. Reviewing those plans can be a starting point, he said, for a more specific plan for a hospital or health system.

He also pointed out that specialists in disaster preparedness generally agree that every dollar spent on mitigation saves much more in the long run. For example, he said, the federal government’s rule of thumb is that every $1 spent to mitigate damage from disasters such as hurricanes and earthquakes saves $6 in potential repairs and response. He noted that many government agencies, including the Federal Emergency Management Agency, have funding earmarked for climate change preparedness that health systems might be able to tap.

The fifth and final step is to take action on the plan that’s been created, Marchman explained. As part of that, he said, health systems should have an “accountability mechanism” to ensure they follow through.

Those mechanisms could take several forms, such as posting the plan online to let the public review it and setting up a means to monitor its progress internally.

Human element Durell Coleman, founder of DC Design, a firm that helps create solutions to social challenges, stressed that health systems should include in their resiliency planning assessments of the impacts climate change will have on humans. Specifically, he said, systems should be aware of how their patients, their staffs and the various populations, especially those with few resources, will be affected and what they can Coleman do to help fortify those groups.

It requires community engagement to do that assessment, Coleman said, so the various stakeholders can share what assets they have or lack, what they are experiencing and what concerns they have. Coleman’s firm does that sort of engagement in various ways, including in-person forums and online interactions.

Health systems that listen to community stakeholders in their climate change resilience planning, along with those who address business continuity and patient and staff needs, have much to gain, Coleman said. For one thing, they will be able to anticipate what situations might arise outside their doors in the event of a climate disaster. For another, they will be seen as allies in the wider effort to mitigate global warming’s threats.

“If we do all the pieces together, we can not only create a fortified set of assets on the hospital or health system side,” Coleman said, “but we can also create a fortified community and that is what’s going to enable everyone to survive these events with the best possible outcomes.”

CHA offers environmental-related resources at chausa.org/environment/ overview.

White House releases climate resilience framework The White House in late September released a 30-page National Climate Resilience Framework, which it calls a comprehensive approach to addressing the projected risks and impacts of climate change.

The framework identifies “key values, priorities, and objectives to help expand and accelerate nationally-comprehensive, locally-tailored, and community-driven resilience strategies.”

Its core objectives are to: Embed climate resilience into planning and management.

Increase resilience of the built environment to both acute climate shocks and chronic stressors.

Mobilize capital, investment, and innovation to advance climate resilience at scale.

Equip communities with information and resources needed to assess their

who deny the current evidence of climate change also ignore that “what we are presently experiencing is an unusual acceleration of warming, at such a speed that it will take only one generation — not centuries or millennia — in order to verify it.”

Most of the damage has been done in recent years, he points out, with more than 42% percent of total net emissions since the year 1850 produced after 1990. He calls out “great economic powers” who he said are more concerned with the greatest profit in the shortest amount of time rather than the climate crisis.

“I feel obliged to make these clarifications, which may appear obvious, because of certain dismissive and scarcely reasonable opinions that I encounter, even within the Catholic Church,” he writes.

climate risks and develop the climate resilience solutions most appropriate for them.

Protect and sustainably manage lands and waters to enhance resilience while providing numerous other benefits.

Help communities become not only more resilient, but also more safe, healthy, equitable and economically strong.

The framework notes that access to essential services such as health care is vital to making communities resilient to climate threats. It states that “investments in a community’s health care system — including in medical supply chains, health care facilities, and outreach networks — will improve not just the overall health and well-being of community members during normal operations, but also their capacity to mitigate, adapt to, and recover from the compounding impacts of extreme weather events and long-term climate stresses.”

— LISA EISENHAUER

A global breaking point In Laudate Deum, Pope Francis calls out the United States, saying its emissions per individual are about two times more than those in China and about seven times greater than the average of the poorest countries. He states that “a broad change in the irresponsible lifestyle connected with the Western model would have a significant long-term impact.”

The pope calls the climate crisis “a global social issue and one intimately related to the dignity of human life.” He says people

vhahn@chausa.org

leisenhauer@chausa.org

November March1, 1,2023 2022 CATHOLIC HEALTH WORLD 7

KEEPING UP

Riccio

Ammons

Eckenfels

Higginbotham

Tinnerello

Libby

PRESIDENTS/CEOS Dr. Dustin M. Riccio to president and CEO for St. Joseph’s Health of Paterson, New Jersey, effective in January. He was president and chief operating officer of Unity Hospital and Unity Specialty Hospital, as well as president of the Eastern Region of Rochester Regional Health. He will replace Kevin J. Slavin, who is retiring as St. Joseph’s president at the end of this year.

Eric Ammons to regional president of Chesterfield, Missouri-based Mercy. He will oversee Mercy’s southeastern Missouri footprint. He was president of the Mercy Jefferson communities in Jefferson County, Missouri. As Ammons moves into his new role, Dan Eckenfels will succeed him as president of Mercy Jefferson communities.

Eckenfels was vice president of finance and chief administrative officer for Mercy Jefferson.

Beau Higginbotham to president and CEO of Ascension Saint Agnes in Baltimore, from interim president and CEO. Jeremy M. Tinnerello to Jackson, Mississippi, market president for Franciscan Missionaries of Our Lady Health System. He was president and CEO of Glenwood Regional Medical Center in West Monroe, Louisiana.

Cynthia Libby to president and chief philanthropy officer of Providence Alaska Foundation in Anchorage, Alaska. She most recently was region director of operations for the Providence Alaska Foundation. Libby replaces Suzanne Carte-Cocroft, who plans to depart the organization for a new role closer to family.

Advent resources now available Order this year’s Advent resources, which include different reflections, stories, artwork, and a coloring page for each week of Advent!

chausa.org/advent

CARE Center From page 1

experience at the CARE Center in Long Beach, California, Ramirez turned to that program for help around 1997. A multidisciplinary team did a full medical workup on him and determined that beyond HIV, he had multiple chronic illnesses. Ramirez says the Ramirez team helped him address each of the conditions and to maintain a proper HIV medication regimen. Gradually, they helped him rebuild his health.

“If it wasn’t for the CARE Center, I don’t think I’d have this quality of life,” says Ramirez, 74.

Ramirez is one of the approximately 2,000 people assisted annually by the program that Dignity Health St. Mary Medical Center started in 1986 to help people with HIV or AIDS. HIV used to be a death sentence for those infected. But groundbreaking medical advancements over the past 30-plus years have dramatically improved prognoses and prospects for people who contract HIV, as well as for those whose infection becomes acquired immune deficiency syndrome, or AIDS. The CARE Center has been evolving its programming and services to meet emerging needs during this time. CARE is short for Comprehensive AIDS Resource Education.

Currently, the facility and its staff of about 50 provide HIV/AIDS treatment, Hope medical and dental care, behavioral health, nutrition services, spiritual care, social services and other offerings.

Randy Hope is social services manager and a former patient at the CARE Center.

He says, “the goal is to stop transmission of the virus and also with the viral load suppressed, the body is less susceptible to opportunistic infections. Then, people can go from surviving with HIV to thriving with HIV.”

‘Not who we are’ HIV attacks cells that help the body fight infection, making a person more vulnerable to other infections and diseases. It is spread by contact with certain bodily fluids of an HIV-infected person, most commonly during unprotected sex, or through sharing injection drug paraphernalia.

The body can’t get rid of HIV and no cure exists. So, once infected, a person has HIV for life. AIDS, a late stage of HIV infection, occurs when the body’s immune system is badly damaged by the virus. Without HIV medicine, people with AIDS typically survive about three years. Once someone has a dangerous opportunistic illness, life expectancy without treatment falls to about a year, says HIV.gov, a website of the Department of Health and Human Services.

Sr. Celeste Trahan, CCVI, leads St. Mary’s founding Sr. Trahan congregation, the Congregation of the Sisters of Charity of the Incarnate Word of Houston. She says when HIV began spreading in the 1980s, there was much public fear because no one understood why it was spreading so fast, how it was transmitted and why people were becoming so sick. Families were disowning people with the virus and even churches and medical facilities were turning them away. Everyone dreaded infection, Sr. Trahan says.

Rev. Stanley Kim, St. Mary mission integration director, says amid the panic Rev. Kim a St. Mary social worker told administrators of her concern that patients with AIDS were being turned away from the emergency department with nowhere else to go.

Charles Anderson, a patient of the CARE Center, visits with the center’s pet therapy dog, Mandy. The CARE Center is part of Dignity Health St. Mary Medical Center in Long Beach, California. It provides treatment and support to people with HIV or AIDS. Anderson has been a patient since 1999.

Rev. Kim says the social worker and St. Mary’s administrators and the Incarnate Word sisters agreed, “This is not who we are. We do not turn people away.”

Comfort care St. Mary leaders developed the CARE Program, later renamed the CARE Center, to fill the gaping void in care. They sectioned off part of the hospital to take in AIDS patients — many of whom were dying.

The CARE Program offered pain management and other palliative care and end-oflife support, as well as home care.

Sr. Trahan notes that a key focus during those early days of the program was building institutional knowledge and understanding of HIV and AIDS and then educating hospital staff and the public with those learnings. The hope was to reduce people’s fear and decrease the stigma around infected people.

Around 1987, researchers began introducing drug therapies to inhibit HIV infection and by 1996 researchers had developed a drug cocktail that completely suppressed the replication of the virus in the body, according to the Mayo Clinic. Since then, researchers have been refining drug regimens. Today’s medications are so effective that most infected people need only one pill daily to maintain HIV treatment and control.

Boosting immunity CARE Center’s Hope says because of these historic, lifesaving advancements in therapy, the outlook has drastically improved for people with HIV or AIDS. If they adhere to the appropriate drug regimen and maintain habits that boost their immunity and decrease their risk of disease generally, most can live a long, healthy life.

Given these exigencies of life with HIV, Hope says, the center focuses on getting atrisk people tested for HIV, providing drugs that can help prevent infection for exposed people, getting newly infected people very rapidly onto a drug regimen that can decrease the virus’ toll and keeping infected people on track with their medications.

Infected people need to take their medications all their life, and the medications are very expensive, notes Hope. The center can provide them at no cost for those without coverage.

The center previously had its services spread out around St. Mary’s campus but recently consolidated them at a “one-stop-

shop” facility. There, patients can get HIV or AIDS treatment as well as other medical care, chronic disease management, dental care, nutrition support and access to a food pantry, counseling and other behavioral care, access to numerous support groups and navigation help with social services. All center staff are trained in providing traumainformed care. Hope says statistics show that the vast majority of people with HIV or AIDS have suffered trauma in their past, and most also suffer from substance abuse.

Hope notes that much of the center’s programming is grant-funded, with some of those dollars coming from St. Mary’s foundation. Some of the services the center delivers are reimbursed by private insurance, Medicare or Medi-Cal, which is California’s Medicaid program.

Tammy Basile, a registered dietician at St. Mary, is part of the interdisciplinary team that helps CARE Center patients to learn about and maintain healthy habits.

She says maintaining proper body composition and boosting immunity is essential for CARE Center patients because if their health deteriorates, they are at higher risk than the general population for very serious outcomes.

Life tools For center client Ramirez, the positive momentum he built with the health improvements at the center years ago also inspired him to take advantage of the CARE Center’s counseling and support groups. In the past, because of social stigma, he had avoided such services. But he says those services helped give him “the tools to live a better life, to listen better, to be more empathetic and to be a better person.” He since has returned to the Catholic Church and says he’s feeling healthy now, in a holistic way.

He adds that people with HIV or AIDS often isolate themselves and become somewhat reclusive because of fears of contracting diseases and exacerbating their condition. He says the center linked him with people “traveling on the same highway” as him and that helped him form important new social connections.

He says it breaks his heart when he sees people who go to the CARE Center once then never return to become a patient. “I think, ‘Your life could be so much better, so much richer.’” jminda@chausa.org

8 CATHOLIC HEALTH WORLD November 1, 2023

Talent show illustrates people can embrace life — and sing, dance and juggle! — after cancer

By JULIE MINDA

The performers at a talent show in Baltimore left no doubt: It certainly is possible to fully live life after a cancer diagnosis and treatment regimen.

People who are thriving after their treatment took to the stage at the show in September to sing, dance, juggle, read poetry and play instruments.

They also shared their stories of being diagnosed with abdominal, colon, appendix, ovarian, uterine or other cancers, receiving treatment and going on to embrace life. Several had been told by clinicians upon diagnosis that they only had a short time to live, but treatment proved those prognoses wrong.

Patients have come to Mercy for this treatment from over 600 cities and 12 countries.

Most of the performers had undergone cytoreductive surgery and hyperthermic intraperitoneal chemotherapy at Baltimore’s Mercy Medical Center from Dr. Armando Sardi, a surgical oncologist and medical director of the hospital’s Institute for Cancer Care. Some performers flew in from far-flung places to show off their skills and celebrate their recovery. Some performers were cancer center staff.

At the outset of the show, Sardi said, “nothing makes me happier than to see people who had no chance, enjoying life.”

He even performed an opening magic act.

Then, the cancer survivors made their own appearances to demonstrate their talents.

Kyra Isaacs, a physician assistant with the department of surgical oncology at Mercy Medical Center, and her dance partner Nii Okine wow the crowd with a swing routine during the talent show for survivors of cancer and their clinicians.

Cancer survivor Bess Livioco, 67, performed two songs with her son and grandson. The trio wore T-shirts that read “In this family, we fight together.”

Paul Kalusa, 29, and his wife performed an African praise melody, with their 2-yearold daughter, Isabella, in tow. Kalusa told the audience he was diagnosed with stage 4 colon cancer just two months after Isabella’s birth. He was told at the time to just go home and spend time with his family as he awaited his death. Instead, he and his wife — who is a nurse — researched options

Paul Kalusa, 29, a survivor of colon cancer, performed an African praise medley with his family — he played bass guitar. Here, Kalusa speaks at the talent show as his wife, Irene Nabutono, looks on, with the couple’s daughter, Isabella, on her back.

until they found Sardi.

Kalusa told the audience at the talent show that when he awoke from his cancer surgery, his wife relayed Sardi’s prognosis to him: “You are cancer free. You are going to live.”

“Here I am today,” Kalusa said.

The talent show was the first such event for this group. It was presented by Partners for Cancer Care and Prevention and held at the McManus Theater at Loyola University Maryland. The Partners for Cancer Care and Prevention nonprofit provides patients

with resources.

The hyperthermic intraperitoneal chemotherapy Sardi performs is an aggressive treatment for a variety of intra-abdominal malignancies in advanced stages, according to a press release. The procedure involves removing visible tumors from the abdominal area and adding a heated chemotherapy solution to the abdominal cavity to destroy invisible tumor cells that may remain.

Visit chausa.org/chw to see more photos from the talent show.

Documentary shines light on complexity of work done by hospital chaplains

By VALERIE SCHREMP HAHN

The camera lens focuses on the joyful, prayerful, often messy world of hospital chaplaincy in A Still Small Voice, a film chaplaincy leaders hope will help elevate their work and educate others about its complexity.

“I thought this was a wonderful tool, to open that door to say this is what chaplains do — the good, the bad, the beautiful, the ugly, all the things. And it was a way of telling our story,” said Erica Cohen Moore, the executive director of the National Association of Catholic Chaplains, during a CHA webinar about the film on Sept. 28.

She and Jill Fisk, director of mission services for CHA, moderated a discussion with the film’s director, Luke Lorentzen, and Rev. David Lorentzen Fleenor, an Episcopal priest and clinical pastoral education supervisor who was one of the subjects of the film.

Ministrations The film premiered at the 2023 Sundance Film Festival, where it won the U.S. Documentary Best Director Award. It will be released in theaters Nov. 10.

The documentary follows Margaret “Mati” Engel during her residency in spiritual care with a small cohort at The Mount Sinai Hospital in New York.

Engel interacts with patients in often gutwrenching circumstances. The film opens with a scene of her talking with a man who is in bed and cannot speak but indicates he doesn’t mind when she holds his hands.

She pushes a cart through the hospital hallways, offering tea and essential oils to weary hospital workers.

She prays with a young couple, new parents to twin girls, one of whom died at birth.

She blesses the baby’s body with holy water contained in a Styrofoam cup.

The scene prompted conversation during the webinar since Engel told the couple

she planned to baptize the baby. Instead, she does a blessing during her ritual with the holy water. “They seem to have some bit of relief and some bit of peace,” said Rev. Fleenor during the webinar. “I’m just gonna call that a win.”

Boundaries In the documentary, Engel talks with her colleagues and Rev. Fleenor, who was her supervisor, about maintaining emotional boundaries as a chaplain, something she finds challenging. Some scenes show Rev. Fleenor in virtual sessions with a trusted adviser about his struggles as a supervisor and maintaining Rev. Fleenor his own boundaries. Eventually, Engel is given another supervisor for the final weeks of the program.

“Over the years I’ve experienced, broadly, two types of students,” Rev. Fleenor said during the webinar. “Those whose boundaries are really open, and a lot gets through and that tends to lead to burnout, just to put it directly. And then others whose boundaries are really tight and closed and it means it’s difficult for them to lean into vulnerability.”

He tends to think of boundaries not as straight lines but more like nets or screens, where some things can get through, he said.

Advancing the field The title of the film comes from a conversation Engel has with an elderly female patient who talks about how she copes with lung cancer. They talk about maintaining integrity in making decisions and grappling with the quality of her life going forward.

“I go at my own pace,” the woman tells Engel, “in order to hear my own small voice.”

Lorentzen said he got the idea for the documentary from his sister, who was working as a hospital chaplain and had just completed the education process before the pandemic. Lorentzen became “deeply curious” about the work and reached out

Margaret "Mati" Engel, right, in residency in spiritual care at The Mount Sinai Hospital in New York, ministers to a patient in a scene from the documentary A Still Small Voice. CHA in September hosted a webinar about the film that included its director, Luke Lorentzen.

to dozens of programs around the country, and connected with Mount Sinai, whose leaders were open and curious about the project.

Rev. Fleenor said he saw the documentary as “a potential opportunity to advance the field” of chaplaincy. In fact, some of his first conversations with others outside the hospital chaplaincy circle about the work were at Sundance and other film festival screenings.

Trust building While filming, the filmmakers and the subjects worked hard at gaining each other’s trust. Everyone filmed got the option to back out, which also meant returning to all patients who had previously agreed to participate. “Once the film was nearing the finish line, watching it with them, and confirming on multiple occasions that they still felt comfortable and excited about being included, that ended in a few scenes actually needing to be removed from the film,” said Lorentzen. “So, there were multiple checkpoints that we set up along the way.”

Lorentzen spent more than 150 days filming at Mount Sinai, many of them during the height of the pandemic. Several interviews are of people speaking behind goggles and masks. The pandemic added another layer of pressure and was a nonhuman character in the film, pointed out Rev. Fleenor.

When asked during the webinar how the project has shaped how he sees the world, he said, “I just continue to learn about the power of vulnerability, how hard it is, how rewarding it is, how fluid it is, given the circumstances.”

Rev. Fleenor is now the manager of clinical pastoral education at Stony Brook Medicine in New York and Engel is doing pastoral work and artwork, spending time in Vermont and Berlin. The patients involved have seen the film, and one of the most meaningful parts of the process has been reconnecting and hearing from them, Lorentzen said.

Cohen Moore said the film captured the complicated nuances of hospital chaplaincy. She thanked Rev. Fleenor and Lorentzen for their work.

“Most people think chaplains just go in a room and pray, and it’s so much bigger than that,” she said. “I think the opportunity there for all of us is how do we continue to tell the story? This is an incredible platform, this is an international platform, to tell the story.” vhahn@chausa.org

Reflection Guide | For viewers of the film A Still Small Voice