Health Progress - Spring 2024

LEADING WITH INTEGRITY

Our ministry is an enduring sign of health care rooted in the belief that every person is a treasure, every life a sacred gift, every human being a unity of body, mind and spirit. This vibrant video series shines a spotlight on the contributions of CHA member ministries in promoting human dignity and the common good.

CHAUSA.ORG/CATHOLICHEALTH

HEALTH PROGRESS®

SPRING 2024

LEADING WITH INTEGRITY

Illustrations by James Steinberg

4 LOOK TO MOSES FOR A MASTER CLASS IN LEADERSHIP

Damond W. Boatwright, FACHE

8 THE POWER OF PURPOSE: CATHOLIC HEALTH LEADERS CULTIVATE INNER LIVES, SUPPORTIVE RELATIONSHIPS

David Lewellen

11 SOWING THE SEEDS FOR HUMAN FLOURISHING

Laura S. Kaiser, FACHE

16 TO TRANSFORM CARE, HEALTH SYSTEMS MUST COLLABORATE TO ADOPT INNOVATIONS

Rod Hochman, MD

22 MEDICAL DIRECTORS OF MISSION SUPPORT CONNECTIONS BETWEEN CLINICIAN EXPERIENCE AND MINISTRY IDENTITY

Sara McGinnis Lee

28 NATIONAL ORGANIZATIONAL ETHICS SURVEY REVEALS INSIGHTS FOR CATHOLIC HEALTH CARE

Becket Gremmels, PhD, Kelly Turner, MA, Timothy Lahey, MD, MMSc, William Nelson, MDiv, PhD, and Jason Lesandrini, MA, FACHE, LPEC

33 WHY AN ALLIANCE BETWEEN COMPLIANCE AND LEADERSHIP IN HEALTH CARE IS CRUCIAL

Andrei M. Costantino, MHA, CHC, CFE

FEATURES

37 WOMEN, THE SYNOD AND CATHOLIC HEALTH CARE: WE MUST ENLARGE THE TENT Sr. Teresa Maya, PhD, CCVI, and Jill Fisk, MATM

45 THE EUCHARIST, IMAGINED AND REAL Fr. Joseph J. Driscoll, DMin

DEPARTMENTS

2 EDITOR’S NOTE

BETSY TAYLOR

50 FORMATION

Integrity Is Nourished by Liturgy

DARREN M. HENSON, PhD, STL

54 MISSION

Embracing Change: It’s Who We Are DENNIS GONZALES, PhD

57 ETHICS

What Does It Mean To Be a Missionary Disciple in Health Care?

NATHANIEL BLANTON HIBNER, PhD

59 COMMUNITY BENEFIT

Hiring Untapped Talent: ‘Anchor’ Organizations

Share Ways to Diversify, Localize Workforce LAUREN WORTH

62 THINKING GLOBALLY

Creating a Road Map for the Ethical Donation of Goods

BRUCE COMPTON and CHRIS PALOMBO, MA, MSHM

21 FINDING GOD IN DAILY LIFE

64 PRAYER SERVICE

EDITOR’S NOTE

Because those who are vowed religious tend not to adopt a “hey, look at me” attitude toward their accomplishments, it may go largely unnoticed and unremarked upon in contemporary society that U.S. Catholic health care has an extraordinary legacy of leadership.

Women religious, brothers and priests raised funds and built hospitals where none existed in this country. They tended to wounded soldiers on battlefields, through smallpox outbreaks and in leprosy colonies. When I tell people that sisters were involved in the flourishing of the Mayo Clinic or the start of Alcoholics Anonymous, they’re surprised.1 CHA’s members shaped a significant portion of health care in America and have done so with an unwavering commitment to those most in need of care.

How have they done this? With exceptional leadership. The first leader in Catholic health care I crossed paths with was Sr. Mary Jean Ryan, FSM, when I was a news reporter in eastern Missouri, and she made the bold call to eliminate smoking on SSM Health property about two decades ago as the system’s president and CEO.2 SSM Health was in the practice of preserving health, and the thinking was that a culture change and support might lead more people to give up the habit. At the time, it was almost shocking. Today, with greater recognition that environments and culture affect health, it seems less so. It was an idea ahead of its time.

The second leader I met was Sr. Mary Roch Rocklage, RSM, the late president and CEO of Mercy, well before I worked for CHA. 3 I interviewed her for an article about how she successfully led an effort to contribute funds to support a St. Louis-area nursing program years prior. Within minutes of starting the interview, I was astonished. She easily walked me through what the issue had been and how she and others resolved it.

I’d had sisters as teachers as a child, and here was another who made an instant impression with her intellect and decision-making abilities, leading an entire health care system. She explained how a need was identified and how she got people on board to address it. If memory serves, I told her I hadn’t known sisters held such leadership positions. They do in Catholic health care, she explained.

The list could (and does) go on and on of leaders in Catholic health care I both like and admire. For much of my career in rather fast-paced environments, I didn’t fully understand when people talked about having mentors. Where were all these people that other

people wanted to emulate? When I came to CHA, I got to know so many people who led differently from what I had experienced in other workplaces: people who ground themselves in their faith, who read and listen widely, and don’t jump to hasty decisions. When they set goals, they are massive and multifaceted: Let’s transform and improve health care in the nation. I had always worked with bright, ethical, hardworking people, but these leaders, dare I say, lead with love. And like the sisters before them, they certainly didn’t draw attention to what they were doing.

What is distinctive about leadership in Catholic health care? Several things. For starters, as a well-respected academic pointed out to me last summer, the bar of the Catholic health care mission is incredibly high: to be the healing ministry of Jesus Christ.

A bad day at the office is one thing in the usual workplace environment, but when you’re supposed to be emulating Jesus in how you approach your work, you’d better hold yourself to a mighty high standard each and every day. Additionally, the amount of thought, time and attention our organizations put into spiritual, personal and professional formation of leaders is reflected throughout the work. While the ministry hires and promotes those with leadership attributes, it also spends a great deal of time thinking about how to cultivate and improve upon those skills.

It is not enough in this culture to lead — we must lead with integrity. Integrity is generally understood to be found in those with honesty and moral uprightness, and integrity also has another meaning: to be a unified whole. Strength can be found in a shared purpose, and everyone can lead in their own arenas. In this shared work, may we acknowledge our shortcomings and work on them, recognize the talents of others to knit together stronger organizations, and lift one another up.

NOTES

1. “Mayo Clinic Hospital, Saint Marys Campus,” Mayo Clinic, https://www.mayoclinic.org/patient-visitor-guide/ minnesota/campus-buildings-maps/mayo-clinic-hospitalsaint-marys-campus; “Sr. Ignatia,” Alcoholics Anonymous, https://www.aa.org/sister-ignatia.

2. “Sister Mary Jean Ryan, FSM,” Catholic Health Association, https://www.chausa.org/about/awards/ lifetime-achievement-award/sr-mary-jean-ryan-fsm.

3. “Sister Mary Roch Rocklage,” Mercy, https://www.mercy. net/about/mission/sister-mary-roch-rocklage/.

BETSY TAYLOR

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VICE PRESIDENT, COMMUNICATIONS AND MARKETING

BRIAN P. REARDON

EDITOR

BETSY TAYLOR btaylor@chausa.org

MANAGING EDITOR

CHARLOTTE KELLEY ckelley@chausa.org

GRAPHIC DESIGNER NORMA KLINGSICK

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2023 AWARDS FOR 2022 COVERAGE

Catholic Press Awards: Magazine of the Year — Professional and Special Interest Magazine, First Place; Best Special Section, First Place; Best Layout of Article/Column, First Place; Best Color Cover, Honorable Mention; Best Story and Photo Package, First Place; Best Regular Column — General Commentary, First Place; Best Coverage — Pandemic, Second Place; Best Coverage — Racial Inequities, Third Place; Best Essay, Second and Third Place; Best Feature Article, Second Place; Best Reporting on a Special Age Group, First Place; Best Reporting on Social Justice Issues — Care for God’s Creation, Second Place; Best Reporting on Social Justice Issues — Dignity and Rights of the Workers, First Place; Best Writing — Analysis, Honorable Mention.

American Society of Business Publication Editors Awards: Journalism That Matters Award; All Content — Enterprise News Story, Regional Silver Award; Print — Single Topic Coverage by a Team, Regional Bronze Award.

Produced in USA. Health Progress ISSN 0882-1577. Spring 2024 (Vol. 105, No. 2).

Copyright © by The Catholic Health Association of the United States. Published quarterly by The Catholic Health Association of the United States, 4455 Woodson Road, St. Louis, MO 63134-3797. Periodicals postage paid at St. Louis, MO, and additional mailing offices. Subscription prices per year: CHA members, free; nonmembers, $29 (domestic and foreign); single copies, $10.

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EDITORIAL ADVISORY COUNCIL

Trevor Bonat, MA, MS, chief mission integration officer, Ascension Saint Agnes, Baltimore

Sr. Rosemary Donley, SC, PhD, APRN-BC, professor of nursing, Duquesne University, Pittsburgh

Fr. Joseph J. Driscoll, DMin, director of ministry formation and organizational spirituality, Redeemer Health, Meadowbrook, Pennsylvania

Tracy Neary, regional vice president, mission integration, St. Vincent Healthcare, Billings, Montana

Gabriela Robles, MBA, MAHCM, president, St. Joseph Fund, Providence St. Joseph Health, Irvine, California

Jennifer Stanley, MD, physician formation leader and regional medical director, Ascension St. Vincent, North Vernon, Indiana

Rachelle Reyes Wenger, MPA, system vice president, public policy and advocacy engagement, CommonSpirit Health, Los Angeles

Nathan Ziegler, PhD, system vice president, diversity, leadership and performance excellence, CommonSpirit Health, Chicago

CHA EDITORIAL CONTRIBUTORS

ADVOCACY AND PUBLIC POLICY:

Lisa Smith, MPA; Kathy Curran, JD; Clay O’Dell, PhD; Paulo G. Pontemayor, MPH; Lucas Swanepoel, JD

COMMUNITY BENEFIT: Nancy Lim, RN, MPH

CONTINUUM OF CARE AND AGING SERVICES: Indu Spugnardi

ETHICS: Nathaniel Blanton Hibner, PhD; Brian Kane, PhD

FINANCE: Loren Chandler, CPA, MBA, FACHE

GLOBAL HEALTH: Bruce Compton

LEADERSHIP AND MINISTRY DEVELOPMENT: Diarmuid Rooney, MSPsych, MTS, DSocAdmin

LEGAL, GOVERNANCE AND COMPLIANCE: Catherine A. Hurley, JD

MINISTRY FORMATION: Darren Henson, PhD, STL

MISSION INTEGRATION: Dennis Gonzales, PhD; Jill Fisk, MATM

PRAYERS: Karla Keppel, MA; Lori Ashmore-Ruppel

THEOLOGY AND SPONSORSHIP: Sr. Teresa Maya, PhD, CCVI

chausa.org/social

Look to Moses for a Master Class in Leadership

DAMOND W. BOATWRIGHT, FACHE President and CEO of Hospital Sisters Health System

In Catholic health care, leadership includes a deep understanding of Catholic identity and a pledge to thoughtfully steward organizations to emulate the healing mission of Jesus.

As I reflect on what it means to me to be a servant leader in the ministry, I think about the life of Moses. In fact, his life story could serve as a master class in what it means to be a leader. The principles cast by Moses’ leadership, his response when called by God and the lessons he imbued in those who surrounded him offer inspiration and instruction to both new and seasoned leaders today.

NATURE VERSUS NURTURE

Before diving into the life and leadership of Moses, let’s first consider a question: Are leaders born or are they made?

Have you wondered how certain individuals ended up in key leadership positions? If you are like me, at various times in your career, you may have found yourself thinking, “Wow, this person is a natural-born leader.” And at other times, you may have asked yourself, “How in the world did this person get appointed to such an important leadership position?”

Personally, I think the question of whether a leader is born or made is a trick question. In my opinion — and certainly when I think about Moses and many other inspiring leaders — it’s clear that the best leaders are both born and made.

HEEDING THE CALL TO LEADERSHIP

In Jeremiah 1:5, God says, “Before I formed you in the womb I knew you, before you were born I dedicated you, a prophet to the nations I appointed you.”

This verse is one many people are unaware of or overlook, but it speaks directly to how God gave us the inherent ability to lead. For me, the verse wonderfully clarifies that most of us are not made simply to wander this world as a passive follower; we are here to lead in the most amazing ways. Moses is generally considered the most important prophet in Judaism and one of the most significant prophets in Christianity and Islam — a beautiful trifecta. He was the man God anointed to bring redemption to His people. God specifically appointed Moses to lead the Israelites from slavery in Egypt to freedom in the Promised Land. This was an amazing feat under extraordinary circumstances that could not have been accomplished without Moses’ innate leadership and intentional mentoring and leadership development from God.

Born leaders are often given opportunities, and it is up to them to act upon these opportunities based on their own free will. Yet, in many circumstances, born leaders evolve into even better

ones with the right amount of encouragement and personal investment.

Assuming this viewpoint about leadership is correct, I offer a few lessons I’ve learned during my career that I recommend to emerging leaders in Catholic health care:

Lesson 1: The chance to be mentored or called to lead may not always align with your timing.

Moses’ leadership development began to take root during his encounter at the burning bush (Exodus 3:3-4), where God called Moses to save God’s people. Many people miss their opportunity for greatness because they feel the timing isn’t right. We might think it’s too early in our careers; we don’t have the right experience; we want to begin or just started a family; or we feel comfortable doing what we are doing right now and don’t see the need to change.

My advice is to get out of your comfort zone. Moses initially did not want to accept God’s invitation to lead. He came up with several excuses; one was that he was not a good public speaker. He even requested that God send someone else instead of him. But after realizing this incredible moment may, in fact, be his “defining” moment and a chance to show God his unwavering trust and belief that God ultimately would provide the means to be successful, Moses reluctantly accepted. That decision paved the way for Moses to receive God’s mentoring in many other ways.

Lesson 2: Lean into leadership moments with courage and confidence.

Once selected for a leadership role or challenge, go for your goals and responsibilities with gusto. Be confident, never arrogant. If you feel uncertain, have faith that the right mentor or set of circumstances will provide you with what you need to succeed. In the case of Moses, once God laid out the plan for him to go to Pharoah and demand he let the slaves go to freely worship their God, Moses received support from his brother, Aaron, and additional experiences that would prove he was worthy to fulfill such an important request.

Don’t forget: It was Moses who had to exude the necessary courage and confidence to accomplish this feat. Ten times — or through 10 plagues, in this case — Moses had to prove to a stubborn Pharoah that he should listen to him and let God’s people go. I mention this because, along the way, all leaders encounter doubters and skeptics, or as my 10-year-old daughter, Shelby, would say, “The

haters, Dad.” Like Moses, stay focused and determined. When you have the right goals and vision and God is at the center of your endeavors, you will eventually prevail.

Lesson 3: Make subsidiarity foundational to your leadership. The following story comes from the Book of Exodus 18:13-23:

“The next day Moses sat in judgment for the people, while they stood around him from morning until evening. When Moses’ father-in-law saw all that he was doing for the people, he asked, ‘What is this business that you are conducting for the people? Why do you sit alone while all the people have to stand about you from morning till evening?’

Moses answered his father-in-law, ‘The people come to me to consult God. Whenever they have a disagreement, they come to me to have me settle the matter between them and make known to them God’s statutes and instructions.’”

Moses’ father-in-law then said this approach was not wise, and that Moses needs assistance, as his approach will wear him out. He said Moses should bring disputes to God and instruct people

Courtesy of Hospital Sisters Health System

Damond Boatwright

in “how they are to conduct themselves and what they are to do.” But he advises Moses to appoint leaders over groups “of thousands, of hundreds, of fifties, and of tens” who can solve the most common disputes while Moses focuses on major cases. “Lighten your burden by letting them bear it with you! If you do this, and God so commands you, you will be able to stand the strain, and all these people, too, will go home content.” The passage speaks to the principle of subsidiarity, a key part of Catholic social teaching. Subsidiarity is a principle that proposes, when possible, leaders should defer matters to those working at the ground levels of an organization or to the least centralized competent authority rather than reserving everything for higher and more distant levels and authorities.

involves one of his final miraculous acts that took place close to the end of his life.

The Israelites had not reached their ultimate vision to make it to the Promised Land, and one more enormous challenge stood in their way: an opposing force.

Amalek came and waged war against the Israelites in Rephidim. “Moses said to Joshua, ‘Choose some men for us, and tomorrow go out and engage Amalek in battle. I will be standing on top of the hill with the staff of God in my hand.’

Joshua did as Moses told him: he engaged Amalek in battle while Moses, Aaron, and Hur climbed to the top of the hill. As long as Moses kept his hands raised up, Israel had the better of the fight, but when he let his hands rest, Amalek had the better of the fight.

Leaders who are frustrated by carrying too heavy a workload — or who have become tired and uninspired by the work itself — should ask: “Am I the only one who should be doing this work? Who else can do this work?”

Had Moses not taken this advice, he could’ve succumbed to a condition plaguing many of today’s Catholic health care leaders: burnout. Leaders who are frustrated by carrying too heavy a workload — or who have become tired and uninspired by the work itself — should ask: “Am I the only one who should be doing this work? Who else can do this work?” It is easy as one climbs the proverbial ladder to think: “Well, I’m here for a reason; I must be smarter and better than everyone else.” Or one can think, “I have to do all this work myself if it is going to get done the right way.”

In all honesty, I have fallen prey to these same thoughts. And the truth is, no one else can do the work exactly the same way I would. But that’s because each of us is one of a kind. That doesn’t mean others aren’t capable or can’t help with the workload.

Lesson 4: Leaders are only as good as those who surround them.

It is fitting to close with a story about the final years of Moses’ life. A number of scholars estimate he lived for around 120 years. One of the least-spoken stories — from Exodus 17:8-13 —

Moses’ hands, however, grew tired; so they took a rock and put it under him and he sat on it. Meanwhile Aaron and Hur supported his hands, one on one side and one on the other, so that his hands remained steady until sunset. And Joshua defeated Amalek and his people with the sword.”

The takeaway? No matter how capable an individual leader may be, that leader must surround themself with people who are smarter, more talented and more skilled to ensure success in meeting any challenge ahead. Our Catholic faith calls us to live and to flourish in community with one another. We, too, are stronger when we work together.

DISCOVER THE LEADER IN YOU

So, we revisit the fundamental question: Are leaders born or made? Again, I would suggest both. As you reflect on Moses as a “master class” leader, ask yourself:

What kind of leader are you?

Will you rise to meet a call to lead?

Can you accept help from others when needed?

What kind of people will you choose to surround yourself?

The answers to these questions will influence both your professional and personal success.

DAMOND W. BOATWRIGHT is president and chief executive officer of Hospital Sisters Health System in Springfield, Illinois. He currently serves as the chairperson for CHA’s board of trustees.

The Power of Purpose: Catholic Health Leaders Cultivate Inner Lives, Supportive Relationships

DAVID LEWELLEN Contributor to Health Progress

As an emergency room physician, Dr. Nicholas Testa saw plenty of pain, suffering and cosmic injustice. “You have moments where you question where is the spirit in this, how is this fair?” he said.

But even in the hardest moments, he is apt to think about the many orders of sisters who made grueling treks far from their homes to create hospitals from the ground up. “When I think about what they did with zero money and little support, it reminds me that this hard work is worth it.”

life working with numbers in Catholic health care, but a midcareer formation course gave her an appetite to go deeper. Earlier in her career, she remembered, “If the balance sheet balanced, I knew the answer was right.” But in her theology studies, “I learned that the world is not black and white.”

“I don’t think you can work in health care without the understanding that there’s something bigger out there that connects all of us.”

— DR. NICHOLAS TESTA

Along with all the other responsibilities of leading a health care system, executives in Catholic health care also have an explicit mandate to tend to their inner lives. It can take many forms, but in the best cases, the sense of mission is implicit in every action they take.

“The easiest way to become a better leader is to become a better person,” said Liz Foshage, executive vice president and chief financial officer of Ascension. She has spent her entire professional

“I don’t think you can work in health care without the understanding that there’s something bigger out there that connects all of us,” said Testa, who today serves as regional chief medical officer for California for CommonSpirit Health. At his first interview for a Catholic health system nearly 10 years ago, he thought he was just applying for a job, but he found that the sense of mission appealed to him. “I enjoyed the stories, the spirit, the connectivity of being in a faithbased organization,” he said. Although he is no longer a practicing Catholic, “having a spiritual compass really mattered to me.”

Cris Daskevich had a similar experience when she interviewed for the job of CEO of CHRISTUS

Children’s in San Antonio. “It was a centering moment” to see the wall display about the history of the Sisters of Charity of the Incarnate Word [Houston and San Antonio] and the Sisters of the Holy Family of Nazareth, she said. “I called my husband, and I said, ‘I think God has a different plan for us.’”

Daskevich, a practicing Baptist, found her formation experience with CHRISTUS Health to be “profoundly touching, to bring the big picture together. It makes the mission we serve even more important.”

Every Catholic health care executive has been through formation programs, but developing a sense of self and connection to others and the mission is work that never ends. “You encounter formation experiences all through your life, and you will continue to encounter them,” said Kyle Klosterman, the system vice president of mission and formation for CommonSpirit Health. “It’s not like, ‘All right, I’ve been formed, I’m done.’”

‘WE HAVE HEART, AND WE’RE HUMAN’

Part of Klosterman’s work is to equip leaders to model and reinforce formative behaviors in daily interactions. “We use the word ‘calling,’ for sure,” he said. “And we use the example of the sisters, helping people to identify that there’s more to this work than the job itself.”

“Once I went through the coursework and experiences, I realized there was a much bigger connection to be made with your whole self,” said Andy Davis, the president and CEO of Ascension Texas. “In the eclectic nature of Catholic health care, there’s an openness to different faiths and walks of life as we find our own purpose and vocation.”

Even when decisions are difficult or unpopular, compassionate leaders have learned to find the spiritual dimension in them. “Change is inevitable, but how you do change is important,” Foshage said. For example, if a department is being eliminated, she makes sure to give plenty of

notice, a good explanation and a transition package. “I make decisions to steward the resources Ascension has,” she said. The sisters “have been around for 400 years. I’ve been with Ascension for just over 30 years. I don’t want the ministry to end on my watch.”

The beginning of the COVID-19 pandemic was one of the toughest times, Daskevich said, when she and other executives worked in the building instead of isolating and had to call other leaders in to work alongside clinical teams. “These were unprecedented situations, filled with many unknowns,” she said. “But we have heart, and we’re human, and we have to show our human side and loving care for each other.”

Davis, however, said that the most difficult times at work are usually the easiest times for him to see the connection to mission. When big, existential questions are on the front burner, “you realize the issues are bigger than yourself, and you need help,” he said. “When things are fantastic, you get a little more relaxed. [But] who or what is causing the prosperous time? That good outcome is not necessarily earned.”

To help keep him grounded and on track, Davis credits the importance of mentors, particularly Neeysa Biddle, the former ministry market leader for Ascension Birmingham. She was Davis’ boss at one point and his mentor for even longer, and he still calls her semiregularly as a thoughtful ear for what is going on in his career and personal life.

Almost every leader interviewed had one or more informal relationship of this kind, and Biddle said, “Nothing can replace that. It’s harder for guys, in particular, to say, ‘I’m struggling.’ Having someone they can feel vulnerable with is critical.”

Biddle is now retired, but she has kept up that bond with about 10 other health care executives who have crossed her path over the years and who trust her now to be a friendly, but honest, resource. How does she tell someone that they made a mistake? “Carefully,” she answered. “It depends on the person and the relationship. I might say, ‘Tell

“You encounter formation experiences all through your life, and you will continue to encounter them. It’s not like, ‘All right, I’ve been formed, I’m done.’”

— KYLE KLOSTERMAN

me what you were thinking or what you would do differently next time.’”

Many large systems have formal programs to pair a senior executive with someone aspiring to management, but in the best scenarios, the connection lasts longer and goes deeper. It doesn’t have to have a spiritual component, but sometimes it does. “I have mentors who taught me to lecture and to practice emergency medicine,” Testa said, “but then some other mentors connect with you in a deeper way, to teach you how to live your life as a professional.”

LOOKING FOR THE RIGHT FIT

An important aspect of spiritual leadership is lifting up others to become leaders, whether through formal mentorship or passing words of encouragement. But moving up from performing a job to supervising others to do the job can be a difficult transition. Spencer Clancy is the system director for talent development and culture at CHRISTUS Health, and part of his job is helping workers explore new roles to see if something is the right fit.

“I have a soft spot for frontline nurses,” Clancy said, “and I want to help them not feel anxiety about leadership. Nurses are trained to heal people, not be supervisors, and it can be anxious for them. They ask for feedback on how to do it effectively, and we give it.”

“Everyone is a leader,” said Anthony Houston, the market CEO for CHI Saint Joseph Health in Lexington, Kentucky. He vividly remembers an exchange at SSM Health years ago when he commented to his then-CEO, Sr. Mary Jean Ryan, FSM, about something “the leaders” had done. “She said to me, ‘We are all leaders. It doesn’t matter what it says on your badge.’ I believe in that, and I see it. We all have gifts, and there’s dignity in that. Everyone is bringing something, even on the hardest days.”

Houston engaged in discernment about the priesthood as a teenager before opting for a career in health care management. “It’s so fulfilling to

work and practice your faith together,” he said.

DAILY PRACTICE

Most executives practice some daily spiritual or reflective routine, often first thing in the morning. Foshage begins her day with 30 minutes of silence and reading, provided by Catholic services that send a new reflection to her inbox every morning. She prays the rosary (there’s an app for that) and adds intentional prayers for people or events on her mind. At the end of the day, she takes 15 or 20 minutes to “bring me back to a place of peace before falling asleep.”

Testa’s recent 50th birthday prompted him to begin practicing meditation. “I feel very fortunate that my work has meaning and purpose,” he said, “but health care doesn’t stop. If you’re going to be successful, you have to find what gives you purpose outside of work,” or else burnout will be the result.

Daskevich starts her day with prayer, a reflection or Scripture. “God always reaches out with a verse, or a meditation or a reflection that is spot on,” she said.

At work, meetings are an important time to take a moment to acknowledge the shared sense of mission. Clancy’s meetings always begin with a reflection, and the responsibility rotates. “Even if you’re not a practicing Christian, you can offer a reflection that grounds us,” he said, and CHRISTUS Health has a formation curriculum to help executives give better reflections.

“Every meeting I’m in, I’m trying to make a positive difference,” Foshage said. This includes taking time at the end to recognize service commitments in action, which could be as simple as, “I saw listening to understand.” These commitments, she said, “are not something extra to work on. They are how we accomplish our work. If you’re constantly reflecting on right relations with others, you become the way you behave.”

Sowing the Seeds for Human Flourishing

LAURA S. KAISER, FACHE President and CEO of SSM Health

This past year, CHA introduced a new vision statement: We Will Empower Bold Change to Elevate Human Flourishing. It’s an aspirational call to each of us in the Catholic health ministry. With just nine words, CHA’s vision statement makes it clear that the health systems of tomorrow must be innovative and courageous, while embracing a mandate to further extend ourselves into all aspects of human flourishing.

The definition of the word flourish, “to grow or develop in a healthy or vigorous way, especially as the result of a particularly favorable environment,” reminds me of Jesus’ parable of the sower:

“‘Hear this! A sower went out to sow.

And as he sowed, some seed fell on the path, and the birds came and ate it up.

Other seed fell on rocky ground where it had little soil. It sprang up at once because the soil was not deep. And when the sun rose, it was scorched and it withered for lack of roots.

Some seed fell among thorns, and the thorns grew up and choked it and it produced no grain.

And some seed fell on rich soil and produced fruit. It came up and grew and yielded thirty, sixty, and a hundredfold.’

He added, ‘Whoever has ears to hear ought to hear.’”

(Mark 4:3-9)

Addressing human flourishing requires assessing the “soil” of our communities, not only what happens within our hospitals and clinics, but also the environments and conditions in which our patients live, work and play. As we know, human health is largely influenced by factors beyond the walls of our health care facilities. The structural,

moral and social determinants of health have the greatest influence on overall well-being and are the main roadblocks to health equity in society.1 For far too many in our communities, the conditions are vulnerable, rocky or choked off with thorns, preventing people from reaching their full potential and enjoying optimal health.

Fulfilling the vision of CHA, and the parable of the sower, requires us to address obstacles such as poverty, discrimination and their consequences, including lack of access to good jobs with fair pay, quality education, healthy foods, reliable housing and transportation, safe environments and affordable health care. Creating a favorable environment for everyone in our communities will require making bold change and empowering our teams at all levels of the health ministry. Yet, because the majority of influences on health are outside of health care, our solutions and efforts must be in partnership with the greater community. Health care cannot be the sole driver, but it can be a conduit for hope and a convener of services for those who have been historically neglected.

In recognition of this, like many of our peer organizations in Catholic health care, SSM Health has built robust health equity structures and goals into our work as a fully integrated health care delivery system. Whether discerning a strategic partnership, implementing a new line of service

LEADING WITH INTEGRITY

or simply asking ourselves what more we can do in daily pursuit of our mission, we include health equity and social determinants in the discussion. In addition, we acknowledge that health care is a major economic driver in the communities we serve, and because of this, we can make tangible investments to foster equitable change.

INVESTING IN OUR NEIGHBORHOODS

One example of SSM Health’s work to drive greater equity structures in our communities is our partnership with the Healthcare Anchor Network, which recognizes that the path to equity is paved through economic development and focuses on hiring, purchasing and investing (see pages 59-61 for more details about this network’s work). Through this work and other internal endeavors, we set significant goals to deliberately recruit, hire and develop talent from communities that have been historically disinvested. Furthermore, we have directed our purchasing power to engage in opportunities with diverse suppliers and service providers, from large construction projects to catering orders. As a result, some businesses that historically would not have been able to compete for our contracts are now engaging with SSM Health as part of an intentional, vibrant

and equity-focused business ecosystem.

Even on a small scale, we can improve human flourishing. For example, SSM Health contracts with a St. Louis nonprofit bakery — one that employs and supports unhoused individuals — to produce loaves of bread for our employees at our annual Heritage Week events. Instead of turning to a large corporate bakery, we provide hope and opportunity for those trying to find a stable place in our community.

On a much larger scale, SSM Health is leveraging a portion of our investment portfolio for socially focused investment opportunities, such as affordable housing. The financial return is less than the market rate, but our social return is significant. In this same vein, instead of following the traditional outsourcing option, we are partnering with another local health care system to start a new health care laundry facility specifically in an urban St. Louis community that has been historically disinvested, providing good-paying jobs and helping to stabilize the neighborhood.

PRESERVATION OF THE EARTH

Sometimes, issues of health equity are global but must be addressed locally. Take climate change. The planet is warming due to human activities,

Courtesy of SSM Health

Laura Kaiser

and health care is a significant contributor. Unstable weather patterns are causing destructive events like floods and drought and creating environments where vector-borne infectious diseases can proliferate. These are existential threats to the health of our communities while generally affecting the poor and vulnerable more than others. While preservation of the Earth has always been a part of SSM Health’s Franciscan heritage and mission, these factors have added urgency to our efforts. In 2022, we accepted the White House pledge to become carbon neutral by 2050 and are bringing this resolve to everything we do, such as reducing the use of particularly harmful anesthesia gases, expanding recycling programs, updating our electronics and lighting, limiting single-use products and installing solar panels to power some of our health ministries.2 Reversing the damage done to our planet will take everyone’s contribution — but as leaders in health care and health equity, we must lead by example.

ADDRESSING SOCIAL ISSUES

SSM Health also made a commitment last year to address food insecurity and challenged all our leaders to identify local solutions. In Oklahoma City, that meant partnering with a neighboring church to operate an urban farm that grows and distributes fresh produce. Most of our health ministries now have food pantries. Some are affectionately called the “Bread Basket” in homage

Health care cannot be the sole driver, but it can be a conduit for hope and a convener of services for those who have been historically neglected.

Of course, environmental management and community development are not our primary business, and our greatest opportunities to foster human flourishing remain in how we practice health care. As a Catholic health ministry, we have always known that our communities and patients face many social issues. Still, we have historically lacked organized methods to routinely understand the extent of their challenges and identify community-based organizations to help address them.

In 2023, we moved assertively to make the connection between the clinical and the social by instituting universal screening for the social determinants of health across our acute care patient population through the Epic electronic health record. Upon admission, all patients are screened for social challenges — including food insecurity, housing instability and other financial difficulties, such as inability to pay utilities — that can contribute to illness. By investing in an Epicbased system to streamline partnerships with community-based organizations, we can connect people with social-determinant needs with resources to address them.

to our founding sisters, who more than 150 years ago carried baskets of food through the streets of St. Louis to feed those in need. Through today’s Bread Basket pantries, patients who screen positive for food insecurity are discharged with two or more days’ worth of nutritious food for their household. To foster long-term food security, we partner with local food pantries and make “warm handoffs” — a method of direct communication — to experts who can help our patients with access to healthy food through more permanent community resources and programs.

TAKING BOLD STEPS

While SSM Health provides these services for anyone admitted to our health ministries, we also know that some populations have more significant issues and higher degrees of inequity, requiring a more specialized investment of time and effort.

The United States has one of the worst maternal mortality outcomes of any economically developed country, largely driven by poor outcomes for Black mothers.3 This has an outsized impact that is also extremely debilitating to communities because the mother is nearly always the anchor of the family, raising the children and providing stability. So, at SSM Health, we challenged ourselves to take bold steps and help stem this harmful trend.

At our Women and Infant Substance Help (WISH) Center in St. Louis, staff members are dedicated to taking care of women with substance use disorder from prenatal care through delivery and up to two years postpartum, helping to lead the way in substance use disorder treatment in

pregnancy. Patients receive not only medical and prenatal care, but also holistic support to address behavioral health and social issues. Through love, patience and nonjudgmental support, their results have been nothing short of miraculous, and their stories make the heart ache for social justice.

Leveraging this work across our obstetrics practice, we invested in high-risk clinics, instituted universal maternal social determinant of health screening, built a referral database for community-based organizations and focused on food insecurity. In Madison, Wisconsin, women of color with social determinant of health issues are enrolled in ConnectRx, a unique partnership between health care systems in which community health workers and doulas provide holistic support throughout pregnancy.4

Another urgent clinical issue that greatly impacts people who are most neglected is behavioral and mental health. Left untreated, people with these issues often wind up living on the streets, estranged from their loved ones, unable to support their families, or worse, end up incarcerated or severely injured as a result of their mental illness. People with chronic health conditions have much poorer clinical outcomes if they also suffer from depression.5 And the number of behavioral health issues among adolescents and teens is a national crisis. SSM Health has made bold moves to address this significant challenge, including opening one of the nation’s first behavioral health urgent care clinics in St. Louis and openly sharing the model with others in hopes it will be replicated.

At the clinic, patients who would otherwise end up in the chaotic world of the emergency room, waiting for hours to be seen, have acute issues quickly addressed by mental health professionals and are then connected to a local provider for sustained care through our multiple partnerships. This model decreased repeat emergency room visits and related admissions. It was so successful that we are opening a second clinic this spring to serve an even more vulnerable population.

The clinic also is located in St. Louis within our Long-Acting Injection clinic, which addresses the frequent and considerable issue of patients not sticking with their pharmacotherapy regimens. After patients stop taking their medications, it can quickly spiral into a crisis. The clinic allows patients with significant mental health chal -

LEADING WITH INTEGRITY

lenges, such as bipolar disorder or schizophrenia, to come to the clinic monthly to receive their medications as an injection. This reduces the probability that highly vulnerable patients will stop taking their medications and creates lasting stability. The clinic’s patients have realized tremendous benefits, including reconnecting with families, being able to hold down jobs, continuing in school, and avoiding trips to the emergency room or arrest by law enforcement.

SOWING THE SEEDS

As we reflect on CHA’s vision statement and the year ahead, we must remember that it takes bold change and leadership to truly impact those things that contribute the most to health equity: the moral, social and structural determinants of health. We all want to see a community where every individual flourishes as God intends. Let’s renew our commitment now to partnerships, innovation and investments that will improve the health and well-being of those we serve and create the good soil to fulfill Jesus’ parable.

LAURA S. KAISER is president and CEO of SSM Health in St. Louis. She served as the 2022-2023 chairperson for CHA’s board of trustees.

NOTES

1. “Social Determinants of Health,” Neighborhood Outreach Access to Health, https://noahhelps.org/sdoh/.

2. “Health Sector Commitments to Emissions Reduction and Resilience,” U.S. Department of Health and Human Services, https://www.hhs.gov/climate-change-healthequity-environmental-justice/climate-change-healthequity/actions/health-sector-pledge/index.html.

3. Asima Ahmad, “America Has the Highest Maternal Mortality Rate among Developed Nations—and It’s on the Rise. Here’s Why We Are Facing a Pregnancy Health Crisis,” Fortune, May 14, 2023, https://fortune. com/2023/05/14/america-highest-maternal-mortalityrate-among-developed-nationsand-rise-pregnancyhealth-crisis-asima-ahmad/.

4. “Dane County Health Council and Partners Launch ConnectRx Wisconsin,” SSM Health, April 14, 2022, https://www.ssmhealth.com/newsroom/2022/4/ connectrx-wisconsin.

5. “Chronic Illness and Mental Health: Recognizing and Treating Depression,” National Institute of Mental Health, https://www.nimh.nih.gov/health/publications/ chronic-illness-mental-health.

To Transform Care, Health Systems Must Collaborate To Adopt Innovations

ROD HOCHMAN, MD President and CEO, Providence St. Joseph Health

The Catholic sisters who were the primary founders of health care in the United States — for Providence, the Sisters of Providence and the Sisters of St. Joseph of Orange — were courageous, pioneering women. They did not hesitate to brave the unknown to serve those in need and be a source of healing and love in the world. When our founding sisters arrived in the American West, it was still a rugged and harsh frontier. Through discernment and determination, they built hospitals, orphanages and schools.

One can only imagine the times of pivotal change they faced amid nearly 170 years of service, especially in the earliest, most challenging days. For those of us following in their footsteps, our founding sisters have left us with clear expectations to respond to the signs of the times. The Sisters of Providence articulated their vision for the future in their “Hopes and Aspirations for Providence Ministries” legacy document, while the Sisters of St. Joseph of Orange guide us to respond to the changing needs of the world and each community member we serve, who the sisters refer to as the “dear neighbor.”

The world continues to change in ways our founding sisters could not have imagined. Yet the heart of the mission remains the same: to serve all, especially those who are poor and vulnerable. Health systems know firsthand how responding to the COVID-19 pandemic accelerated the use of technology and changed the landscape of health care access. Now, with the explosion of generative artificial intelligence (AI) driving even more rapid change, the real transformations for health care are imminent.

FORGING A NEW ERA OF TRANSFORMATION

After spending years investing in information

technology infrastructure and digital and cloud technology, health systems are ready for rapid AI innovation. In serving all, the founding sisters expect us to use resources wisely to meet an individual’s needs while also reminding us to take risks for the greater good. When we care for the whole person this way, we create healthier communities.

To deliver personalized care in the modern world, health systems must leverage a platform that connects whole-person experiences and behaviors.1 This requires clean, reliable data to drive informed decision-making. Yet only 57% of a health care organization’s data is used in key decision-making. 2 At Providence, many of our data challenges stemmed from the fact that our ministries were on different versions of Epic, or a separate electronic health record altogether. We also had a few different enterprise resource planning systems for human resources, finance and supply chain. Our varied systems lacked integration, resulting in time-intensive manual processes that often made using our data for critical decisions and comprehensive operations challenging.

Given health care’s dependence on data and technology, to streamline and modernize our systems and get them in the cloud, we recruited

leaders from some of the most renowned technology companies on the West Coast. Guided by their expertise, we built teams to help identify gaps and create a road map with an aim for Providence to become not only the most innovative organization across health care, but also across industries. To support that strategy, just as COVID-19 was gaining momentum in the U.S. in 2020, Providence opened a global innovation center in Hyderabad, India.

SUPPORTING PATIENT CARE WITH WORLD-CLASS INNOVATION

Investing in global innovation centers is something you may expect from the corporate sector. So why would a nonprofit Catholic health system serving communities in seven western states take this approach? In their Hopes and Aspirations, the Sisters of Providence remind us that, “as transportation and communication bring us closer together, we hope Providence Ministries will embrace a spirit of collaboration, not competition, in service of the Mission.”3 In responding to changing times, the sisters guide us to reach out to others and new forms of service.

With advanced technology at the heart of delivering personalized quality care to all, ensur-

ing the tools, systems and data our frontline caregivers rely on are fully monitored and maintained 24 hours a day, seven days a week, is another vital way to care for our communities. That’s why we established the Providence Global Center (also known as Providence India) in an area of the world that is home to some of the best technology talent and capability centers.4 At the center in Hyderabad, we refer to our technology specialists as caregivers because of the important role they play in supporting our care teams in the U.S.

This team of 1,200 helps us uphold our value of integrity by ensuring the safety and security of patients’ protected health information. They also make it possible for us to bring the latest advances to our patients through their expertise in data analytics, AI and machine learning, cloud and product engineering, cybersecurity, software and application development, network operations and lab solutions. Being in a different time zone, they keep our systems securely running around the clock along with information technology teams in the U.S.

Our Providence Global Center specialists can choose to work for any number of prominent technology companies, but they are inspired and called by Providence’s mission. Working with

Once Films

Rod Hochman, MD

their mission leader, the center responds to the needs of their home communities by supporting the Catholic Health Association of India and other local organizations. They are committed to building an inclusive workforce, especially given that women make up less than a third of the world’s workforce in technologyrelated fields.5

One way the Providence Global Center is working to advance women in tech is with Thrive. This sixmonth return-to-work program helps women professionals who have been on a career break for a year or more to ease back into work and apply for professional roles at the center.6 And the contributions our center’s teams are making to Providence’s cutting-edge capabilities show their dedication to improving the communities we serve.

LEADING WITH INTEGRITY

seemingly simple solutions — such as in-basket management to help clinicians triage messages — will dramatically reduce the time they spend on administrative tasks so they can focus on caring for their patients.

Generative AI will keep fueling advances like these in everything from patient outcomes and clinical breakthroughs to improved caregiver well-being. The potential is great, especially at a time when health care labor shortages and caregiver burnout are unsustainably high.

COLLABORATION ESSENTIAL TO TRANSFORMING CARE

As digital health innovations continue to accelerate, generative AI has the power to transform care delivery sooner than we think. By leveraging the expertise of our teams in the U.S. and India, Providence has been thoughtfully leaning into generative AI, and we are already seeing how it helps us take advantage of technology while staying aligned with our value of integrity.

We developed MedPearl, a clinician education and referral platform built directly into our electronic health record that uses generative AI to help advise primary care physicians on caring for and referring patients in need of specialty care. This tool, which was implemented for our providers in 2023, supports clinical decision-making by providing guidance that is continuously updated by primary care physicians and specialists across Providence.7 Also, our Trial Connect program uses augmented intelligence to match underserved patients with our more than 2,500 research trials.8

Generative AI will keep fueling advances like these in everything from patient outcomes and clinical breakthroughs to improved caregiver well-being. The potential is great, especially at a time when health care labor shortages and caregiver burnout are unsustainably high. Even

Fully realizing the benefits of generative AI requires clean and consistent data. Despite infrastructure investments by health systems, unstructured data in the electronic health record — such as clinical notes and imaging — has long been an untapped resource that could hold the key to major advances in prevention, diagnostics and treatment. Bad actors will also exploit generative AI for their own means, bringing heightened risks for health systems and patients. Clinicians will be responsible for leading the charge in prioritizing the ethical use of generative AI and ensuring the right governance to safeguard patient data and privacy. But in our environment of rapid innovation and a workforce shortage, health systems simply do not have the runway or resources to transform care delivery alone. Partnerships between health systems, the technology sector and other experts will play a key role.

CONTINUING FUTURE COLLABORATION

As a founding member of the data consortium Truveta,9 Providence is collaborating with more than 30 other health systems to use complete, deidentified and clean electronic health record data to power transformation through AI, predictive analytics and clinical research. Similarly, to keep up with technology and protect against cyberthreats, health systems can seize the opportunity to collaborate on IT support and cybersecurity rather than duplicating resources.

With our center in India and the digital capabilities and solutions we are developing, Providence is in a unique position to respond to the

GET IT

Health Progress and Catholic Health World

needs of the dear neighbor and advance our vision of health for a better world by helping other health systems scale innovation and care for their communities. As health systems evaluate their capabilities to understand what they can do well on their own and when it makes sense to partner with like-minded organizations, our door is always open to explore collaboration.

DR. ROD HOCHMAN is president and CEO of Providence St. Joseph Health. Hochman is a former chair of CHA’s board of trustees and a recipient of CHA’s 2023 Sister Carol Keehan Award. He serves on the board of GE HealthCare and was chair of the American Hospital Association in 2021.

NOTES

1. Sara Vaezy, “Distribution and Decentralization Are Crucial in The Healthcare Sector,” Forbes, July 5, 2023, https://www.forbes.com/sites/forbes businessdevelopmentcouncil/2023/07/05/ distribution-and-decentralization-arecrucial-in-the-healthcare-sector/.

2. “HIMSS and Arcadia Market Insights Pulse Survey: Healthcare Leaders Know Data Is Key for Decision-Making — But Many Struggle to Take Action,”

Arcadia, 2023, https://arcadia.io/resources/ state-of-healthcare-analytics.

3. Sisters of Providence, Mother Joseph Province, “Hopes and Aspirations for Providence Ministries,” Caregiver Headlines, 2010, https://caregiverheadlines. org/wp-content/uploads/2024/02/2019Oregon-Pictures-Providence-Hopes-andAspirations-book-SP-logo.pdf.

4. “How India Is Emerging as the World’s Technology and Services Hub,” EY India, January 27, 2023, https://www.ey.com/ en_in/india-at-100/how-india-is-emergingas-the-world-s-technology-and-serviceshub.

5. “Women in Tech Stats 2024,” WomenTech Network, https:// www.womentech.net/en-us/ women-technology-statistics.

6. “Thrive Program,” Providence India, https://www.providence.in/careers/ thrive-return-to-work-program.html.

7. Giles Bruce, “Generative AI Helps Providence Make Specialty Referrals,” Becker’s Health IT, August 16, 2023, https://www. beckershospitalreview.com/innovation/ generative-ai-helps-providence-makespecialty-referrals.html.

8. “Trial Connect,” Providence National Foundation, https://foundation.providence. org/national/our-priorities/trial-connect. 9. Truveta, https://www.truveta.com.

“ ”

Let integrity and uprightness preserve me; I wait for you, O Lord.

(PSALMS 25:21)

Medical Directors of Mission Support Connections Between Clinician Experience and Ministry Identity

SARA McGINNIS LEE Vice President of Mission and Clinical Integration, Mercy

Physicians are at the core of what it means to be health care — essential leaders of care teams and clinical initiatives who represent the deep purpose of the organization. They are called to heal, and the practice of medicine is the core of their work. Yet, operational leaders often hear physicians say they feel disconnected from much of the organization’s decision-making and strategy discussions. For the Catholic health ministry, this gap is worth exploring, especially to sustain our identity, mission and values, as it represents dissonance in a sense of meaning and purpose.

These comments from Dr. Laurie Orme, an internal medicine and pediatric medicine physician with Mercy in Oklahoma, illustrate why this gap may occur: “Physicians live in a busy, fastpaced world where they need to make immediate decisions that can be life-altering for the patients they serve. While they may look ahead at how a disease process is going to progress, it is difficult to think about strategy five years down the road. Mercy administration, on the other hand, has to prepare for the future, and their focus in meetings or communications reflects that.”

Mercy is exploring how to overcome or lessen this distance through a new role that aims to bring together physicians and mission integration: the medical director of mission. A board-certified physician or advanced practice clinician, the medical director of mission invites physicians and operations leaders to recall and celebrate shared purpose; explains to new providers the meaning of ministry identity; enables physicians to participate in and lead formation in distinct ways; and

shapes communication and effort around physician well-being, a key aspect of retaining providers that resonates with a Catholic view of human flourishing. They do this in partnership with mission leaders and local physician wellness champions, with commitment from senior clinical leaders to budget and sustain visibility for the importance of the position.

RECOGNIZING THE SACRED

Conceptualized by clinical leaders, the medical director of mission role began nearly three years ago and has grown to three directors, with a fourth and final position to begin by end of this fiscal year. Each serves a respective region within Mercy’s geography and an area of ministry-wide focus: primary care, service lines or operations.

The insight found in the work between mission leaders, medical directors of mission and other clinicians heightens the focus on patients, which is core to Mercy’s strategy and affirmed in the Ethical and Religious Directives. Regardless of

where the patient is throughout their care experience — whether care providers accompany them at a time of suffering, healing, increased well-being or as they face advance care planning decisions — the experience between patients and those who care for them is where God is present and is the core of what it means to be a healing ministry.

As the introduction to the ERDs notes, “The mystery of Christ casts light on every facet of Catholic health care: to see Christian love as the animating principle of health care; to see healing and compassion as a continuation of Christ’s mission; to see suffering as a participation in the redemptive power of Christ’s passion, death, and resurrection; and to see death, transformed by the resurrection, as an opportunity for a final act of communion with Christ.”1

employer and colleagues, and final steps include interviews and orientations.

Medical directors of mission and mission and ethics leaders have refined how and where in this process elements of Mercy’s mission, values and the ERDs should be introduced. The medical

“A physician or provider first chooses medicine out of a calling to heal. Our role with mission strives to reignite that heart in our colleagues by going out to them to acknowledge how central their daily practice of medicine is to our ministry’s purpose for existing.”

— DR. BASSAM HADI

Mercy’s first medical director of mission, neurosurgeon Dr. Bassam Hadi, who serves the St. Louis area, explains, “A physician or provider first chooses medicine out of a calling to heal. Our role with mission strives to reignite that heart in our colleagues by going out to them to acknowledge how central their daily practice of medicine is to our ministry’s purpose for existing.”

Sharing sacred moments in operational meetings reminds clinical and operations leaders about the importance of daily patient-physiciancare team interactions, complementing discussion around visit or procedure length, format, efficacy and cost. This practice — a key mission department and Mercy goal — allows for conveying ordinary experiences throughout one’s day in which a greater purpose and God’s transcendent presence are sensed.

A CONNECTION TO MISSION

A second focus of the medical directors of mission has been refining the involved and distinctive hiring and onboarding process for physicians. It begins with recruiters spending a year or more in dialogue with qualifying candidates, explaining compensation, practice models, team dynamics and Mercy as a ministry. Later, candidates have opportunities to get to know their potential

directors of mission co-lead orientation for new physicians/providers to ensure mission and ethics elements are shared in the most relevant way. They do this by sharing personal examples of how they came to understand what it means to be a ministry from a clinically trained, patient-focused perspective, such as reconciling the value of providing excellent patient service with the need to attend to the value of stewarding budgets for all patient needs, including those who cannot pay. Or they might acknowledge that scientific mindsets, narrow focus (shaped by training) or awareness of the multireligious makeup of their peers kept them at a distance from “mission talk.”

Involving physicians to shape their new professional peers’ experiences, from the earliest days, honors the reality that physicians typically choose their careers out of personal commitments to the care of others; make unique investments in their education and training; and often practice in one place for a lifetime, connecting deeply to the communities they serve.2 An early introduction to and recognition of the organization’s identity, values, culture and the care it provides offers a wide perspective to new physicians.

FLOURISHING THROUGH FORMATION

A third area of collaboration between mission leaders and the medical directors of mission is the inherent leadership physicians and other

advanced practice clinicians have within their own care teams to influence culture, including team formation practices. To help physicians shape effective formation for their teams, mission leaders and the medical directors of mission customize formation opportunities for physicians that allow for greater format and time flexibility.

Creating these avenues to facilitate participation in formation practices can help lessen the disconnect that can occur between physicians and the organization. “In regard to mission, physicians see our coworkers participating in formation and engaging in our values and charism, but until recently, we weren’t included,” comments Dr. Kim Creach, a radiation oncologist and medical director of mission for Mercy’s southwest Missouri region. “Our administrative leaders saw us busy providing patient care and didn’t want to interrupt us to share a reflection, sacred moment or an aspect of our heritage. Without an expectation to be present — and with busy schedules — we usually didn’t join in. Ultimately, that can lead to us missing out and not feeling connected.”

In one recent example, a group of physicians, nurse practitioners and physician assistants worked with mission leaders to develop a care team formation approach. The goal was to support clinician involvement and to tailor content that spoke most directly to their daily work. Posters were placed in outpatient clinics’ break room areas where all care team members could write answers to questions connecting their experiences to Mercy’s values. The exercise concluded through meetings where care team members could view the completed poster together and note how these elements reflect Mercy’s mission, values and charism.

Through a separate effort in one of Mercy’s communities, a medical director of mission individually rounded to clinics and, from gathered peer feedback, is working with mission leaders to create video and print formation resources that are both short and meaningful for physicians themselves to lead.

STRUCTURES TO ADVANCE WELL-BEING

A fourth way mission has been able to support clinicians in collaboration with the medical directors of mission is through well-being. As clinicians practice, they bring their professional call-

LEADING WITH INTEGRITY

ing and commitment into environments where their work is powerfully shaped by technology and compensation models measuring productivity and outcomes. As a result, that which is central to the healer’s role — the person in front of them — is at risk of being lost, potentially taking with it the physician’s sense of meaning and purpose.

To counteract this, medical directors of mission and mission leaders have convened the work of well-being. These efforts include helping to shape systemwide communications to physicians, promoting the defining and measuring of well-being using the Stanford Model³ (which recognizes organizational, practice efficiency and personal resilience elements); enhancing peer support and recognition approaches; connecting local well-being committees to leadership support and advocacy; and facilitating safe spaces for processing emotional/spiritual experiences. Physicians in key leadership roles support these efforts as a strategic priority.

BUILDING EFFECTIVE COMMUNICATION

Establishing the medical director of mission roles and their collaboration with mission leaders has also shaped the mission department’s worldview. Through multiple efforts implemented between mission and physician leaders, more than 120 physicians and advanced practice providers are involved in new ways.

Mission leaders are well-equipped to understand the nuances and impact of the unique physician experience due to their theological study of human flourishing, right relationships, the common good, suffering and healing. These lenses can apply to physicians’ encounters with patients, the pressures they feel as part of our nation’s health care system today, and their own challenges to sustain well-being.

Measuring the impact of this work is underway. As the new roles were in development, Mercy was reorganizing and advancing multiple senior physician leadership roles. During that time, our 2021 AMA survey of more than 900 respondents, which focused on physician/clinician well-being and burnout, showed an 11% increase in our providers’ responses to the question, “I feel providers are valued at Mercy.” Also in 2021, we added two custom questions to understand what our physicians and other providers value most and what they perceive Mercy values most, so that we

can work toward greater alignment. The results confirmed that often there is a differing perception between physicians and operational leaders about priorities. Some physicians may perceive leadership messaging to emphasize business performance more than patient care — their utmost value. Yet, operational leaders see fiscal management as supportive to and essential for exceptional patient care and in delivering the mission itself.

PARTNERS IN LEADING THE MISSION

Clinicians have a desire to serve those in need and benefit their communities, which parallels the motivations and worldview of the Sisters of Mercy who began and sustained this ministry. Those in mission roles have an opportunity to partner with clinicians in aligning the language, concepts and experience of the practice of medicine with ministry identity.

When physicians understand the potential they hold to “lead the mission” with their col-

QUESTIONS FOR DISCUSSION

leagues and care teams and connect system and operational initiatives to the care of patients and communities, mission integration penetrates our Catholic health care organizations more deeply. Mercy looks forward to clinicians as ever-stronger partners and leaders in mission as our program continues to flourish.

SARA McGINNIS LEE is vice president of mission and clinical integration for Mercy in St. Louis.

NOTES

1. Ethical and Religious Directives for Catholic Health Care Services: Sixth Edition (Washington, DC: United States Conference of Catholic Bishops, 2018), 6.

2. Thomas C. Ricketts and Randy Randolph, “The Diffusion of Physicians,” Health Affairs 27, no. 5 (September/ October 2008): 1409-1415, https://doi.org/10.1377/ hlthaff.27.5.1409.

3. “The Stanford Model of Professional Fulfillment,” Stanford Medicine, https://wellmd.stanford.edu/about/ model-external.html.

Physicians and advanced practice clinicians need to feel valued in their professions and that their work to heal or accompany patients reflects the values and mission of their organization. Mercy’s Vice President of Mission and Clinical Integration Sara McGinnis Lee details how the system has created medical directors of mission. The clinicians in these roles communicate with other doctors and advanced practice clinicians about the meaning of ministry identity and help connect them to a shared purpose in the organization, spiritual and leadership formation, and physician well-being resources.

1. What do you think about the role as it is described? How does your ministry build relationships in these critical clinical areas?

2. Health care professionals are busy, with multiple daily demands. How do you think ministry leaders can reinforce the importance of the organization’s mission and values in the health care setting to ensure they are foundational to its healing work?

3. Discuss the types of prayer, reflection or support you’ve found nurturing or restorative in your ministry. Could more of it be replicated for physicians and advanced practice clinicians? If so, how?

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This program requires 30 credits (10 courses). These credits may roll over into the Doctoral Degree that requires another 18 credits (6 courses) plus the dissertation.

Doctor of Philosophy (PhD) and Doctor of Healthcare Ethics (DHCE)

These research (PhD) and professional (DHCE) degrees prepare students for leadership roles in academia and clinical ethics.

MA Entrance – 12 courses

BA Entrance – 16 courses

Graduate Certificate in Healthcare Ethics

This flexible program requires 15 credits (5 courses). All courses may be taken from a distance. The credits may roll over into the MA or Doctoral Degree (PhD or DHCE).

Questions? 412.396.4504 or chce@duq.edu

duq.edu/globalhealthethics

National Organizational Ethics Survey Reveals Insights for Catholic Health Care

BECKET GREMMELS, PhD, KELLY TURNER, MA, TIMOTHY LAHEY, MD, MMSc, WILLIAM NELSON, MDiv, PhD, and JASON LESANDRINI, MA, FACHE, LPEC

Organizational ethics guides institutional decisions to align them with organizational values and is a fundamental component of institutional integrity. Although these principles dovetail closely with those in compliance, legal, human resources and other areas, it is its own distinct area of work. However, since organizational ethics is still an emerging field, it is often unclear what it actually entails, especially in health care.

To help shed light on the day-to-day work related to organizational ethics, in early 2022, we launched a national online survey of ethicists that attempted to describe the practice, scope and context of organizational ethics in health care.1 Of the 93 survey respondents, one third of them worked in Catholic health care.2

As explained in the survey, organizational ethics is an organization’s efforts to “define its core values and mission, identify areas in which important values come into conflict, seek the best possible resolution of these conflicts and manage its own performance to ensure that it acts in accord with espoused values.” 3 Upholding these standards is the responsibility of everyone in the organization, especially leaders, as their actions more directly influence the institution’s decisions and practices. Through greater understanding of the importance of the role of organizational ethics, Catholic health care leaders can help further the ministry’s commitment to its mission and values.

SURVEY RESULTS

Of the survey’s 14 questions, those most significant for Catholic health care leaders focused on the structure of organizational ethics in the system, areas of organizational ethics that respondents most frequently encountered, the definition

of organizational ethics and respondents’ views on barriers to its success.

Structure of organizational ethics work in the ministry: The three most common structures reported by ethicists in Catholic health care are including organizational ethics as part of overarching institutional ethics programs (18, 58%), employing an organizational ethicist (9, 29%) and including organizational ethics work in the responsibilities of a clinical ethics committee (8, 26%). (See Figure 1 on page 29.) The “Other” responses mainly described mission integration work and discernment as the main structure for organizational ethics. The data from non-Catholic health care was similar, except that the second highest response was that organizational ethics is not done in the respondent’s institution (20, 32%).

Areas of organizational ethics work most frequently encountered: The three most often encountered domains of organizational ethics work in Catholic health care are creating ethicsrelated policies, organizational ethics consultation regarding a particular concern, and access to care for uninsured or other vulnerable patients. Again, responses from ethicists in non-Catholic systems were similar, except the domain of reviewing workplace ethics was tied with organizational ethics consultation to round out the top three (see

Figure 2 on page 30).

Definition of organizational ethics: We asked respondents if their organization’s definition of organizational ethics was different from the one used in the survey. Of those from Catholic health care systems, the most common answers include 12 who said their definition aligns with the one in the survey, six who responded that their institution had no definition of organizational ethics and five who said that their definition was different. Just four respondents reported no formal definition at their system.

Barriers to success of organizational ethics: The three most commonly reported obstacles to successful organizational ethics work in Catholic health care are lack of systemwide understanding of the role and function of organizational ethics, leadership’s lack of recognition of the need for organizational ethics expertise, and a tie between the inability to join meetings in which relevant decisions are made and leadership’s lack of recognition of the importance of an organizational ethics program. Ethicists at non-Catholic facilities had similar responses for two of these barriers, and tied for the second most common barrier was the adequacy of funding for organizational

LEADING WITH INTEGRITY

ethics expertise (see Figure 3 on page 31). Other barriers reported by ethicists at Catholic facilities include scarcity of ethics resources, lack of time to meet the demand for organizational ethics work, referral of organizational ethics concerns late in the process (often due to the speed at which decisions are made) and lack of clarity about what organizational ethics is.

KEY FINDINGS

This national survey of organizational ethicists identifies several points of interest to leaders in Catholic health care. First, organizational ethics appears to be more commonly acknowledged as an area of practice in Catholic health systems. Only one ethicist (3%) at a Catholic facility reported they do not perform organizational ethics work, compared to 20 (32%) in non-Catholic hospitals. We suspect this may be due to the historical prominence of ethicists and mission leaders at the highest levels of Catholic health ministries since mission integration began in the 1970s, in addition to the presence of ethicists even earlier.4 The role of a mission leader as an executive team member is in part to work with leaders to ground their decisions and actions in the mission

Figure 1: Structure of Organizational Ethics Activities at Catholic vs. Non-Catholic Institutions

Reported Frequently Encountered

Creation of institutional policies regarding ethics issue

Availability for ad hoc organizational ethics consultation

Participating in institutional health care resource allocation considerations

Participating in institutional business decisions

Weighing pros and cons of charitable fundraising strategies

Promoting access to care for uninsured and other vulnerable patients

Disclosure of population-level risk

Reviewing workplace ethics

Disruptive or inappropriate behavior amongst leaders

Assistance with internal institutional communications about values underlying leadership decisions

Assistance with institutional communications to the public about values underlying leadership decisions

Creation and implementation of an ethical climate survey

Educate health system leaders on ethical leadership

Creation or modification of institutional mission, vision and/or values statement

and values of the ministry.5

Second, the survey results show that Catholic health systems are twice as likely to include organizational ethics within a larger ethics program than as part of a clinical ethics committee. This could be due to the historical focus on organizational ethics in Catholic health care, as the ministry has long used a discernment process to make operational decisions. Several sections of the Ethical and Religious Directives for Catholic Health Care Services (ERDs), especially Part One and Part Six, focus on organizational ethics, even if they do not use the term.6 On the one hand, such an approach that moves fluidly between clinical and organizational ethics may blur the lines between the two fields or lead to synergistic collaborations. However, this would appear to explain why the results show that organizational ethics committees are comparatively rare in Catholic settings. This cohesive view of clinical and organizational ethics among Catholic ethicists could result in less focus on resources specific to organizational ethics.

Number of respondents in Catholic health care (total = 31)

27 (87%)

21 (68%)

17 (55%)

15 (48%)

9 (29%)

21 (68%)

5 (16%)

17 (55%)

4 (13%)

14 (45%)

9 (29%)

2 (7%)

20 (65%)

10 (32%)

Number of respondents in non-Catholic health care (total = 62)

45 (73%)

29 (47%)

28 (45%)

8 (13%)

6 (10%)

24 (39%)

4 (7%)

29 (47%)

6 (10%)

14 (23%)

8 (13%)

9 (15%)

16 (26%)

8 (13%)

Third, Catholic ethicists were more likely than their non-Catholic counterparts to agree on which activities comprise organizational ethics work. Most Catholic ethicists agreed that they frequently encountered nearly half of the 14 assessed areas of organizational ethics, compared to just one domain experienced by non-Catholic ethicists. Still, these results show that the field of organizational ethics has much work ahead to further define its scope. One respondent even stated, “I believe that the ambiguity of the term ‘organizational ethics’ itself is the largest obstacle,” when speaking to the success of this work.

Fourth, regarding barriers to success, Catholic respondents did not cite adequacy of funding nearly as highly as non-Catholics, and few respondents of any affiliation said that availability of expertise was an obstacle. Yet, as mentioned earlier, most Catholic respondents described a lack of organizationwide understanding of organizational ethics as a barrier to success. They noted leadership’s lack of recognition of its need and importance as other common hurdles. We inter-

Figure 2: Domains of Organizational Ethics Activities

pret this to mean the resources and expertise for organizational ethics are available in the Catholic ministries that responded, but leaders are unaware of when or how they can be helpful. The barriers reported in non-Catholic health care are markedly similar.

ENHANCING ORGANIZATIONAL ETHICS

Given this data, we offer four insights for leaders in Catholic health care:

1. Ethicists and leaders in Catholic health care should work together to increase familiarity and comfort around recognizing and requesting help with organizational ethics issues. This could be as simple as education on how and when an ethicist or organizational ethics committee could help leaders. Most importantly, they need to embed organizational ethics questions, expertise and resources into the decision-making process. If this is standardized in the process, then a lack of awareness should not be a concern. Such changes could also help avoid raising organizational ethics issues or seeking expert advice too late in the process. For example, if a new marketing campaign is

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ready for release, it is likely too late to consider ethics or mission input or concerns.

2. Leaders should seek advice on ethical issues more frequently. Ethicists appear to see many organizational ethics issues that go unaddressed. This would likely explain why the top two reported barriers to success in organizational ethics are a lack of understanding of its role and the need for this expertise. Leaders should not hesitate to reach out early to their ethicist (or, in some cases, mission leader), even when unsure if or how an ethicist could help. As one respondent said, “The driven nature of health care moves teams well down a decision path before they realized they could have benefitted from pausing for a mission/organizational ethics discernment.”

3. We need more scholarly publications centered on the work of organizational ethics, including in Catholic health care. While we might expect some structural variation in organizational ethics activities due to a system’s unique needs, the substantial diversity we found may be due to a lack of awareness of possible structures and how others do this work. For example, there is limited literature

Figure 3: Reported Barriers to Success in Organizational Ethics Work at Catholic vs. Non-Catholic

on what an organizational ethics committee is and how it works differently than one focused on clinical ethics. The same is true for the organizational ethics work of a clinical ethics committee and an organizational ethicist. Even just a few published descriptions of these structures would go far toward strengthening the field.

4. Ethicists across Catholic health care should look to define the scope of organizational ethics work. Clarity on what is included and excluded from this field would help solidify it as a separate body of work worthy of dedicated resources and attention. This could include an article, a consensus statement of interested parties or explicitly addressing the importance of organizational ethics in the ERDs. Part of this work should include a definition of organizational ethics with broad agreement.

FURTHER GROWTH AHEAD

We acknowledge the limitations of this survey. Although this survey’s small number of respondents may limit its findings about the practice of organizational ethics in Catholic health care as a whole, it does appear that organizational ethics in the ministry is alive and well and that there is room for improvement. As we continue this research, we encourage Catholic health care ethicists, leaders and mission leaders to reflect on how they might use these results and insights in their ministry. This work can begin by reflecting on a few questions:

What is the structure for organizational ethics within my health system?

Do I know when and how to request help with an organizational ethics issue?

What can I do to help leaders understand how organizational ethics expertise can help them in their work?

How am I being called to help organizational ethics grow and flourish in the areas I influence?

Through a better understanding of organizational ethics practices and its scope, future discussions can help lead to more institutional support, resources and training so the ministry can further continue its healing mission.

BECKET GREMMELS is system vice president of theology and ethics at CommonSpirit Health. KELLY TURNER is a mission intern at SSM Health and a doctoral student in health care ethics at Saint Louis University. TIMOTHY LAHEY is an infectious disease physician and

director of medical ethics at The University of Vermont Medical Center. WILLIAM NELSON is a professor and director of the ethics and human values program at Geisel School of Medicine at Dartmouth College. JASON LESANDRINI is the assistant vice president of ethics, advance care planning and spiritual health at Wellstar Health System.

NOTES

1. Kelly Turner et al., “Organizational Ethics in Healthcare: A National Survey,” HEC Forum 36, no. 1 (January 17, 2024): https://doi.org/10.1007/s10730-023-09520-3. The Dartmouth College Institutional Review Board (Dartmouth Committee for the Protection of Human Subjects) approved this research protocol for exemption from further review under Category II.

2. We don’t have a total number of those working in organizational ethics in U.S. health care. Ethicists who were invited to take the survey included those at the American Society for Bioethics and the Humanities’ Organizational Ethics Affinity Group and the Clinical Ethics Consultation Affinity Group, the Medical College of Wisconsin bioethics listservs, as well as a list of ethicists working at Catholic institutions and Seventh-day Adventist institutions. Of the survey respondents who worked in Catholic health care, eight had mission in their title. Of those, three had a doctorate in bioethics, one completed an ethics fellowship, one had an ethics certificate from the National Catholic Bioethics Center and another had the health care ethics consultant certification from the HCEC Certification Commission. Four of these also had mission and ethics in their title. Of the two who did not have formal ethics training, both had gone through significant ethics education. Additionally, 19 of those who worked in Catholic health care said they worked in a system office; eight in a hospital; two in an academic medical center; and two at the regional level.

3. Steven Pearson, James Sabin, and Ezekiel Emanuel, No Margin, No Mission: Health Care Organizations and the Quest for Ethical Excellence (Oxford: Oxford University Press, 2003), 32.

4. Brian Smith, “Form Follows Function: The Evolution of Mission Integration in U.S. Catholic Health Care,” Health Progress 101, no. 2 (March/April 2020): 51-60.

5. Patrick McCruden and Mark Kuczewski, “Is Organizational Ethics the Remedy for Failure to Thrive? Toward an Understanding of Mission Leadership,” HEC Forum 18, no. 4 (December 2006): 342.

6. For example, see the general introduction and Directives 7, 9, 11 and 22: Ethical and Religious Directives for Catholic Health Care Services: Sixth Edition (Washington, DC: United States Conference of Catholic Bishops, 2018).

Why an Alliance Between Compliance and Leadership in Health Care Is Crucial

ANDREI M. COSTANTINO, MHA, CHC, CFE Vice President of Integrity & Compliance, Trinity Health

In a rapidly evolving health care landscape, almost all health care organizations reported an increased need for regulatory compliance in recent years. 1 To navigate these turbulent waters, a powerful alliance between health care compliance and leadership is not just a choice — it’s a necessity.

In modern health care systems, the need to emphasize patient safety, ethical practices and regulatory compliance has never been greater. To navigate the complex landscape of health care regulations and to ensure high-quality care, health care organizations must foster a strong partnership between their compliance teams and other leadership.

Based on my 17 years of experience working in the Integrity and Compliance department at Trinity Health, I offer my insight on the importance of this alliance and how it can effectively promote both regulatory compliance and strong operational performance within a health care system.

PARTNERSHIP IN ACTION

To demonstrate the importance of a partnership between compliance and leadership, I point to a recent whistleblower case in which Trinity Health resolved a Department of Justice (DOJ) investigation last year into the medical necessity of certain surgery procedures. The initial inquiry was three years ago, and we heard nothing for most of this period. Then, suddenly, the DOJ scheduled a meeting with our facility leadership to discuss their results. The DOJ shared that their experts had determined an 85% error rate for the charts they reviewed, and they presented Trinity Health with a settlement demand of nearly $10 million.

Trinity Health disagreed with the DOJ expert’s findings. The Integrity and Compliance team partnered with legal, clinical, information technology, finance and revenue departments to conduct further internal review. Through this collaboration, Integrity and Compliance demonstrated that all charts reviewed by the DOJ met necessary medical criteria and that the surgeries had prior payer approval and were correctly billed. We determined that we owed nothing and were paid correctly. We reported our results to the DOJ and a few months later, the whistleblower opted out of the claim. The judge closed the case, and even though the DOJ’s experts had originally noted an 85% error rate, they also walked away from the case.

This result would not have been possible without the collaboration of all the departments working together with Integrity and Compliance. The bottom line was that instead of owing $10 million, our system paid back nothing. This investigation demonstrates the value of an effective Integrity and Compliance program and the value collaboration with leaders of different departments can bring.

PROMOTING A CULTURE OF INTEGRITY

At Trinity Health, we thoughtfully named our work the Integrity and Compliance program, as

Elements of Trinity Health’s Integrity and Compliance Program

Code of Conduct

Leadership and Oversight

Education and Training

Policies and Procedures

Reporting Systems

Monitoring and Auditing

Integrity and Compliance Program

Response and Prevention

Enforcement and Discipline

Risk Assessment

the realm of ethics and responsible conduct, compliance and integrity are often discussed interchangeably. However, it is important to note that each word has a significant difference in meaning.

Compliance focuses on meeting regulatory requirements and refers to adhering to external laws and regulations and following internal policies. Complying with laws and regulations is the very minimum expected at Trinity Health. One of our core values is integrity: “We are faithful to who we say we are.” For us, compliance simply means, “Let’s go out and not break the law today,” or asking ourselves, “Can I do this?” Integrity means, “Let’s do the right thing today,” and forces us to ask ourselves, “Should I do this?” This should be an important distinction in health care today. Health care is arguably one of the most regulated industries, and the fact is that most of our compliance challenges are in gray areas with room for different interpretations.

A good example is in the early 2000s, when a health care services company unrelated to our system was in the news and paid the DOJ more

than $900 million to resolve false claim allegations.2 More than $788 million of the $900 million was to resolve claims arising from the company’s receipt of excessive “outlier” payments (payments intended for limited situations involving extraordinarily costly episodes of care). These claims resulted from the hospitals’ alleged substantial inflating of their charges for higher-priced services and supplies in excess of any cost increases associated with patient care and billing.

The same consultants who assisted the other organization approached Trinity Health to promote a service that could improve revenues by increasing outlier charges to the Medicare program. The consultants said that “everyone was doing this” and tried to convince Trinity representatives that they should not miss out on this additional revenue. The potential revenue increase was significant, and the question of “Can I do this?” came up. But, with Trinity Health’s emphasis on integrity, the real question became, “Should I do this?” At the end of the day, the system’s C-suite executives decided this was something

Source: Trinity Health

they should not do — it didn’t feel right. They took a step back, considered how this practice could be viewed by the public, media and regulators five years from now, and asked themselves, “Should we do this?”

The key is to promote a culture of integrity. The partnership between compliance and leadership encourages a culture of integrity and ethical behavior. This takes time and will not occur overnight. It takes trust. What is the first thing someone thinks of when they get a call from integrity and compliance? It’s that they are in trouble, like the police or the IRS showing up at their door. Changing this perception is important so that relationships can become more collaborative.

BUILDING TRUST, ESTABLISHING RELATIONSHIPS

Trinity Health’s Integrity and Compliance program addresses each element of an effective corporate compliance program (see graphic on page 34 for further details).

The program has four primary goals:

1. Promote ethical behavior and conduct standards by all who work in Trinity Health, including colleagues, volunteers, medical staff and suppliers.

2. Foster an organizational culture that promotes compliance with laws, regulations and professional standards.

3. Educate and train all Trinity Health employees concerning the system’s commitment to act with integrity and honesty, and follow all laws and regulations that apply to Trinity Health’s operations.

4. Establish systems to monitor Trinity Health’s operations continuously, and identify and correct any violations or deficiencies in a timely and appropriate manner.

To meet these goals and establish collaborative relationships, it’s important to be invited to certain meetings to listen and provide guidance. The goal is to provide value and support business strategies where possible so that departments automatically invite Integrity and Compliance colleagues to the table in the future. There are many departments in a health system corporate office: clinical, finance, legal, payor strategies, revenue and supply chain, to name a few.

More than 15 years ago at Trinity Health, the Integrity and Compliance program staff devel-

LEADING WITH INTEGRITY

oped an approach to work with revenue leaders on various projects. However, colleagues were not always invited to all meetings. Examples of this included when new service lines were established, billing changes were made for certain services or a consultant was brought in for a review. Over time, trust was built and senior leaders saw that Integrity and Compliance colleagues could provide valuable insight to help the decisionmaking process, providing proactive guidance to align with regulatory requirements. The results of this relationship created a standing meeting with revenue and the Integrity and Compliance team, where today a broad range of issues are discussed. By integrating compliance considerations into strategic planning, leaders can make informed decisions that prioritize both business objectives and regulatory compliance.

Building trust and showing how the Integrity and Compliance program adds value helps form a more solid alliance with leaders. For example, we have always worked closely with Colleague and Labor Relations staff. As a branch of our human resources department, they investigate human resources issues that come to us via our Compliance hotline. They know that we defer to their expertise and vice versa. The director of the Colleague and Labor Relations team admired our complaints processes and database so much that they asked us to help build a similar module for them. Now, our systems are maintained by the same staff, and, with our complex and evolving organizational structure, our hierarchies are managed together at a single point so reports can be aggregated, trends can be observed, etc. This valuable new organizational process resulted from the trust and collaboration established between both departments.

A LEGACY OF INTEGRITY

The evidence of our Integrity and Compliance program’s strong relationships with leadership is clear as we protect Trinity Health’s legacy and integrity:

We have had no Corporate Integrity Agreements (a document that outlines the obligations to which a health care entity agreed as part of a civil settlement) or mandated compliance requirements in Trinity Health’s 23-year history.

With our integrity focus, we have kept our reputation clean and stayed out of media headlines for corporate ethical lapses.

Our ministries recognize that we provide value-added, cost-effective integrity/compliance services, as illustrated by our program results and stellar internal services surveys.

Our Board of Directors expresses gratitude for our support in fulfilling their governance oversight responsibilities.

A strong partnership between health care compliance officers and leadership is essential in ensuring regulatory compliance and effective leadership within the health care sector. By prioritizing patient safety, promoting ethical conduct, mitigating legal risks, fostering strong leadership values and achieving operational excellence, health care organizations can build a foundation of trust and deliver high-quality care to their patients. Collaboration between compliance and leadership enables health care organizations to navigate the complex regulatory landscape successfully while ensuring compassionate and ethi-

QUESTIONS FOR DISCUSSION

cal health care services.

ANDREI M. COSTANTINO is vice president of Integrity & Compliance at Trinity Health. He has more than 30 years of executive experience specializing in multiple areas, including regulatory compliance issues, Medicare and Medicaid fraud defense work, compliance risk assessments, and compliance/reimbursement education and training.

NOTES

1. “Regulatory Overload: Assessing the Regulatory Burden on Health Systems, Hospitals and Post-acute Care Providers” American Hospital Association, October 2017, https://www.aha.org/sites/default/files/ regulatory-overload-report.pdf.

2. “Tenet Healthcare Corporation to Pay U.S. More than $900 Million to Resolve False Claims Act Allegations,” Department of Justice, June 29, 2006, https://www. justice.gov/archive/opa/pr/2006/June/06_civ_406.html.

Trinity Health’s Vice President of Integrity and Compliance, Andrei M. Costantino, details the system’s commitment to promote ethical behaviors and conduct standards for all who work in Trinity Health; foster an organizational culture of compliance with laws, regulations and professional standards; and educate and train employees regarding integrity in operations and in systems that identify any violations or deficiencies in a timely manner so they may be addressed.

1. How do you understand the relationship or differences between compliance and integrity in your workplace and your professional behavior? Is one more structural and the other more personal?

2. Are you aware of when to invite a compliance team member to the table to discuss concerns or issues that might arise related to regulations, laws and the operational aspects of health care?

3. What resources does your system have if compliance issues arise? Can questions quickly be addressed around the clock? Is there someone who can provide guidance to you as needed?

4. What connection do you see between your organization’s integrity and compliance efforts and the ministry’s mission and values? How is compliance an integral part of your Catholic identity?

Women, the Synod and Catholic Health Care: We Must Enlarge the Tent

SR. TERESA MAYA, PhD, CCVI Senior Director of Theology and Sponsorship, Catholic Health Association

In 2021, the Catholic Church began a three-year process called the Synod on Synodality to “provide an opportunity for the entire People of God to discern together how to move forward on the path toward being a more synodal Church in the long-term.”1 When this process was announced, I intentionally kept my expectations at bay. Could synodality change anything? Why pay attention? The Catholic Church faces many challenges, as do the ministries in our Church, including health care. What could this synod process possibly offer?

But a morning in the Pastoral Center of the Archdiocese of San Antonio changed everything. I was curious enough about the synod to register for my diocese’s listening sessions, where I participated at a table with several women who worked in a local parish. Their passion shamed me, as did their hope for this process: “Maybe this time, Sister, the Church will understand how much they need women.”

I walked away from that gathering, aware that my hope for a church that welcomed the gifts of women was thawing. I feared the vulnerability, wondering if I could take another letdown.

SPEAKING TRUTH TO POWER

As the global church carried out a massive consultation process and every diocese around the world was called to take part in national and continental phases, the conversations kindled my hope further. The U.S. Conference of Catholic Bishops report in October 2022 stated that nearly all synodal consultations recognized “women’s unparalleled contributions to the life of the Church, particularly in local communities. There was a desire for stronger leadership, discernment, and decision-making roles for women … .”2 The conversation with the women at my table had been replicated in nearly every diocese of the United States.

When the synod’s “Working Document for the Continental Stage (DCS)” challenged Catholics everywhere to “enlarge the space of your tent,” I was hooked.3 I read the paragraphs on “Rethinking Women’s Participation” several times because they were so different in tone and content to other church documents: “From all continents comes an appeal for Catholic women to be valued first and foremost as baptized and equal members of the People of God. There is an almost unanimous affirmation that women love the Church deeply, but many feel sadness because their lives are often not well understood, and their contributions and charisms not always valued.”4

I soon learned I was not alone in my sentiments, both of surprise and increasing hope. Theologian Susan Bigelow Reynolds wrote in Commonweal, “I found myself heartened by the DCS, both for the universality of its call to rethink women’s participation in the Church and for the multiplicity of voices and perspectives represented therein.”5 Indeed, she states that the document “suggests a sense among the faithful that the status quo not only represents a problem for women but, fundamentally, for the mission of the Church.” The Spirit was speaking through the global consultation. This time, the women we sit next to in the pew, the women who serve in

ministries and the women who have stayed were speaking truth to power, just when so many moved away and others spoke in carefully crafted statements that wouldn’t spark yet another investigation.6

Expectations were high when the October 2023 synod participants were announced. The Vatican had confirmed women participants with voting rights for the first time in our Church’s history, and that is a lot of history. Again, the synthesis report contained a different kind of language: “Churches all over the world have expressed a clear request that the active contribution of women would be recognized and valued, and that their pastoral leadership increase in all areas of the Church’s life and mission. In order to give better expression to the gifts and charisms of all and to be more responsive to pastoral needs, how can the Church include more women in existing roles and minis-

tries? If new ministries are required, who should discern these, at what levels and in what ways?”7 Participants at the October synod from different parts of the world have all mentioned how critical women’s participation in the Church was to all present in Rome.

The synod is for everyone. All of us create communion by participating and going forth on mission. So, how do Catholic health care ministries contribute to this process? As a ministry of the Church, we need to find ways to promote synodality. Discernment and formation need to model the synodal process, as Darren Henson, CHA’s senior director of ministry formation, recently wrote in the winter issue of Health Progress. 8

But synod is calling us to do more: Catholic ministries must assume their synodal responsibility in welcoming the gifts and diversity of women. The team that gathered the synod reports from all

The superior of Sacred Heart Hospital, Sr. Praxedes (born Desanges Lamothe), is pictured in Medford, Oregon, around 1913. The Sisters of Providence began the hospital in 1911, where today Providence Medford Medical Center cares for patients.

Photo courtesy of Providence Archives, Seattle

over the world invited us to “focus on what the Lord is calling us to through the experience of lived synodality: ‘Enlarge the space for your tent, spread out your tent cloths unsparingly; lengthen your ropes and make firm your pegs.’” (Isaiah 54:2) The words of Isaiah “invite us to imagine the Church similarly as a tent, indeed as the tent of meeting, which accompanied the people on their journey through the desert: called to stretch out, therefore, but also to move.”9 Enlarging the tent on women’s leadership will offer a unique gift to our Church and women everywhere because it is rooted in our identity and the power of a culture centered on human flourishing, the power of “how” we care. Here are some first steps: embrace our heritage of women’s leadership, step up to continue our legacy, remain grounded in scripture along the way and recognize the time is now

to enlarge the tent.

EMBRACING WOMEN’S HERITAGE IN CATHOLIC HEALTH CARE

To further recognize the value of women’s leadership, we need to begin with who we are. A prophetic way for our ministry to engage with synodality is to return to our history with new questions. What does the heritage of women’s leadership in Catholic health care offer our Church today? How has women’s leadership in every area of our ministry created spaces where all gifts are welcomed and encouraged?

We have heard our origin stories — the sisters who braved the frontier to open and build hospitals — but have we paused enough to truly recognize how unusual that was at the turn of the 20th century, when women couldn’t even vote? And

Sisters and nurses are among those hard at work in this operating room of Mercy Hospital in Hamilton, Ohio, in 1903.

Photo courtesy of Sisters of Mercy of the Americas, Mercy Archives, Belmont, North Carolina

It Is Time to Enlarge the Tent

JILL FISK, MATM

Called to bring Jesus’ healing within communities, the Catholic health ministry exists to be a visible sign of an invisible reality to patients and families. As the largest group of nonprofit health care providers in the United States and serving as a ministry of the Church, we need to recognize the impact our ministry can have by welcoming the gifts of all, especially women. We can model for our Church how to welcome the gifts of all. In the same way our care and compassion root our identity as a ministry, we must consider how we might enlarge the space of our tent through practices and policies that support women’s leadership. What is our obligation to lead the moral formation and flourishing of communities in service to the Church?

What might it look like for Catholic health care to truly embody this visible commitment to equitable workforce practices for women? How might our diversity, equity, inclusion and belonging (DEIB) practices set the standard in forprofit health care entities and other church ministries in promotion, succession planning and microaggression education? Like the sisters before us, we must keep the call to embody a healing ministry at the forefront at executive tables and lead the way to demonstrate belonging that models our highest view of human dignity. But perhaps, more importantly, what do we risk if we fail to maintain our commitment?

Honoring the synod call requires paying special attention to the signs of the times. We are challenged to listen to everyone, especially those persons “who may risk being excluded: women, the people with disabilities, refugees, migrants, the elderly, people who live in poverty, Catholics who rarely or never practice their faith, etc.”1 And engagement with new generations remind us that we must invite new conversations to the table to respond to our changing communities. What is ours

to do as Catholic health care?

First, we must notice the women around us. We need to see all women and recognize their potential, gifts and insight.

Be intentional and strategic. Support a pathway that intentionally promotes women’s leadership.2 This work is ongoing, not “a one and done.” Even in Catholic health care, with a rich tradition of female leadership, the numbers of women chief executives are low. Support for women in these roles isn’t about “checking boxes”; it’s about recognizing the full and varied experiences women bring to leadership.

Steward the generational transition well. To empower women’s leadership across our ministry, quality succession planning through competency development, recruitment and career goals will enable us to move faithfully forward.3

Create mentorship and support groups for the long haul. Sisterhood moves societal change forward.

Organize the ministry to support women. This includes offering supportive services, such as paid

maternity leave, child care, elder care,4 career development, affinity groups, flexible work options, etc.

The synod moves us on the journey to the reign of God, and there is always more we can do. May we all continue to bear the fruits of the synod through gender inclusivity in Catholic health care so that we may truly “enlarge the space of our tent.”

JILL FISK is director, mission services, for the Catholic Health Association, St. Louis.

NOTES

1. “What Is Synodality?”, Synod 2021/2024, https://www.synod.va/en/ what-is-the-synod-21-24/about.html.

2. See pages 36-45: “Living Synodal Leadership: Responding to the Call of the Holy Spirit,” Leadership Roundtable, 2022, https://issuu.com/leadershiproundtable/ docs/summitreport2022-final-forweb.

3. “Faithfully Forward–Succession Planning,” Catholic Health Association, https://www.chausa.org/mission/ faithfully-forward.

4. Debra Kelsey-Davis, “Double-Duty Caregiving: Clinicians Caring for Others at Work and Home Need Support,” Health Progress 104, no. 4 (Fall 2023): 13-17.

beyond the founding years, do we recognize the ongoing contributions of women leaders?

The systems we serve are the result of entrepreneurial women who led with a keen awareness of the signs of their times and built Catholic health care in America.10 Barbra Wall, who has written about this story, notes that “The public face of Catholic authority has always been decidedly male; it is indeed ironic, then, that the overwhelming majority of Catholic hospitals in the United States were established and originally managed by women.”11 How often do we pause to consider the improbability of our ministries to prosper in that environment?

We need to cherish the photographs. In every decade of our ministries’ histories, women are prominent. The pictures tell an incredible story unique to North America: women helping in hospital wards, deliberating around a boardroom table and working in other roles. This happened when most other ministries and industries barred or could not even imagine women in leadership. Yet, in our histories, we see women in the C-suite, governance and general administration. Our photographs contrast sharply with those that documentarian Immy Humes published in a collection of images from 1862 to 2020 titled The Only Woman. Her questions could be ours: “Why was she there? Did the men see her as an ‘infiltrator’…? More important, how did she feel being there?”12

Sisters are women, too. We need to frame our

We have heard our origin stories — the sisters who braved the frontier to open and build hospitals — but have we paused enough to truly recognize how unusual that was at the turn of the 20th century, when women couldn’t even vote?

history in its context. Sure, the leadership in the early days was mostly composed of sisters; some of us would argue they were able to do it only because they were sisters. And what we learn from this sisterhood will be key to the future, encouraging support networks for women. Still, we need to remember that this was a time when even a sister could not attend The Catholic University of America, when male clergy ruled over Catholic life. Sisters built health care systems long before the changes called for by the Second Vati-

GROUNDED IN SCRIPTURE: WOMEN’S LEADERSHIP

ABullet

s we grow into the synod model of communion, participation and co-responsibility, we must also reflect upon women’s inclusivity in the call of sacred Scripture. In the Hebrew text, we discover Deborah as the only woman among Israel’s leaders who ruled and also served as a prophet (Judges 4:4-5). Paul’s writings highlight Phoebe as a sister in ministry, deacon and primary benefactor to his missionary ministry (Romans 16:1-2). So, too, the Gospel writers witness to the women surrounding Jesus’ ministry: Mary, Martha and Mary Magdalene. These scriptural models of inclusion for women must inform how we are to continue the Church’s ministry for women to flourish, both in the ongoing work of the synod and our response in Catholic health care.

Women at the time of Jesus were not considered full persons and were instead viewed as the property of men and could not study the Torah or participate in public life. We should be inspired every time Jesus refuses to treat women as inferior and speaks and interacts with them in public. Just as Jesus valued and cared for women in the Bible, our ministries need to be places where women are treated with dignity. Our ministries need to be places where women are heard, healed and safe because this is who we are as a Catholic ministry: the healing ministry of Christ. When rooted in Scripture, the gaps in our welcoming become visible. What is ours to do in a time when we are called to promote human flourishing?

—Jill Fisk and Sr. Teresa Maya

can Council, when it began moving the Church away from a clericalized culture where women had no authority. What can we still learn from this history? How will we ensure that this heritage of women’s leadership is truly one of Catholic health care?

STEPPING UP TO CONTINUE OUR LEGACY

The synod is teaching us the value of participation, communion and cherishing diverse collaboration as a gift from God. Fewer sisters will remain at our tables, but they long for the women of our ministry to step confidently into their voices and gifts. Together, they will always leave their foot at the door so other women can enter. They will always challenge us to do more and better because they know women have leadership, authority and gifts.

The sisters have done their part; now, our ministries need to step up and do better. We need to

continue modeling for church and society what welcoming the gifts of women can do for human flourishing.

SR. TERESA MAYA is senior director, theology and sponsorship, for the Catholic Health Association, St. Louis.

NOTES

1. “What Is Synodality?”, Synod 2021/2024, https:// www.synod.va/en/the-synod-on-synodality/what-isthe-synod-about.html.

2. “National Synthesis of the People of God in the United States of America for the Diocesan Phase of the 20212023 Synod,” USCCB, 2022, https://www.usccb.org/ resources/US%20National%20Synthesis%2020212023%20Synod.pdf.

3. “Working Document for the Continental Stage,” General Secretariat of the Synod, October 2022, https://www.usccb.org/resources/Documento-

Longtime leaders in Catholic health care Sr. Doris Gottemoeller, RSM, CHA’s President and CEO Sr. Mary Haddad, RSM, and George Avila, then a CHRISTUS Health vice president, confer at the 2019 Catholic Health Assembly in Dallas.

Photo by Jerry Naunheim Jr./© CHA

Tappa-Continentale-EN.pdf.

4. “Working Document for the Continental Stage.”

5. Susan Bigelow Reynolds, “Are We Protagonists Yet?”, Commonweal, December 9, 2022, https://www.commonwealmagazine.org/ women-church-synod-francis-catholic.

6. Annmarie Sanders, However Long the Night — Making Meaning in a Time of Crisis: A Spiritual Journey of the Leadership Conference of Women Religious (Scotts Valley, California: CreateSpace, 2018); Laurie Goodstein, “Vatican Ends Battle With U.S. Catholic Nuns’ Group,” The New York Times, April 16, 2016, https://www. nytimes.com/2015/04/17/us/catholic-church-endstakeover-of-leadership-conference-of-womenreligious.html.

7. “XVI Ordinary General Assembly of the Synod of Bishops First Session (October 4-29, 2023): Synthesis Report,” XVI General Ordinary Assembly of the Synod of Bishops, https://www.synod.va/content/dam/synod/ assembly/synthesis/english/2023.10.28-ENGSynthesis-Report.pdf.

8. Darren Henson, “How the Synod on Synodality Serves as Model for Ministry Formation,” Health Progress 105, no. 1 (Winter 2024): 47-50.

9. “Working Document for the Continental Stage.”

10. Suzy Farren, A Call to Care: The Women Who Built Catholic Healthcare in America (St. Louis: Catholic

AUTHORS’ NOTE

The authors wanted readers to know they were inspired to write this article because women are half of the Church. As they wrote, they held in their hearts women who love the Church and serve their parishes; women who are care providers and need support networks to know they are not alone. They write for those who serve in the Catholic health care ministry and the accounts of joy and adversity they have been humbled to hear. And they write for children, the future of the Church.

Health Association, 1996).

11. Barbra Mann Wall, Unlikely Entrepreneurs: Catholic Sisters and the Hospital Marketplace, 1865-1925 (Columbus, Ohio: Ohio State University Press, 2005). And Wall’s other book: American Catholic Hospitals: A Century of Changing Markets and Missions (New Brunswick, New Jersey: Rutgers University Press, 2011), 59.

12. Immy Humes, The Only Woman (New York: Phaidon Press, 2022); Lauren Christensen, “‘The Only Woman’” in the Room,” The New York Times, July 29, 2022, https://www.nytimes.com/2022/07/29/books/review/ the-only-woman-immy-humes.html.

God’s Eye on the Sparrow

For just this moment, bring your attention to your breath.

INHALE deeply and settle yourself into your body.

EXHALE the stress and tension you feel.

On your next inhale pray, God’s Eye On The Sparrow

And as you exhale, God’s Eye On Me

God’s Eye On The Sparrow

God’s Eye On Me

KEEP BREATHING this prayer for a few moments.

(Repeat the prayer several times)

CONCLUDE, REMEMBERING:

Even now, God is with you, as near to you as your breath.

Continue giving yourself the gift to pause, breathe and heal, knowing you are not alone.

“Therefore I tell you, do not worry about your life, what you will eat or drink; or about your body, what you will wear. Is not life more than food, and the body more than clothes? Look at the birds of the air; they do not sow or reap or store away in barns, and yet your heavenly Father feeds them. Are you not much more valuable than they?” MATTHEW 6:25-26 PAUSE.

The Eucharist, Imagined and Real

FR. JOSEPH J. DRISCOLL, DMin Director of Ministry Formation and Organizational Spirituality, Redeemer Health

There is an often-told story about a little boy who wakes up in the middle of the night from flashing lightning and booming thunder, terrified and crying out for his dad. His dad comes in and reassures him, “God is always here to take care of you.” Clinging on to his father, the boy blurts out, “But Dad, I need a God with skin on.”

If nothing else, Roman Catholicism is a religion with skin on. It is both a religion and its rituals that cover the body of persons, places and things where God through Christ and his Church is in, of and with flesh. A God whose real presence, with “skin on,” is truly incarnational.

It is a religion and ritual manifested in smells and bells, colors and fabrics, even saints and stories with gory and glory that one holds on and clings to in good times and bad. It is a religion that lives beyond black-and-white doctrinal words on paper through colorful, relatable stories in action.

The late Andrew Greeley, the American priest and sociologist, calls this word-made-flesh drama the “Catholic imagination,” a sensibility felt and experienced in the “raw power” of stories originating in our faith.1

Greeley contrasts a cognitive understanding of the incarnation, resurrection and real presence of Christ in the sacraments with the underlying stories that have the power to attract persons to a faith through images in living color: a Madonna and child in a cave; joyous women and stunned men approaching an empty tomb and unknown strangers; and the tense drama of intimacy, suspense and even betrayal at the Last Supper.2

This grasp and hold through story and sensibility is imagined and extended in the Church’s sacramental life. It is amplified through persons, places and things made and emphasized as holy

by the expression “the real presence” of Christ in his church and the sacraments.

As described by the Council Fathers at the Second Vatican Council, “the liturgy of the sacraments and sacramentals sanctifies almost every event in their [believers’] lives; they are given access to the stream of divine grace which flows from the Paschal mystery of the passion, death, the resurrection of Christ, the font from which all sacraments and sacramentals draw their power. There is hardly any proper use of material things which cannot thus be directed toward the sanctification of men [and women] and the praise of God.”3

In Catholic health care, the sacraments, especially the Eucharist, are core to spiritual care. The Eucharist is not simply a regular routine, or an “administration” of a sacrament, but much more, both imagined and real.

Our Catholic sensibility imagines the body of Christ as real, present and accessible in persons (prayer, community, communion of saints), places (chapel and tabernacle) and things (the bread and wine). Our sensibility imagines a deeper story playing out daily in the ways the Eucharist is realized and experienced in and around our patients, residents and clients.

Even the physical structures of our facilities point to this sacramental sensibility: the crosses, chapels, prayers, music, statues, vestments,

flowers and, most importantly, the bread, wine, water and oil. All of these are “skin” experienced in Divine realities that can be seen, touched, smelled, heard and tasted.

The Eucharist is the daily bread Jesus teaches us to pray for (Matthew 6:9-13). We imagine and experience the real presence of the earthly body of Christ, his church as the living body of Christ, the tabernacle and chapel as the dwelling place of the body of Christ, the sacramental bread and wine as the body and blood of Christ, and the vision of a transformed, heavenly body in the risen Christ.

The Eucharist is not simply a consecrated host distributed. The Eucharist is Christ at the Last Supper. The Eucharist is Christ in communion with the disciples at the Last Supper. The Eucharist is in the upper room where Christ and his disciples ate the Last Supper. The Eucharist is Christ in the bread lifted, taken, blessed, broken and given as his body and blood at the Last Supper. The Eucharist is the risen body promised and “proclaimed until he comes in glory.” This is the story.

tions also bring their prayer practices and rituals to our facilities. So, too, gathered in communal prayer, individuals are in communion with their God, alone and together.

In our Catholic imagination, the proclamation of faith is the real presence of the body of the person of Christ in prayer.

THE HOST IN COMMUNITY

The community of caregivers, imagined and real, is primarily through touching with care. Those with injury await his healing touch.

Christ is real, present and accessible to individuals and the caring community. We open the doors, wait and reach out. Nearly everyone entering our facilities is a stranger or alien isolated from the familiar by illness. Like the child in the

In our Catholic imagination, the proclamation of faith is in the caregiver’s presence as the body of Christ touching those who are sick and suffering.

Through an expanded and imagined sacramental sensibility, we bring color, shape and design to this originating story by a Eucharistic presence in our institutions that is revealed through Jesus as the Host Himself, the community as Host, the Host in the tabernacle, the Host in our hands and a vision of the Heavenly Host.

THE HOST

Christ is the Host himself, imagined and real, primarily through listening in prayer. With ears attentive, people listen to him.

Christ is real, present and accessible in personal and communal prayer. This is the conversation each of us enjoys in the inner sanctuary of one’s heart and soul. The Catholic imagination is in our individual practices and rituals, how we pray, to whom we pray and with what we pray.

Communally, the word is Christ speaking. The Scriptures are raised high; we stand, sing, listen to the proclamation and respond, individually and as a community.

Our Catholic sensibility is not limited to our Catholic tradition, as those of other faith tradi-

night storm, fear, anxiety and the unknown need a God with “skin on.”

With body, mind and soul injured, the person is touched by the caregiver, the body of Christ reaching out with healing hands.

The beautiful words of St. Teresa of Ávila could be the description of those who minister in our facilities:

“Christ has no body now but yours.

No hands, no feet on earth but yours. Yours are the eyes through which he looks compassion on this world. Yours are the feet with which he walks to do good. Yours are the hands through which he blesses all the world. Yours are the hands, yours are the feet, yours are the eyes, you are his body. Christ has no body now on earth but yours.”4

Touch can be, and most often is, as deeply spiritual as physical. In all of the encounters a resident, patient or client has with the body of Christ in our caregivers, the touch itself provides healing through contact with a warmth of body and soul.

Some receive sacramentally a physical and spiritual touch through the “laying on of hands,” the rubbing of oil on the forehead and hands, or the Anointing of the Sick, particular to the situation. For example, these sacraments may be received before surgery, in terminal illness or due to advanced age.5

Our Catholic sensibility is not limited to our tradition. All caregivers who reach out with care and compassion — no matter their religious or spiritual tradition — are included as part of the body of Christ in Catholic health care facilities. Their compassion and care are that of the church they represent.

In our Catholic imagination, the proclamation of faith is in the caregiver’s presence as the body of Christ touching those who are sick and suffering.

THE HOST IN THE TABERNACLE

The tabernacle, imagined and real, is experienced primarily by seeing with eyes of faith beyond that sacred place that reserves the hosts. It holds the power to see beyond its doors into sacred dwelling places.

Christ is real, present and accessible in holy places. The chapel doors open to a sacred space in our facilities where up front and center — by design and intent — the tabernacle sits. Eyes behold a candle’s flickering light signifying the presence of the body of Christ inside the innermost doors of this sacred space.

Like the Ark of the Covenant of the Hebrew Scriptures, the presence of God dwells in proximity to the believing community who reverence this holy reserve of the body and blood of Christ (2 Samuel:6, Psalm 132). Sometimes, the host is adorned in a gold monstrance for believers to focus on Christ in their praise, prayers and intercessions.

Having the body of Christ in a sacred place allows for quiet reflection and prayer away from the noise and nuisance of everyday busyness and business. This sacred space is private and public, individual and communal, sometimes one or the other or both.

Our Catholic sensibility of sacred space is not limited to our tradition. People of all faiths and spiritualities are welcome to come and rest awhile. Sometimes there are books with pens for writing prayer requests. Sometimes the seasons of the year — Advent, Christmas, Lent and Easter

— display the colors and moods of expectation, joy, suffering, repentance and sorrow. Stations of the Cross, statues and votive candles all create a sense of laying down one’s burdens and looking up to see the unseen with yearning or satisfaction. The flickering light serves as a reminder that Christ is in this sacred place.

A Presbyterian minister who was director of pastoral care at a large Catholic hospital found the chapel and tabernacle a special place for him to pray. “Whenever I pray before the sacrament, I feel hot tears in my eyes, very different than my normal tears,” he explained. “Christ’s presence is very different in that space.”

In our Catholic imagination, the proclamation of faith is looking up and seeing the sacred dwelling of the real presence of the body of Christ in the tabernacle.

THE HOST IN OUR HANDS

The body and blood of Christ, imagined and real, is primarily experienced in tasting the bread and wine through the sacramental action of eating and drinking.

Christ is real, present and accessible in the mystery of receiving his body and blood in the re-enactment of the Last Supper, a ritual of communion given as an immemorial gift to “do this in memory of me.” Central to Eucharistic teaching is that Christ is present sacramentally, not merely in symbol or sign. It is a presence different from Jesus’ earthly presence and different from Christ’s resurrected presence. However, this “real presence” in sacrament is no less a meeting, an encounter with Christ in his body.

The Church extends that sense of “real presence” to the other six sacraments, grouped as initiation, healing and life commitment. Here, the Catholic imagination engages and embodies the sights, sounds, touches, smells and tastes of God in Christ and his Church sacramentally. The sensibility experienced in the use of water, bread, wine, oil, white garments, lighted candles, the sign of the Cross, words of forgiveness and symbols represent a life commitment.

Our Catholic sensibility of sacraments is not limited to those in the Catholic tradition. Our facilities invite, even seek out, other ministers, rabbis and imams to perform and facilitate the rites and rituals for our patients, residents and clients of other faith traditions to provide them an encounter with the Divine.

Finally, the participation of those who are not Catholic in worship is powerfully symbolized by an invitation to come up to the altar with arms folded to receive a blessing from the one God over all of God’s people. Although we may be different in communion, we are all still one before the Creator God.

In our Catholic imagination, the proclamation of faith is realized in tasting and seeing the goodness of the Lord in the consecrated body of Christ in the bread and cup (Psalms 34:9).

THE HEAVENLY HOST

The body of Christ, imagined and real, rising up to the heavens in “the communion of saints” is experienced through the power of smelling. “Let my prayer be incense before you; my uplifted hands an evening offering.” (Psalms 141:2)

Christ is real, present and accessible to those who have gone before us in faith. From the earliest creed comes the profession of a belief in “the communion of saints.” 6 As referenced earlier, the Eucharist is understood and professed in a faith rooted in the Paschal mystery embodied in Christ’s passion, death and resurrection. This immemorial celebration given by Jesus in earthly history is promised and fulfilled in Christ in a heavenly eternity.

In the Catholic imagination, it is during the funeral rites — and especially in the final prayers of committal — that the body is surrounded with incense, symbolizing the Church’s prayers rising up as the presider motions upward with the incense and the community sings and prays the soul to heaven.

The funeral is normally celebrated at the Eucharist, where the mystery of our faith is proclaimed in his death, resurrection and coming again. The body of a risen Christ into which the deceased once baptized into his death is now promised a share in his resurrection.

Our Catholic sensibility is not limited to our tradition. People die in our facilities and families mourn. In this understanding of a heavenly host, the body of Christ awaiting this final transformation is a sign of hope that we live and share.

In our Catholic imagination, the proclamation of faith is realized in how we revere the human body at the time of death with our vision of the body of Christ assumed in a heavenly host awaiting us — and our loved ones — in faith.

CONCLUSION

The Eucharistic minister holds up the host, or hands over the cup, and says, “The body of Christ, the blood of Christ.” The recipient then responds in an act of faith and says, “Amen.”

In our facilities, our Catholic imagination understands and offers a richer and fuller sensibility of the real presence of Christ in his body. Although offered to an individual as a sacramental host, it is so much more. The body of Christ is the host; Christ himself encountered in prayer; the body of Christ in the hosting community of caregivers; the body of Christ in the host reserved in the tabernacle; the body of Christ in the host in our hands; and the body of Christ transformed in the heavenly host of those gone before us.

And as a Catholic health care ministry, enabling our residents, patients and clients to experience a God with “skin on,” to each of these and all, we respond as a ministry with an act of faith, “Amen.”

FR. JOSEPH J. DRISCOLL is director of ministry formation and organizational spirituality for Redeemer Health in Meadowbrook, Pennsylvania.

NOTES

1. Andrew Greeley, The Catholic Imagination (Berkeley: University of California Press, 2000), 1.

2. Greeley, The Catholic Imagination

3. Second Vatican Council, Sacrosanctum Concilium, 1963, 61.

4. “Teresa of Ávila Quotes,” Goodreads, https://www.goodreads.com/author/quotes/74226. Teresa_of_vila.

5. International Commission on English in the Liturgy, Pastoral Care of the Sick: Rites of Anointing and Viaticum (New York: Catholic Book Publishing, 1983), 146-49.

6. “Apostles’ Creed,” United States Conference of Catholic Bishops, https://www.usccb.org/prayers/ apostles-creed.

INTEGRITY IS NOURISHED BY LITURGY

Notre Dame Cathedral in Paris readies for its grand reopening on the Feast of the Immaculate Conception in December. Following the devastating fire in 2019 that engulfed its nave, French President Emmanuel Macron pledged to reopen it within a few years. No doubt the ritual will unfold with great fanfare and throngs of believers and onlookers alike.

DARREN M. HENSON

Another magnificent church drew gobs of people last year for the completion of the penultimate soaring tower more than a century in the making: the Sagrada Familia basilica in Barcelona, Spain. Just what is it about these masterpieces that so evoke not just awe and wonder, but a deep stirring of the soul?

Their sheer massiveness, for one, brings this feeling of amazement. When onlookers take in the size, they find themselves mesmerized by the symphonic cohesion throughout the design: a mix of stone, glass, woodwork and materials that exudes harmony. The artistic beauty stands as an icon against society’s confusion, complexity and chaos. For centuries, the cathedral model has drawn seekers desiring fulfillment, not only in the world around them but also in their interior life.1

something larger than itself, namely God. Mass begins by naming and honestly recognizing our breaches of integrity, or acknowledging our sins, which is unflinchingly met by God’s mercy, forgiveness and undivided love. Liturgy remembers and celebrates God’s saving and healing love in word and sacrament, and it points the gathered assembly toward the full restoration of all creation in eternity.

The Church’s documents governing architecture and worship state, “The sacred liturgy is a window to eternity and a glimpse of what God calls us to be.”2 God desires for us to be our fullest selves, undivided from the imago Dei dwelling in

When worshippers gather for liturgy, we are reminded that humanity is contingent upon something larger than itself, namely God.

Integrity signifies an unimpaired condition. For example, in mathematics integers are numbers without fractions or decimals. In other words, things that are complete and undivided possess integrity.

Liturgy, similar in its word origin to physiological ligaments and instrumental ligatures, binds those gathered to God. In one classical definition of God, it is said that God is the undivided and unconditioned ground of all being and creation. When worshippers gather for liturgy, we are reminded that humanity is contingent upon

all human life. Thus, it is no wonder that metaphorical images of integrity saturate the liturgy. Liturgical norms state, “Sculpture, furnishings, art-glass, vesture, paintings, bells, organs, and other musical instruments as well as windows, doors, and every visible and tactile detail of architecture possess the potential to express the wholeness, harmony, and radiance of profound beauty.”3 This gives context for why materials and items used in worship must be of sound quality and reflect natural integrity. Through examination of how some of these sacred examples hold integrity, we can better emphasize and understand their meaning for our own integrity.

INTEGRITY OF SYMBOLS

There was much abuzz about the return of the bees when a fresh translation of the liturgical texts came to English-speaking communities in 2011. 4 Liturgical law requires the Paschal candle (also referred to as the Christ candle) to be made from 100% beeswax. Other altar candles must be comprised of at least 51% beeswax. The poetic prayer text of the Easter Exsultet, chanted at the vigil in a dark church and illuminated only by the Paschal candle and individual tapers lighted therefrom, praises the bees for creating the candle’s wax and offering its use. The candle’s burning flame reflects the light and life of the Risen Lord. The radical reality of the resurrection must be matched by pure wax gifted from creation itself.

Another significant symbol of Christ Jesus in the liturgy that demands natural materials is the altar. Once a bishop dedicates one, it is Christ.5 A Eucharistic liturgy begins with the priest presider greeting this symbol of Christ by kissing the altar. The mensa, or tabletop, is made of natural stone since it represents Christ Jesus, the Living Stone

(1 Peter 2:4). Upon the stone or rock of Christ, the people bring forth simple gifts of bread and wine. The bread must be unleavened wheat bread with no sweeteners or additives, and the wine must be unspoiled “fruit of the vine,” or grape wine, and not of other fruits. Here, too, the visible elements of liturgy reflect integrity or wholeness.

Music plays a preeminent role in liturgical prayer. Church documents presume the use of an organ or piano at worship — along with a cantor or choir — to serve and enable the gathered faithful to offer their own voices in prayer and praise. Music is primordial, and it served as a precursor to human speech. Liturgical documents stress the importance of live music. Recorded music can facilitate rehearsals, yet it should never replace the congregation, choir, organ or piano, and other instrumentalists at the liturgy.6 There is an integrity to live music. Not only does it eschew the commodification and consumption of recorded music, but it also brings disparate voices into a harmonious whole.7 The meter of music syncs voices and words together the way a parade aligns the steps

Breathtaking aspects of the Antoni Gaudí-designed La Sagrada Familia in Barcelona, Spain, signal to worshippers that they are in a sacred space.

Photo by Rajek/Shutterstock

of a marching band.

Like music, church documents call for authenticity in the flowers and decorations used at Mass. Living flowers and other plants, as opposed to silks or plastics, stand as reminders of the gift of life God has given to the human community.8 Even as flowers wither and plants shed brittle leaves, they remind us of the Paschal mystery: the rhythm of birth, life, death and new life revealed in Jesus’ life.

Even the vestments that liturgical ministers wear should be made of traditional or natural materials. The vision is that items used in liturgy possess a nobility and dignity that enables sacredness to shine through more clearly, particularly in our synthetically saturated — if not artificial — world.

More than a decade ago, when the iPad hit the sales floor, a savvy priest created an app for the Roman Missal (the liturgical book used by a priest presiding at Mass), causing a hubbub in liturgy circles and among some Catholic faithful.9 The discussions stemmed from a Catholic sensibility that liturgy draws upon nature where God is revealed. Electronic devices are far removed from their natural components and further obscure hints of the divine imprint upon them.

There are plenty of examples of those so fixated on liturgical details that they lose all sight of the deeper intended meaning evoked by the symbol. While avoiding liturgical fussiness on the one hand, a more genuine perspective is to view these examples as deep commitments to authenticity. When we steep ourselves in things that are authentic and discover the meaning, beauty and inspiration they illicit from us, we may be more likely to imitate them.

INDIVIDUAL INTEGRITY

and claiming our whole selves as body, mind and spirit, it also positions us within the cosmos, as it should. If integrity refers to a wholeness, then we must see our whole selves within it.

Corporate programs and dazzling conventions would make us think that integrity is something we can produce on our own with the right set of drills, like a fitness routine. Yet, claiming and growing into our own fullness and authenticity as God’s own daughters and sons may have less to do with what we do but rather attentiveness to what God is doing to us and desires to do through us.

It is a mistake to think that God needs our praise — God certainly does not need our worship. After all, God, as the source of all life and creation, does not need anything. Instead, it is we who need the actions and rhythms of liturgy. We grow and strengthen our integrity when we place ourselves before the One who made us, sees our inmost depths and gently forms us evermore into the image and likeness of God. Theologian James Alison aptly reflected that, at the Eucharistic liturgy, our primary role is to give thanks, relax and allow God to do with us as God wills.10

Through the liturgy’s rituals, we encounter the living God to whom we belong. As we look around the assembly, we see the community in which we live and the lives of others who depend upon us and our dependence upon them.

Articles on business leadership and organizational culture offer steady advice on integrity and authenticity. People pay good money for courses and conferences on this topic. And yet, for centuries, liturgy has offered a noncommodified means of growing in authenticity and fostering our integrity.

The liturgy offers an alternate view of the world, as well as our relationships to one another, to God and to ourselves. In addition to seeing

At liturgy, we finally pull down the shades over electronic screens and silence our devices, and with nothing more than empty hands and open hearts, we rest in the lap of divine love. We set aside the pages and tabs of spreadsheets, close down the dashboards, and allow the natural beauty and wonder from the sung processions to the proclaimed word from human voice, bodily gestures of peace and sacred objects to tap into the recesses of our mind and soak into our soul. Through the liturgy’s rituals, we encounter the living God to whom we belong. As we look around the assembly, we see the community in which we live and the lives of others who depend upon us and our dependence upon them. At liturgy we offer our praise and gratitude to the God who cre-

ated and sustains it all and draws it all back into God’s vision of integrated harmony and love.

Some leaders of ministry formation programs may feel swayed to bypass experiences in a Catholic chapel or liturgical space out of a good-intentioned sensitivity that leaders in Catholic health come from society’s plurality. Such sensitivities to non-Catholics pose an important awareness. At the same time, the liturgy’s many symbols provide clues about a Catholic view of healing, wholeperson care, relationship with the wider church community and creation itself, and one’s own connection to transcendent realities. The chapels, churches and sacred spaces reveal aspects about the sisters and brothers who founded our ministries. Their prophetic vision and integrity of word and deed could not have been realized apart from the fullness of life or integrity they encountered in Jesus, most often experienced in daily rituals of the liturgy.

One facet of formation is to invite leaders to explore aspects of Catholic identity. This is especially true for individuals who come from life experiences with scant experiences with Catholicism, Christianity or any type of religious perspective. Ministry formation in Catholic health care never proselytizes. Orienting a formation cohort to a Catholic worship space is akin to a tour guide showing foreigners hidden gems in La Sagrada Familia.

Ministry formation provides the opportunity to introduce and offer insight to participants about sacred spaces and the rituals they contain and affords an opportunity for dialogue and questioning. Participants may see the liturgy and its environment as a composite whole, reflecting the mystery of God who desires closeness and intimacy with God’s creation, especially with all people bearing God’s image and likeness. Ministry formation’s rituals and liturgical experiences may heal wounds of misunderstanding and offer fresh awareness.

A CONNECTION TO SELF AND BEAUTY

When someone enters a glorious sacred space, like Notre Dame, a hush befalls them. It is akin to first stepping into a forest dripping with evergreen branches. It is a profound encounter with beauty, which, from ancient philosophy to today,

is a primary means used by the Divine to reach us. The liturgy urges us to see things differently and more deeply. It forms minds and hearts to become live with a similar authenticity and integrity as reflected in the sacred objects and the presence of Christ Jesus encountered in the ritual.

DARREN M. HENSON, PhD, STL, is senior director of ministry formation at the Catholic Health Association, St. Louis.

NOTES

1. Robert Barron, Heaven in Stone and Glass: Experiencing the Spirituality of the Great Cathedrals (Chestnut Ridge, New York: Crossroad Publishing, 2002).

2. United States Conference of Catholic Bishops, Built of Living Stones: Art, Architecture, and Worship, section 15.

3. USCCB, Built of Living Stones, section 149.

4. Rose Pacatte, “Bees’ Return Enriches Easter Vigil,” National Catholic Reporter, March 27, 2016, https://www.ncronline.org/blogs/ncr-today/beesreturn-enriches-easter-vigil; Shawn Tribe, “Easter and the Bees,” Liturgical Arts Journal, April 13, 2020, https://www.liturgicalartsjournal.com/2020/04/ easter-and-bees.html.

5. USCCB, Built of Living Stones, sections 56-57. See also “Rite of Dedication of an Altar,” Chapter 4, no. 9.

6. USCCB, Built of Living Stones, sections 60–62.

7. Albert Borgmann presents an excellent reflection on recorded music’s pitfalls in his thoughtful critique of technology. He argues that a technology-driven lifestyle beckons for a human response that can only come from what he terms “focal practices,” or activities that people must continuously practice and that require a focus of the mind. These activities can be things like jogging, playing an instrument or baking. The ultimate focal practice is liturgy. See his book: Power Failure: Christianity in the Culture of Technology (Grand Rapids, Michigan: Baker Publishing Group, 2003), 29-33.

8. USCCB, Built of Living Stones, section 129.

9. “NZ Bishops: No Liturgical Use of Roman Missal iPad,” CathNews New Zealand, May 1, 2012, https://cathnews. co.nz/2012/05/01/nz-bishops-say-no-to-liturgical-useof-roman-missal-apps-for-ipad/.

10. James Alison, “Those with Eyes to See,” James Alison, March 19, 2005, http://jamesalison.com/ those-with-eyes-to-see/.

EMBRACING CHANGE: IT’S WHO WE ARE

As Catholic health leaders, we believe in the power of transformation to bring ourselves and our ministries more fully to life. Yet seemingly never-ending and accelerated change wearies us.

DENNIS GONZALES

I recently had the opportunity to participate as a panelist on a CHA webinar with my colleagues Jill Fisk, CHA’s director of mission services, and Lisa Reynolds, vice president for change management with CHRISTUS Health. We had an uplifting dialogue and engaged in an experiential practice that focused on ministry leadership and our readiness and ability to embrace change during these challenging times for all of us serving in Catholic health care. Following that webinar, I found myself reflecting on the discussion and how we can be more effective leaders who can help our ministries survive and thrive in turbulent times — while at the same time maintaining our integrity and commitment to our mission.

As I gathered my thoughts from our discourse, I went back and reviewed what research tells us about how leaders can successfully navigate significant change and challenges. With my background in organizational development, I wanted to construct a rich and accurate description of the “universal experience” of leaders who have had similar experiences in organizations during periods of change, crisis and upheaval. I hope to shed some light on the complex and unique role that leadership plays and the different approaches they have used during difficult times.

successful approaches during organizational change revealed that a person’s individual experience as a leader was unique; however, some interesting commonalities and differences emerged. One is that a leader’s worldview is critical. Specifically, a generally positive worldview indicates a greater ability to embrace organizational change as an opportunity to grow and improve. The optimistic worldview confirms the assertion that this way of perceiving the world, combined with a leader’s intrinsic skills, qualities or emotional intelligence — even more than their intellect — serve as primary drivers of whether or not that leader can successfully encourage the creation of an organizational culture that responds positively to change and can adapt and grow in response to it.1 In ministry language, this brings us to the question: Are we a hopeful people?

Collaboration and teamwork form the bedrock of an effective leadership strategy, and in this critical role of encouraging the creation of collaborative networks, a leader must also be a good communicator.

Collaboration and Solid Communication

EFFECTIVE QUALITIES TO ADDRESS CHANGE

Positive Worldview

It won’t come as a surprise that the findings around

Collaboration is another key quality that successful leaders must possess. Only then can we serve as catalysts whose primary function is to build relationships and foster the creation of complex networks throughout an organization. Collaboration and teamwork form the bedrock of an effective leadership strategy, and in this critical role of encouraging the creation of collaborative networks, a leader must also be a good communica-

tor. These vital skills include effective listening, written and oral communication skills, excellent nonverbal skills, approachability and transparency. These important leadership qualities speak to our ability to relate to and appreciate the perspectives of others, the ability to demonstrate good social skills, the ability to engage in difficult dialogue and the ability to learn through ongoing critical reflection.2

in us to emerge, but in most instances, managerial courage will be required in the daily conversations leaders have with coworkers.3 These conversations and difficult dialogues are worth having to focus on how best to achieve the mission.

Conflict Resolution

In today’s complex world, ethical dilemmas and competing interests permeate the workplace. Only through open and honest dialogue will leaders be able to assess, address and resolve the myriad of complex situations that await them in their organizations.

These competencies relate directly or indirectly to a leader’s ability to collaborate and communicate effectively with others. All are very personal and internally focused, reaffirming the premise that the leadership qualities that are most critical during times of change are in the affective domain, which are frequently referred to as “soft skills.” Fortunately, this is precisely where Catholic health care leaders excel.

Visionary Leadership, Managerial Courage

Effective leaders are visionary and work with others and the community to define a missionfocused picture of the future. This vision is not static, however. A leader must have an everevolving vision that adapts to the organizational culture and business environment. This requires us to think globally and see the bigger picture, especially amid difficult change experiences.

At the same time, a leader must be skilled at having difficult conversations not only with those they manage but also with colleagues and those who manage them. Engaging in these discussions with the latter generally involves greater risk, yet exerting such managerial courage does not always mean playing the role of the “warrior.” There are rare occasions that will call for the warrior leader

I would suggest that current and future leaders add conflict resolution skills to their toolbox. There are a variety of techniques people can learn to help them navigate potentially sensitive conversations. Such training will help leaders become more adept at exerting managerial courage when called upon to do so. In today’s complex world, ethical dilemmas and competing interests permeate the workplace. Only through open and honest dialogue will leaders be able to assess, address and resolve the myriad of complex situations that await them in their organizations. Managerial courage and conflict resolution can no longer be relegated to the category “other duties assigned as necessary” in the leader’s job description. An effective leader must be able and willing to have those difficult conversations with their employees, colleagues and managers. The cost of not doing so is simply too high.

THE POWER OF REFLECTION

Finally, while holding and demonstrating these leadership competencies, skills and behaviors is quite a challenge for anyone, none is possible without frequent reflection or prayer. This is particularly important in today’s rapidly changing world, where knowledge and technology are advancing exponentially. Leaders are called upon more than ever to keep pace. Reflection seems to be a natural process for some, while for others, it must be learned and practiced. It may begin as an extraneous and almost artificial activity. But eventually, it needs to become an internal and continuous process, a lifelong disposition and a consciously applied means for greater effectiveness in leadership.4 Reflection can be hard and extra work, but its benefits are immeasurable in both personal and professional terms. We need

only look to the example of the religious sisters who came before us and continue to serve with us to appreciate the power of reflection.

Critical reflection is important for identifying and questioning assumptions, which opens the door for leaders and organizations to learn from experience and history. Only through this process can leaders pause and ponder who they are, where they are going and what they need to do to get there. Reflection allows a leader to step back and consider all viewpoints, options and consequences. Through this practice, effective leaders can assess the current status of their own learning processes, their staff and their organization in comparison to where each should be moving. Gaps and opportunities, strengths and weaknesses, and needs and resources can all be identified and evaluated through reflection.

Reflection provides an opportunity to peacefully realize that one does not have all the answers and cannot succeed alone. Through reflection, leaders can learn not only from their own life experiences but also from those of their staff and colleagues and the accumulated knowledge and wisdom of their predecessors.

HONORING THE REALITY OF CHANGE

Perhaps it is fitting to recall the teachings of Gandhi when discussing the implications for leaders striving to help organizations succeed in turbulent times. As author Alan Axelrod wrote in Gandhi, CEO: 14 Principles to Guide and Inspire Modern Leaders:

“No enterprise ever simply arrives at its goal as a ship arrives at its dock. The idea of ‘maintaining’ an organization’s status is an illusion. It cannot be

done. There is, as Gandhi explained, always movement, always change. The great leadership issue, therefore, is one of navigation: the creation of purposeful, productive movement within an environment of movement. This requires continual vigilance and planning as well as a high level of energy. Gandhi embraced these requirements of leadership, from which, in any case, he saw no escape.”5

Ongoing reflection and a hopeful worldview that boldly embraces change are what will ground and sustain us, come what may. This important lesson is yet another that our foundresses have graciously passed on to us. We need only to remember.

DENNIS GONZALES,

PhD, is senior director, mission innovation and integration, for the Catholic Health Association, St. Louis.

NOTES

1. Daniel Goleman, Richard Boyatzis, and Annie McKee, Primal Leadership: Learning to Lead with Emotional Intelligence (Boston: Harvard Business Review Press, 2002).

2. Lorraine Slater, “Pathways to Building Leadership Capacity,” Educational Management Administration & Leadership 36, no. 1 (January 2008): 55-69.

3. Lee G. Bolman and Terrence E. Deal, The Wizard and the Warrior: Leading with Passion and Power (San Francisco: Jossey-Bass, 2006).

4. Jack Mezirow and Associates, Learning as Transformation: Critical Perspectives on a Theory in Progress (San Francisco: Jossey-Bass, 2000).

5. Alan Axelrod, Gandhi, CEO: 14 Principles to Guide and Inspire Modern Leaders (New York: Sterling Publishing Co., Inc., 2010).

WHAT DOES IT MEAN TO BE A MISSIONARY DISCIPLE IN HEALTH CARE?

In November 2013, Pope Francis released the Apostolic Exhortation, Evangelii Gaudium ( The Joy of the Gospel ). This document outlines Francis’ vision of the Church as discussed in the Synod of Bishops in 2012. The document consists of five chapters covering areas of the Church’s mission, our communal commitment and the social dimension of evangelization. Francis calls all baptized to renew their identity as missionary disciples to help the poor and vulnerable and to bring the peace of Christ into the world.

NATHANIEL BLANTON HIBNER

Ten years after the document’s release, I believe the lessons shared are still relevant to today’s environment. The guidance the Pope shares is vitally important to remind our ministry of the role of the Church in society.

WE MUST ‘MOVE FORWARD, BOLDLY’

Pope Francis begins Evangelii Gaudium by reminding us that the Church is “herself a missionary disciple.”1 This missionary disciple, whom God so loves, will “move forward, boldly take the initiative, go out to others, seek those who have fallen away, stand at the crossroads and welcome the outcast.”2

These are challenging words for the greater Church community and the ministry of health care. Our history has always been one of going to the peripheries to meet the community’s needs. You may want to ask if your ministry is one of a missionary disciple, by evaluating: How in the last 10 years has your organization taken the first step to reach out to those most in need and advanced a culture that ministers at the margins?

WE CANNOT RISK BEING A BYSTANDER

Francis repeats that “the Church has made an option for the poor which is understood as a ‘special form of primacy in the exercise of Christian charity, to which the whole tradition of the Church bears witness.’”3 He is astonished by the current media environment, asking how can it be that “it is

not a news item when an elderly homeless person dies of exposure, but it is news when the stock market loses two points?”4 Do we not continue to see this indifference 10 years later? Through the pandemic, the deaths of millions around the world became just another number reported on the nightly news. Our culture failed to recognize the individual lives taken from us and the need for a more concerted effort to help those left behind. As Francis states, “none of us can think we are exempt from concern for the poor and for social justice … .”5

A second pillar of Church teaching which Francis writes of is our commitment to the common good. “God, in Christ, redeems not only the individual person, but also the social relations existing between men.”6 The love of Christ moves us not only to the peripheries but also to renew the connections we hold nearby. As relational people, made in the image of a trinitarian God, we, too, must focus on the broader community. This dual movement of concern with individuals and the common good has been a continual dynamic expressed by the Pope. It is one that, at times, can be challenging to balance. But Francis reminds us that “what the Holy Spirit mobilizes is … above all an attentiveness which considers the other ‘in a certain sense as one with ourselves.’”7

Turning away from the poor and vulnerable and our common commitments has only become easier. We know the many ways in which our society creates a barrier with those it deems unworthy. Phrases like “the common good” have been weaponized as political. However, the Church and its health care ministry cannot risk being a

bystander. Francis fears such a reality. He writes:

“Any Church community, if it thinks it can comfortably go its own way without creative concern and effective cooperation in helping the poor to live with dignity and reaching out to everyone, will also risk breaking down, however much it may talk about social issues or criticize governments. It will easily drift into a spiritual worldliness camouflaged by religious practices, unproductive meetings and empty talk.”8

off; it is not an ‘extra’ or just another moment in life. Instead, it is something I cannot uproot from my being without destroying my very self. I am a mission on this earth … .”10 What do you see as your mission in the health care ministry? Can we

Phrases like “the common good” have been weaponized as political. However, the Church and its health care ministry cannot risk being a bystander.

We now have extensive data highlighting the importance of social conditions to the wellbeing of individuals. These social determinants of health have revolutionized how we approach health care. Our Church’s commitment to social justice and whole-person care connects strongly with this new approach. Therefore, how is your ministry finding new ways to stand with and help those most in need? Are we all going beyond talking about social issues toward active engagement with change?

WE ARE ALL A MISSION ON THIS EARTH

As many can see, Pope Francis has tried to renew and revise the formal structure of the Church. This document is an example of such reimagination. He believes that a change in structure will permit more people to participate in the missionary role of the Church. He hopes “that we will be moved by the fear of remaining shut up within structures which give us a false sense of security, within rules which make us harsh judges, within habits which make us feel safe, while at our door people are starving and Jesus does not tire of saying to us: ‘Give them something to eat.’”9 (Mark 6:37)

As the papacy and the Church question whether the current structure is properly aligned with the mission of Jesus Christ, its health care ministry ought to do the same. How has the U.S. health system prevented us from our original path? What new market demands cause us to fear new models of care or new demands from the community?

Each of us has a part in the mission of the Church. Francis recognizes his missionary role: “My mission of being in the heart of the people is not just a part of my life or a badge I can take

reimagine our own structures so that each person can find themself as a missionary disciple?

CONTINUING TOWARD OUR VISION

Pope Francis laid out a vision for the Church a decade ago. He emphasized the need to see the Church as a missionary disciple of Christ, one that goes out to the people and is committed to the poor and vulnerable and the common good. There has been some movement toward this vision.

We have much more to do. However, he gives us the courage to escape the comforts of complacency and the rigidity of well-aged structures. He invites us all to see ourselves as participants in this mission. This is not an easy request, and its mission did not originate 10 years ago. It certainly did not arrive today. Yet, Francis reminds us, “God asks everything of us, yet at the same time he offers everything to us.”11

NATHANIEL BLANTON HIBNER, PhD, is senior director, ethics, for the Catholic Health Association, St. Louis.

NOTES

1. Pope Francis, Evangelii Gaudium, 40.

2. Francis, Evangelii Gaudium, 24.

3. Francis, Evangelii Gaudium, 198.

4. Francis, Evangelii Gaudium, 53.

5. Francis, Evangelii Gaudium, 201.

6. Francis, Evangelii Gaudium, 178.

7. Francis, Evangelii Gaudium, 199.

8. Francis, Evangelii Gaudium, 207.

9. Francis, Evangelii Gaudium, 49.

10. Francis, Evangelii Gaudium, 273.

11. Francis, Evangelii Gaudium, 12.

HIRING UNTAPPED TALENT:

‘ANCHOR’ ORGANIZATIONS SHARE WAYS TO DIVERSIFY, LOCALIZE WORKFORCE

Seventeen health systems across the country — including Bon Secours Mercy Health, CHRISTUS Health, CommonSpirit Health and Providence — signed an “Impact Workforce Commitment” last year to build healthy and equitable local economies through their hiring and workforce development programs and policies.1 The commitment was designed in partnership with a leadership group of Healthcare Anchor Network (HAN) member health systems and the National Fund for Workforce Solutions. The commitment includes goals to address economic and racial inequities in the communities they serve by aligning hiring and workforce power with clinical and community efforts.

A core focus of the commitment is to reach at least 10% of new hires annually by 2027 as “impact hires” — or individuals from economically disadvantaged areas who are hired into quality jobs that require less than a bachelor’s degree and are connected to career pathways. Traditional hiring practices are often designed to whittle down the applicant pool, hindering the consideration of skilled applicants with untapped talent who may struggle to stand out due to a lack of access to education and training, low income or other socioeconomic challenges. By partnering with community-based organizations, workforce intermediaries and education providers to create intentional hiring pathways to quality jobs, health systems can expand employment opportunities for residents who face hiring barriers while improving the efficiency of their recruiting and hiring processes.

REMOVING HIRING AND WORKFORCE BARRIERS

Community-based organizations and workforce intermediaries can help prepare candidates who face barriers to employment through training, skills development, interview preparation and wraparound support, such as child care and transportation assistance. These organizations often play a key role in connecting health systems with specific populations in the community they may not have relationships with, including those

who have been released from the criminal justice system.

Other strategies to increase impact hires include training programs that prepare individuals to fill specific positions with consistent openings, paid internships — including “earn-and-learn” programs that offer opportunities for incumbent employees to receive paid, job-specific training to move into more advanced positions — and apprenticeships. These programs are complemented by internal policy changes that remove hiring barriers. In particular, signatories of the Impact Workforce Commitment strive to advance skills-based hiring and revise job descriptions to remove inflated and unnecessary education and experience qualifications.

INVESTING IN EMPLOYEES TO TRANSFORM COMMUNITIES

As part of its Impact Workforce Commitment, Providence views this initiative as bolstering its ongoing efforts to build a workforce that reflects its communities and advance equity for its caregivers and their families. Providence achieves this by building targeted career pipeline programs; developing apprenticeships (including for medical assistants and pharmacy technicians); and partnering with historically Black colleges and universities (HBCUs) and institutions that serve Hispanics and other minorities to ensure students

LAUREN WORTH

of color are connected to talent pipelines.

Nearly four years after the outbreak of the COVID-19 pandemic, health systems across the country continue to struggle with critical workforce shortages in nursing and allied health careers. Many stem from structural inefficiencies that existed before COVID, like educational programs’ inability to meet demand and lack of access to affordable education. For example, according to a report by the American Association of Colleges of Nursing, nursing schools turned away

benefits that help lower-wage employees overcome financial instability.

Healthcare Anchor Network member Trinity Health Michigan developed an evidence-based hiring process to reduce unconscious bias in recruitment and hiring. This approach evaluates candidates holistically, focusing on the skills relevant to each job and reducing the potential for unconscious bias to impact hiring decisions. This has led to improvements in the quality of hires, a reduced first-year turnover rate and increased workforce diversity. In 2023, the health system was recognized as a CareerSTAT Frontline Healthcare Worker Champion by the National Fund for Workforce Solutions.

By preparing and recruiting local residents to fill high-need roles, health systems can increase their talent pools and create economic opportunities for community members.

nearly 92,000 qualified applicants from baccalaureate and graduate programs in 2021 due to insufficient numbers of faculty, resources and funding.2 These problems are compounded by high levels of health care employee burnout, a lack of awareness of health care career opportunities and demographic shifts that strain talent pools, including a large number of nurses approaching retirement. The need for nurses and allied health care workers is projected to increase over the coming decades to meet an aging population’s needs.3

By preparing and recruiting local residents to fill high-need roles, health systems can increase their talent pools and create economic opportunities for community members. In addition, addressing barriers to retention — such as child care, elder care and transportation — through benefits and financial support services and helping them to navigate these personal challenges can lead to increased retention and dependability. Career coaches can also work with newly hired employees to ensure they receive the support they need to succeed in their role. For example, if an individual has a disability and needs special accommodations, coaches help them navigate the organization to make sure that their needs are met.

A comprehensive impact workforce strategy also includes programs and policies that address bias in recruitment and advancement, as well as

Another Healthcare Anchor Network member, Louisiana-based Franciscan Missionaries of Our Lady Health System, provides financial support for its workforce through a microloan investment fund. Launched in 2018 through an effort with Catholic Charities of the Diocese of Baton Rouge, the fund offers low-interest loans that employees can apply for to avoid predatory payday lending. These loans are part of a continuum of services to help lower-wage employees overcome financial instability — from advance paycheck services to financial counseling and support for debt recovery — provided by a third-party partner to support community development.

Training and investment in employees’ career advancement can also improve employee morale. According to a 2023 study on allied health workforce retention commissioned by Ultimate Medical Academy, 60% of health care support workers surveyed said they expect to leave their job within five years. Among current employees, 77% said they “want a job where I can see a clear path for advancement.”4 Moreover, managers who participate in job training programs have reported increased pride in working at the institution. As part of the Impact Workforce Commitment, health systems are investing in workforce development and career pathway programs to ensure that employees in lower-wage health care occupations have opportunities to progress into higher-skill, higher-wage roles. Bon Secours Mercy Health has invested in employee benefit and internal mobil-

ity programs as part of its mission to improve the health and well-being of its communities. The health system offers full tuition assistance and tuition reimbursement for specific clinical roles for employees who want to advance their careers while working there. This includes an annual benefit of up to $10,000 for in-network nursing and graduate degrees.

Bon Secours Mercy Health also offers employees financial assistance funds — or hardship funds — which can be used to pay for unexpected expenses such as car repair costs. In addition, employees have the option to access their pay immediately after earning it instead of having to wait until the end of their pay period.

By participating in the Impact Workforce Commitment, the health systems involved have agreed to take systemwide measures to ensure fair and equitable leadership opportunities and by continuing to work toward all staff being more reflective of communities. CHRISTUS Health pledged to the commitment goals in recognition that individual health and wellness are intrinsically tied to stable employment and income. By focusing on increasing opportunities for historically marginalized populations, CHRISTUS Health will expand recruitment for individuals from economically disadvantaged areas to fill community health worker roles through a partnership with AmeriCorps VISTA.

Another health system that has pledged to the commitment, CommonSpirit Health, will expand its efforts across its 23-state footprint by educating supervisors about implicit bias and inclusive development and promotion strategies, focusing on competencies and skills needed to be successful in a given role. A partnership with Charles R. Drew University of Medicine and Science, an HBCU in Los Angeles, will help to diversify CommonSpirit Health’s nursing workforce by adding faculty, resources and a mentorship program to the school’s nursing program, which will make nursing careers more accessible to its students.5

RAISING THE BAR TO ADDRESS INEQUITIES

The Impact Workforce Commitment, along with the additional Healthcare Anchor Network leadership commitments,6 provides a map for other health systems seeking to meaningfully address the social and economic drivers of health. Developing systemwide career pathways, advancing employee financial stability and investing in workforce development initiatives can help better ensure in the long-term a workforce that is more productive and invested in institutional success.

LAUREN WORTH is project manager of workforce and community engagement initiatives for Healthcare Anchor Network.

NOTES

1. “Impact Workforce Commitment,” Healthcare Anchor Network, May 10, 2023, https:// healthcareanchor.network/2023/05/ impact-workforce-commitment-iwc/.

2. “Nursing Faculty Shortage Fact Sheet,” American Association of Colleges of Nursing, October 2022, https://www.aacnnursing.org/news-data/fact-sheets/ nursing-faculty-shortage.

3. “Nursing Faculty Shortage Fact Sheet.”

4. “Sounding the Alarm on Healthcare Staffing: New Study Reveals 60 Percent of All Healthcare Support Workers Expect to Leave Their Job in the Next Five Years,” PR Newswire, June 21, 2023, https://www. prnewswire.com/news-releases/sounding-the-alarmon-healthcare-staffing-new-study-reveals-60-percentof-all-healthcare-support-workers-expect-to-leavetheir-job-in-the-next-five-years-301857064.html.

5. “CommonSpirit Health and Charles R. Drew University of Medicine and Science Partner to Diversify and Grow Nursing Workforce,” CommonSpirit Health, May 9, 2022, https://www. commonspirit.org/news-and-perspectives/news/ charles-drew-university-partnership.

6. “HAN Leadership Commitments,” Healthcare Anchor Network, https://healthcareanchor.network/ han-leadership-commitments/.

THINKING GLOBALLY

CREATING A ROAD MAP FOR THE ETHICAL DONATION OF GOODS

When I came to CHA in 2010, one of my first projects was to research the state of in-kind donations — or “medical surplus recovery” — from Catholic health care to organizations in low- and middle-income countries. The resulting research study conducted by Accenture Development Partnerships that year showed that while donations were happening, there was significant room for improvement to ensure our efforts had a positive impact in meeting the needs of people and communities.1

Over the past 14 years, progress has been made; however, there are ample opportunities to ensure this work fully aligns with our core commitments reflected in our Shared Statement of Identity for the Catholic Health Care Ministry to promote and defend human dignity, attend to the whole person, care for those who are poor and vulnerable, promote the common good, act on behalf of justice, steward resources and serve as a ministry of the Church.

In late 2023, CHA and its global health advisory council convened a group of ministry leaders and community partners to formally launch a community of practice dedicated to establishing a road map for the future of in-kind donations, ensuring quality standards across the Catholic health ministry. The group will work to identify innovative ways to improve processes for the delivery of high-quality, usable items that positively impact the people and communities we hope to assist. Elements of the road map will include global health and solidarity, responsible medical donations, environmental impact, outcome measurement, ethical standards and ways to identify the right Medical Surplus Recovery Organization with which to partner.

Damond Boatwright, CHA board chair and president and CEO of Hospital Sisters Health System, opened last year’s inaugural community of practice meeting by underscoring the dedication of Catholic health care to the well-being of

every human person and our call to care for creation. Boatwright emphasized the significance of CHA’s new vision statement, We Will Empower Bold Change to Elevate Human Flourishing, in guiding these efforts. He expressed, “What I really want to convey today is that everyone in health care has a role to play in responsible medical donations. It’s not just supply chain work or the work of our mission leaders. We need everyone to understand the basic principles and be committed to high-quality and ethical practices.” Additionally, Boatwright shared his personal commitment to ongoing learning in this area.

Chris Palombo, chief executive officer of Dispensary of Hope, a subsidiary of Ascension, and leadership council chair for the MedSurplus Alliance, was also in attendance at the gathering. Dispensary of Hope provides pharmacies and safety-net clinics with medications donated by pharmaceutical manufacturers that patients in need can receive for free.

During the event, Palombo shared insights that resonate with the Leading With Integrity theme of this issue of Health Progress, and he elaborates here on how honoring our commitment to integrity involves making measurable impact in improving the health of our global communities.

Palombo’s thoughts challenge us to lead with integrity as we empower bold change to elevate human flourishing. I invite your participation in the community of practice for in-kind donations, and CHA will share updates on this ongoing work, as we take to heart Pope Francis’ plea in Laudato Si’ to hear both “the cry of the Earth and the cry of the poor.”2

BRUCE COMPTON

COURAGE TO RESPONSIBLY SERVE OUR MOST VULNERABLE

CHRIS PALOMBO, MA, MSHM

As a leader in the Medical Surplus Recovery Organization space and an organization that delivers medications, our goal goes beyond shipping boxes and ensuring shipments reach their destination. As a nonprofit medication distributor, we give the clinics and pharmacies that we serve confidence in knowing that the medicines they order and receive from us meet or exceed quality measures and licensing requirements. Yet, the ultimate aim is to improve the health of those in need, specifically those living in poverty. It is through innovation and evaluation that we honor our mission and ensure our work to keep our patients first.

Fulfilling this commitment demands evaluating health outcomes, the truest measure of whether our efforts make a lasting difference. Are the donated medications actually improving the lives of the most vulnerable? This question forms the cornerstone of our work at Dispensary of Hope. Many patients have shared their stories of how access to affordable, needed medication has made a difference, even been life-saving.3

We’re committed to setting the highest standards in medication distribution. Everyone, regardless of background, deserves access to quality medication delivered through a secure and reliable supply chain. This upholds not only the principle of equitable access but also the trust placed in us by generous medication donors.

We are impacting the lives of people who have found themselves without insurance.

A robust supply chain minimizes risks such as diversion, tampering and contamination, ensuring the medicine reaches patients safely and effectively. We operate at the same high standards as pharmaceutical manufacturers and licensed distributors, using best practices and leveraging partnerships with trusted third-party evaluators like Advisory Board Company and RTI International. Their research demonstrates not only improved health outcomes but also significant health care savings.4 Access to free medication for people who are uninsured reduces the overall cost of health care delivery through improved health outcomes.5

For Medical Surplus Recovery Organization leaders distributing surplus products, insisting on measuring health outcomes is nonnegotiable. We serve the most vulnerable, a privilege that comes with immense ethical responsibility.

Losing sight of this can have devastating consequences for those relying on our services. True to our mission, we must relentlessly measure our impact and ensure every action contributes to a healthier future for those who need it most.

CHRIS PALOMBO is chief executive officer of Dispensary of Hope and leadership council chair for the MedSurplus Alliance. Dispensary of Hope is a U.S.-based nonprofit domestic medication distributor and a subsidiary of Ascension that helps to bridge the gap between pharmaceutical generosity and vital medication for the poor.

NOTES

1. “CHA Medical Surplus Donation Study: How Effective Surplus Donation Can Relieve Human Suffering,” Catholic Health Association, April 2011, https:// www.chausa.org/docs/default-source/general-files/ b5c12ee8b2084119b16cd7bd86752e221-pdf.

2. Pope Francis, Laudato Si’, The Holy See, https:// www.vatican.va/content/francesco/en/encyclicals/ documents/papa-francesco_20150524_enciclicalaudato-si.html.

3. “Stories of Hope,” Dispensary of Hope, https:// www.dispensaryofhope.org/Stories-of-Hope.

4. Benjamin T. Allaire et al., “Does Access to Free Medication Reduce Health System Costs? An Evaluation of the Dispensary of Hope Program,” Journal of Managed Care & Specialty Pharmacy 29, no. 2 (February 2023): https://doi.org/10.18553/jmcp.2023.29.2.187; Jonathan Hughes and Abby Sparkman, “Charitable Medication Distribution Improves Care For Uninsured Patients with Diabetes,” American Journal of Managed Care 29, no. 11 (November 2, 2023): https://www.ajmc.com/view/ charitable-medication-distribution-improves-care-foruninsured-patients-with-diabetes.

5. Hughes and Sparkman, “Charitable Medication Distribution Improves Care For Uninsured Patients with Diabetes.”

Reclaiming Our Light

DARREN M. HENSON, PhD, STL, and JILL FISK, MATM MEMBERS OF CHA’S MISSION DEPARTMENT, ST. LOUIS

OPENING AWARENESS

As we gather, we may find it difficult to find the words that resonate with a meeting agenda, time of year, or the things happening in our neighborhoods or worldwide. We humbly acknowledge the seemingly unending pressures faced by health care leaders today:

Lingering upheavals stemming from the pandemic years include:

Workforce shortages and challenges.

Natural disasters.

Financial belt-tightening.

Organizational overhauls. (In a moment of silence, acknowledge how you and those around you face challenges.)

SACRED TEXT

Our weariness and wandering are as old as the human race. In the Hebrew Scriptures, at the conclusion of the Book of Joshua, Joshua reflects on his long life and the many preceding generations. (Joshua 24:1–15) The message is clear: God has been faithful.

Joshua recalls how God led Abraham and Sarah away from their homeland across the river. Of Abraham’s many descendants, some went to Egypt, where they were enslaved. While their exodus appeared a liberation, they were pursued by soldiers in chariots and on horseback. There was a long period in the wilderness. There was fighting with the Amorites, then with King Balak, then with Balaam. Though the Lord rescued them, the people again encountered tension and harm from those in Jericho. This history has not been easy!

Completely aware of the torturous events of the ages, Joshua prepares to die and offers a farewell, uttering that recognizable line, “As for me and my household, we will serve the Lord.” The people echo in reply, “… we also will serve the Lord, for he is our God.” They say this to him not once, but three times. Even when recalling great hardships and generations of suffering, they emphatically state, “No! We will serve the Lord!”

Joshua’s reflection recalls plagues, battles, curses and destruction. Yet none of this shakes the confidence that God has been with them.

REFLECTION

Spend a few moments contemplating:

What would your own history sound like, interpreted in this way?

What is it like to say, “We will serve the Lord,” amid the struggles in ministry today?

The final time the people assure the dying Joshua that they will serve the Lord, they add, “… and will listen to his voice.” (Joshua 24:24) In saying this, they claim their own inner, Godgiven light.

FROM FAITH TO LIGHT

It’s precisely in moments of struggle when we may be dogged by doubts. If we remember the times of God’s fidelity, we awaken to rediscover God’s faithfulness once again. When conflict appears, when relational strife peaks or when circumstances unexpectedly turn, life has a way of testing human capabilities. Divine help is needed.

And in the reaching, in the finding, in the relocating of God as Source and

Light and Faithful One, the light of Christ within is once again lit. As the Lord of Light reignites one’s being, the present reality dims and God’s steadfastness is on display, luminous and constant.

Let us pause and reflect on the following:

What circumstances might reignite you to recognize God’s faithfulness?

How might reclaiming the light of Christ within allow you to be a light in your current circumstances, for yourself and those you lead?

Are there particular practice(s) that help you keep the light of Christ bright within you?

CLOSING PRAYER

Let us pray.

O Faithful One, you are our constant source of help.

You light our darkness. You abide with us as we wander in the day.

Attune us to You, all that we are. No matter where we find ourselves, may we be people of the light. May we be luminous, and may our light emblazon our workplaces, neighborhoods and communities.

O Light Eternal, let our light shine for others, now and forever. Amen.

NOTE

This prayer service is inspired by the Pray As You Go daily prayer website and app — located at https://pray-as-you-go.org/ player/2023-08-18 — and was further adapted due to CHA member request after its use at a mission leader seminar last year.

Navigating the complex ethical realities of health care can be a challenge.

Access

 The assembly main stage will feature thought leaders in health care policy, the future of technology, financial reform, industry innovation and Catholic identity.

 Breakout sessions and peer conversations will provide rich opportunities for dialogue and engagement around the pressing issues of our time, including artificial intelligence, health care reform and the unique role of Catholic health care in fostering unity.

 Pre-assembly learning modules will explore the nuances of where the Catholic vision of health care fits with American health care.

A specialist in public finance and health economics, Amy Finkelstein, PhD, is the John & Jennie S. MacDonald Professor of Economics at the Massachusetts Institute of Technology. She has been awarded multiple honors and fellowships for her research, including a MacArthur Foundation Fellowship and the John Bates Clark Medal.

One of the health care industry’s leading digital futurists, Tom Koulopoulos is the author of 13 books and founder of Delphi Group, a Boston-based think tank which provides strategic advice to Global 2000 organizations. Drawing on more than 30 years of experience in his field, Tom’s insights have been described as thought-provoking, content rich and inspirational.