Health Progress – May-June 2019

JOURNAL OF THE CATHOLIC HEALTH ASSOCIATION OF THE UNITED STATES

HEALTH PROGRESS MAY - JUNE 2019

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100th ANNIVERSARY

HEALING SPACES

50 SPONSORS ARE CALLED TO BE PROPHETS AND REFORMERS CHARLES E. BOUCHARD, OP, STD

DEPARTMENTS 2 EDITOR’S NOTE MARY ANN STEINER 58 MISSION AND LEADERSHIP Let’s Declutter Our Healing Environments BRIAN SMITH, MS, MA, MDiv 61 COMMUNITY BENEFIT Funding Collaboration in a Rural Community MARK THOMAS, MDiv, BCC 63 THINKING GLOBALLY Respect for Culture Plays Important Role in Care Settings BRUCE COMPTON Illustrations by Roy Scott

65 AGE FRIENDLY Focus on What Matters: Simplying Complex Care of Older Adults MARY TINETTI, MD

4 TRINITY HEALTH EXPLORES HEALING PRESENCE Philip J. Boyle, PhD 10 THROUGH A GLASS DARKLY: HEALING AND THE RELIGIOUS IMAGINATION Zeni Fox, PhD

21 POPE FRANCIS — FINDING GOD IN DAILY LIFE

16 ‘HOLY SEEING’ FROM THE ART OF THE SAINT JOHN’S BIBLE Barbara Sutton, DMin

67 BOOK REVIEW

22 THE DESIGN IMPERATIVE: AN ANTIDOTE FOR CLINICAL COMPRESSION Kathy Okland, RN, MPH, EDAC

72 PRAYER SERVICE

69 EXECUTIVE SUMMARIES

28 HEALING GARDEN FOSTERS A HEART OF LOVE Jim RIchter, MA 32 A MEDICAL SAFE HAVEN FOR SURVIVORS OF TRAFFICKING Jennifer Cox and Ron Chambers, MD, FAAFP 38 LABYRINTH WALK SERVES AS TOOL FOR SPIRITUAL JOURNEY Becky Urbanski, EdD 40 TO BE A HEALING PLACE Bridget Deegan-Krause, MDiv, BCC 44 MEDITATION ON HEALING AND SACRED PLACES David J. Shuch, DDS

Motortion Films

48 REFLECTION: A PLACE OF PEACE Jean Monahan

IN YOUR NEXT ISSUE

YOUNG PEOPLE AT RISK

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EDITOR’S NOTE

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an you imagine how often the prodigal son, once back in his father’s house, told the story of his redemption? How many guests at table or strangers in the market listened to the tale of his wayward life and how his father’s enormous love and forgiveness restored him to health and wholeness? He must never have tired of the telling.

Many years ago I heard the Episcopal theologian and author Morton Kelsey tell his own story of a prodigal father. He told it so powerfully that I remember it decades later. Of course, by the time I heard it, he, like the prodigal son, must have told it many times.

MARY ANN Kelsey was an esteemed auSTEINER thor and speaker, who admitted that when choosing among priorities, family didn’t always come first. His son, especially, was a mystery, even a disappointment, to him, and they had little to do with each other until the son, suffering from an illness he’d kept from his parents, came home to die. In their house by the ocean, his parents cared for him in the room with the view he had always loved. The father came to know how narrow his own frame of understanding had been and how large his son’s heart was. Overwhelmed by the losses and how little time was left, Kelsey wept as he asked his son’s forgiveness for not being there for him. Not the man of words his father was but eloquent in his brevity, the son said, “But you are now.” Forgiveness and healing in another father’s house.

This issue of Health Progress is focused on healing spaces. For too long I thought the emphasis was on the noun rather than the adjective: that we would feature beautiful architecture and innovative design. It turns out that the more important word is “healing,” and that the wise authors who wrote for us never allowed the healing to fall second to the spaces that support it. Modest clinics that care for trafficked victims, sacred corridors through which patients are wheeled to urgent treatments, private rooms where families wonder what to do next, quiet nooks that nurses find to relieve the stress and grieve the losses. These are the healing spaces.

Special thanks to Philip J. Boyle, who served as guest co-editor for this issue of the magazine.

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Boyle led Trinity Health’s initiative to explore how its mission statement, which calls the ministry to be a “transforming, healing presence to those it serves,” should be carried out in the system’s buildings, chapels, hospital corridors, lobbies and employee lounges. He led us to intriguing article topics and expert authors.

First titled Hospital Progress, the official journal of the Catholic Health Association of the United States, published its first issue in May 1920 and changed its name to Health Progress in 1984. With this issue, Health Progress begins its 100th year.

Without stretching the point too far, we like to believe that the magazine has served as its own kind of healing space. In its very first issue, Fr. Charles Moulinier, SJ, CHA’s first president, called for a standardization of excellence across Catholic hospitals as a part of Catholic identity rather than an alternative to Catholic identity. In this issue, Fr. Charles Bouchard’s article on how Health Progress has led discussions of identity and sponsorship over the decades, makes exactly the same point: we aren’t an either/or ministry, but a both/and one. Each of the next five issues will host an article on other topics that define CHA’s work as an association: community benefit, advocacy, ethics, international outreach and mission integration.

As Kai Ryssdal, host of National Public Radio’s “Marketplace,” says when he opens program, “Let’s do the numbers.” Hospital/Health Progress has published 1,030 issues since 1920. Each issue has about ten articles on the special topic, one indepth feature, six regular columns and one original prayer. Last year the magazine won 12 national publishing awards. You are one of 15,637 who’ll receive the print version this month; if you’re reading us online, welcome to a growing readership.

Whatever your preference, please keep reading and visit www.chausa.org/HealthProgress100 for other interesting facts, pictures and updates.

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VICE PRESIDENT, COMMUNICATIONS AND MARKETING BRIAN P. REARDON EDITOR MARY ANN STEINER masteiner@chausa.org MANAGING EDITOR BETSY TAYLOR btaylor@chausa.org GRAPHIC DESIGNER LES STOCK

ADVERTISING Contact: Jennifer Wiegert, 4455 Woodson Rd., St. Louis, MO 63134-3797, 314-253-3424; fax 314-427-0029; email at ads@chausa.org.

SUBSCRIPTIONS/CIRCULATION Address all subscription orders, inquiries, address changes, etc., to Kim Hewitt, 4455 Woodson Rd., St. Louis, MO 63134-3797; phone 314-253-3421; email khewitt@chausa.org. Annual subscription rates are: CHA members $55; others $75; and foreign $75.

ARTICLES AND BACK ISSUES Health Progress articles are available in their entirety in PDF format on the internet at www.chausa.org. Health Progress also is available on microfilm through NA Publishing, Inc. (napubco.com). Photocopies may be ordered through Copyright Clearance Center, Inc., 222 Rosewood Dr., Danvers, MA 01923. For back issues of the magazine, please contact the CHA Service Center at servicecenter@chausa.org or 800-230-7823.

REPRODUCTION No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording or any information storage and retrieval system, without permission from CHA. For information, please contact Betty Crosby, bcrosby@ chausa.org or call 314-253-3490.

OPINIONS expressed by authors published in Health Progress do not necessarily reflect those of CHA. CHA assumes no responsibility for opinions or statements expressed by contributors to Health Progress.

2017 AWARDS American Society of Healthcare Publication Editors: Gold for Best Single Issue; Gold for Best Commentary; Silver for Best Human Interest Story; Silver for Best Cover Illustration.

Catholic Press Association: First, Second, Third & Honorable Mention for Best Feature Article; Second Place for Best Regular Column; Third Place for Best Coverage of Immigration; Third Place for Best Article Layout.

EXCEL (Association Media & Publishing): Silver for Best Feature Article.

Produced in USA. Health Progress ISSN 0882-1577. May - June 2019 (Vol. 100, No. 3).

Copyright © by The Catholic Health Association of the United States. Published bimonthly 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, $55; nonmembers, $75; foreign and Canada, $75; single copies, $10.

POSTMASTER: Send address changes to Health Progress, The Catholic Health Association of the United States, 4455 Woodson Road, St. Louis, MO 63134-3797.

EDITORIAL ADVISORY COMMITTEE Coletta C. Barrett, RN, FACHE, vice president, mission, Our Lady of the Lake Regional Medical Center, Baton Rouge, La. Kathleen Benton, DrPH, president and CEO, Hospice Savannah, Inc., Savannah, Ga. Sr. Rosemary Donley, SC, PhD, professor of nursing, Duquesne University, Pittsburgh.

Camille Grippon, MA, system director, global ministries, Bon Secours Mercy Health, Marriottsville, Md. Marian Jennings, MBA, president, M. Jennings Consulting, Inc., Malvern, Pa. Tracy Neary, regional vice president, mission integration, St. Vincent Healthcare, Billings, Mont.

Donald Obermann, director of finance, Ascension, St. Louis.

Sr. Kathleen M. Popko, SP, PhD, president, Sisters of Providence, Holyoke, Mass.

Laura Richter, MDiv, system senior director, mission integration, SSM Health, St. Louis.

Gabriela Robles, MAHCM, MBA, vice president, Community Partnerships, Providence St. Joseph Health, Irvine, Calif.

Michael Romano, national director, media relations, Catholic Health Initiatives, Englewood, Colo.

Fred Rottnek, MD, MAHCM, director of community medicine, Saint Louis University School of Medicine, St. Louis.

Becky Urbanski, EdD, senior vice president, mission integration and marketing, Benedictine Health System, Duluth, Minn.

Brian Yanofchick, MA, MBA, senior vice president, sponsorship, Bon Secours Mercy Health System, Marriottsville, Md.

CHA EDITORIAL CONTRIBUTORS COMMUNITY BENEFIT: Julie Trocchio, BSN, MS CONTINUUM OF CARE AND AGING SERVICES: Julie Trocchio, BSN, MS ETHICS: Nathaniel Blanton Hibner, PhD(c) FINANCE: Rhonda Mueller, CPA INTERNATIONAL OUTREACH: Bruce Compton LEADERSHIP AND MINISTRY DEVELOPMENT: Sr. Mary Haddad, RSM, MSW, MBA LEGAL: Catherine A. Hurley, JD MINISTRY FORMATION: Diarmuid Rooney, MSPsych, MTS, DSocAdmin MISSION INTEGRATION: Brian P. Smith, MS, MA, MDiv PUBLIC POLICY AND ADVOCACY: Lisa Smith, MPA THEOLOGY AND SPONSORSHIP: Fr. Charles Bouchard, OP, STD

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HE ALING SPACES

Trinity Health Explores Healing Presence PHILIP J. BOYLE, PhD

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rinity Health is pursuing its ongoing desire to understand better the elements of Catholic identity by focusing on the nature of a healing environment and incorporating its findings into the health care setting. Trinity’s mission statement calls on us to be a “transforming, healing presence.” Our health system has recently gained a deeper knowledge about the qualities of a healing environment, and, in the process, it discovered some surprising connections.1 In 2016 Trinity Health, which is based in Livonia, Mich., and provides care in 22 states, embarked on a quest to investigate the nature of the healing environment from several practical concerns.

Clearly, a healing presence is based upon the ability to offer clinical quality care of the highest level; however, the question remained whether there were other elements of healing that the system should promote for the good of patients and employees. Over the years, many conversations about “transforming, healing presence” were interpreted to mean a “healing environment.”

These conversations included a question that repeatedly arose during our internal ministerial assessment process, known as Promoting Catholic Identity.2 The concern was: How could Trinity measure whether its ministries were maturing in their goals to be a healing presence?

Trinity’s mission integration department asked: “What are credible measures of a healing presence/environment that can be woven in the triennial assessment of ministries? Is there a list of characteristics that should be evaluated?”

Another practical concern materialized from cultural and religious tensions over what images and art should be displayed on Trinity Health campuses. For example, employees at all levels had intense discussions over whether every space

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needed a cross and Catholic images, or whether and how Trinity Health should make use of visual symbols to accommodate persons of all faiths?

The most significant impetus to examine a healing environment arose when Trinity Health purchased a limited heritage edition of The Saint John’s Bible, coincidentally at the same time we were beginning to research the elements of a healing environment. The Saint John’s Bible is the first hand-illuminated manuscript of the entire Bible in 500 years and contains more than 160 stunning, newly created images throughout its seven volumes. The creators of The Saint John’s Bible had a vision statement to “ignite the spiritual imagination of all people.” As the volumes of the Bible moved across several sites, we found the response

What are credible measures of a healing presence/ environment that can be woven in the triennial assessment of ministries? Is there a list of characteristics that should be evaluated?

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to the Bible from staff and visitors sparked a broad leadership and community members — about discussion about the place of beauty in healing. their experiences of a healing environment. They The beauty of image and word in The Saint John’s also advised us to conduct a walk-through of each Bible folios almost single-handedly galvanized organization and document with pictures how our commitment to the relationship of art and patients experience the environment as they healing presence. The physical presence of the manuscript in several of Few respondents connected the ministries convinced us of the need to systematically explore and healing environment with physical make clearer the element of a healspace, although some settings with ing environment as it relates to our mission statement and, more broadly, beautiful views and quiet disposed Catholic identity.

Thus, in 2017 Trinity Health Misthem to healing. Most healing sion Integration embarked on an iniexperiences they recounted involved tiative to explore the elements that compose a ‘healing environment’ and an encounter inside or outside investigate, in particular, the positive health care with a person or a ways to nurture and advance a healing presence. chaplain.

The goals of the Healing Environment Initiative were formulated to: Understand existing practices and guide- move through their care. Staff visited 10 sites, lines currently operating within Trinity Health. including hospitals, senior-living residences and Identify characteristics and additional Programs of All-Inclusive Care for the Elderly, guidelines to further describe, enhance and create and interviewed 200 people in 20 focus groups, a healing presence within Trinity Health facilities. asking them simple questions about their experi Produce tools for mission leaders and exec- ences of a healing environment. utive leadership that will assist in advancing the characteristics of a healing environment.

ENVIRONMENTAL CUES The first step in the initiative entailed gather- The first theme that focus groups considered ing a design team drawn from talent both inside was: “Remember a situation where either you felt and outside Trinity Health, including an archi- healed or experienced someone being healed. tect, health care design professionals and theo- What was the incident? Who was there? What logians who think about the intersection of art were the sights, sounds and aromas?” What we and spirituality. Simultaneously, mission integra- found was remarkable. Few respondents contion staff reviewed literature on a healing envi- nected healing environment with physical space, ronment in health care. The review of “evidence- although some settings with beautiful views and based design” research in health care pointed to quiet disposed them to healing. Most healing the strong correlation between the built environ- experiences they recounted involved an encounments and the potential for physical and emo- ter inside or outside health care with a person or tional healing.3 For example, natural light, images a chaplain. They spoke of a ritual or homeopathic of nature and reduced noise have been shown to therapies; in short, what made an impression was correlate with reduced anxiety and aid in healing. a soothing interaction with someone or someNoteworthy in its absence, the evidence-based thing tangible and tactile. design literature pays little attention to other eleAt first, what respondents reported as healments that contribute to a healing environment. ing was unanticipated by the mission integration The design group recommended that Trinity staff and design team, and the focus group reports Health Mission Integration representatives, go seemed different from the elements of evidenceout and see what constitutes a healing environ- based design. But the design team’s work and litment within Trinity Health. We were asked to erature converged: Whether it is the provision of conduct focus groups at a range of sites, speak- spiritual care, a ritual, or seeing a familiar picture ing with key stakeholders — patients, employees, or listening to soothing music, these interventions

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shared the ability to deflect a person’s attention tures how a patient might experience the differfrom pain and suffering and to open their spiritual ent spaces. For example, they traced how a patient imagination. Focus group interviews repeatedly comes into the emergency department or to an indicated that design choices in the built environ- admissions desk, and then travel to a patient room ment could signal to patients they were in a place and on to labs or other health care services areas. of healing, but more notable was attending to the The design team advised mission integration staff whole person not only by treating the body with to be mindful how transitions felt from one space exceptional clinical care, but also attending to to another. Were the transitions jarring, or did mind and spirit. These wholistic treatments have they provide an unexpected view of something a truly recognizable impact on fostering a healing beautiful to deflect the mind from suffering? environment.

One major observation was the difference A second focus group question explored how between “on-stage” and “off-stage” settings, terms employees experience healing in the workplace. drawn from theater. On-stage settings in health Participants were asked: “Since you experience care are lobbies and public rooms where patients, a lot of suffering and death in your work, and families and the public glean first impressions. because even when you are doing your level best Most on-stage settings were beautiful. Those that in your job, the pressures of health care often cre- offered images drawn from nature and familiar ate distress, where do you go to make sense and local settings were comforting. Patients’ rooms meaning of these pressures?” Their answers were that had natural light and vistas to direct the troubling from an employee engagement per- patients’ gaze were more cheering than those spective. Too many employees recounted that the with no natural light or views. Sites that had local only place of refuge to make sense of pressures of artists displayed in high volume created opportheir work was to hide in a bathroom stall. Oth- tunities for patients to connect with the art and ers retreated to their cars. Very few sites reported offer a point of deflection from their present they had safe spaces to cry, to grieve, to decom- health concerns. In contrast, a site that had the press, and to make sense of the difficult work same abstract images throughout the institution they face daily. Even sites with rooms dedicated were, at minimum, uninspiring. Most noteworthy, to refresh employees were not used widely, and if they were Creating a healing environment for so designated, some had been repurposed for other uses. employees is a critical precondition for This qualitative information providing a healing presence to patients. flags an important management issue. Research draws a clear connection between employee well-being and a newly opened PACE program that offers daily patient satisfaction. If employees are upset, there health care for low-income adults who have little is a probable negative effect on patient healing financial resources for visual beauty, had enlarged and satisfaction. Creating a healing environment pictures of nature and the community displayed for employees is a critical precondition for pro- throughout the sites, much to the enjoyment of viding a healing presence to patients. the Program of All-Inclusive Care of the Elderly Focus group participants explored a third participants. issue: “What spaces in this ministry give you The mission integration staff experienced peace or satisfaction and which ones create dis- great variability in off-stage settings, where sonance and distress?” Respondents noted that patients and supplies are transported but which natural light, vistas, pleasing spaces whether pri- are out of the public eye. Some off-stage settings vate or communal, such as fireplaces or water fea- provided beautiful transitions from spaces with tures, enhanced a healing environment. As might ample familiar images, and one site even placed be expected, areas that were noisy, looked messy images on the ceiling for patients to enjoy as they or felt dirty, such as carpet with a sticky sensation, were being wheeled on gurneys from here to or that seemed sterile, created unwanted disso- there. At one site, transport employees acted like nance for patients and employees alike. tour guides, emotionally and intellectually preThe mission integration staff conducted walk- paring and comforting patients as they wheeled throughs of the ministries, documenting with pic- them though the transitions patients were see-

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ing and feeling. Other off-stage settings were jarring for patients and staff alike. Many corridors were long and painted unremitting white with no images to deflect a patient’s anxiety. A good reason may exist for such sterile-looking environments, but perhaps there is also an underexplored opportunity to promote a healing environment.

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environment provides a transformative moment, shifting the emphasis from the interior life of the designer, architect or artist to the interior life of the person experiencing suffering and pain.

A third attribute that emerged is the place of beauty in a healing environment. As Scriptures attest and theologians have believed for centuries, beauty is an attribute of God. Environments that bring beauty to patients or those in suffering and pain bring an incarnational presence of the healing God. Perhaps not surprisingly, the arrival of The Saint John’s Bible, containing modern abstract hand-painted images, ignited the spiritual imagination of employees and patients alike to a healing presence. Environments that offer beautiful natural views, art, music, poetry, human touch and the opportunity to spend time with animals, can open the spiritual imagination to healing in a way that allows God’s healing grace to enter.

The design team reviewed the qualitative evidence and compared it with existing studies of evidence-based design and scholarship in art and theology. The process resulted in an emerging sketch of attributes that characterize a healing environment.

An overarching attribute provides a measure for all other attributes. Simply put, a positive healing environment can be evaluated in terms of the end-state of a patient’s well-being, including senses of connection to people and community, lack of isolation, safety, A positive healing environment restoration, hope and trust. The oppocan be evaluated in terms of the site is true. Interactions that destroy or diminish this sense of well-being end-state of a patient’s well-being, inhibit healing.

A second attribute is the place of including senses of connection the spiritual imagination in creating to people and community, lack of a healing environment. Art, architecture, soft music and therapeutic touch isolation, safety, restoration, hope share a common effect with spiritual and trust. care and rituals in that they dispose a person’s spiritual imagination to something beyond their inner concentration on What needs to be stressed is the contrast pain and suffering. When a patient is isolated in between the volume of evidence-based design lithis or her pain, interventions that can spark the erature and design group observations and focus spiritual imagination provide a sense of hope and group feedback. Compared to the volumes of eviconnection. Mission integration staff initiated the dence-based design literature, there is much less qualitative research to gather information on the current research in the literature on the spiritual built environment, but that broadened to include aspects of healing, such as the place of sacraments, any means that ignites a person’s spiritual imagi- ritual, prayers and spiritual care. Consequently, nation, including spiritual care as well as tactile the role and importance of spiritual imagination elements that engage the whole person, body in healing is not squarely in the public eye. mind and spirit.

Theologians have long observed that the spiriA related thought is that interior design, archi- tual imagination opens a window to experiencing tectural elements, visually attractive images and beauty that draws the human spirit into places of other sensory prompts have the ability to unseat a comfort, joy, healing and wholeness. Therefore, person’s expectation and create a transformative any part of the built environment or of encounmoment. Inviting visual frames or images allow ters with others while in the health care setting for a particular kind of looking — a steady, intense can open the spiritual imagination, whether or absorbed form of vision. This promotes a pon- through visual aspects, calming sounds, rituals or dering where persons consider an image from therapies with art or pets. This healing cannot be various angles and ruminate on it. This is the limited to patients and their families alone, but it beginning of the spiritual imagination. The built should extend to our employees, who need pri-

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vate spaces to grieve and make sense of the difficult task of providing of health care to the sick and dying. Employees need places to recharge and fuel their own spiritual imaginations.

Trinity Health’s research began with the hypothesis that the investigation into a healing environment would produce a checklist of what should or should not be displayed within our ministries. What emerged was something much more significant. To create a healing environment, the most important action is to adopt a posture of mindfulness and discernment toward all physical and spiritual elements that contribute to a sense of healing and well-being. This mindfulness about how created reality mediates healing is central to Catholic identity. Catholics believe that God became incarnate and therefore all created reality is a means to make present God’s healing. Attention to the healing environment cannot be limited to clinical quality; our identity requires us to be intentional so that all that a patient sees, hears, touches, is an opportunity to mediate God’s healing presence.

Trinity Health aspires to be a transforming, healing presence in the communities we serve.

Trinity Health’s study of the matter made it more evident that a healing environment requires quality clinical care, but also a built environment that includes beauty, meaning and connection to open a person’s spiritual imagination through the senses. Gaining a deeper understanding of this phrase contributes not only to gaining clearer understanding of Catholic identity, but more importantly, to creating a transforming, healing

environment for those we serve and those with whom we serve.

PHILIP J. BOYLE is senior vice president, mission and ethics, Trinity Health, Livonia, Mich.

NOTES 1. Trinity Health views its work to enhance healing environments as part of a broader effort in Catholic health care to better understand how Catholic identity should be reflected in patient care. See for example, M. Therese Lysaught, Caritas in Communion: Theological Foundations of Catholic Health Care (St. Louis: The Catholic Health Association of the United States, 2014) and CHA Ministry Identity Assessment (St. Louis: The Catholic Health Association of the United States, 2018).

2. Trinity Health’s internal ministerial assessment process, called Promoting Catholic Identity, is based upon the framework for achieving performance excellence that is part of the Malcolm Baldrige National Quality Award program. The program raises awareness of quality management and evaluates the maturity of an organization’s core institutional qualities. In Trinity Health’s case, this includes being a healing presence.

3. For more on healing spaces, see Jennifer DuBose et al., “Exploring the Concept of Healing Spaces,” Health Environment Research & Design (2016): 1-14. Kimberly Firth and Katherine Smith, “2007 Survey of Healing Environments in American Hospitals: Nature and Prevalence” (Samueli Institute, 2007): 1-34. Jaynelle F. Stichler and Kathy Okland, Nurses as Leaders in Healthcare Design: A Resource for Nurses and Interprofessional Partners (Nursing Institute for Healthcare Design, 2015).

QUESTIONS FOR DISCUSSION Philip Boyle’s article concerns Trinity Health’s commitment to be a “transforming, healing presence” and the ministry’s effort to set about measuring, evaluating and proposing ways to keep true to that commitment.

1. Do you think “healing presence” is measurable? Who should be included in defining what healing presence means for your ministry? Would the criteria be uniform throughout the system or would it vary by geography, patient population or function (acute care, long-term care, etc.)?

2. Trinity’s mission team identified the characteristics of healing presence as excellent clinical quality, elements of evidence-based design in the built environment, and meaningful encounters with clinical and pastoral staff. Discuss your own experience of healing in terms of those three elements and what your ministry does to maximize healing presence.

3. Spiritual elements of healing, such as sacraments, ritual, art, music and prayer can engage the spiritual imagination. What opportunities does your ministry offer to patients and families to help spark spiritual imagination and pursue meaning as well as healing. What safe spaces and resources does your ministry offer employees to cry, grieve, decompress and make sense of the difficult work they do?

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Through a Glass Darkly

Healing and the Religious Imagination ZENI FOX, PhD

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he use of design to create healing environments draws upon many aspects of human creativity. One source is religious imagination, which is the capacity to envision the transcendent when perceiving a specific, concrete and earthly reality. Two examples — one from the Middle Ages that reflects traditional themes and one recent example focused on the contemporary world — allow for an entry point for the exploration of the relationship between healing and the religious imagination.

Years ago, the BBC created a video, “The Many Images of Christ.” It included one image of the crucifixion that depicted Jesus covered with sores from St. Anthony’s Fire, a disease that was a great scourge in medieval times. Known as the “Isenheim Altarpiece,” it is a triptych considered to be the German 16th-century painter Matthias Grünewald’s greatest work. It was commissioned by the Hospital Brothers of St. Anthony, an order founded for the purpose of caring for those suffering from St. Anthony’s Fire and the plague. The first step in the treatment of those coming to that German hospital was the prayerful contemplation of Grünewald’s painting, an invitation to see their own suffering mirrored in Christ’s suffering. That particular image of Christ invited the grievously ill person viewing it to enter into, to imagine the experience of Christ, who suffered and who also heals. Although it was created 500 years ago, the Isenheim Altarpiece can be seen as illustrating the essence of a Trinity Health project on healing design. Both explore the vital relationship between healing and the healing environment to foster healing spaces in health care settings.

A very contemporary example occurred in the spring of 2018, when the Metropolitan Museum

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of Art in New York City mounted the exhibition, “Heavenly Bodies: Fashion and the Catholic Imagination.” It drew the largest attendance of any exhibition there, ever.1 The exhibit opened with a quotation from the late Fr. Andrew Greeley, a noted sociologist and author, about the religious imagination: “Catholics live in an enchanted world: a world of statues and holy water, stained glass and votive candles, saints and religious medals, rosary beads and holy pictures. But these Catholic paraphernalia are merely hints of a deeper and more pervasive religious sensibility that inclines Catholics to see the Holy lurking in creation.”

There were two main parts of the exhibition; the first displayed sumptuous vestments and other liturgical objects lent to the Met by the Vatican. Another presented evening dresses and wedding gowns, reminiscent of depictions of Mary attired as Queen of Heaven, as well as other fashion inspired by more everyday ecclesiastical garb (such as soutanes, the garments worn by priests, and religious habits). The work of many prestigious fashion designers was represented.

One reviewer said, “For the 55 designers exhibited here, Catholicism is both a public spectacle and a private conviction, in which beauty has the force

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of truth and faith is experienced and articulated today, our modern society with all its gifts and through the body.”2 How cogent a comment, when challenges. The result: the pages include within focused on a health care setting — beauty, truth, them images of the Hubble telescope, the links focus on the body. The exhibit certainly “cap- of DNA and the flowers that grace the meadow tured the imagination” of the roughly 1.6 million and woodland around the Abbey. The illuminawho visited and contemplated it. This contemporary exhibition provided Although it is the project of Catholic another angle of vision on the Trinity project: the imagination, particumonks, they also envisioned the larly the religious imagination, brings work as a vehicle for ecumenical another dimension to the question of healing design. outreach to Christians throughout One focus point for Trinity’s the world.

Healing Design project is The Saint John’s Bible. The health care system purchased a copy of the Bible and displays the tions are very beautiful, but more, as Fr. Michael volumes in its health care settings. The devel- Patella, OSB, the project’s chair of the committee opment of this artistic masterpiece is in itself a on illumination and text has noted, “They are spirstory driven by the imagination of many people: itual meditations on a text. It is a very Benedictine in the envisioning of the project; in the way it was approach to Scripture.”5 brought to life; and now in its many pastoral appliAnd, this beautiful work of art, in seven volcations. It began with the desire of Donald Jack- umes, has indeed caught the imagination of great son, the Queen’s calligrapher who lives in Wales, numbers of contemporary people, Christians, to create the first handwritten and hand-illumi- yes, but many, many more. In various institunated manuscript of the Bible since the invention tions, copies are displayed, and each day a page is of the printing press. turned. Sometimes small groups of workers and The Benedictines of Saint John’s Abbey in Col- visitors gather to be present for a “page turning,” legeville, Minn., embraced the vision for the Bible; often marked with quiet or spoken prayer. Saint they desired to mark the turn of the millennium, Alphonsus Regional Medical Center in Boise, the beginning of the third millennia of Christian- Idaho, welcomed an edition of the Bible with a ity, in a special way, and this appealed to — yes, ritual pilgrimage through all the areas of the comtheir imagination. Their mission statement for plex; they reported that it “ignites hope and healthe project reads: “At the dawn of the 21st century, ing for patients and staff alike.”6 In addition, a travSaint John’s Abbey and University seek to ignite eling exhibition sponsored by Saint John’s drew the spiritual imagination of believers throughout great numbers of people, in different parts of the the world by commissioning a work of art that illu- United States. minates the Word of God for the new millennia.”3 Although it is the project of Catholic monks, they THE RELIGIOUS IMAGINATION also envisioned the work as a vehicle for ecumeni- It is significant that the name for the “”Heavcal outreach to Christians throughout the world. enly Bodies” exhibition highlights the idea of the Thus began a “collaboration between calligra- “Catholic imagination.” One review of the show phers, artists, theologians, historians and schol- explains that when the curator, Andrew Bolton, ars stretching across the Atlantic.”4 Calligraphers was planning the exhibit, “he found that a majorused quill pens, gold and platinum leaf and hand- ity of designers seemed indebted especially to ground pigments on vellum prepared from the Catholic imagery.”7 For this reason, the exhibitraditional source of sheep skins. At the same tion opened with a quotation from Fr. Greeley. time modern technology was utilized: computers He believed that the Catholic imagination was to plan the layout and the line breaks for the text, distinctive, most deeply rooted in the Church’s and modern communication means for conversa- sacramental life and its focus on story. In the late tions between the artists in Wales and the monks 1970s, a number of theologians were exploring the in Minnesota. The placement of and content for imagination.8 Greeley was convinced it was the the illuminations similarly sought to connect imagination that bound Catholics to the church. the past, the tradition, the text, with the world of Catholics’ lived conviction is that the transcen-

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dent, God’s very self, is glimpsed, made present or even experienced through earthly realities, such as water, bread, wine, oil, bodies (the sacrament of matrimony), family life (the domestic church) and human community. Greeley explored how Catholicism is rooted in the function of the imagination. Using his tools as a sociologist, Greeley expanded on this thesis in various ways, discovering links, for example, between an individual’s image of God and ongoing connection with church life.9 Though Greeley explored the religious imagination, especially the Catholic imagination, its “implications touch upon any form of imagination that deals with the transcendent —‘the question of how the absence of God becomes the presence of God.’”10 When we pause before or are arrested by a particular concrete, specific reality, at times our imagination invites us to glimpse, as through a glass darkly, the transcendent within which it resides.

THE SPIRITUAL IMAGINATION

extraordinary good news so powerful one must be changed by it if one is truly alive.”13 Oliver herself wrote: I don’t know exactly what a prayer is.

I do know how to pay attention, how to fall down into the grass, how to kneel in the grass, how to be idle and blessed ...14 Oliver does not link this experience with any religious tradition. I would say that she does indeed glimpse the transcendent (which, of course, is all one can ever do), but it has no name.

Oliver worked with words, the architect Steven Holl with space and structure. He designed the chapel at Seattle University, one of 28 Jesuit colleges/universities in the United States. He turned to two main sources of inspiration. First, St. Ignatius of Loyola, the founder of the Jesuits. Holl visited each of the sites central to Ignatius’ life and studied his writings. He noted that light and darkness were central themes. His second source of inspiration came from students. “I think there has been more student input on this job than any

Mary Oliver, a poet loved by great numbers of Americans, died Jan. 17 of this year. One obituary noted: “Her poems, which are built of unadorned language and accessible When we pause before or are imagery, have a pedagogical, almost homiletic quality. It was this ... that arrested by a particular concrete, seemed to endear her work to a broad specific reality, at times our public, including clerics, who quoted it in their sermons; poetry therapists, imagination invites us to glimpse, who found its uplifting sensibility well suited to their work; composers as through a glass darkly, the ... who set it to music ... Her poems ... transcendent within which it resides. are suffused with a pulsating, almost mystical spirituality.” Interestingly, the same obituary references critics who found other university project I have done ...” He said her work shallow.11 I would suggest that these con- he designed the space to be “forward looking, but trary views arise because of the nature of imagina- anchored in the past.” His guiding concept for the tion: it grasps things in their unique individuality design was “A Gathering of Lights” because of the and, in so doing, intuits that which is the depth way St. Ignatius’ vision of the spiritual life moves of the reality. Oliver perceived the depth of the between light and darkness. reality of the natural world, by focusing intently Light enters the space in multiple ways, on concrete, unique realities; for some readers, reflected off baffles, through colored glass; the the depth remains obscure. She said, “Attention alcove for the reservation of the Blessed Sacrais the beginning of devotion.”12 This is echoed ment has walls entirely covered in melted beesin the contemporary focus on mindfulness and wax, giving a luminous glow. A large reflection is an underlying reason why the iconography of pool is at the entrance. At night, lit from within, The Saint John’s Bible is so powerful in engaging the chapel is a beacon of light radiating outward the religious imagination in viewers. A reviewer to the campus and city.15 This artistic expression of one of Oliver’s books comments on the poem explicitly draws upon a religious tradition, the “Swan”: “The sighting of the swan constitutes, story of Ignatius, the components of liturgical to the poet’s mind, a revelation — a piece of space, the lived lives of students and their desires

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for their worship space; it is an expression of the religious imagination. (However, those who visit this space, who seek quiet or solace in this space, who pray in this space, may or may not glimpse the transcendent through it.) The dominant artistic element, light, is a universal natural symbol, and certainly has the potential of engaging the spiritual imagination.

IMPLICATIONS FOR HEALING DESIGN

of Mass, many worshippers gathered in the space below each statue of Mary. They brought flowers, some knelt, all were quietly present to a religious representation which, it seemed, truly engaged them in prayer, appealing to their religious imagination. The church was “alive” as a place of encounter with the transcendent, through the images of Mary.

A teaching from the Second Vatican Council provides a context for approaching the task of healing design in Catholic facilities. The Dogmatic Constitution on the Church places emphasis on the presence of God in the lives of all persons of good faith, even those who have not yet arrived at an explicit knowledge of God. Furthermore, “Whatever good or truth is found amongst them is considered by the Church to be a preparation for the Gospel … and given by God who enlightens all that they may at length have light.”16 Artistic representations drawn from the Catholic past, when placed

This article has focused primarily on visual representations that engage the religious and/or spiritual imagination. Of course, many other elements could be considered, such as an appeal to the other senses, perhaps especially sound. From the narrower focus on visuals here, there are many implications for the healing spaces project Trinity Health has been exploring.

An initial consideration is that Western, Christian culture, which provided continuity with a long tradition of religious stories, symbols and artistic representation, The dominant artistic element, no longer provides the dominant “past” that, for example, The Saint light, is a universal natural symbol, John’s Bible and the chapel at Seattle and certainly has the potential of University draw upon. Furthermore, today, the “present” is more fractured. engaging the spiritual imagination.

Our cultural references are more varied. Representation that draws only on the past does not have the potency, for most in dialogue with today’s world, have the potenof our contemporaries — especially the young — tial to engage the religious imagination of many that it once did. The kind of deep engagement with people (patients, staff and visitors), Catholic and the past, in dialogue with the present as described others. Artistic representations from the natural in the examples above, is essential if visual artistic world and contemporary life (see, for example, representations are to engage the imagination of The Saint John’s Bible illustrations referencing the people in today’s culture. And there is an added images from the Hubble telescope and of DNA, challenge: our self-consciously aware multicul- or the many beams and artifacts saved from the tural society. conflagration of the World Trade Center) have the Two specific spaces illustrate the complexities potential to engage the spiritual imagination. In of this task. The first is a chapel in a nonsectarian both cases, healing is invoked, as it was with the hospital that includes symbols from Christianity, Isenheim altar.

Judaism and Islam arranged so that one can sit The creation of The Saint John’s Bible was to face any one of these. The space is cramped, the collaborative work of many individuals and poorly lighted and rather ugly. The symbols are groups, linked in their desire to design and execute the most stereotypical from each tradition. In my an artistic work with deep pastoral resonance. judgment, this chapel provides a place of quiet, The task of creating artistic representations for which is welcome, but does not engage the reli- Catholic health care settings requires exactly this gious, nor spiritual, imagination. One could say it collaboration: seeking themes that will link past has no heart. The second is a church in Los Ange- and present at the service of healing and finding les. Around the walls, there are varied representa- these themes translated into paintings, sculptures tions of Mary, each from a different South Ameri- and other visuals that invite contemplation. The can country. There is also a small chapel for the pursuit of such spaces and images also has a larger reposition of the Blessed Sacrament. At the end social role. It will help to nourish the imagination

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of those involved in its execution, and those who will meditate on its expressions. This is a vital task in our modern, technological society, because the imagination “requires a nourishing environment or it will atrophy–[because] imagination is at the heart of the question asked by any religious leader.”17 The hope is that Trinity Health’s project will not only aid the healing of individuals, but through the power of the religious imagination, will contribute to the healing of modern society.

ZENI FOX is a member of the Ascension Sponsor.

She is a professor emerita of Immaculate Conception Seminary, Seton Hall University in New Jersey.

She has lectured and written extensively on lay ministry and the spirituality of the laity. Called and Gifted: Toward a Spirituality for Lay Leaders, which she co-edited with Sr. Regina Bechtle, SC, is widely used in ministry leadership programs.

NOTES 1. Eliza Brooke, “A Fashion Exhibit Just Became the Met Museum’s Most Popular Show Ever. Here’s Why,” Vox, Oct. 12, 2018, www.vox.com/thegoods/2018/10/12/17965642/heavenly-bodiesmetropolitan-museum-of-art-fashion-exhibit. See also the Met’s website, https://www.metmuseum. org/exhibitions/listings/2018/heavenly-bodies/ exhibition-galleries-met-fifth-avenue.

2. Jason Farago, “’Heavenly Bodies’ Brings the Fabric of Faith to the Met,” The New York Times, May 9, 2018, www.nytimes.com/2018/05/09/arts/design/heavenlybodies-met-costumes.html.

3. The Saint John’s Bible website, www.saintjohnsbible. org.

4. The Saint John’s Abbey website, www.saintjohnsabbey.org/monastic-life/abbey-spirituality1/ saint-johns-bible/.

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5. Susan Sink, The Saint John’s Bible: An Introduction, (Collegeville, MN: Liturgical Press, 2008), 14. This quote is also found at www.saintjohnsbible.org/promotions/ process/principles.htm.

6. The Saint John’s Bible website. An executive at Saint Alphonsus Medical Center also shared the story of the Bible’s arrival with the author.

7. Leo J. O’Donovan, “The Fashion of Faith,” National Catholic Reporter, May 26, 2018, www.ncronline.org/ news/media/fashion-faith.

8. See for example, Walter Brueggemann, The Prophetic Imagination, (Minneapolis: Fortress Press, 1978).

9. Andrew M. Greeley, The Religious Imagination, (New York: Sadlier, 1981).

10. “Introduction,” Through a Glass Darkly: Essays in the Religious Imagination, John C. Hawley, ed., (New York: Fordham University Press, 1996) xii-xiii.

11. Margalit Fox, “Mary Oliver, 83, Prize-Winning Poet of the Natural World Is Dead,” The New York Times, Jan. 17, 2019, www.nytimes.com/2019/01/17/obituaries/maryoliver-dead.html.

12. “ Mary Oliver on Grief and Loss,” The New York Times, Jan. 19, 2019, https://www.nytimes.com/2019/01/17/ books/mary-oliver-grief.html.

13. Angela Alaimo O’Donnell, “Mary Oliver’s Good News,” America, Nov. 1, 2010, https://www.americamagazine. org/arts-culture/2010/11/01/mary-olivers-good-news.

14. Mary Oliver, House of Light (Boston: Beacon Press, 1990). The poem is “The Summer Day” https://www.loc. gov/poetry/180/133.html.

15. Information from the Seattle University website and from explanatory material provided at the chapel, https://www.seattleu.edu/chapel/.

16. Lumen Gentium, Dogmatic Constitution on the Church, Article 16, Second Vatican Council, 1964, www.vatican.va/archive/hist_councils/ii_vatican_ council/documentsvat-ii_const_19641121_ lumen-gentium_en.html.

17. Through a Glass Darkly, xii.

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‘Holy Seeing’

From the Art of The Saint John’s Bible BARBARA SUTTON, DMin

“W

ould you like to see the Word of God dance on a page?” calligrapher Donald Jackson asked the monks of Saint John’s Abbey when he solicited their sponsorship for The Saint John’s Bible in 1998. With a discerning spirit, they commissioned the first handwritten illuminated edition of the Bible in 500 years.

The process of illuminating passages in this Bible used the monastic practice of lectio divina: a careful reading of the text, looking at each detail of word choice or phrasing and letting the inspiration sink in and become something new for the 21st century.

The practice of visio divina or “holy seeing” also serves as a method for praying with The Saint John’s Bible. Using six steps — listening, meditating, seeing, praying, contemplating and becoming Christ-like — I invite people to see the Scripture with the eye of their heart and to fix their sacred gaze on an illumination of the Bible. Formation programs, health care centers, campus ministries, retreat centers, religious communities, parishes and interfaith communities as well as individuals seek out visio divina for their own spiritual practice.

Drawing from the beauty of the Bible text and its images, the practice holds the possibility to stir the memory, to contemplate the messages of the Scriptures and to stimulate our spiritual senses, drawing us closer to the Paschal mystery.

It is a particular kind of looking, a steady, intense or absorbed form of seeing and pondering with the eyes of faith. Participants ruminate on the passages from various angles. The pondering becomes prayer when the reflection arises in a mind that is open to God. Visio divina is a prayer process that has unexpected outcomes, such as bringing a corrective

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Resurrection

healing or affirmation that is stirring in one’s life or in society. The decision to include the faces of women in The Saint John’s Bible was for the very sake of healing. The faces of biblical women often

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are omitted from the Sunday lectionary, and by illuminating their faces The Saint John’s Bible is able to bring us face to face with these holy women. The stories of “holy seeing” are many.

One young woman prayed with the Resurrection illumination and came to know Mary Magdalene as the first to go and tell the good news of the Resurrection. The woman exclaimed, “Is that true?

Is Mary of Magdala the first disciple?” While it is seemingly a catechetical moment, it was also a healing moment for this young woman. She decided, “Then I am going to read the Bible.”

Sacred art does not just nurture only the patient, but the patient’s family and friends, doctors and care teams, and all who walk the hospital halls and play important roles during key moments in a person’s healing journey. The people who work the night shift at Saint Alphonsus Regional Medical Center in Boise, Idaho, had their hearts awakened when they were able to see themselves and their work in a new light during the Christmas season. They were the first shift at the hospital to be presented the Christmas story illuminated in The Saint John’s Bible as it traveled throughout the hospital on a moveable cart. The night workers, like the shepherds who kept watch in the night in Bethlehem, were first to see and reflect the light of Christ in their faces.

Pope Francis told an audience in 2016 that beauty, under the care of artists, has the ability to transform even the everyday lives of men and women.1 Visio divina as a contemplative prayer practice holds the possibility of healing one’s self and relationships. For example, research indicates it holds the possibility for one to be kinder, more sensitive, more open to others and less self-centered. As one begins the discipline of developing a sacred gaze and holy seeing, he or she may be less prone to violent reactions in the face of unpleasant situations. They gain perspective and become more open to how others see the world. Visio divina evokes a greater awareness that God lives in us and in those other people we meet on the margins.

It can, as Pope Francis said, “shine beauty especially where darkness or gray dominates everyday life … simple actions, small sparks of beauty and love” shown to the environment in which people live can bring healing and provide an alternative to indifference and cynicism.2 Visio divina creates sanctuary space for people to express and interpret their own spiritual journeys toward healing. The Saint John’s Bible’s illumination for Creation, which used collage to rep-

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resent the seven days of creation, invokes a spiritual framework for busy people who are overly committed. The seventh day, the Sabbath, is a panel filled with shades of gold, which was chosen to represent the divine mystery of God. The visio divina process allows us to know ourselves better. How many of us can lay claim to a Sabbath that is void of anything other than an immersion in the life of God? The response to this question

Birth of Christ

is typically a gesture like an eye roll or the shaking of a head, that I interpret as “no.” In the “no,” a transformative moment emerges, shifting the emphasis from the interior life of the artist to the interior life of the viewer. When contemplating this image with others and probing deeper, I can point to the seven panels that are hinged with gold boxes, moving from left to right, the number of boxes increases incrementally by one. Are our days hinged on God? Are we able to see the movement of God’s life through our week? Or do we resist exploring these moments? Do we want more gold in our days? What is the cost for more golden moments in our lives?

Often there are surprise moments in visio divina as the process releases emotions not sitting on the surface. It may call forth ancient tears.

So it was for the first time a young woman fixed

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her sacred gaze on the illumination The Resurrection, in which Mary of Magdala stands face to face with the resurrected Jesus, their sacred gazes fixed on one another. Mary dons a red garment, and Jesus is robed in shades of royal purple. In a visio divina process, the woman noticed Mary Magdalene was wearing red, and this recalled the woman’s mother, who loved to wear red and looked beautiful in it. But, the young woman said, her father was a jealous man and refused to let her mother wear red because of its association with the color prostitutes wear. Because of this, the young woman was disturbed that Mary of Magdalene would be dressed in red. The young woman’s encounter with the illumination reawakened memories of her relationship with her father. In a healing moment, she was able to shed her childhood assumptions and heal the memory imposed by her father. She chose a vibrant red Easter dress to celebrate the Resurrection on Easter Sunday.

Praying with sacred art can transform a com-

Woman Taken in Adultery

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munity as well as an individual. It can reveal to the church and to society what they most need to see. I witnessed this twice with the illumination the Woman Caught in Adultery. The first was at a Mother’s Day retreat sponsored by the Visitation Sisters of Minneapolis. The second was with an alumni group of men who had studied for the priesthood.

A small group of women living in the neighborhood prayed lectio and visio divina with the image for the Woman Caught in Adultery. A young woman played the main character as the group acted out the scripture text. Later, her story emerged. She had recently given birth to her third child. Out of fear, and not knowing for certain the baby’s father, she placed the baby for adoption the week before the retreat. Days following the retreat, I received a heartwarming call to tell me that she sought to regain custody of her baby and was successful. Through the retreat she was able to see her life differently. She knew for the first time that she was loved by God and the community of women gathered. She now believed in her ability to be a mother and to love this child.

The community of women served as a window to the sacred healing power of the Gospel during the retreat and their care for this young, vulnerable mother transformed her life.

A year later, I had a second opportunity to use this illumination with an alumni group of men who had studied for the priesthood. While it is tempting to recycle an old reflection, I couldn’t because visio divina provides an opportunity to see with new eyes, as it did for me and the men gathered. In my sacred gaze that time, I noticed my resistance to those men on their pedestals throwing stones at the woman, thinking, “how dare they?” I even felt a little smug when Jesus said, “Let anyone among you who is without sin be the first to throw a stone at her.” I visualized them leaving the scene, one by one. In my lectio divina, the phrase that stood out for me was “such women” when the scribes and Pharisees said to Jesus: “Moses commanded us to stone such women. So what do you say?” These two words, “such women” made me feel the contempt and utter disregard the phrase conveys in this context because they isolate and objectify the woman. We have often heard or referenced “such women” in a negative light. For example, “such women” just want power, or “such women” want to be ordained deacons or priest. What did these words and this illumination mean for the clergy gathered? What did it mean for me?

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My heart took a turn and was arrested with a profound image that I couldn’t relinquish. What if the woman caught in adultery was the personification of Holy Mother Church? What if I was the man, asking the same question he asked of Jesus, “What do you say?” I began to think of how I can be so quick to judge Holy Mother Church at times.

I set myself above her, casting a complaint or judgment on any number of modern-day offenses: misuse of power, abuse and sexism, lack of financial transparency and parish closings. It is so very hard at times to let go of the stones and walk away.

Adam and Eve

Am I willing to get off my pedestal and lay down my stones and be a part of rebuilding the church?

Some alumni wept, others bowed their heads in contrition. Have we failed to fully embrace the challenge of the Gospel — and struggle to fully receive and believe in the radicalness of the non-

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condemnatory love Jesus has for each of us? For those of us who struggle to embrace our own particular darkness, our own particular brand of infidelity, I invited them, and myself to see the church in a new way and consider a journey of healing from shame and sadness to instead accept the invitation to cross the threshold of the door of mercy once again into the life of God. As Jesus gently confronted this woman and released her from condemnation, he challenged her as well. He does the same for us. He draws the curtain aside and asks us to walk in the light of his way. Those stones, thrown by men on high, could be used differently, to build safe sanctuaries or to bridge divides. We make decisions with our stone walls, choosing whether to build a wall of contempt, let the walls crumble and collapse, or to put the stones together and rebuild.

In the crucibles of our lives, lectio and visio divina prompt people to see their lives differently. And yet, the challenge for those who are often in need of healing is that this prayer form is not accessible. It requires the art of accompaniment by one who will illuminate the story of God for others. The art of accompaniment can show a person something that is not physically seen.

I accompany a woman with memory loss and her family. Jeanne lives in a long-term care center.

Art and beauty engage her and have been a way for her to communicate and express herself. For example, a health care worker placed a chrysalis in a glass jar in her room, which she calls home.

Metamorphosis happened before Jeanne’s very eyes. Together on a spring day, Jeanne and her husband released the butterfly, which gently came back to land on their hands. The moment with the butterfly was transformative, a symbol of their enduring love. This moment required silence, words would stumble and fail.

Days later I introduced The Saint John’s Bible illumination at the end of Mark’s Gospel, which includes a milkweed plant with each process of metamorphosis for becoming a butterfly: the egg, the caterpillar, the chrysalis and the butterfly.

The illumination depicts the abrupt ending of the Gospel, after the resurrection, when the disciples were told, “Do not be alarmed, you are looking for Jesus of Nazareth, who was crucified. He has been raised; he is not here. Look, there is the place they laid him. But go, tell his disciples and Peter that he is going ahead of you to Galilee; there you will see him, just as he told you.” This illumination sparked a discussion with Jeanne of the many ways Jesus can change us, transform us. Jesus

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can turn bitterness into peace, her, “we are in the Bible.” She hatred into love, anger into joy, was dazzled and delighted. I and sinners into saints. Jesus knew in that moment the Scripturns people who feel meantures were no longer depleted ingless into people who know for her and had become a healthey matter. And Jesus turns ing force. death into new life. Something It is when we see with our clicked for Jeanne simultaneheart that we can find beauty ously on every level. The rush in everything and see a word of aesthetic pleasure was visdance, even in death and sickible. With this encounter of ness. Our spiritual senses illubeauty, love opened her eyes. minate the Gospel not only It happened again and again in the Bible alone, but in butfor Jeanne as each grandbaby terflies, grandmothers, Holy was born. Unable to visit the Mother Church, adulterous baby, Jeanne waited patiently women, men on high, vibrant until the new family was able fabrics and in our silence. to visit. Meanwhile we prayed with the illumination of The BARBARA SUTTON is the direcBirth of Christ and as a response tor of ministerial formation Jeanne chose magazine images and field education and on the and made a soulful collage for faculty of Saint John’s School the newborn and together we of Theology and Seminary, composed a poem. Each time Collegeville, Minn. She directs she marveled at her own art the Seeing the Word curricuand said, “I did that?” Through lum project for The Saint John’s the act of contemplation and Bible.

Milkweed and Butterfly creating art, the windows into Jeanne’s emotions and thoughts gave rise to her Resurrection, Donald Jackson, Copyright 2002; Birth of joy and accomplishment. She made art, holy cards Christ, Donald Jackson, Copyright 2002; that will tell the story in years to come of a grand- Woman Taken in Adultery, Aidan Hart with contributions mother’s love for her grandchildren. from Donald Jackson and Sally Mae Joseph, Copyright The Saint John’s Bible reflects a contemporary 2002; Adam and Eve, Donald Jackson, Copyright 2003; multicultural society far removed from its medi- Milkweed and Butterfly, Chris Tomlin, Copyright 2002; eval predecessors. The illuminations include The Saint John’s Bible, Saint John’s University, Collegimagery from other sources such as science, techeville, Minnesota USA. Used by permission. All rights nology, Eastern religious traditions and Native reserved.

American images. Many illuminations emphasize women, neglected people and those who are poor. NOTES At the heart is God’s global message of hope and healing for all time, for all peoples, for all gen- 1. Hannah Brockhaus, “Pope Francis: Through Beauty, erations, and over all history. The painted faces Artists Make the World Better,” Catholic News Agency, of Adam and Eve in the Garden of Eden speak of Dec. 7, 2016, https://www.catholicnewsagency.com/ humanity’s desire to be alive. This illumination news/pope-francis-through-beauty-artists-make-theserves as a mirror, and Jackson, the calligrapher, world-better-89502. writes “Adam and Eve are mirrors of us.”3 In a holy 2. Brockhaus, “Through Beauty.” moment, I observed a hospital chaplain, an Afri- 3. Susan Sink, The Art of The Saint John’s Bible: The Comcan-American woman, fix her gaze on Adam and plete Readers Guide (Collegevillle, MN, Liturgical Press, Eve. She told me she had called her mother to tell 2013), 10-11.

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Viktor Bohuslav Bohdal / Shutterstock.com

Finding God in Daily Life Against the backdrop and in the context of the great problems of our time, theology and art must therefore continue to be animated and elevated by the power of the Spirit, which is the source of strength, joy and hope.

Nov. 17, 2018, Vatican City, Pope Francis’ comments at the awarding of the Ratzinger Prize.

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The Design Imperative: An Antidote for Clinical Compression KATHY OKLAND, RN, MPH, EDAC

S

eeking care, you enter. You are not alone. Others also are scheduled for appointments today. You step back and wait your turn. Now registered as a patient and with papers in hand, you take a seat in a sea of chairs. Television, telephones, texts, and the traffic of staff, couriers and carts create their own noise, each taking a piece of your peace away.

Supporting care, you assist. You are family, friend — a visitor to a health care setting. You are surrounded by a milieu of players consumed by their own conversations, circumstances and matters requiring coordination; all are navigating details and decisions that include translation, interruptions and distractions. Layer by layer, tension builds. Meanwhile, you long for simplicity amidst an industry of inherent complexity.

Delivering care, you respond to patient, family and system demands. As the knowledgeable practitioner responsible for the optimal experience, you, like patients and families, seek peace and simplicity. The physical and psychological demands numb your senses and dull your attention to the noise of alarms, communications and the cadence of activity.

Whether it’s the patient, family or provider experience, health care complexity drives fragmentation and frustration. Does this describe your experience in a health care setting? Has the obvious become invisible? Do you acknowledge stressors from activities and the environments in which they occur? How can awareness be elevated to expose the conditions that lead to clinical compression — greater demands on providing care with fewer and often changing resources?

What can be learned from the environment when

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factors that cause stress exceed human adaptive capacities? As every available resource at health care employees’ disposal is being leveraged for operational effectiveness, it’s time for greater awareness of the health care environment and its impact.

THE CHARACTERISTICS OF A CLINICIAN

Health care workers, including nurses, physicians and pharmacists, continue to earn Gallup poll’s highest ratings from Americans for their honesty and ethical standards. For instance, more than 4 in 5 Americans rate nurses as “very high” or “high,” earning them the top ranking among a diverse list of professions for the 17th consecutive year in 2018. At 3.5 million strong, nurses represent the largest segment of the nation’s health care workforce. There are many motivations to pursue this caring profession. Nurses tell of their own experiences with illness or those of a loved one, of the inspiration to ease human suffering, or simply the spiritual calling to serve. Nurses seem to be selfless by nature. As caregivers, nurses are known to prioritize the needs and care of others in lieu of their own. With this sense of altruistic purpose, how does the human spirit compete with the psychological and physical demands that the delivery of health care imposes?

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CLINICAL COMPRESSION AND CAPACITY

Contemporary clinical practice is challenging and complex. Medical advances and the technology explosion require learning and unlearning at the speed of change. This drives endless re-engineering of an enterprise created for a model of care that no longer exists. Clinical compression is produced by doing more, better, faster and with fewer and changing resources to support it. Clinicians overcome extraordinary complexities amidst extreme constraints; their efforts may, in turn, conceal the true nature of the environment’s insults and shortcomings. Stress results from responding to these realities. Left unchanged, care providers experience a diminishing and evernarrowing band of their emotional and physical faculties, affecting the capacity for care — and the capacity for who they are as caregivers. At the end of the day, clinicians are human beings caring for human beings.

Evidence continues to mount regarding the symptoms of clinician stress. The Institute for Healthcare Improvement’s 2017 white paper, Framework for Improving Joy in Work, notes that if burnout in health care were described in clinical or public health terms, it might be called an epidemic. Nearly half of nurses exhibit substantial symptoms of work-related burnout.1 Many factors, latent and active, system and individual, interact to cause patient safety incidents. Human factors are important contributors, and recent research indicates the importance of staff wellbeing.2 Thus, there is reason to explore every available resource to remedy this reality.

Health care leadership has never been more committed to employee engagement, retention and well-being. Many health care systems have

Emphasizing the importance of relationships, team building and well-being is essential in a caring ecosystem. measures that support work-life balance, collaborative staffing models, shared governance and the development of contemporary leadership competencies. These competencies include support and advocacy for interprofessional practice partnerships, applied evidence that informs decision-making and systems thinking to improve the

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full continuum of care. Yet clinicians around the world are stressed, overworked and burned-out.

According to Abraham Maslow’s hierarchy of needs, individuals can’t reach their full potential if they are struggling with basic needs.3 Emphasizing the importance of relationships, team building and well-being is essential in a caring ecosystem.

While increasing emphasis is placed on programs that enhance engagement and performance, there is an alarming absence of attention to measures that address the impact the physical environment can have on human experience and performance. At the same time, a growing body of knowledge suggests that the physical health care environment can greatly contribute to health professionals’ overall experience by either supporting or inhibiting work performance, staff safety and occupational stress, as well as job satisfaction and retention.

THE CLINICIAN AND THE ENVIRONMENT OF CARE

Consider the settings where care encounters occur. It is sacred ground. Patients trust their vulnerabilities and imperfect natures to others for intervention, in hopes for a better well-being.

The relationship is not entirely unlike that of a pastor and a parishioner. The history of the great religions reminds us of the redemptive qualities of our sanctuaries, our cathedrals, tabernacles, monasteries and temples. These holy places are designed to create the conditions for receiving and believing, as if to prompt healing of a different kind — the soul. How might we learn from that?

We live in a physical world, experiencing the world through our senses. Some 90 percent of us spend 90 percent of our time in, near, or influenced by the built environment.4 Empirical studies show that 10 percent of what determines the quality of individuals’ health is their physical environment.5 The “health of houses” described

by Florence Nightingale in the 1860s addressed, even then, ways that the environment defends health, prevents disease and protects caregivers.6 We are indelibly connected to our surroundings. Buildings “hold” us, suggesting they can be a physical and a psychological refuge for health and healing. But, like a body, a building cannot heal on its own.

DESIGN LITERACY

Those who embrace space as a clinical specialty are committed to the cause of greater environmental awareness. Yet, as important as environ-

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ment is to care, many academic institutions lack been focused on the “where” of care. The location, curricula to provide this knowledge to today’s the place where care is given — that space matmedical professionals. When students are intro- ters. Greater awareness is a necessary antecedent duced to health care disciplines, the “environ- for progress in the movement to raise the design ment of care” often defaults to The Joint Com- imperative as equal to the therapeutic imperative. mission standards of compliance related to fire, Who better than nurses or clinicians to be an intesafety and regulatory readiness. If practice stan- gral part of designing the care experience — and dards enhance outcomes, then shouldn’t facility the environments of care? standards related to the built environment do the same? Today, The Joint Commission is to clinical ENVIRONMENT AS AN EXTENSION OF HEALING best practice what the Facilities Guidelines Insti- As prevailing pressures challenge clinical perfortute is to health care facility design best practice. mance, the emergence of environments to combat Conceived in the Hill-Burton era, when the law fatigue and burnout are worth highlighting. While supported the construction of more hospitals no single design intervention will produce signifiand clinics in the nation, the Facilities Guidelines cant and sustainable results, a compelling quesInstitute exists to guide best practice in the health tion to ask is “do our design decisions make care care built environment. As an independent non- more, or less, human?” It is critical that the design profit informed by practicing experts in research, supports the caregiver’s ability to provide safe design, operations and construction — the insti- and effective care to every patient, every time.7 tute produces minimum standards for health care facilities.

While no single design intervention Clinical best practice is accepted as evidence-based practice. In the 1980s, a will produce significant and seminal study by Roger Ulrich correlated sustainable results, a compelling the reduced post-operative length of stay to room settings with a view of nature. question to ask is “do our design As a result, evidence-based design was born. Today, there are over 1,500 sciendecisions make care more, or less, tific articles that link physical design to human?” health care outcomes. This emerging science elevates the industry, the importance of research and the responsibility of the proLet’s take a typical break room on an inpatient fessionals who commit to planning, design and unit as an example. According to building code, construction of health care facilities. health care environments require staff lounges Knowledge is power. For clinicians seeking to or break room areas. There is a consensus that understand, network and collaborate as health clinical care environments are cluttered and chacare design evolves, the Nursing Institute for otic. Try this challenge: tour a break room, and Healthcare Design is the voice for leadership, edu- it’s likely the clutter and chaos is worse. In most cation and advocacy. In just a decade, this organi- cases, the settings are a complete contradiction zation has earned the reputation as a trusted advi- to the perception of “a break.” These rooms often sor to the Facilities Guidelines Institute and the serve multiple purposes, from food preparation Center for Health Design communities, as a part- (refrigerator, microwave, sink, food storage and ner and resource providing clinical points of view more), restroom facilities and locker storage. on planning for the design industry and academ- They post employee announcements, community ics. These organizations exist to improve health signage, team memorabilia, reference materials. outcomes by leveraging design. The work shapes They often have a television, entertainment for the future of health care environments. some, noise to others. Break rooms that include If we know this, then why do so many of our a window, natural light, comfortable seating and health care environments remain essentially adequate locker capacity — features that many unchanged? If the design of the built environment workers appreciate — might almost seem to be makes such a difference, why don’t we think more a luxury. According to the Facilities Guidelines about it? Policies, protocols and practices con- Institute, lounge facilities should be no less than stantly change — but the same awareness has not 100 square feet (9.29 square meters). A 10-foot by

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10-foot room serving multiple staffers and multi- and the International Association for Healthcare ple functions is hardly sufficient space to support Security and Safety in its design guidelines. Suga sense of separation from constant stimuli. gested attributes of “staff rest area” environments This example highlights not only the norm, but include: access to daylight the need for attention to design features in health views of the outdoors care environments. Architect Adeleh Nejati, PhD, restricted from public access surveyed 1,000 medical surgical nurses for an evi readily accessible to the work unit dence-based design study. She investigated the independent from staff on-call rooms main restorative components of staff break areas carpeting for noise control in health care facilities and the features of break a single residential bed areas perceived as being well-designed by those storage space for linens who used them. The results revealed that staff break areas are more likely used if they are: The terminology can be confusing. A medita in close proximity to the patient care tion room, staff lounge, break, respite or on call assignment room, are not one and the same. Elevating aware allow for complete privacy from patients and ness and advocating for areas that support harfamilies mony and wholeness is not only necessary, but accommodate individual privacy or social- essential to restore the human spirit for healization with co-workers by choice ing. Further, this article includes a call to action support access to outdoor spaces compared for leadership to champion support of it. Health to window views, artwork or indoor plants care systems or facilities that rethink restoration There is nothing about this study that is a rev- spaces can start with considering privacy, beauty elation — other than that the current state of break environments is clearly Health care as an industry would very different from the preferred state. Instead, it shows nurses and do well to support research which other clinical staff have fundamental points to design features that and simple desires for break areas.

It reinforces the innate human need should be replicated and workplace for peace, privacy, nature and choice.

Surroundings affect the quality of the cultures that are supportive of experience. “When one designs someon-site restorative spaces. thing, they do not design only objects, or only buildings — they design the life of people. And this understanding cannot be and simplicity. For reasons already identified, the cut away from the design perspective.”8 Accepting conventional approach to an environment for the environment’s influence upon human behav- breaks does not align with the healing environior, there is reason to include restorative design ments we espouse to create. elements as an antidote for seemingly unavoidable noise, clutter and chaos. Health care as an CONCLUSION industry would do well to support research which At the center of the patient experience is the carepoints to design features that should be replicated giver experience. Workplace design has a signifiand workplace cultures that are supportive of on- cant impact on clinician behaviors, attitudes and site restorative spaces. well-being that then influences clinical practice The 2018 Facility Guidelines Institute “Guide- and health outcomes. Further, health care is long lines for Design and Construction of Hospitals” overdue in completely recognizing how critical brings in to clear view the importance of sup- well-designed clinical environments are for treatport areas for staff. The spaces are called “staff ment and well-being and how important it is for rest areas” and should be provided to every unit the culture to support them. that assumes care for patients overnight.9 OrgaAccording to architect Frank Gehry, “I nizations that support such spaces include The approach each building as a sculptural object, Joint Commission, Veterans Health Administra- a spatial container, a space with light and air, a tion, Agency for Healthcare Research and Quality, response to context and appropriateness of feel-

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ing and spirit. To this container, this sculpture, the user brings his baggage, his program and interacts with it to accommodate his needs. If he can’t do that, I’ve failed.”10 People and places possess the capacity to heal.

Ideally, whether one seeks care, supports care or delivers care, all will realize that the design imperative of the health care environment is not selfindulgent, but rather self-evident.

KATHY OKLAND is a nurse and author who calls space her specialty and calls Spirit Lake, Minn., her home. She serves as senior healthcare consultant to Herman Miller Healthcare with a goal of elevating clinical design literacy. Okland is credentialed in parish nursing, nursing home administration and is past president of the Nursing Institute for Healthcare Design.

NOTES 1. Jessica Perlo et al., “IHI Framework for Improving Joy in Work,” IHI White Paper, (Cambridge, MA, Institute for Healthcare Improvement, 2017), www.ihi.org/ resources/Pages/IHIWhitePapers/Framework- Improving-Joy-in-Work.aspx.

2. Louise H. Hall et al., “Healthcare Staff Wellbeing, Burnout, and Patient Safety: A Systematic Review,” edited by Fiona Harris. Plos One 11, no. 7 (July 8, 2016). https://doi. org/10.1371/journal.pone.0159015.

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3. The Advisory Board, “Cracks in the Foundation Undermine Nurse Resilience,” 2018, www.advisory.com/ research/nursing-executive-center/resources/posters/ nurse-resilience.

4. Christopher Day, Places of the Soul: Architecture and Environmental Design as Healing Art, 3rd ed. (New York: Routledge, Taylor & Francis Group), 2014.

5. Carlyn Hood et al., “County Health Rankings: Relationships between Determinant Factors and Health Outcomes,” American Journal of Preventive Medicine 50, no. 2 (Feb. 2016): 129-135.

6. Florence Nightingale, Notes on Nursing: What It Is, and What It Is Not, (New York: Dover Publications, 1969).

Reprint of the 1860 American edition.

7. Jaynelle Stichler and Kathy Okland, eds. “Nurses as Leaders in Healthcare Design: A Resource for Nurses and Interprofessional Partners,” (Herman Miller, Inc., Zeeland, MI, 2015): 58.

8. Amanda Dameron, “Michele De Lucchi,” Dwell, May/ June 2017, 34.

9. Facility Guidelines Institute, “FGI Guidelines for Design and Construction of Hospitals,” 2018, www.madcad. com/library/FGI-Guidelines-Hospital-2018/.

10. This Frank Gehry quote is from Blueprint, Nr. 90-92, 1992. Retrieved from www.celebritysociety. com/FRANK_GEHRY__A_Visionary_Beyond_A_ Blueprint?pg_view=2. See also Melanie Sommer, “Frank Gehry: Architect as Sculptor,” MPR News, Jan. 19, 2007, www.mprnews.org/story/2007/01/19/gehryprofile.

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Healing Garden Fosters A Heart of Love JIM RICHTER, MA

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tooping down to be on eye level with her patient in the wheelchair, the therapist lightly rested her hand on his knee. The two engaged in conversation and soon both were laughing, enjoying a warm spring morning in the healing garden at Mercy Health Anderson Hospital in Cincinnati. The physical therapists working in Anderson Hospital’s acute rehabilitation unit look forward to bringing some of their patients outside for therapy, or even just some fresh air, when weather permits. On this day, the therapy included exercises working some joints, especially the knee — a replacement knee, I assume.

When Anderson Hospital leadership contemplated a campus expansion in 2015, they recognized an opportunity to incorporate some special features as part of the construction and remodeling. There is a hill behind the hospital, so the only realistic place to expand was in front of the existing structure. In keeping with the then-emerging Mercy Health style for new towers, a five-story, rounded front tower was built, completing a circle of sorts — connecting to the original A and B wings. The design created space in the middle of the circle which was perfect for a courtyard or, better, a healing garden.

As the initial excitement about a healing garden space settled into the reality of budgets and construction limitations, several key people began very intentional work designing the layout and features for the garden, the chapel and the new lobby areas. They also had the task of selecting the sacred art that would be used in each of those areas. The goal was not so much to find beautiful art to display, as it was finding the exact pieces that would “tell our story” and give all who enter a sense of what we are about, how we want to serve and, perhaps most importantly, why we are here.

Sr. Mary Lou Averbeck, a Sister of Mercy and mission liaison to the administration, guided the design team in understanding the significant

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components of our history and connection to our roots. In 2014, Sr. Averbeck had an opportunity to visit Ireland and the House of Mercy started

by Catherine McAuley in 1827. While there, she toured the Mercy International Centre, located on the House of Mercy campus in downtown Dublin. In addition to crossing that item off her bucket list, she experienced, first-hand, things she had only seen in pictures and heard in stories.

She was able to place her hand in Catherine’s, as the bronze sculpture outside the House of Mercy invites. She connected to Catherine’s spirit, as the sculpture symbolically assures each person that all are welcome there.

Inspired by that visit to Ireland, Sr. Averbeck and I set about finding a sculptor who could create our own version of Catherine for our lobby.

Hand carved by Stefan Stuflesser high in the mountains of Northern Italy, a life-size rendering of Catherine, with her left arm on the shoulder of a young mother with a baby, now graces our lobby.

It is one of the first things to catch the eye of anyone entering our house. Catherine’s right hand is slightly extended with her palm up, echoing her bronze counterpart in Ireland, assuring that, “All are welcome in this healing place.”

Moving through the lobby, a large glass window and door on the left invites you to step into the healing garden. As the door gently closes

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from every country in which they serve each were invited to pour water brought from their country into the rill as a way of connecting their ministries of service with the constant outpouring of God’s love, compassion and mercy. Upon completion of our rill at Anderson Hospital, we held a special blessing ceremony in 2016 and invited all the local Sisters of Mercy to attend. Together with leaders and staff from the hospital as well as members of the neighborhood community, each person ritually poured holy water into the rill, symbolizing the connection to our mission and our role in extending Jesus’ healing ministry.

Issuing from a rock wall, the water flows into a basin that empties into a channel which runs the length of the garden to a collecting pool. You can visually follow the water as it runs under a walking bridge, between two long stone benches and under a second walking bridge until it reaches the collecting pool. There your eyes are drawn to the bronze sculpture of Mary above the pool. She is posed with arms fully extended to the heavens, saying “yes” to her calling to be the bearer

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behind you, it is immediately obvious that you have entered a holy space. It’s quiet out here — and quite different from the hallway you just exited. You may notice the classical sculpture of the Madonna della Strada, inspired by the 1897 painting by Italian artist Roberto Ferruzzi, on your left and the small labyrinth on the ground to your right.

Walking into the middle of the garden you hear the sound of water flowing on your left and are drawn to its source. The first design for the garden included a traditional fountain. While that would have been nice, it would have been merely a water feature. In creating a healing garden, we knew there was potential for much more. Working closely with the lead architects, we were able to create our version of a rill, which is a small stream, that would fit in the space we had available. It was inspired by the original rill in the courtyard of the Mercy International Centre in Ireland.

The rill there was created for the inauguration of the Mercy International Centre in 1994. As part of their dedication events, Sisters of Mercy

A healing garden at Mercy Health – Anderson Hospital in Cincinnati includes a rill, or stream, that has been blessed with holy water and a statue of Mary saying “yes” to the call to be the mother of God’s son.

They symbolize the hospital’s Catholic mission and its role as part of Jesus’ healing ministry.

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Mercy Health

of God’s son and to bring his presence among us. pital in Mariemont, Ohio, closed in 1989. All the The sculpture is entitled “Fiat” — May it be done artwork and special features connect us to our unto me according to your will.

Catholic identity and to our mission to be a source As footlights come on at dusk, Mary, in her Fiat of healing and compassion. Like other hospitals pose, casts a larger-than-life shadow 15 feet up the that have retained features from shuttered or stone wall behind her. It is stunning in both its remodeled buildings, we have found that employsimplicity and its power. She reminds us that we, ees, patients and their families appreciate these too, must say “yes” in answer to the call to serve ties to our heritage and communities.

— to continue to bring and be the Outside the chapel is a comextension of Jesus’ compassionmissioned artwork entitled, ate, healing ministry in our day “Love One Another,” which and in our time. offers the wording of that uniAnother significant design versal invitation according to element is a large glass wall 13 major religious traditions between the healing garden and worldwide. Created by Sister of the Chapel of Divine Mercy.

St. Joseph Mary Southard, the While the wall serves the funcacrylic on canvas invites us to tional purpose of keeping the eleponder: What in life can the love ments outside, the glass allows of God not penetrate? the visual merging of the inteBeyond the simple “tour” I rior and the exterior. As a metahave led you on, there is another phor for a spiritual journey, the dimension that really brings to glass wall serves to connect the life the reasons why the sacred external demands of our daily art and sacred places of Mercy lives with the inner strength and Health – Anderson Hospital are resources of our spirit. so important to us. What we Once inside, you may notice could not have known ahead of twinkling lights as you return time is how the spaces would through the door into the main A sculpture by Stefan Stuflesser actually be used. We had wonhallway and turn left toward the shows the founder of the Sisters dered if the saying, “If you build chapel. As you round the corner of Mercy Catherine McAuley it, they will come!” would be to enter, you are invited, “All are with a mother and baby. McAutrue of the healing garden? If we welcome to rest and pray in this ley’s hand is extended with her placed the statue of Catherine holy place.” Entering through palm up, echoing a sculpture in in the front lobby, would peothe stained-glass doors, pre- Ireland. ple stop by and put their hand served from the 1989 expansion in hers? Would they linger to at Anderson Hospital, you discover the source appreciate the message of the Love One Another of the lights that caught your eye earlier. Across painting? the ceiling, arched from low (by the door) to high Sr. Averbeck has shared stories of seeing young (where it joins the glass wall), is a field of twin- children coming up to the Catherine statue to see kling lights, a star-filled night sky, with a bolder the baby the mother is holding. They get right solid light emanating from a cross in sunken relief up there to touch the baby and sometimes give across the span. Indirect lighting around the cha- the child a kiss. Whoever is privileged to witness pel invites quiet and reflection. one of those moments almost invariably stops to There is a place for private prayer and soli- watch and enjoy that touching scene. In the halltude set apart by a short wall of colored glass. If way outside the chapel, I have observed people you choose to pray there, you will see in front of from various faith traditions studying the Love you the newly refurbished tabernacle, the special One Another painting. Conversations with some place where the Blessed Sacrament is reserved. of them reveal how much they truly appreciate The altar was blessed by Cincinnati Archbishop the openness and inclusion of many faith tradiDennis Schnurr during the chapel dedication cer- tions. A plaque on the opposite wall reiterates the emony on September 29, 2016. On the back wall Mercy message: All Are Welcome. are statues of Mary and Joseph, brought over to Sometimes you can hear people praying in Anderson Hospital when Our Lady of Mercy Hos- front of the tabernacle, crying softly, or see them

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The chapel at Mercy Health – Anderson Hospital was blessed by Cincinnati Archbishop Dennis Schnurr in 2016.

kneeling in earnest prayer for God’s help with whatever is weighing on their hearts. Because the book of intentions and prayer requests fills quickly, it needs to be replaced often. Somehow people know that they are not alone when they are in our sacred places. They know there are others who share a belief in a God who loves us and cares about our needs and well-being. They believe that the prayers they enter in the book will be lifted by others who will pray with them for those intentions. It is an unspoken connection, and yet a powerful one.

Back in the garden, on a different day, a manager sat with one of her employees – the two of them having what appeared to be a difficult conversation. I asked myself, why would a manager choose the healing garden to have such a discussion with someone? Knowing the manager fairly well, I chose to believe that she knew that both she and her staff member would benefit from the

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healing nature of the garden space. That somehow things are safer there – that it’s OK to be vulnerable and honest, even when the topic is unpleasant.

Later two nurses walked into the garden and sat together for a few minutes, just long enough to get a breath of fresh air and decompress from the stress of a hectic day. They told me on the way back in that it’s the place on campus where they can find a moment of peace and remember why they are here in the first place.

The Chapel of Divine Mercy and the healing garden form the center of our Anderson Hospital campus and symbolize the heart of who we are.

They help us remember why we chose health care and to work at Mercy. Those sacred spaces help all who enter to hear Catherine’s reminder that they are indeed welcome in our house!

JIM RICHTER is director of mission integration, East Market, Mercy Health – Cincinnati.

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A Medical Safe Haven For Survivors of Trafficking JENNIFER COX AND RON CHAMBERS, MD, FAAFP

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he victims of human trafficking — which encompasses forced labor and sex trafficking, include men, women and children in all 50 states as well as countries worldwide.1 Trafficking victims experience a range of acute and chronic physical and mental health issues resulting from their traumatic experiences, many of which have lifelong detrimental effects. Nearly every clinic and health care setting likely will see victims of human trafficking at some point,2 but there is an ongoing gap in the field of trauma-informed care, which supports a “safe clinical space” model of care.

Due to insufficient training for providers and limited implementation of survivor-oriented care, many people who have experienced trafficking characterize their interactions with health care providers as re-traumatizing, which deeply threatens their continued access to the services and support they need. The clinical experience or exam room often has not been seen as a safe space for victims and survivors. The Human Trafficking Medical Safe Haven at Mercy Family Health Center, part of Dignity Health Methodist Hospital of Sacramento, is working to change this for victims of labor and sex trafficking.

In 2014, San Francisco-based Dignity Health, in partnership with the Dignity Health Foundation, launched the Human Trafficking Response Program to better identify trafficked people in health care settings and to provide trauma-informed care and services to those who have experienced abuse, neglect or violence, including human trafficking. The health care system educates staff, physicians and other providers, volunteers, and contract employees about human trafficking. Dignity Health provides “Human Trafficking 101: Dispelling the Myths” training with basic education

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about human trafficking, including definitions, prevalence, common misconceptions and common red flags.3 In Sacramento, a Dignity Health family medicine residency training facility called the Mercy Family Health Center developed the Human Trafficking Medical Safe Haven to provide comprehensive, trauma-informed health services to people who have experienced trafficking.

The Human Trafficking Medical Safe Haven program offers comprehensive services at one location for patients of all ages, including primary and urgent care, X-rays, lab tests and access to hospital specialists. The medical safe haven clinic model is supported by the Dignity Health Foundation and the Sacramento, Calif.-based Mercy Foundation.

Jeanine (whose name has been changed to protect her identity) was only 15 when she first walked through the doors of the medical safe haven in 2016. She was referred by Sacramento County Child Protective Services staff; it was suspected that she was being exploited for commercial sex trafficking. Her provider saw a number of subtle signs that, in context with the patient’s

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presenting concerns, were recognized as red service provision to those at risk of human trafflags for trafficking. She had her head down, with ficking or trafficking survivors using traumashoulders stooped and didn’t make eye contact. informed practices and survivor-informed prinShe wore a revealing outfit, had a flat affect and an ciples. The human trafficking medical safe haven overall submissive demeanor. She was reluctant meets a 30/30 rating on the survivor-informed to discuss her situation, initially asking, “Why am best practices assessment tool, primarily because I even here?” it engages and values the voices of survivors, The provider used survivor-informed prac- those who have experiential knowledge in accesstices and interview techniques to establish a ing health care while being trafficked and who can sense of safety for Jeanine. The teen eventually speak to what constitutes a safe and healing space. disclosed she was being sold nightly on the interSurvivors have shared with the medical safe net for sex. She had been coerced into “the life” haven team their prior experiences in health care by a trafficker with whom she was still involved. settings. One of the medical safe haven patients Upon examining her, we determined that she was said, “When I went to an ER because my pimp experiencing depression and anxiety. She lacked beat me up, I felt judged, like I was just another many of the support systems necessary to keep drug addict.” Unfortunately, at many clinics her safe and out of harm’s way. across the country, providers often lack the trainIn a traditional health care setting, she might ing, resources and institutional support to prohave been given medication for her conditions vide trauma-informed care. For the victims and and sent on her way. But at the medical safe haven, survivors of human trafficking and other forms instead of just treating her symptoms, we focused on her The strength of a trauma-informed safety and healing, and provided or connected her to resources approach within a medical clinic setting including therapy, medication is that patients who may have in the past management and a supportive advocate, who could help her experienced re-traumatization through regain control of her life and recover from her trauma. judgment, stigma, impatience and lack

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of empathy are now welcomed into a

The strength of a traumasafe space where they are supported informed approach within a medical clinic setting is that and cared for in a non-judgmental, patients who may have in the empathetic way that focuses on their past experienced re-traumatization through judgment, stigma, healing first and foremost. impatience and lack of empathy are now welcomed into a safe space where they are supported and cared for in a of violence and trauma who enter these clinics, non-judgmental, empathetic way that focuses on their interactions with health care providers are their healing first and foremost. frequently characterized as negative or harmThe safe and healing clinical environment cre- ful. Our patients have reported feeling rushed ated within the medical safe haven was built upon through previous appointments by an impatient the standards outlined in the Survivor-Informed provider who didn’t take the time to ask any quesPractice assessment tool, developed by fellows of tions about how they got there. They’ve reported the 2017 Human Trafficking Leadership Academy, long wait times just to get in to see a physician in organized through the National Human Traffick- the first place. They’ve told us about the social ing Training and Technical Assistance Center worker who asked pointed questions and seemed and Coro Northern California.4 A team of six non- to judge everything they said. They’ve told us how government service providers and six leaders the staff allowed their abuser back into the room who were trafficking survivors worked together after expressly being asked not to. Most of all, to develop recommendations on how to enhance they’ve told us they didn’t feel safe.

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There is danger in past trauma. Studies have family members.

Peer support: Support from clinical peers is shown us time and again that trauma earlier in life, especially childhood traumas, can have extremely integral to the organizational and service delivery detrimental effects on future health and lifes- approach and is a key vehicle for building trust, pan.5 Prior trauma greatly increases the risk for and for establishing safety and empowerment.

Collaboration and mutuality: There is a several chronic conditions and health-adverse behaviors including depression, alcohol and sub- true sense of partnership between organizational stance abuse, heart disease, liver disease, chronic leaders, staff and patients. obstructive pulmonary disease, risk of intimate partner violence, sexually There is danger in past trauma. transmitted diseases and infections, autoimmune disease, financial stress, Studies have shown us time and suicide and self-harm, among others. again that trauma earlier in life, Trauma can be associated with a single life event that leaves damagespecially childhood traumas, can ing scars which often go unseen, or a person can experience multiple trauhave extremely detrimental effects mas. A single trauma is limited to one on future health and lifespan. point in time, an incident such as a rape, a serious car accident, the sudden death of a loved one. Repeated traumas are The ripple effect from training providers, residefined as a series of traumatic events happening dent physicians and others on trauma-informed to the same person over time; they can include care is that it creates a harm reduction model of repeated sexual or physical assaults, exposure to care that extends to all patient populations served. frequent injury or abuse of others, or seemingly unrelated traumas. Repetitive exposure to trau- PROMOTING A SAFE ENVIRONMENT mas can have a cumulative effect over one’s life- The medical safe haven takes a number of steps time, but single traumas don’t necessarily have tied to trauma-informed care. The practice works less psychological impact than repeated traumas. to promote a sense of security by bypassing the Some repeated traumas are sustained or chronic. waiting room and bringing the patient to a priSustained trauma experiences tend to wear down vate exam room immediately upon arrival. If a a person’s resiliency and ability to adapt. Some patient wishes, a medical staff member or patient examples include children who endure ongoing advocate stays with the patient during the visit. abuse, people who are in violent relationships and Appointment times are longer than they may be people who are victims of human trafficking.6 for other patients, with 45 to 60 minutes for a According to the Substance Abuse and Mental visit. This allows time to build trust, to review the Health Services Administration’s guiding princi- patient’s history and needs, to allow the physician ples of a trauma-informed approach, trauma can to thoroughly explain laboratory tests needed or significantly affect how an individual engages results. The longer appointment times also allow in major aspects of their life, including ongoing for referrals to additional services and time for health services. Health care systems and profes- patient advocate support. sionals are encouraged to apply trauma-informed Sex trafficking survivors provided insight on care in all aspects of patient care and services, how to create a clinical environment that is welfrom registering a patient to providing clinical coming, safe and healing. They said they want care, in order to more effectively treat patients. to be heard during their visit and valued as deciThe core tenets of trauma-informed care include:7 sion makers in their care. They told providers to Safety: Throughout the organization, staff understand that as patients they have challenges and patients should feel physically and psycho- remembering their history due to trauma. Surlogically safe. vivors expressed the need for providers to be Trustworthiness and transparency: Orga- patient with them and not judge them when somenizational operations and decisions are conducted thing may trigger an emotional or psychological with transparency and with the goal of building reaction during an exam. They may not be able and maintaining trust among staff, patients and to control when they shut down or become agi-

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tated. And finally, they want to make choices. That said having the ability to choose where they sit during an exam, or whether or not they are ready to answer questions regarding their personal and medical history, makes a big difference. They said allowing choices can help them feel safe within the clinic room.

Billing practices also are designed to ensure patient safety and privacy. The medical safe haven sees patients regardless of their insurance coverage. It helps patients without insurance obtain

never holding back their compassion that compels them to give the highest quality of care. The doctors show kindness without judgment. It is a whole new experience from the past health care they have received, where they did not feel safe enough to talk about the trauma in their life both current and past. This fear led to most of their medical and mental health needs being unnoticed and untreated. Other providers dismissed their stories with disgust or disbelief, but at the medical safe haven they are heard with empathy, (and receive) trauma-informed and survivorinformed care.”

Survivors expressed the need Every staffer who interacts with for providers to be patient with patients receives an annual two-hour training in the tenets of trauma-informed them, and not judge them when care. Resident physicians complete a something may trigger an emotional 10-week curriculum, including a survivor perspective on health care experiences to or psychological reaction during help guide best practices. We also stress the importance of safety for our providan exam. They may not be able to ers as well. Secondary trauma, or taking a patient’s trauma internally and expericontrol when they shut down or encing it yourself, is a real challenge for become agitated. health care providers who work with victims of trafficking and violence. Part of Medicaid, and it directly bills insurance only. creating our healing space means supporting proThat’s because billing a patient could put the viders’ resiliency, so they can provide our patients person at risk, if they are living in an unsafe envi- with the best possible care and support and so they ronment with someone who might harm them. can look after their own well-being. Providers Patients also do not receive a bill for any aspect are not scheduled for initial appointments with of their visits, including required labs, medica- patients back to back, giving them time to protions, and identified behavioral health and men- cess any vicarious trauma triggers they encountal health follow-up treatments. Most of the safe tered during an appointment. They are trained to haven patients do not have the resources to pay debrief and decompress, and use grounding techfor services. niques, strategies to remain in the present and to The medical safe haven receives feedback from try and minimize stress and anxiety. community agencies, which provide services to The clinic also has a patient advocate to suplabor and sex trafficking victims, and which refer port those who have been trafficked. Patient advoclients to our clinic. Staff at agencies have seen cate Tara Stowbunenko explained, “If a patient benefits to this care approach. has an appointment scheduled, as a patient Sawan Vaden, the anti-trafficking program advocate, I will call to schedule transportation manager from the Community Against Sexual if needed. I will then speak with the patient to Harm organization in Sacramento, said, “The remind them of the appointment and confirm that very first time I accompanied one of my clients they have transportation. I always remind them to to the medical safe haven, I felt a little nervous call or text if there are any issues. The day of the and skeptical, not knowing what to expect, but appointment I may send a quick message, ‘Hey, was completely amazed by the level of care that just a reminder that you’ll be picked up at 12:15 went into this first encounter. I had never expe- p.m.’ When the patient arrives at the clinic, the rienced or even had an idea that something like team is ready for him or her; the provider is often this could be a reality for women like us. The doc- briefed prior to the appointment of any issues that tors at Mercy Family Health Center Medical Safe need to be brought up. When the appointment is Haven treat our clients with dignity and respect, complete, the provider walks the patient back to

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the clinic coordinator and patient advocate to schedule future appointments, help make a plan to complete any follow-up lab work, and address any social issues mentioned by the provider and assist with a warm-hand linkage to community referrals.” She said patients always have someone providing “a warm hand” to them, assisting with their needs so they are supported. “This helps patients feel safe, which makes it more likely that they’ll come back,” she said. Stowbunenko’s role as a patient advocate is through a partnership of Dignity Health Methodist Hospital and WEAVE, Inc. WEAVE, based in Sacramento, provides services to assist survivors of domestic violence, sexual assault and sex trafficking.

Jeanine, our patient who came to us as a victim at 15, has been seeing us for almost three years now. We’ve been able to treat her depression and anxiety and enroll her in therapy and peer support groups. With the help of community organizations, we have provided or connected Jeanine and countless other patients to the resources needed to live the lives they want to live. Part of our healing space is creating a bridge of trust between the clinic and the organizations that provide services like housing, food, job training, counseling and financial assistance to victims. These organizations have long been a source of healing and safe spaces for victims of trafficking and violence.

With their help, we can ensure comprehensive, collaborative, long-term care for victims both in and outside of the clinic and create a healing space for all who come through our doors.

Today, Jeanine is making great strides in her journey of healing. She last visited her physician at our clinic to discuss her upcoming college applications. Stories like Jeanine’s show us just how powerful creating a healing space for victims and survivors of human trafficking and other forms of violence and abuse can be. While in the past, the health care community has not always understood or appreciated the extent of human trafficking, the need to identify its victims in the clinic, and the importance of trauma-informed therapeutic care, we are making progress to create clinical healing spaces for all victims and survivors.

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JENNIFER COX is program director for Dignity Health’s Human Trafficking Medical Safe Haven, located at Dignity Health Methodist Hospital in Sacramento, Calif. RON CHAMBERS is program director of the Dignity Health Methodist Family Medicine Residency Program and medical director for the Human Trafficking Medical Safe Haven.

Dignity Health and Catholic Health Initiatives have merged into CommonSpirit Health.

NOTES 1. National Human Trafficking Hotline, hotline statistics, https:// human trafficking hotline.org/states.

2. Laura J. Lederer, Christopher A. Wetzel, “The Health Consequences of Sex Trafficking and Their Implications for Identifying Victims in Healthcare Facilities,” Annals of Health Law 1, vol. 23, (2014): 61-91.

3. More information about the Human Trafficking Response Program, a program that is both survivor-led and survivor-informed, is at www.dignityhealth.org/ human-traffickingresponse.

4. More information about the Human Trafficking Medical Safe Haven program, access to a shared learning manual and resources for residency programs, and the Survivor-Informed Practice Self-Guided Assessment Tool and other information is at www.dignityhealth.org/ msh.

5. Centers for Disease Control and Prevention, About the CDC-Kaiser ACE Study, https://www.cdc.gov/ violenceprevention/acestudy/about.html.

6. Substance Abuse and Mental Health Services Administration, “Trauma-Informed Care in Behavioral Health Services, Treatment Improvement Protocol,” TIP-Series 57, (Rockville, MD: Substance Abuse and Mental Health Services Administration, 2014), www.integration.samhsa.gov/clinical-practice/SAMSA_TIP_Trauma.pdf.

7. Substance Abuse and Mental Health Services Administration, SAMHSA News, “Guiding Principles of TraumaInformed Care,” 22, no. 2 (Spring 2014), www.samhsa. gov/samhsaNewsLetter/Volume_22_Number_2/ trauma_tip/guiding_principles.html.

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Labyrinth Walk Serves as Tool for Spiritual Journey BECKY URBANSKI, EdD

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t Benedictine Health Center at Innsbruck in New Brighton, Minn., one of the first things visitors to the long-term care center see is a large, flat maze close to the front entrance.

On any given day, it is not unusual to see residents in walkers or wheelchairs, staff and family members or even neighbors quietly and slowly following the contemplative path.

Called a labyrinth, it is part of the healing garden at this suburban Minneapolis care center.

A circular design found in almost every religious tradition over the past 4,000 years, a labyrinth can be seen in etchings on the walls of caves, in decorative tiles for floors, in basketry, pottery and coins as well as other items. Historically, patterns on the floor or on the ground that can be walked as a path or maze are called labyrinths.

Labyrinths are used for meditation, dance, rituals, ceremonies and sometimes just for fun. Also considered a spiritual tool, a labyrinth can represent an individual’s spiritual journey with its many unknown twists and turns and have an ultimate goal of reaching the center.

Today, labyrinths can be found at hospitals, long-term care centers, schools, prisons, retreat centers and many other locations. Studies have shown that a labyrinth walk can assist with stress reduction, problem-solving, self-healing, awareness, harmony, creativity and other personal improvements. Taking a few minutes to walk the labyrinth can bring calm to a frustrating day, help give clarity to a situation or simply allow someone to enjoy a beautiful day.

“There is no right or wrong way to walk a labyrinth,” said Fran O’Connor, spiritual care director at Benedictine Health Center at Innsbruck. “We encourage our staff members to use the labyrinth with our residents and I often see our associates outside with an individual explaining what they are doing together.”

The labyrinth at Benedictine Health Center

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at Innsbruck was dedicated in 2012 and is part of four major gardens at the organization. “It is integrated with the walking paths featuring flowers and native grasses,” said Reid Hewitt, administrator/chief executive officer of the community. The design is based on a historical pattern found near the Baltic Sea and in northern European countries. Designed by Lisa Moriarty at Paths of Peace, the gentle turns of the labyrinth are suitable for people of varying abilities, including those using medical equipment. The colors of teal and tan were selected for their gentle and soothing qualities. Additionally, the particular shade of teal is recognizable as one of the primary identity colors for the organization.

“It is simply a beautiful outdoor location that is used to connect with others. We have invited our local neighbors to use the labyrinth as our health center is an important part of our community,” said Hewitt.

BECKY URBANSKI is senior vice president, mission integration and marketing for Minnesotabased Benedictine Health System.

NOTE Information for this article came from The Labyrinth Society, www.labyrinthsociety.org; Wikipedia, https:// en.wikipedia.org/wiki/labyrinth; and interviews with Reid Hewitt and Fran O’Connor at Benedictine Health Center at Innsbruck in New Brighton, Minn.

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Rolf Hagberg

HE ALING SPACES

HOW TO WALK A LABYRINTH

Pause at the entrance and breath slowly. Pray for awareness, an open mind and heart. Use this time to release your thoughts and concerns and unclutter your mind. Find a pace that is natural and comfortable. Use a mantra— repeat a word or phrase in rhythm with your pace. Let the walk unfold on its own. The center is a quiet place for rest. Stay as long as you wish. Journey out by re-tracing your steps with greater clarity, peace and serenity and connect the quiet center with the outside world.

Source: Fran O’Connor, spiritual care director, Benedictine Health Center at Innsbruck

A BLESSING FOR YOUR LABYRINTH WALK May you meander the labyrinth’s path within the present moment of your life story.

May you step into the labyrinth with your depth questions, sorrows or grief.

May you bring to the labyrinth your dreams and joys, hopes or thanksgivings.

May your walk challenge and teach when needed, and open your heartmind to possibilities.

May you explore in the labyrinth your wisdom, courage, compassion and sincerity.

May your walk offer creative insights, calm focus and a lift for your spirit.

May you relish the experience of the walk.

May you discover your essence of wellness, as you step-by-step and turn-by-turn dance this form of body, mind and spirit prayer.

Amen.

— Rev. Barbara Kellett

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To Be a Healing Place BRIDGET DEEGAN-KRAUSE, MDiv, BCC

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am blessed with wonderful friends, friends who laugh at my jokes, who bring me good soup, who hold me accountable, who cry with me when I am sad. When a private heartache hit several months back, these friendships served as safe havens, as their company offered a space to heal, helping me to remember who I am as I began to live into a new reality.

Those of us who have enjoyed the shelter of such relationships understand that the best compliment we offer another is to say: “You are a refuge, a safe place. You are a port in the storm, a haven. A place of rest.” We may even recognize how these relationships reveal God to us, a God whose loving care is described as a haven and in spatial and structural terms of protection and respite, as well: that is, as a shelter, a refuge, a hid-

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ing place (Psalms 46, 62, 91), and as a place where the heavily burdened will find rest (Matthew 11:28).

For those of us who seek to be this kind of shelter, who desire to offer our presence as a safe place for another, we know the need to be ready. We recognize that the next phone call, text message, or knock on the door may bring news of a friend’s frightening biopsy, struggling marriage, creeping

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addiction, unexpected loss or some other aching need for healing.

In his beloved book, To Bless the Space Between Us, the late Irish poet and theologian John O’Donohue encourages us to bless one another and to name the sacred in our midst, with special attention to those tender, fraught places where healing is needed.1 With his inspiration, I offer three blessings — a blessing of delight, of candor and of memory — for potential use and to accompany those of us who seek to be a healing place for others.

THE BLESSING OF DELIGHT

Delight is a beautiful blessing we offer one another when we share our joyful recognition of another’s uniqueness, particular experience, dignity and worth. A powerful New Testament model of one who blesses with delight is Elizabeth, the knowing older cousin of Mary (see Luke 1:39-56). We are told that upon discovering her pregnancy, Mary departed “in haste” to the sanctuary of her cousin’s home, where we can imagine that this young, pregnant, unwed woman longed to feel welcome and safe.2 Upon Mary’s arrival, Elizabeth’s proclaims “in a loud cry” her delight and reverence: Most blessed are you among women, and blessed is the fruit of your womb. And how does this happen to me, that the mother of my Lord should come to me? … For at the moment the sound of your greeting reached my ears, the infant in my womb leaped for joy. Blessed are you who believed that what was spoken to you by the Lord would be fulfilled (Luke 1:42-45).

We can imagine Elizabeth, the loving cousin, who is now both elder and peer in pregnancy, as well as prophetic witness for Mary in this moment, saying: “It is good to have you show up at my door.

Your pain and messiness, along with your excitement and your confusion, are all welcome here.

You are safe. I am honored to receive you.”

We see in this scene how the blessing of delight bears fruit, bringing confidence and joy. In the text, Elizabeth’s reception immediately prompts Mary to sing her glorious Magnificat (“My soul proclaims … my spirit rejoices …”). But this is also how any of us who are received with such profound joy, affirmation and delight might be

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prompted to (perhaps metaphorically) sing: “I am blessed and good. I am part of a long line of ancestors, beloved in God’s sight. The future looks brighter. God is so good.”3 This encounter might be imagined as a sacred bumping of bellies, apt among pregnant friends, or a joyful embrace between those who share the life-changing news of a new job, or a successful recovery, or the culmination of a difficult discernment process. As with Mary and Elizabeth, when the mystery of you meets the mystery of me, life is stirred within and between us. We will see what new song and new life will emerge.

I know the power of being received in a way that proclaims and celebrates my own value and dignifies the mystery within, by one who knows how to be with me in my pregnant moments, and whose reception prompts me to break into song.

You too may know what it means to receive the

Delight is a beautiful blessing we offer one another when we share our joyful recognition of another’s uniqueness, particular experience, dignity and worth. blessing of such a gift, perhaps through a compliment from a trusted source that boosted your confidence at a key moment, and prompted you to see, celebrate and claim your gifts. Whether in the form of an enthusiastic greeting, an animated text message, or some other communication, whenever we articulate our genuine delight in another, we do nothing less than amplify God’s loving and affirming voice, such as Jesus heard at crucial times throughout his ministry: “You are my beloved in whom I am well pleased” (Luke 3:22).

The blessing of delight makes room for all this.

THE BLESSING OF CANDOR

Candor is the quality of being open, honest and frank. We offer the blessing of candor when we are lovingly generous in our honesty, when we judiciously share from our perspective and experience, and when we offer the possibility of hope.

Our model here can be the resurrected Jesus who,

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in love and without restraint, reveals his own a spirit of trust, the blessing of candor has often wounds to a shocked Thomas, and then invites made way for transformation.

Thomas to touch them, for his own reassurance.

“Put your finger here and see my hands. Reach THE BLESSING OF MEMORY out your hand and put it in my side” (John 20:27). We offer the blessing of memory when we We might easily overlook the implications and remember and honor the story of another. Often significance of this moment and the deep wisdom with this blessing, too, comes the discovery of a and generosity of spirit that it reveals. Notice that shared story. This blessing is especially imporJesus allows Thomas the opportunity not only tant when we are overwhelmed or have lost our to touch his wounds, but even to place his hands way. We experience this blessing when we hear a within them. This offers a perspective that only loving friend say: “I know you and I see you. Let direct contact, intimate trust and hard-won, per- me remind you of what you have been through, sonal experience can bring. what you have endured.” Or, it may come with a I am reminded again, in this context, of my own hope-filled offer: “Let’s unpack this story a bit and pregnancy experience, and the words and actions reweave the loose ends. A new story may be ready of my own beloved, experienced older cousin. to emerge.”

Before the birth of my first child, she candidly Our model for one who blesses with memory showed me her stretch marks, saying, “No one is again the resurrected Jesus, as he accompanies else is going to tell you this, but I will. This is going grieving disciples on the road to Emmaus (Luke to hurt. You will be overwhelmed. But then, you will heal.” I recall, too, upon Candor is the quality of being open, receiving the news of a child’s fateful diagnosis, a wise clinician who honest and frank. We offer the looked me squarely in the eye and blessing of candor when we are said, “We know something about this here. I don’t know how this will end lovingly generous in our honesty, for you, or where this will lead, but you are here, taking an important first when we judiciously share from our step. And that is good.” We can likely perspective and experience, and all imagine such a clinician or family member or trusted friend, one who when we offer the possibility of hope. offered the unrestrained truth and said some version of: “I’m not going to lie to you. This is going to be hard. But then you 24:13-35). “What are you discussing with each will heal … And that is good …” other as you walk along?” Jesus asks, as yet unrecThe blessing of candor shows us that knowl- ognized. As they tell their story of grief and heartedge can be powerful and lead to healing, and ache and mysterious happenings, Jesus listens that we can trust and be entrusted with honesty, knowing there is much more to their story. We vulnerability and truth. It may also be uncom- can imagine Jesus saying some version of: “OK. fortable, in its offering or reception. Yet, when Let’s walk through this again …,” as he helps them offered lovingly, it respects the integrity of each, hear, see and interpret their own story in a new and the ability of both parties to handle whatever way. And as he does so, the disciples found that is shared. In my own life, the blessing of candor their hearts burned, a sign that transformation has opened a door to growth, as when a colleague had begun. helped me see where additional learning was necFor us as for these disciples, healing can begin essary for a new role I had accepted. The bless- with shared stories. Just as Jesus blesses the couple ing of candor, in the form of a frank conversation, on the road with his invitation to share, a skilled has led me to collect more data, and to advocate couple’s counselor knows that the best way to for needs that I did not recognize. The blessing warm the chill of a struggling marriage is to bless of candor has come in the form of feedback that the couple with memory, to ask each to recount helped me understand how my behavior was the story of how they met, fell in love, or what hurtful to another. When offered with generosity memories they share and cherish. Hope is stirred and respect for the dignity of all, and received in and healing can begin in the process of sharing

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and hearing precious memories: “I remember this … I remember you.”

In my own life, as a beloved friend began his brave climb out of an addiction, I often reminded him of his larger story, and the hallmarks of health and happiness for him: what it was like to walk on the beach, to prepare a good meal, to play a fun game of cards, to freely, honestly give and receive love. When life later handed him an ominous diagnosis, again I would simply say, “I remember you.

I’ve witnessed your recovery. You can do this hard thing. I trust your wisdom. And I know there is more to your mysterious beautiful story than this pain, this suffering of today.”

The blessing of memory lands us in hope. We bless each other as we share our own memories of solidarity, survival, possibility, success or even triumph much like a resilient elder may remind us, “We’ve been here before. This is a pattern that our ancestors knew well.” Layer upon layer, we can be assured that your story and God’s story are one and the same, and so it is one of renewed life and the triumph of love, in the end.4 Our own stories of living, dying, rising and glory are stories no less mysterious, powerful and beautiful than that of Jesus’ own transformation.

WHERE GOD DWELLS

“How lovely is your dwelling place, O Lord …”

(Psalm 84).

Faithful friendship is a sturdy shelter, we read in the book of Sirach (6:14). On my best days, I want to offer my delight, my affirming greeting and my house as Elizabeth did, as a safe place, a sanctuary.

I want to offer my steady presence, shared experience, candor, trust and tender remembering, as Jesus did, to help others heal and connect their story with the larger story of resurrection and new life of which we are all a part. I suspect you want to do this, too.

But even on our best days, our hearts and our minds, our doorways and our inboxes can feel too full. The need for healing refuge is so great, and there is often more than the shelter of one heart can hold. So rather than holding it alone, let’s do this together, striving for the joyous welcome and reassurance of Elizabeth, and with the loving accompaniment of Jesus in mind. Let’s invite God in to find a home in our hearts, minds, homes and company, to move in and through and to dwell among us. We can put the Holy Spirit to work,

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shoring up the structure to be sturdy and lovely.

Someone needs the gift of your blessing today — perhaps someone you are mentoring, a discouraged friend, or an emerging leader who cannot yet see how amazing they are. Delight in them.

Tell them how gifted and full of possibilities they are. Offer them a sharing of your own hard-won experience and help them to remember their own wisdom. Help them see the sacred within themselves and in their story. Do so with respect and reverence, perhaps also sharing a perspective or a bigger picture for them to reflect upon — one that offers the possibility of renewal or something altogether new. Someone needs all of this today.

Remembering the example of Elizabeth and the example of Jesus, let us together offer shelter and blessings of delight, candor and memory. In both giving and receiving such sanctuary, let’s both offer and say to one another: “Welcome” or “I’m on my way over.”

BRIDGET DEEGAN-KRAUSE is a chaplain and the co-founder and managing partner of Leadership Formation Partners, which provides formation programming, including the award-winning Mission: Day by Day, for Catholic health care organizations around the United States. She is based in Detroit.

NOTES 1. John O’Donohue, To Bless the Space Between Us: A Book of Blessings (New York: Doubleday, 2008). For health care leaders who regularly lead reflections, consider adding this beautiful resource to your bookshelf.

2. Mary and Elizabeth’s encounter has been depicted by many, including the artist Brother Mickey McGrath.

His colorful work, The Windsock Visitation, graces the entrance to the monastery of the Visitation Sisters of Minneapolis and includes foundress St. Jane de Chantal’s words, “This is the place of our delight and rest.”

3. I have taken the liberty of paraphrasing Mary’s glorious Magnificat.

4. The Sisters of Mercy of the Americas’ cross with its multiple layers offers us a helpful visual here. Its simple form gives us a symbol of profound solidarity: layer upon layer, mercy upon mercy. We can imagine the cross of our lives laid upon the crosses of others, all gently held upon the base that is the cross of Christ.

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HE ALING SPACES

Meditation on Healing and Sacred Spaces DAVID J. SHUCH, DDS

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hen we look with depth and seriousness at the relationship between healing and sacred spaces, the commonalities that emerge show that they are inextricably linked. Healing is a broad term that can cover everything from a cut finger to a damaged planet. Rather than illustrating every point along this particular spectrum, let us explore two points of human healing, remote from each other: from the bruised knee to the broken heart of a girl we’ll call Madeline.

At age 6, Madeline plays outside and her mother is watching her. In an instant, she falls and bruises her knee. She cries and runs to mommy, who gives her a hug and tells her that everything will be OK. Mommy cleans up the scrape, puts a bandage on it, kisses the knee, and Madeline, no longer crying, runs out again to play. In this instance mom addressed two separate, but related issues: healing needed to begin both at the physical site of the scrape and within Madeline’s emotional life. At the physical site, a fabric of skin cells became torn.

Bleeding began, and a biological process of repair commenced. Leaving alone the physiology of skin repair, let us look briefly at the instant that this fabric of skin cells becomes “aware” of the breach.

There is a kind of communication between the cells of the skin that senses every kind of stimulation — temperature, pressure, irritation, pleasure and so on.1 Some of the messages of this communication rise to the level of our awareness, but many don’t. In this instance, pain is the signal sent to trigger awareness, but the signals that remain subtle are what we want to focus on right now.

The fabric of cells that form our surface have a keen sense of integrity, one we can think of as a kind of harmonic sound, like a church choir ton-

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ing a long, harmonious chord that alerts the cells that all is well. When there is a breach, the tone changes. Think of this in the same way as in a forest filled with birdsong, if a predator enters the space or if there is fire, the birdsong changes and all the animals are alerted.

Madeline is a strong little girl with sufficient reserves to heal once the process gets started. And it is not much for her skin cells to sound the alarm and for the necessary cells to begin this process of repair. It is just in this notification that healing begins. Think of this as a choirmaster taking

The fabric of cells that form our surface have a keen sense of integrity, one we can think of as a kind of harmonic sound, like a church choir toning a long, harmonious chord that alerts the cells that all is well.

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out a pitch pipe and sounding a new note for all church not far from her home; a great old buildthe choir members to tone to, in order to bring ing with soaring walls, stained glass windows and everyone back into the resonant key. But, for the great quantities of quiet. She goes and sits in an moment, let us assume that for whatever reason, empty pew at a time when there is no service. She Madeline’s skin cells don’t get out the signal to cries quietly for a time and then she stops, but she repair. In such an instance, help can come from stays a while and in a way and without explanation the outside, through that reassuring kiss from her she trades a bit of her grieving for a bit of solace. mother; a prayer offered for her healing; a visit to a The walls and the light and the pews themselves trusted pediatrician who treats her, places a hand seem to understand and are more than willing to on her shoulder, tells her she has been brave, and enable this exchange. that her knee will be good as new in a week. In Healing has begun and the choirmaster in this some way a substitute choirmaster can sound the instance is not a person, but the combined intenappropriate pitch and bring the choir back into tions — the prayers — of hundreds or thousands resonance. of people who have contributed to this creation: Every form of healing is a variation on this a space where healing can occur. How is it that a theme. The nature and complexity of the tone will space can serve as a choirmaster? Madeline will change, the nature and complexity of the choir- leave the church with the same areas of brokenmaster will change, but on every level, this is what ness that she had when she first arrived. The difhealing is.

Young Madeline also became fearWhile a person with a compassionate ful and began to cry. Her mom gave her comfort and reassurance. In this heart and a capacious soul can bring instance, there was a similar bruise on a very specific kind of help, an object what we could call Madeline’s emotional body. With enough time, had or space rendered sacred can set she just been on her own, she would the tone for healing in the broadest have stopped crying. But perhaps without the help from her mother, a possible way. scar might have formed on her soul — “play is dangerous” or “be afraid of sidewalks.” But her mother served the purpose ference will be that she will have gained an overof choirmaster and sounded just the right tone to arching feeling of wholeness; a feeling distinct heal her daughter’s emotional body, and all with- from her previous overarching feeling of brokenout a scar. ness. And in this broad and general sense, rather Now, Madeline is older, had her first boyfriend, than in any narrow and specific sense, Madeline’s and sadly, it did not end well. Madeline is heart- condition begins to mend. broken! She feels grief in her heart, longing in her The idea that a space can be made to resonate body, loneliness in her loss, and aloneness in her is not news to anyone who has heard live music soul — for who else could ever understand how in an acoustically perfect concert hall. But as we hard it is to have lost at love? On each of these have already noted there are resonances that are levels healing needs to come — at different times, not limited to sound. The fabric of cells resonate; from different people and from new experiences, our hearts resonate; but there seems to be a chasm each will resolve. At the right time a tone will between physical resonance that can be explained sound and that part of Madeline’s being will reso- by physics and resonances in living things that can nate, “Oh, yes, I remember now …that feeling of be explained more or less by biology. wholeness, that feeling of belonging, that feeling The laws of classical physics easily explain of joy in life.” A parent, a good friend, a trusted the parameters of resonance for a tuning fork or relative — saying the right words at the right time, a concert hall. But there are kinds of resonances or simply being present and supportive — these in all living things that are beyond what classical are the choirmasters that will aid in healing Mad- physics can describe. Biology can get us closer eline’s heart. but ultimately there will need to be a new science, But what is the first thing that Madeline does perhaps a marriage of biology, quantum physics, when she finds herself in anguish? There is an old theology and a smattering of systems of medicine

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practiced in China and India that, taken together, will give us a complete understanding.

Within the past 20 years some bricks have been laid in building a bridge to span this chasm. In the 1990s, Masaru Emoto suggested that emotional content was, in some way, captured and stored in water.2 More recently Claude Swanson has written about some scientific findings hinting that within the spinning clouds of subatomic particles — those same clouds that quantum physicists view as containing only random distributions of the particles within them — there exist forces that freely interface with consciousness, imbuing those random distributions with higher patterns of order.3 And William Tiller and co-authors have written about many of the scientific experiments that he has performed, showing that trained meditators, meditating with a particular intention within a prescribed space or meditating on a chosen object, can imbue that space or that object with scientifically testable attributes that directly relate to those same intentions.4 It seems that in this sense, science is finally finding its alignment with religion — churches and monasteries; grottos and clearings within a forest, a treatment room in a doctor’s office, or just a small study —with a chair and simple desk— what is important is that within a space, a particular intention is held again and again and again; over days and years, perhaps by a group of likehearted people or maybe just a single soul.

The principles of repeated intention within a space do not imbue only sacredness. The aura felt inside an abandoned prison or a former asylum will, in different ways, test the fortitude of any visitor. And crime scenes where there has been violent loss of life need no series of repetition to leave these spaces feeling defiled.

So, it would seem sacred spaces should not have any “mixed use” that includes the careless expression of emotions. There needs to be a con-

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sistency of mood, of purpose, of intention. The space must be made to feel safe and compassionate, but not overwhelming. In this way, a space can resonate a sacredness that can knit a broken soul.

And like a choirmaster toning a heavenly pitch, it can signal the start of healing. If a healing process needs help from an outside source, it must come from someone, some thing or some space that can hold a particular vibration. And while a person with a compassionate heart and a capacious soul can bring a very specific kind of help, an object or space rendered sacred can set the tone for healing in the broadest possible way.

DAVID J. SHUCH is an author with three books on the intersection of science, spirituality and healing, Doctor, Be Well: Integrating the Spirit of Healing with Scientific Medicine; The Charm Carver (an allegory about healing); and the recently published Letters to a Young Healer. He is a dentist, practicing and living in northwestern New Jersey.

He is also the creator of Dr. Shuch’s Remarkable Edible Toothpaste.

NOTES 1. Marc Chanson et al. “Connexin Communication Compartments and Wound Repair in Epithelial Tissue,” International Journal of Molecular Sciences 19, no. 5 (May 3, 2018): 1354. https://doi.org/10.3390/ijms19051354.

2. Masaru Emoto, Messages from Water (Tokyo: Hado Kyoiku Sha Co., 1999).

3. Claude Swanson, Life Force: The Scientific Basis: Breakthrough Physics of Energy Medicine, Healing, Chi and Quantum Consciousness, Vol. 2 (Tucson: Poseidia Press, 2009), Chapter 7.

4. William A. Tiller, Walter E. Dibble and Michael J. Kohane, Conscious Acts of Creation: The Emergence of a New Physics, (Walnut Creek: Pavior Pub, 2001), Chapter 6.

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Reflection

A Place of Peace JEAN MONAHAN

“In the tender compassion of our God, the dawn from on high shall break upon us, to shine on those who dwell in darkness and the shadow of death, and to guide our feet into the way of peace.” —Canticle of Zechariah (Luke 1:78-79)

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midst the planning and paperwork that preceded my husband’s retirement, we made a resolution: to return to volunteering at a food pantry, something we had foregone when our children were young and life was hectic. That was June. My husband died in August, and by summer’s end I was channeling my grief and anger into tossing canned goods into bags.

Miss Berdonna was one of our regulars, faith- small and unfamiliar. No choices here: a curtain filled and upbeat, so the morning I heard her sobs for privacy, a loaner bed, a view of the institution’s rising above the routine clatter of the pantry, I was air conditioning unit. (Smiling ruefully, a hospital surprised. “I’m tired; I’m so tired,” she wailed. Her chaplain tells of softly singing “Amazing Grace” purse had been stolen (no money to speak of, but with a patient, only to hear a gentleman several her prescriptions were gone), and taxes were due curtains over take up the refrain.) on her little house… and her mother had died and As space shrinks in tangible – and maybe intan… . I understood. Arms entwined, we swayed back gible — ways, the merest touch, sound or image and forth, mingling our tears and our pleading. becomes an instrument of healing. Recently a “One day at a time, sweet Jesus, that’s all I’m ask- hospice nurse described one of her final visits ing of you; O give me the strength to do what I have with a terminally ill woman with “a hard shell,” to do.”

Somehow, here, among the mar“One day at a time, sweet Jesus, ginalized and poor of spirit, I found my footing. that’s all I’m asking of you; O give me I have a friend who finds solace in the strength to do what I have to do.” nature, and this week she will retreat to a cabin deep in the woods to pray for peace after a painful divorce. Many others I know who, she said, “held things tightly inside, until find healing fellowship in support groups. But so I asked about the lone picture hanging over her often those who dwell in darkness — the critically bed.” The woman proudly identified it as the “Litill, the dying and the bereft — are not surrounded tle Brown Church” from the beloved 19th-century by beauty or a circle of companions. They must hymn later made famous by Rosemary Clooney — make do with spaces that are circumscribed and “No place is so dear to my childhood as the little

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brown church in the vale” — and told of how her pletely vulnerable, open to receive and give love son had taken her there years ago. As the woman regardless of my accomplishments.” began to reminisce, her tears flowed and she It is summer again. This time I make my way opened up about her pain and her fears. to the food pantry literally stooped with grief and But how does a healer traverse the distance loneliness over the death of my youngest son. (A from success measured on charts to peace prof- concerned neighbor asks if I have been checked fered in tender touches and familiar hymns? Years for osteoporosis …) God willing, this place will ago I was moved by the story of a young doctor in again be a healing space, just as Nouwen found a NICU who, anguished at the sight of a mother his at Daybreak. weeping with empty arms next to her preemie’s Something — a metallic clang, a shadow crib, and knowing the child would not/could not — causes me to glance at the dumpster in the survive, removed the wires and tubes, swaddled parking lot where a volunteer has just tossed the infant, and placed the baby in the mother’s a collection of clothing rejects from the thrift arms. It is moments of balance and unknowing, store next door. I watch as one of our clients played out from premature birth to final breath, scurries up the surface of the bin and drops that must challenge the spirit and the spiritual for the health “These broken, wounded, and completely care provider. Where is their unpretentious people forced me to let go healing space?

The well-known author of my relevant self — the self that can do and lecturer Henri J.M. Nouwen aptly summed up burnthings, show things, prove things, build out as “a convenient psychothings — and forced me to reclaim that logical translation for a spiritual death.” He spoke from unadorned self in which I am completely personal experience, his own vulnerable, open to receive and give love “dark place.” After 20 years teaching at Yale, Harvard and regardless of my accomplishments.”

Notre Dame universities, and feeling dry to the bone, he — HENRI J.M. NOUWEN lumped it all for life with the mentally handicapped residents of the L’Arche down inside, leaving only his feet visible as community near Toronto, Canada (appropriately they cling to the ledge to keep him from tumcalled “Daybreak”). bling in. Within seconds he re-emerges with a At Daybreak, Nouwen found refreshment pair of shoes and slips them on. As he turns to among people “who were considered, at best, give me a sheepish but triumphant grin, I feel marginal to the needs of our society… those who a deep urge to run and embrace my dumpsterdon’t demand of us — except to touch and love.” diving friend whose simplicity has washed over In his book, In the Name of Jesus, he described my grief with the coolest and tenderest of touches. how “These broken, wounded, and completely unpretentious people forced me to let go of my JEAN MONAHAN, a mother and grandmother, relevant self — the self that can do things, show resides in St. Louis. She was formerly a pre-med things, prove things, build things — and forced me advisor and assistant dean of academic advising to reclaim that unadorned self in which I am com- for Saint Louis University.

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HEALTH PROGRESS

Sponsors Are Called to Be Prophets and Reformers FR. CHARLES E. BOUCHARD, OP, STD

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lmost a quarter of a century ago, Health Progress published several articles on questions of Catholic identity and Catholic institutions by respected leaders in the ministry. Fr. J. Bryan Hehir wrote the first one in which he raised questions about institutional identity and described its three historical stages of institutional identity. Lawrence Singer and Sr. Helen Amos, RSM, echoed some of his concerns and raised questions of their own. We have learned a great deal since 1995, but we are still struggling with many of the questions Fr. Hehir, Singer and Sr. Amos raised. As Health Progress marks its 100th volume as a publication, I would like to recall some of their observations and suggest that we are now moving into a fourth stage of thinking about institutional identity and sponsorship.

Fr. Hehir acknowledged a concern at the time that Catholic health care had lost its identity. He said he did not believe that it had, but he did say that our identity would have to be refashioned in a new context of “the rational demands, the secular settings, the pluralistic context and the scientific requirements of the world of health care.”1 That much, at least, has not changed. Today, we face all of the challenges Fr. Hehir cited and then some.

In terms that are now familiar to many of us, he described three stages of development of our ministry: the immigrant stage, which began in the Ellis Island days, lasted until at least 1960. It was a time when great numbers of immigrants, most of them devoutly religious (not just Catholics, but Methodists, Lutherans, Orthodox Christians and Jews) came to the United States from Western Europe, Ireland, Russia, Central and Eastern Europe and elsewhere. Most of our Catholic institutions

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— schools, hospitals and social service agencies — were founded during that time to educate and care for Catholic immigrants. These institutions not only provided care but a supportive community during the difficult transition from immigrant to established citizen.

A second stage began in 1965 at the end of the Second Vatican Council, when the church was maturing into respectability and acceptance in a land that had initially been suspicious, sometimes even hostile, to Catholics as immigrants. The church in the U.S. began to understand itself as part of a pluralistic world and to wrestle with the challenges of health care financing (especially the vast sums of money injected into health care by Medicare and Medicaid) and increasing government oversight and regulation. Catholic health care became professionalized as the founding members acquired advanced credentials in clinical areas and health

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administration. It was no longer just charitable blood’ pedigrees to reexamine their place in the work and a safe harbor for struggling immigrants market, and some are deciding to substantially but part of a vast network of health care services alter their institutional presence, if not to leave — Catholic, other-than-Catholic and public. As the market altogether.”3 Fr. Hehir said in his article, “The result of the These events raised new questions about the Council’s vision — in the world, for the person, role of the state in delivering and funding health in dialogue with the world — is a church that is more open to the Catholic health care became secular, is universal in its concepprofessionalized as the founding tion of service and defines itself as a servant.”2 members acquired advanced The impact of Vatican II was evident in so many ways. Catholic credentials in clinical areas and health laity were given some responsibiladministration. It was no longer just ity for governance in the church through parish councils, and some charitable work and a safe harbor for were admitted to certain limited liturgical roles or held advisory struggling immigrants but part of a vast roles to bishops. The permanent network of health care services. diaconate was inaugurated. In health care and education, religious sisters were still a strong presence, but they care as well as the growing influence of the marwere joined by growing numbers of new lay ex- ket as systems jockeyed for prominence and ecutives. These were small steps, but they pointed sometimes survival in an increasingly competito much bigger changes to come. tive world (sadly, some Catholic hospitals even In 1995, Fr. Hehir saw yet another stage of de- competed with one another). As the presence of velopment marked by rapidly evolving technol- religious women began to diminish, individual ogy, increasingly complicated funding and the hospitals became part of systems and systems befailure of the sixth attempt at national health care gan to collaborate (the era of “co-sponsorship”) reform in 1992. In an “Exhortation to Sponsors,” and then to merge (the era of ministerial juridic written about the same time persons). 4 The first public juridic as Fr. Hehir’s article, health person — Catholic Health Care Fedcare attorney Singer identieration — was formed in 1991. Others fied the time as a critical pefollowed steadily in the years that folriod. “Catholic healthcare is lowed. Today there are 30 ministerial at a crossroads,” he wrote in juridic persons worldwide, more than the September-October 1997 half of which are in the United States.5 issue of Health Progress. “At The time after 1995 was marked a time when its mission – by new corporate structures and new providing high-quality, spirmodels of sponsorship, but also by an itually based care, particuincreased emphasis on diversity and larly to the poor, is needed inclusion. This was a worthy goal, more than ever, it finds itself but it led to a self-consciousness and threatened. Managed care, flattening of Catholic identity. Some together with the refusal of feared that we could not claim our sophisticated purchasers Catholic identity and at the same time to pay for inefficiency, has radically altered the be diverse and inclusive. In addition, many sisters health care landscape. Sharp competition is forc- who had at one time been active participants in ing venerable Catholic organizations with ‘blue- institutional ministries began to opt for hands-

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on service to the poor, which they saw as a more powerful direct witness to the ministry of Jesus.

Some Catholics began to draw an unfavorable comparison between the “institutional” church and some other kind of church, one which was presumably less bureaucratic, more authentic and more spiritual.6 The problem with this view is that the church, warts and all, is part of our incarnational understanding of the Body of Christ. To be sure, there is a transcendent church, “the spotless Bride of Christ” beyond time and history, but we see that church imperfectly through our human institutions. To deny the reality of this incarnate church is to fall into some kind of dualism. We need to believe in the transcendent church and also its earthly, institutional expression.

Fr. Hehir understood this and emphasized the importance of the church’s institutional mission.

“Fashioning an identity always requires institutional strategy,” he said, adding that we need to be more “aware of the value of institutional presence. Today our institutional instinct is a social asset; in this society, institutions will not do everything, but they will fundamentally shape the quality and character of life. How we keep alive that institutional presence is an ecclesial theme, a social challenge and a human necessity.”7 These were prophetic words.

Sr. Amos, at the time president and CEO of Mercy Medical Center in Baltimore, also was thinking institutionally. Although she was speaking specifically of sponsorship as an institution, Sr. Amos noted ambivalence about institutions that existed in the 1990s.8 “We vacillate between seeing ourselves as part of the problem, and seeing ourselves as, potentially at least, as part of the solution … We worry that our resultant power may be more attuned to maintaining the institutions themselves than to serving the medically underserved.”9 She also noted the desire of many women religious to serve the needs of the poor more directly. In other words, was the power of institutional ministry a contradiction in terms? Was it possible to be a committed follower of Jesus and part of a large ministerial corporation, or would institutional power co-opt us from

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the start? Still, she insisted that the institution of sponsorship remained an “essential bearer of our ideals and meanings” even if it was imperfect.10

SACRAMENTALITY

When they affirmed the value of institutions, Sr. Amos and Fr. Hehir implicitly acknowledged the sacramental dimension of these institutions and the importance of sacramentality to Catholic life generally. In every aspect of Catholic life — liturgy, devotions, religious life, institutional ministries — we use real, tangible things as mediating symbols of grace. On a personal level, we use bread, water, wine, and words of human commitment to signify Christ’s presence; socially, we use organizations, institutions and structures to do the same thing. This sacramental character is the key to renewal of our ministries and of the church itself if they are to remain effective signs of God’s presence in the world. This is true even when they fail or cause scandal, as most things human eventually do. Despite human sin, we believe that human persons — and the things they create — remain suitable vehicles for grace. Our founders may not have used this language, but this is the reason they founded these ministries in the first place. They believed that human beings and their endeavors could, to some small extent, foreshadow the reign of God. Today, in a world dominated by huge corporations, institutional ministries provide a counterweight to other organizations that are not primarily concerned with human wellbeing, the common good or the transcendent possibility of life. Can our ministries model a different kind of financial accountability, a different kind of leadership, a different way of doing business that impacts other businesses?

WHAT IS THE NEXT STAGE?

So where are we today? If in 1995, Fr. Hehir left us subject to the “catalyst of social forces,” is our path any clearer in 2019? What is the next stage of development of Catholic health care and the other ministries of the church?

I believe that we are in a time when the promise of Vatican II is just beginning to be realized. The Council documents used previously unimaginable language to describe the church as the “people of God” and to restore Baptism to its place as the primary sacrament of vocation, giving

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it precedence over Holy Orders and priesthood. under the vigilance of the bishops in whose dioThe promise of those words has been realized ceses their ministries operate, but it transcends very slowly, and not without setbacks and resis- any one diocese. This is a truly remarkable develtance, but there have been important advances. It opment. In fact, as far as I can tell, it is unprecgave rise to permanent deacons, who are ordained edented in the history of the church. diocesan ministers not bound by celibacy (as a sign Few Catholics are aware of the existence or of our inadequate understanding of ordination, theological significance of these new canonical they are still often referred to as “lay deacons”). entities; many bishops know little about them and Ministry expanded to include both ordained and do not fully understand their significance. Even lay ministers, the latter being employees of par- sponsors themselves are wrestling with their ishes and schools who began to do things formerly identity, their role and emerging responsibility. done only by priests or sisters. In some rural dioceses, they even I believe that we are in a time when the became “lay parish coordinators,” and functioned much like pastors, promise of Vatican II is just beginning except that they could not celeto be realized. The Council documents brate the sacraments. Even though many of these lay ministers were used previously unimaginable language arbitrarily employed, poorly paid to describe the church as the “people of and lacked the ecclesial status and recognition that priests, deacons God” and to restore Baptism to its place and sisters enjoyed, they still represented an important realization as the primary sacrament of vocation, of Vatican II theology. giving it precedence over Holy Orders and These changes were a start, but the biggest change in our underpriesthood. standing of lay leadership from Vatican II is occurring now, in the shift from religious sponsorship to new juridic In his “Exhortation to Sponsors,” Singer menpersons that are largely lay. Singer and Sr. Amos tioned the various pressures that sponsors were both understood the import of this development. subject to in 1995. “Sponsorship is in flux,” he Though largely unnoticed, it is the new ministe- said. Investor-owned health care, takeover ofrial juridic persons, consisting largely of lay per- fers, partnerships with physicians, confusion (or sons that are the most definitive and important conflict) with boards are just a few of the presrealization of the new role of the laity. The new sures they faced. Still, he says, “These pressures generation of lay sponsors are not just deacons, are not entirely negative. Sponsors can in fact use religious educators or even parish directors. They the pressures as an impetus to provide strong, inare groups that are authorized by the Holy See to novative leadership for Catholic health care. Now “sponsor” or guide the mission and identity of a is the time for sponsors to exercise such leaderministry. ship.”11 Partly because they are above the fray of Sponsors, the members of sponsoring bod- day-to-day management and governance,” he ies like Catholic Health Care Federation (now said, “they have an obligation to develop innovasponsors of Catholic Health Initiatives and Dig- tive solutions,” beginning with the way in which nity Health, known together as CommonSpirit church authority is exercised. This flows from Health), Ascension Sponsor, Bon Secours Mercy the prophetic nature of sponsorship. Although Ministries, and more than a dozen others, are the prophetic charism is present throughout the mostly public juridic persons of pontifical right. church — even in traditional church structures This means that canonically they have a certain — the foundation of new religious orders was equivalence to a diocese or a religious order. They understood as a prophetic impulse. I believe the have official ecclesial status and have real author- same is true of new sponsors. We did not expect, ity over a ministry of the church. Their authority, or even imagine, the sudden decline in the numlike that of a sponsoring religious community, is bers of women religious, yet their willingness to

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explore new options for the ministries they spon- come from the periphery, “they can only lead to sored opened the door for these new juridic per- a reform of the church and reform in the church, sons. Born of the Sisters of Mercy, the Daughters rather than a break, if they are taken up and incorof Charity, the Franciscan Sisters, the Sisters of porated by the church into its unity.”15 Bon Secours and many others, these new entities Congar also notes that there are two ways in in the church have been nurtured by the prophetic which these innovations come about through the charisms of those communities. Those charisms power of the Spirit. One is what he calls the via are being superseded by new charisms, the nature juris (way of the law). These kinds of innovations of which we are only beginning to understand. come about through changes in the law (for examThe new gifts will certainly reflect the historic ple, the creation of the permanent diaconate). The charism of the founding communities, but they other way is the via facti (by way of fact, or de facwill gradually take on a life of their own in a new to, as we might say). These innovations arise from world with new demands.12 practice, so that action of the Spirit is discovered It is important to describe what the prophetic inductively. In the case of public juridic persons, charism is and is not, because in my opinion the there is a little bit of both involved. The idea for word is overused when applied to any new or un- the ministerial juridic person arose from need, but conventional thought someone might have. True it was endorsed by canon law as the public juridic prophecy is essential to the pilgrim church which persons were established. The law, Congar says, is always on a journey and passes through many “often lags behind circumstances and changes in different times and cultures. Given the various the law occur as a result of catching up with what pressures cited by Fr. Hehir, Sr. Amos and oth- is already going on.” It is a beautiful example of ers, we must count on a prophetic charism to the Spirit working on two different levels to effect help us make necessary adaptations. “Prophecy change, or reform, in the church.16 as a permanent charism in the church has many Today’s sponsors are called to exercise that aspects,” says Cardinal Yves Congar, one of the charism with confidence and boldness in the reprincipal theologians behind the documents of building of these essential ministries in a new Vatican II.13 The prophetic charism exists both in the hierarchy and in the church at The evolution of sponsorship is an large, but there must be a “complementarity between a principle of continuity or expression of the church’s prophetic form coming from the hierarchy, on the charism. one hand, a principle of movement or unexpectedness, coming from those inspired to act on the frontiers,” on the other. Most of the time. Sponsors today are rooted in the venerable time, he notes, “initiatives do not come from the charisms of their founders, but they are also claimcenter, but from the periphery, from below rather ing new charisms. They have the chance not only than from above.”14 to innovate, but to disrupt business as usual and esThe evolution of sponsorship is an expression tablish some new approaches to faith-based health of the church’s prophetic charism. The new mod- care. Concretely, this involves at least three things. els came not from the Vatican or the bishops, but First, sponsors must recover the sacramental from the periphery in the form of an initiative of character of our institutional ministries. While health care systems that were seeking a way to collaboration, partnerships and joint ventures are preserve the ministries that had been founded clearly the order of the day, we must enter into and led by religious women for generations. They them carefully, making sure that we preserve our conceived this new canonical structure and sub- own faith commitments and our commits to humitted it to the Congregation for Institutes of Con- man dignity, justice and the common good. secrated Life and Societies of Apostolic Life for Second, sponsors must find ways to integrate approval, exactly in the way the founding orders Catholic health care with our other institutional had been conceived and approved. Both were an ministries so that together we have greater imexample of Congar’s theory of innovations com- pact. Fr. Hehir noted that Catholic health care is ing from below and seeking approval from above. the largest nonprofit health care system in the Furthermore, Congar says, even if such changes United States, Catholic Charities is the largest

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social service agency, and Catholic schools constitute the largest private educational system in the country. This is still true today. “Size never proved anything,” he says, “but there is something to presence. If one seeks to influence, shape, direct, heal, elevate and enrich a complex industrial democracy, it cannot be done simply by the integrity of individual witness. It is done by institutions …”17 This is a powerful call to increase our influence not as a kind of ecclesial imperialism but as a way of protecting human dignity and revealing the grace of God in social and political life.

Our voice and our values, especially Catholic social teaching, have a place in the public debate.

There is a downside to institutional life. Sociologists have noted the influence of “accumulated expectations of other actors in an organizational field” that make it difficult for a single organization to deviate in a significant way.18 These expectations can be a good thing, such as when they lead to evidence-based standards of care and higher quality, but they also can lead to “institutional isomorphism” where every health care institution begins to resemble every other one. We must be careful so that we don’t sacrifice our identity and purposes in imitation of “the best” hospitals that may eschew faith and spirituality in favor of scientific rigor, or as a way of emphasizing diversity and inclusion. This has been the undoing of many faith-based colleges and universities that abandoned religious affiliation in favor of academic freedom.19 For us as Catholics, these are not competing values. We value faith and scientific rigor, we can also have a clear identity and be inclusive and diverse. This is the Catholic genius. It is not “either/or” but “both/ and.”

We also must take care that we do not compromise our identity in order to avoid negative pressure from advocacy groups that criticize us because we do not provide certain reproductive procedures, physician- assisted suicide, or euthanasia.20 A New York Times article in 2018 suggested that we were hiding our Catholic identity to get more people through our doors. The article said, “Over the past decade or so, a number of Catholic hospitals have changed their names to

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something less obviously Catholic. In 2012, for example, Catholic Healthcare West became Dignity Health.” And “At the end of the day, it appears that Catholic systems want to diminish their Catholic identity to be more marketable,” one person interviewed for the article said. 21 The issue was raised again in March of 2019, when the Journal of the American Medical Association published a study of Catholic hospital websites. It reported that less than a quarter of Catholic hospitals directly described themselves as “Catholic,” and that many failed to use words such as saint, holy, or Jesus or to mention or provide a link to the Ethical and Religious Directives for Catholic Health Care Services.22 We must reclaim with pride a heritage rooted in quality, compassionate and inclusive care that is inherently spiritual. We want to be the best, but we also want to be different. We need to ask ourselves whether we should be more explicit about our Catholic identity. It is possible that some patients may be put off by more explicit identifiers, but the values we hold are human values and we have no reason to be ashamed of them. We should also remember that investor-owned systems that have purchased Catholic hospitals usually want to keep the Catholic name because they see it as a market advantage. There may be things that we do not do, but we cannot allow ourselves to be defined by such things.

Third, sponsors must take an active role in working with and for the bishops, some of whom may see Catholic health care as irrelevant, or worse. This means always working to reveal that Catholic health care is not just a business but a ministry, rooted in and serving the local church.

It also means educating bishops about the complex clinical situations encountered in health care and the challenges in applying the concise language of the ERDs to these complex questions.

Even though our primary purpose is health care, we should certainly take every opportunity to collaborate with and enrich the local church in which we find ourselves. This means finding new ways to connect with local dioceses and parishes.

Finally, there is perhaps nothing more important than to recognize the emergence of new

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charisms and gifts in the church, and to carefully form them for the church. Sponsors must establish profiles and identify potential sponsors and then initiate, sustain and assess formation programs at all levels of the ministry. Using the language of sociologist Max Weber, Sr. Patricia Wittberg, SC, describes in her book the age of “religious virtuosos” (religious men and women in Catholicism, deaconesses in several Protestant denominations) who devoted their lives to seeking spiritual perfection and helping others do the

The future of our institutions can only be assured with solid theological and spiritual formation, and only sponsors can mandate this from their ministry’s Board of Directors on down. same. They prepared for this by years of religious formation, distinctive garb and vowed life in community. They did the heavy lifting of identity and culture, and at least in the United States they created the Catholic Church and most of the Catholic institutional ministries as we know them today.

How will we continue this momentum without them? This is the challenge for tomorrow. The future of our institutions can only be assured with solid theological and spiritual formation, and only sponsors can mandate this from their ministry’s Board of Directors on down.

CONCLUSION

The emergence of public juridic persons as corporate sponsors of the ministry of health care is an ecclesial earthquake. It is radically reshaping the way we understand and govern our institutional commitments. Sponsors are not just caretakers, holding these ministries in trust until some future day when vowed religious emerge to reclaim their historical role. Lay people are now in this for the long haul, and it will require a new understanding of their baptisms, a full appreciation of their share in the priestly, prophetic and kingly role bestowed

by Baptism, and a commitment to the personal formation required by this new vocation.

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FR. CHARLES E. BOUCHARD, OP, is senior director, theology and sponsorship, the Catholic Health Association, St. Louis.

NOTES 1. Fr. J. Bryan Hehir, “Identity and Institutions: Catholic Healthcare Providers Must Refashion Their Identity as Actors and Advocates in the World,” Health Progress (November-December 1995): 17-23.

2. Hehir, “Identity and Institutions,” 21.

3. Lawrence Singer, “Exhortation to Sponsors,” Health Progress (September-October 1997): 54-56.

4. There is some confusion about terminology. The generic canonical term is “public juridic person”(PJP), but when we apply that to ministerial entities, we often refer to it as a “ministerial juridic person” (MJP) or a “ministerial public juridic person” (MPJP) to distinguish it from other kinds of PJPs, such as dioceses or religious orders.

5. The shift from religious to lay CEOs was dramatic at Catholic hospitals. In 1988, there were still 196 religious serving as hospital CEOs and 420 lay CEOs; by 1996, the number of religious had dropped to 45 hospital CEOS, with 525 lay CEOs. In 2019, there are no sister CEOs of Catholic hospitals. This was not an intentional, strategic change, yet it had an enormous effect on the nature of this ministry. A list prepared by Fr. Elias Ayuban, CMF, in May of 2018, cites 17 ministerial juridic persons in the United States, seven in Australia, four in Canada and two in Ireland. Some of these are only health care, but others include education and social services.

6. Desire for a less institutional church is not new.

Theologian Yves Congar cites a German column written in 1934 by “a Roman Catholic Priest” which called for “more Christ and less church,” more gospel and less church,” and “more love and less church,” as if all of these things were opposites. “Gedanken zur Erneuerung der Römisch-Katholischen Kirche,” in Eine Heilige Kirche (Jan 1934) 50-57. This dichotomous view is still around.

Tom Smith, a former priest and diocesan pastoral life director, wrote, “I Can’t Get the Institutional Church Out of My System,” (National Catholic Reporter blog, May 30, 2017). His point was that he likes some aspects of this institutional church, but it did not always meet his criteria for authentic religion.

7. Hehir, “Identity and Institutions,” 23.

8. Confidence in institutions generally has declined steadily over more than 40 years. The annual Gallup poll of confidence in institutions reports that in 1975, 68 percent of respondents had “a great deal or quite a lot” of confidence in the church and organized religion.

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In 1998, it had fallen to 59 percent. It dropped steadily to 38 percent in 2018. The medical system fared even worse, going from 80 percent high confidence in 1975 to 40 percent in 1998 to 36 percent in 2018. See their annual survey at https://news.gallup.com/poll/1597/ confidence-institutions.aspx.

9. Sr. Helen Amos, “A Moral Quandary for Sponsors,” Health Progress (January-February 1996): 20-22, 42.

10. Amos, “A Moral Quandary,” 22.

11. Singer, 56.

12. New understandings of sponsorship and the role of public juridic persons and ministerial juridic persons were explored in the May-June 2017 issue of Health Progress.

13. Yves Congar, True and False Reform in the Church, trans. Paul Philibert (Collegeville, MN: Liturgical Press/A Michael Glazier Book, 2011). Originally written in 1950, its publication and translation were initially prohibited.

Congar revised it in 1968, and this translation is based on the 1968 version.

14. Congar, True and False Reform, 184, 238-40. He notes that even in a church as hierarchical as ours, “not one single religious order has ever been created by the central power. All such initiatives come from the periphery.”

15. Congar, True and False Reform, 244.

16. Congar, True and False Reform, 277. It is important to qualify the word “reform” here, especially in a time when we are thinking about reforms that will prevent child abuse or financial mismanagement. We might distinguish reparative reform, which is concerned with remedying causes of corruption or scandal, and adaptive reform, which is primarily what Congar was talking about. It is this second kind of reform, not the result of

scandal or corruption, but because of changed circumstances that requires new theology, new structures or new ways of relating to the world.

17. Hehir, “Identity and Institution,” 18.

18. Patricia Wittberg, From Piety to Professionalism and Back: Transformations of Organized Religious Virtuosity (Lanham, MD: Lexington/Rowman and Littlefield, 2006), 14. She cites “coercive pressures” that result from government mandates and tax laws, or requirements of accrediting agencies; “normative pressures,” embodied in training courses and professional schools and standards, and “mimetic pressures,” which arise in times of uncertainty when each organization tends to model itself, consciously or unconsciously, on what its competitors are doing.

19. James Tunstead Burtchaell makes this point (controversially) in his book The Dying of the Light: The Disengagement of Colleges and Universities from Their Christian Churches (Grand Rapids, MI: Eerdmanns, 1998). Melanie Morey and John Piderit, SJ, raise similar questions in their study of Catholic higher education, Catholic Higher Education: A Culture in Crisis (New York: Oxford University Press, 2006).

20. Katie Hafner, “As Catholic Hospitals Expand, So Do Limits on Some Procedures,” New York Times, Aug. 10, 2018.

21. Hafner, “As Catholic Hospitals Expand,” quoting Lori Freedman, a medical sociologist at the University of California, San Francisco.

22. Joelle Takahashi et al., “Disclosures of Religious Identity and Health Care Practices on Catholic Hospital Websites,” The Journal of American Medical Association 321:11 (March 19, 2019): 1103-4.

QUESTIONS FOR DISCUSSION Fr. Bouchard notes that Catholic health care has been wrestling with its institutional identity from its early days in the U.S. and continues in the ongoing evolution of sponsored ministries.

1. Describe your ministry’s model of sponsorship. Has it been this way from its founding, or has it evolved through other forms? What aspects and activities of your ministry are most guided by the evolving charism of your sponsors?

2. Fr. Bouchard compares new models of sponsorship to the origins of religious congregations: they were born of a need or a hope for reform rather than being created by the hierarchy. How do you think the sponsors of your ministry are responding to change — especially in mergers and acquisitions, population health, health informatics and technological discoveries with ethical implications?

3. Catholic health care alternately has been accused of watering itself down for marketing purposes and pumping itself up to merit nonprofit tax status. Discuss Fr. Bouchard’s argument that we can value both faith and scientific rigor, that we can embrace Catholic identity and be genuinely inclusive and diverse. In what ways does your ministry fulfill that both/and? In what ways does it fall into an either/or?

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MISSION AND LEADERSHIP

LET’S DECLUTTER OUR HEALING ENVIRONMENTS

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’d heard about Marie Kondo, a Japanese interior design consultant, from friends who spoke religiously about her method of decluttering and how her book changed their lives.

The book, The Life-Changing Magic of Tidying Up: The Japanese Art of Decluttering and Organizing, has set off a decluttering craze across the globe.

The book breaks down her radical, two-pronged approach to tidying up. First, survey everything you own, ask yourself if it gives you joy, and if it doesn’t, thank it for its service and purge yourself of it. Second, only when belongings that speak to your heart remain, put BRIAN SMITH every item in a place where it’s visible, accessible and easy to use. Kondo says, “only then will you have reached the nirvana of housekeeping, and never have to clean again.”1 I don’t think she is saying you’ll never have to use your Swiffer or vacuum again, but what she means is that when we surround ourselves only with those things that give meaning and purpose to our lives, we find an inner peace.

What can we learn from Kondo’s decluttering method as it applies to our healing environments?

And can a tidy, uncluttered environment bring calm and healing for our patients, residents and caregivers?

There are five basic steps to Kondo’s method that may be useful in our health care settings.

1. Tidy all at once.

Instead of devoting a few hours to cleaning one room or an area of our facility, make the decision to tidy the whole facility over a one-week period, then maintain it. This is not for the housekeeping or the environmental services departments to do, but for everyone in the facility. It will require thoughtful organization, scheduling and delegation of duties, especially for common-use areas.

Of course, this requires that we coordinate who will be doing patient care and who will be declut-

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tering. But think of how rewarding it could be for everyone in the organization to come together to make a facility uncluttered and tidy. Having the chief executive officer or facility administrator roll up their sleeves and pitch in can be inspirational to the other caregivers. Suddenly, everyone is taking ownership for the whole facility and not just their unit or their department. Going forward, everyone is more likely to keep a watchful eye, so clutter does not start creeping back. The healing environment belongs to all of us, and we are its stewards.

2. Visualize the destination.

Kondo suggests that you have a concrete vision of what you want your space to look like. I once worked for a CEO who shared her vision for what the halls of our hospital should look like. “When I walk through the halls, I want to see all the equipment on one side, with a nice clear path on the opposite side. I do not want to see any pieces of paper taped on doors, walls or nurses’ stations.

If it is important communication, we will have it on the unit bulletin board, which will be neat and refreshed every week.” It was a simple vision that everyone knew and followed.

As we approach the week for tidying up our facilities, what is our vision for what our healing space will look like and feel? Health care requires

Can a tidy, uncluttered environment bring calm and healing for our patients, residents and caregivers?

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a lot of stuff: equipment and machines for safety, hygiene and quality; furniture for patients’ and visitors’ comfort; wheelchairs, walkers, rehab devices and more. Does all of our equipment need to be on the floors at the same time in plain view?

Where do we locate the stuff we need, so it is there when we need it, but out of the way when we don’t?

This does not give us permission to jam everything into closets and storage rooms. Closets are notorious for becoming the place where we accumulate clutter. Kondo tells her readers one characteristic of people who never seem to be finished tidying up is that they attempt to store everything without getting rid of anything. They delay making the decision, and they end up putting it in the back of a closet. Only after we discard and make room will we be able to organize. I would suggest leaders take a hard look in the closets and storage areas within your facility. They will be a good barometer of how much decluttering your organization needs to do.

3. Determine if the item “sparks joy.”

Kondo’s maxim, “if it gives you joy, keep it and if not, be grateful for it and let it go,” needs a little translation to be applied to our care settings. The joy we are seeking in our facilities is that people feel welcomed, respected and cared for. There should be a sense of calm, peace and healing rather than noise, chaos and clutter. When we ask, “what do we need to keep and what can we part with,” the better question might be to ask, “does this assist in the healing process of our patients/ residents, their loved ones and our caregivers?”

Is it necessary? Does it assist in the care and healing process? Or to use the words of William Morris, the 19th-century English designer, artist and writer, “Have nothing in your house that you do not know to be useful or believe to be beautiful.”2

4. Tidy by category, not location, and tidy in order.

According to Kondo, most people want to declutter by beginning with a drawer, closet or room.

She suggests not to declutter by location but by category. She begins with clothes, followed by books, papers, miscellaneous items and finally sentimental items. Again, we need to translate this step into our health care settings and approach decluttering by category and not by physi-

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I would suggest leaders take a hard look in the closets and storage areas within your facility. They will be a good barometer of how much decluttering your organization needs to do. cal locations. Going from least important to most important, or least critical to healing to most critical to healing may be a better way to sort our decluttering work.

The equivalent to clothes, books and papers may be the old linens and gowns we have been storing, paper manuals that are outdated or have online versions and paper files that could be digitized and stored in “the cloud” rather than in filing cabinets. Do we have magazines in our waiting areas that are more than two months-old? The possibilities for pitching are endless!

The category of miscellaneous includes furniture, equipment, supplies and décor. Are our patient and resident rooms furnished with the intention of providing comfort, peace and healing? Is there enough space to move around? Do we repair, recycle or discard broken furniture and equipment? I once worked in an organization that had a 10,000 square-foot offsite rented storage unit. Guess what it was filled with? Broken furniture and equipment, old computers and expired supplies. They asked me as the mission leader, if I could “find good homes for all of this junk?” I suggested we have a garage sale, take any reasonable offer and give the proceeds to the system’s foundation.

The equivalent of sentimental items in our care settings may be the religious symbols, the pictures of our founders and foundresses, our heritage walls and displays and other heirlooms that have been passed down through generations.

If these items give us pride and joy, we should prominently display them in a way that reminds us of who we are.

With that said, we may need to be selective about which pieces are essential to preserve and

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which ones we can let go of. Several years ago, I was walking through the halls of a Catholic hospital, and I noticed every wall was covered with religious art, statues and crosses. There were so many pieces I thought I had walked into a religious goods store. I asked the chaplain with whom I was walking where all this religious art came from. She proudly responded that when patients and staff died, their families donated these items to the Catholic hospital. Rather than discard their loved one’s sentimental items, they were asking the hospital to become their caretakers and display them. The result was hundreds of old crosses,

in the cart and stored in their designated location.

This allows all clinicians on any shift who are called to a Code Blue to know where everything is located without spending precious time searching for what they need to save a life. Unfortunately, when something is missing from the crash cart or the cart is cluttered, lives are endangered.

5. Put your hands on everything.

BRIAN SMITH, MS, MA, MDiv, is senior director, mission innovation and integration, the Catholic Health Association, St. Louis.

CONCLUSION

The Life-Changing Magic of Tidying Up: The Japanese Art of Decluttering and Organizing may just be a fad. Or maybe, it has struck a chord with people because of its simple call to minimalism in an age of materialism. Maybe by asking ourselves the question, “do the things I sur“Do the things I surround myself round myself with give me joy and meaning,” we are discovering it is not things that with give me joy and meaning?” are essential. Relationships, the objects that remind us of those relationships, our crucifixes, pictures of Jesus, Mary, saints, pray- history and culture give us deeper meaning and ing hands, wall rosaries, and even a 12- by 6-foot purpose. In health care, some of those things will tapestry of the Last Supper! Needless to say, sen- remind us of who we are, what is our mission and timentalism became clutter to the eye, and to a why we are serving in the healing ministry. Some non-Catholic entering the facility, it could be, I am of those items will be beautiful, others will be usesure, a bit frightening. ful to the healing environments we steward.

The final step in Kondo’s methodology requires you to touch every item in your home and ask if it still gives you joy. It will not be possible for one person to touch every item in a health care facility and make that decision. That is where organization, delegation and empowerment come into play. Once there is agreement on what is essential, useful, gives beauty and joy, then organize the items so they can be effectively used.

An example of putting things away properly in health care is how we maintain our crash carts.

Only items necessary for a Code Blue should be

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NOTES 1. Marie Kondo, The Life-Changing Magic of Tidying Up: The Japanese Art of Decluttering and Organizing (Berkeley, CA: Ten Speed Press, 2014).

2. William Morris, “The Beauty of Life,” a lecture before the Birmingham Society of Arts and School of Design given on Feb. 19, 1880, later published in Hopes and Fears for Art: Five Lectures Delivered in Birmingham, London and Nottingham, 1878-1881 (1882).

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COMMUNITY BENEFIT

FUNDING COLLABORATION IN A RURAL COMMUNITY Beyond ‘Return on Investment’ MARK THOMAS, MDiv, BCC

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ur community has reaped benefits in recent years from the addition of a new role, a collective impact health specialist. In this position, a grant writer applies for grants on behalf of others. Initially presented as a way to prevent missed opportunities for improvements in health and human services due to limited grant procurement resources, the collective impact health specialist role became a reality in 2014. Leaders from Providence Hood River Memorial Hospital in Oregon, a ministry of Providence St. Joseph Health, knew local nonprofits needed help to fund their innovative programs and activities. What they didn’t know at the outset was the significant impact this community grant writer would have on galvanizing a culture of community collaboration.

A collective impact health specialist is a grant writer, a resource available at no charge to community partners — the experts in addressing social determinants of health. The role was created to leverage the hospital’s community benefit investment dollars to procure grants and donations for local nonprofits to carry out priorities from the community health improvement plan. The role is structured to encourage the hospital and community partners to work together with clear communication, shared decision-making and a division of labor.

Funders have shown they recognize the value of this approach. In five years, grantors have directed nearly $10 million dollars to community partners in the Columbia Gorge, representing almost a 20:1 return on investment. This role was recognized by the Robert Wood Johnson Foundation when it awarded its Culture of Health Prize to the Columbia Gorge community in 2016.

To structure the program, Providence Hood River Memorial Hospital outsourced the contracting for the position to the United Way of the Columbia Gorge as a neutral party. The two organizations co-created the job functions of the collective impact health specialist, defining guidelines

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for using the grant writing services and outlining a list of local, eligible agencies. They continue to provide ongoing oversight when needed.

Under the agreement, the hospital funds the collective impact health specialist as a community benefit contribution. For its part, the United Way oversees the employment contract and also convenes an advisory committee with representatives from the hospital, United Way and Columbia Gorge Health Council – a group tied to the local Medicaid program.

Paul Lindberg, JD, is the collective impact health specialist who works with partners across sectors to identify needs, convene partners to design initiatives to address those needs and secure funding. Since 2014, Lindberg has helped develop more than 30 new initiatives and secured funding to support those initiatives.

The job responsibilities of the collective impact health specialist include developing relationships with pertinent community organizations, promoting awareness of collaborative opportunities and activities, coaching local agencies on maximizing impact, researching funding opportunities and preparing project proposals with measurable outcomes.

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This program focuses on the Providence Hood River Community Health Improvement Plan, which is based on the hospital’s Community Health Needs Assessment. The community health improvement plan was developed by examining public health data and conducting surveys and listening sessions with community members and health care providers. Using the Robert Wood Johnson Foundation’s Culture of Health Vision to Action Framework, the following “drivers” were established as priorities for grant proposals: Sense of community Built environment and physical conditions (housing affordability, access to healthy foods, youth safety, equity in physical activity opportunities and transportation) Access to comprehensive primary care, stable health insurance, mental health service and routine dental care The Providence Hood River Community Health Improvement Plan forms the basis for funding community partners to address these prioritized community health needs. Examples of programs funded by grants from this program are: Afterschool programs to address childhood obesity Safe routes for children to walk to school Healthy corner stores Community health worker trainings Pathways community hub (part of a collaborative approach to care coordination) Community I.D. cards that improve access and security for vulnerable people Veggie Rx program providing vouchers to farmers markets for those experiencing food insecurity It’s important to note in many of these cases, Providence not only sponsored the grant writer, but also contributed cash used for required “matches” from funders.

MARK THOMAS is director of mission integration and spiritual care for the Providence Gorge Service Area, including Hood River, The Dalles and surrounding areas in Oregon.

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T H I N K I N G G L O B A L LY

RESPECT FOR CULTURE PLAYS IMPORTANT ROLE IN CARE SETTINGS A story is told about Albert Einstein when he was traveling from Princeton on a train.

When the conductor came down the aisle punching tickets, Einstein reached in his vest pocket; he could not find his ticket, so he reached in his trouser pockets. It wasn’t there so he looked in his briefcase, but still could not find it. He looked in the seat next to him, but it was not there.

The conductor kindly said, “Dr. Einstein, I know who you are; we all know who you are.

I’m sure you bought a ticket; don’t worry about it.” The conductor then continued on his way punching tickets. Just before he went to the next car he turned around and saw the great scientist on his hands and knees looking under his seat for his ticket.

The conductor rushed back and said, “Dr. Einstein, Dr. Einstein, don’t worry. I know who you are. No problem. You don’t need a ticket.”

Einstein said, “Young man, I too know who I am. What I don’t know is where I am going.”

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ith an emphasis on Healing Spaces, this edition of Health Progress has caused me much more angst than normal. Maybe it’s the juxtaposition of the conversation regarding healing spaces domestically and the context I bring from my experiences in international outreach. It’s difficult to transition from U.S. hospitals deciding to install a flowing fountain or to promote a serenely silent corridor, while in many places on earth, just having access to a physician within an hour’s time would be farfetched, and open windows in the operating room are a reality.

Admittedly when I began writing, I didn’t know exactly where I was going. Like Einstein, I knew my experiences, and I know about our ministry’s work to provide spaces where healing can happen — both spiritually and physically — but I didn’t BRUCE know where to go as to not be COMPTON negative or downplay the impact we have in low- and middleincome countries.

Something from the World Health Organization’s Health Promotion Glossary, published in 1998, inspired me as a definition of a health setting: “The place or social context in which people engage in daily activities in which environmental, organizational and personal factors interact to affect health and well-being.”

It’s not exactly about a healing space, but

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it speaks to the importance of culture. Just as a building is often designed to blend in with or purposely stand out from its surroundings, our actions in international outreach must be based on where we are going in order to provide healing that surpasses our Western definition. We have to have a trusted partner in the country we’re going to who is a part of the community that requested our services. We have to listen to the local community and respect their desired outcome for any partnership. We have to be in tune with their norms and notions of a life well lived.

In the examples that follow, I admit to needing a course correction. In the first example, I was traveling to a destination I hadn’t previously known. I fell into the traps of assumption and a desire to solve a problem that didn’t actually exist. In the second, an obvious need was initially unmet.

I hope they provide you with food for thought in your own work. As you read them, please ask

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yourself: are the space and people, the interactions and attitudes, technically and culturally appropriate to meet the needs of those receiving care? Are we fostering an environment that is in alignment with our healing ministry?

“I CAN GET MATTRESSES”

I was recently in Africa as part of a team visiting a facility that prepared children for orthopedic surgery and helped them recuperate after surgery.

During our orientation, staff told us that they had a 50-bed facility, but typically had around 100 children in residence. I recall my initial reaction of concern that such overcrowding was impacting even this one aspect of a child’s life — to not even have a bed of one’s own. But as the door opened, and we went in, it was explained to us that children are sometimes three or even five to a bed … by choice.

The children were creating little communities of their own. They were cleaving to one another and creating smaller communities from which to build their identities. It was completely within the cultural norm in this community. In this context, to sleep alone would have been isolating. It would almost have been cruel.

So here I was, already making plans in my head to determine if anything could be done to donate beds or mattresses, to be of some assistance in their living space, and I had it all wrong. These children weren’t being forced two-to a bed, they were being healed in a loving, supportive community.

OVERLOOKING THE OBVIOUS

Having a space that heals — while also maintaining the dignity of the patient — is a hallmark of Catholic health care. In our hospitals, clinics and assisted living facilities, we try to be sensitive to upholding the dignity of any child of God in our care. And while this can hold true in international outreach, it can be far more challenging — logistically and culturally.

A case in point is St Francis de Sales Hospital in Port-au-Prince, Haiti. CHA members and others raised more than $10 million for the facility to be rebuilt following the 2010 earthquake. It was designed with some patient wards and some private rooms as well as private exam rooms — a vast improvement to what had been there before. However, even with all of the meetings, site visits and

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conversations, we missed something. It was not until the Haitian hospital staff came back to CHA asking for privacy curtains that we realized that we had not planned for an item that would have absolutely been second nature in the U.S. setting.

We were able to fulfill the request and there are now curtains for privacy in several wards, but how was it that we didn’t even think of it in the original planning process or even during any of the many tours of the facility pre- and post-dedication? How did we think of the shell, but not the experience of a patient, vulnerable, with a family member alongside them, looking for something so insignificant as a sheet of material to separate them from view?

We overlooked an essential element of healing.

TOOLS FOR USE

Thankfully, as we consider culture in relation to where we are going, and once there providing healing, there are many tools to use and a lot of work to build upon.

Helpful resources include the WHO’s Healthy Settings work and research, Health Care Without Harm’s resources (under the Global heading, then to Green and Healthy Hospitals). Useful tools from CHA include Guiding Principles for Conducting International Health Activities; Short-term Medical Missions: Recommendations for Practice; A Reflection Guide for International Health Activities, all of which can assist us in this important work.

They help to ground us and provide us with questions, activities and tools for prayerful reflection. They can assist us through our discernment process when trying to develop culturally appropriate healthy settings in an international context — to remind us to be mindful of where it is that we are going, and not just what we are wanting to do.

BRUCE COMPTON is senior director, international outreach, the Catholic Health Association, St. Louis.

WEBLINKS WHO Healthy Settings information: https://www.who. int/healthy_settings/about/en/.

CHA International Outreach: https://www.chausa.org/ internationaloutreach/Overview.

Health Care Without Harm Green and Healthy Hospitals: https://noharm-global.org/issues/global/ global-green-and-healthy-hospitals.

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A G E F R I E N D LY

FOCUS ON WHAT MATTERS Simplifying Complex Care of Older Adults MARY TINETTI, MD

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hat does it mean to be age-friendly? At its most basic in a health care context, it means providing safe, high-quality care that lines up with what matters most to an older adult. Mary Tinetti, MD, Chief of Geriatrics at Yale School of Medicine and Yale-New Haven Hospital, and co-chair of the advisory group for the Institute for Healthcare Improvement’s Age-Friendly Health Systems initiative, explains the keys to providing the best care possible for older adults.

What defines an age-friendly health system?

In an age-friendly health system, all the people who work in the health system and interact with older adults are familiar and comfortable with, understand, and are competent at addressing what matters to each individual. They know how to adjust their interactions and expectations to meet each person’s needs. This is whether they clean rooms or welcome patients into an office or whether they’re clinicians, social workers or physical therapists.

To do that, you must understand that people accumulate more conditions and become more complex as they age. They may have some vision and hearing difficulties that need to be recognized and adjusted for. They may have mobility issues, so they need more help moving around. Most importantly, we must recognize that older individuals vary in what matters most to them. Some of them want their blood pressure as normal as it can be or their glucose levels always spot-on. Others are more concerned with feeling comfortable and unburdened by day-to-day health care details.

Faced with tradeoffs across many conditions and treatments, older adults vary in the outcomes they most value and desire. Being age-friendly means

Being age-friendly means recognizing and responding to individuals’ different needs, interests and priorities.

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recognizing and responding to individuals’ different needs, interests and priorities.

A central part of the age-friendly approach is focusing on improving care on the so-called “4Ms.” How do you explain this focus and why it is so important?

By creating the 4Ms, we’re trying to make care that is very complex more manageable. We’ve identified the core issues that should drive all care and decision making for older adults. The 4Ms apply regardless of the individual diseases people have because these are the areas that are affected by essentially all diseases. They also apply regardless of how many functional problems the patient may have, or the cultural, ethnic or religious backgrounds they bring with them.

The 4Ms are: What Matters — This means acknowledging that older adults vary in what matters most to them about their health and their health care Medication — Ensuring it does not interfere with What Matters, Mentation and Mobility Mentation — This includes preventing, identifying, treating and managing depression, dementia and delirium Mobility — Supporting older adults to move every day How might the age-friendly approach work in a patient’s life?

An older adult with Parkinson’s disease can help us understand why using the 4Ms is important.

Parkinson’s disease affects walking and other

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NOTE: This interview has been edited for length and clarity. Go to the Institute for Healthcare Improvement website to read the full interview at http://www.ihi.org/communities/blogs/howfocusing-on-what-matters-simplifies-complexcare-for-older-adult. Age-Friendly Health Systems is an initiative of The John A. Hartford Foundation and the Institute for Healthcare Improvement in partnership with the American Hospital Association and the Catholic Health Association of the United States.

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DALLAS / JUNE 9 – 11

movement, but it also affects parts of the brain that help with memory, problem-solving and carrying out tasks of daily life.

There are medications for treating Parkinson’s that will help with mobility, but they can make thinking worse. So, if a clinician just focused on improving somebody’s mobility, the treatment plan could contribute to confusion or memory difficulties. On the other hand, if you ignore treating someone’s mobility, they may not be able to do what’s important to them.

This is where the “what matters” communication comes in. “From what you’ve said, Mrs. Smith, I understand that what matters most to you is to be able to walk to the corner store and pick up your groceries twice a week.” To do that, she needs to be able to walk. She also needs to remember what she wants to get at the store and how to find her way back home. If you just say, “I see your tremor is worse. Let’s increase your medication,” and Mrs. Smith gets more confused, she can’t do something that’s important to her. On the other hand, if we say, “This medicine is making you too confused. I think we need to stop it,” and then she can’t move, then she still can’t do what matters to her.

The age-friendly approach means saying something like, “Mrs. Smith, I recognize it’s important to you to be able to walk to the store and get your groceries. Let’s look at your medications.

Let’s balance them to get the right amount. Let’s stop this other one that may be making you a little confused, and then let’s see if you’re able to maintain your mobility without making your memory worse.”

It simplifies care planning to ask what matters most to the patient because it helps you determine where to focus. If you put what matters most to a patient at the center of decision-making discussions, then you can balance everything else.

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BOOK REVIEW

THE POWER OF ORDINARY THINGS TO BRING HEALTH, HAPPINESS LAURA RICHTER, MDiv

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hile Dr. Larry Dossey’s book on healing cogent cases on each topic, sharing both scientific was published more than a decade ago, its and psychological evidence as well as personal foundational themes about the power of ordinary narratives for consideration. His appeal to physithings in healing are worth revisiting. In The Ex- cians is particularly loud, calling to them as one tra-Ordinary Healing Power of Ordinary Things: of their own, who underwent similar training. He Fourteen Natural Steps to Health and Happiness, writes as someone who over the years broadened he dedicates each chapter to a healhis thinking regarding some ing agent. These include personal of the presented topics or retraits like optimism, natural wonders turned to inclinations from beincluding dirt, bugs and plants, and fore medical training. He cites supernatural elements like miracles, his lifelong interest in mystery hearing voices and mystery. Roundas one such example which ing out the remaining chapters, he inmedicine does not generally cludes the value of forgetting, the sigregard positively, but remains a nificance of novelty, the importance particular interest to him and an of risk taking and the benefits of doimportant tool in the treatment ing nothing. He approaches the topic of patients. of health, stressing holistic healing Dossey presents the work and wellness, not just the elimination of others to provide supportof disease, making health relevant to ive evidence for the topics he anyone who desires a sense of wellraises. From sharing cardiolobeing and wholeness. gist Bernard Lown’s suggestion Each chapter is laid out thoughtthat defeatist phrases like “You fully, blending a combination of nar- THE EXTRA-ORDINARY HEALING are going downhill fast,” or “You rative, scientific theory and practical POWER OF ORDINARY THINGS: are living on borrowed time” application. His work will appeal to FOURTEEN NATURAL STEPS counter a patient’s ability to be the ordinary person reading for indi- TO HEALTH AND HAPPINESS optimistic about a diagnosis, to vidual enrichment as well as the pro- BY LARRY DOSSEY, MD Fechner’s Psychophysical Law fessional treating a patient in need Three Rivers Press, $13.95 that underlies why the third bite of healing. He singles out physicians 306 pages of chocolate cake never tastes as in particular from the clinical realm, good as the first, Dossey is eager as many may hold reservations about the named to utilize science to support the themes of each healing agents given their scientific training. chapter. Writers, musicians and theologians can While some topics presented still have limited ac- be found as well, offering quotes that provide supceptance in research circles, Dossey proposes all porting evidence for each of the healing agents. should keep an open mind regarding how healing Dossey uses everyday examples, like how superis achieved and include natural means as contrib- lative branding items (like fancy names for cofutors to healing. He works diligently to present fee sizes and oversized drinks at retail chains)

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This work will appeal to the ordinary person reading for individual enrichment as well as the professional treating a patient in need of healing. challenge our ability to gravitate toward simplicity to the unexplained blooming of plants as messages of encouragement at a time when it is needed. His cases are presented persuasively in the hopes we can see ordinary things as solutions to what ails us.

The book is rich with spiritual practices to better connect us with each of the healing “things” he covers. From using meditation to ground oneself and stave off the desire to chase after the newest thing, to letting unhappiness be an invitation to craft a more fulfilling life, he presents a multitude of possibilities in each chapter. He makes the case that classical music, letting tears flow freely, playing in the dirt and paying attention to unexplained mysteries can all bring us to a state of better health.

Some of his suggestions will not appeal to all, as patients may express disgust about utilizing maggots or leeches to treat various conditions — and may become worried about tending to the voices in their heads.

Dossey’s main point, for the average reader and the physician alike, remains valid — we need to remain open to the countless healing agents in our lives each day. If you are looking for a new way to approach or encounter healing, Dossey’s book could provide new thinking and supporting evidence that there is more to ordinary, everyday things than you might suspect.

Upcoming Events

from The Catholic Health Association International Outreach Networking Call

Pre-Assembly Mission Leader Seminar

Ecclesiology and Spiritual Renewal Program for Health Care Leaders

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Community Benefit Webinar: “What Counts as Community Benefit?”

June 9 |8 a.m. to noon CT

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May 5 – 10 (Invitation only)

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Pre-Assembly Community Benefit Program

Pre-Assembly Program: The Heart of Aging Services June 9 |9:30 – 11 a.m. CT

Joint Global Summit: Compassion, Ethics & Excellence in Global Health

2019 Catholic Health Assembly

Faith Community Nursing Networking Call

June 25 | 3 p.m. ET

May 14 – 15

May 15 | 3 p.m. ET

Human Trafficking Networking Call

June 9 – 11

Mission in Long-Term Care Networking Call International Outreach Networking Call Aug. 7 | 3:30 p.m. ET

May 30 | Noon ET

A Passionate Voice for Compassionate Care® chausa.org/calendar

LAURA RICHTER is system senior director, mission integration, SSM Health, St. Louis.

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EXECUTIVE SUMMARIES Trinity Health Explores Healing Presence PHILIP J. BOYLE — Trinity Health is pursuing its ongoing desire to better understand the elements of Catholic identity by focusing on the nature of a healing environment and incorporating its findings into health care settings. Beginning in 2016, Trinity embarked on a quest to more fully investigate the nature of the healing environment. The most significant impetus to pursue that quest arose when Trinity purchased a heritage edition of The Saint John’s Bible, a hand-illuminated manuscript, at the same time the health system was researching the healing environment.

The goals of its Healing Environment initiative were to understand existing practices and guidelines in operation within Trinity Health; identify characteristics and additional guidelines for a healing presence within facilities; and produce tools for

Page 4 mission leaders and executive leadership to assist with advancing a healing environment.

The system gathered a design team. Members of its mission integration department visited sites and talked to patients, employees, leadership and community members about elements of a healing environment. A positive healing environment is also important for employees, for their own well-being and so they can provide a healing presence for patients. Such an environment can be evaluated in terms of the end-state of a patient’s well-being, including senses of connection to people and the community, lack of isolation, safety, restoration, hope and trust. Engaging the spiritual imagination is important to creating a healing environment. A healing environment requires quality clinical care and a built environment that includes beauty, meaning and connection to open a person’s spiritual imagination through the senses.

Through a Glass Darkly: Healing and the Religious Imagination Page 10 ZENI FOX — The use of design to create healing environments draws upon many aspects of human creativity. One source is religious imagination, which is the capacity to envision the transcendent when perceiving a specific, concrete and earthly reality.

An examination of responses to a 16thcentury work of art, the “Isenheim Altarpiece,” and a 2018 show at the Metropolitan Museum of Art, “Heavenly Bodies: Fashion and the Catholic Imagination,” explore the relationship between healing and the religious imagination.

The late sociologist and author Fr. Andrew Greeley explored the “religious sensibility that inclines Catholics to see the Holy lurking in creation.” Mary Oliver, the American poet who died earlier this year often used accessible imagery suffused with

spirituality that seems to refer to the transcendent. As Oliver worked with words, architects use space and structure. Steven Holl’s design of the chapel at Seattle University draws in part from the writings of St. Ignatius of Loyola with his themes of light and darkness.

The task of creating artistic representations for Catholic health care settings requires collaboration. In a health care environment that supports healing spaces, such collaboration involves seeking themes that link past and present at the service of healing, and finding the themes translated into visuals and art that invite contemplation. The hope is that Trinity Health’s project will not only aid the healing of individuals, but through the power of the religious imagination, will contribute to the healing of modern society.

‘Holy Seeing’ from the Art of The Saint John’s Bible Page 16 BARBARA SUTTON — The process of illuminating passages in The Saint John’s Bible used the monastic practice of lectio divina, a careful reading of the text that includes choosing a word or phrase, and letting the inspiration become something meaningful in a new way.

Another practice, visio divina, or “holy seeing” provides a method for praying with The Saint John’s Bible. Using six steps — listening, meditating, seeing, praying, contemplating and be-

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coming Christ-like — the author invites people to look at one of the Bible’s illuminations and view it with the eye of the heart, perhaps stirring the person’s memory or stimulating the spirit.

This practice of visio divina can bring a person a healing or an affirmation in their life.

This article details several instances where people engaged in visio divina realized something about themselves, their relationships and their communities.

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The Design Imperative: An Antidote for Clinical Compression Page 22 KATHY OKLAND — Contemporary clinical practice is challenging and complex. This drives endless re-engineering of an enterprise created for a model of care that no longer exists. Care providers experience a diminishing and ever-narrowing band of their capacity for care — and the capacity for who they are as caregivers. At the end of the day, clinicians are human beings caring for human beings.

A growing body of knowledge suggests that the physical health care environment can greatly contribute to health professionals’ overall experience by either supporting or inhibiting work performance, staff safety and occupational stress, as well as job satisfaction and retention.

The nonprofit Facilities Guidelines Institute guides best practice in the health care built environment. While no single design intervention will produce significant and sustainable results, a compelling question to ask is, “do our design decisions make care more, or less, human?” As an example, staff rest areas should be provided to every unit that assumes care for patients overnight. Suggested attributes of staff rest areas include access to daylight, views of the outdoors, a space restricted from public access and readily accessible to the work unit and independent from staff on-call rooms, carpeting for noise control and storage space for linens.

Health care is long overdue in completely recognizing the criticality of well-designed clinical environments for treatment and well-being, and the culture to support them.

Healing Garden Fosters a Heart of Love Page 28 JIM RICHTER — Mercy Health – Anderson Hospital includes special features to celebrate its religious tradition and healing mission that were part of a 2015 campus expansion. Sr. Mary Lou Averbeck, RSM, and mission liaison to the administration, and Jim Richter, director of mission integration, East Market, Mercy Health – Cincinnati, found an artist who could create a sculpture of Catherine McAuley, the founder of the Sisters of Mercy, for the hospital’s lobby. It is inspired by a statue in Ireland, where Sr. Averback and other visitors have placed a hand in the hand of the Catherine statue there. The sculpture in Cincinnati also includes a mother and baby, and welcomes visitors to the hospital.

A healing garden on the Anderson Hospital campus grounds includes a rill, or small stream, that was inspired by the rill in the courtyard of the Mercy International Centre in Ireland. A

bronze sculpture of Mary above a collecting pool shows her with arms extended to heaven, saying “yes” to her call to bear God’s son and bring Jesus among us. The sculpture is entitled “Fiat” — May it be done to me according to your will.

Among other design elements at the hospital, much thought was given to the chapel. It includes a field of twinkling lights, like a star-filled night sky, and bolder light in the ceiling designed in the shape of a cross. The chapel incorporates stained glass doors from a 1989 expansion of the hospital and statues of Mary and Joseph brought to Anderson Hospital when a Mercy hospital in Mariemont, Ohio, closed in 1989.

The artwork and historic and religious features connect those at the hospital to its Catholic mission to be a source of healing and compassion.

A Medical Safe Haven for Survivors of Trafficking Page 32 JENNIFER COX and RON CHAMBERS — Victims of human trafficking — those who are coerced or sold into forced labor or sex work — include men, women and children in all 50 U.S. states and worldwide.

Trafficking victims experience acute and chronic physical and mental health issues relating from trauma, which can have lifelong detrimental effects.

In 2014, San Francisco Dignity Health, in partnership with the Dignity Health Foundation, launched the Human Trafficking Response Program to better identify trafficked people in health care settings and to provide trauma-informed care in safe and healing spaces. In Sacramento, Calif., a Dignity Health family medicine residency

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training facility developed the Human Trafficking Medical Safe Haven to provide comprehensive, trauma-informed health services to people who have experienced trafficking. This clinical environment was built upon standards outlined in the SurvivorInformed Practice assessment tool, developed by fellows of the 2017 Human Trafficking Leadership Academy (organized through the National Human Trafficking Training and Technical Assistance Center and Coro Northern California). The recommendations drew from the input of trafficking survivors to get their insight about what constitutes a safe and healing space.

Additionally, the core tenets of trauma-informed care include safety, trustworthiness and transparency, peer support between clinical peers, and collaboration and mutuality between organizational leaders, staff and patients.

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Labyrinth Walk Serves as Tool for Spiritual Journey Page 38 BECKY URBANSKI — At Benedictine Health Center at Innsbruck in New Brighton, Minn., one of the first things visitors to the long-term care center see is a large, flat maze close to the front entrance. It’s not unusual to see residents with walkers or in wheelchairs, staff, family members or area neighbors following the contemplative path. A circular design found in almost every religious tradition over the past 4,000 years, labyrinths can be seen etched onto cave walls, in the designs of decorative floor tiles, and incorporated into baskets, pottery, coins and other items.

Historically, patterns on the floor or the ground that can be walked as a path or maze are called labyrinths. They are used for meditations, dance, rituals, ceremonies and sometimes just for fun. Also considered a spiritual tool, a labyrinth can represent an individual’s spiritual journey with its many unknown twists and turns and its ultimate goal of reaching the center.

This article includes a guide by Fran O’Connor, spiritual care director at Benedictine Health Center at Innsbruck, about how to walk a labyrinth, and a blessing for a labyrinth walk by Rev. Barbara Kellett.

To Be a Healing Place Page 40 BRIDGET DEEGAN-KRAUSE — The author offers three blessings — a blessing of delight, of candor and of memory — to accompany those who seek to be a healing place for others who are undergoing life changes or suffering from disappointments or ailments. She provides personal and Biblical examples.

Delight is a beautiful blessing we offer one another when we share our joyful recognition of another’s uniqueness, particular experience, dignity and worth. Candor is the quality of being open, honest and frank. We offer the blessing of candor when

we are lovingly generous in our honesty, when we judiciously share from our perspective and experience, and when we offer the possibility of hope. We offer the blessing of memory when we remember and honor the story of another. Often with this blessing comes the discovery of a shared story.

Faithful friendship is a sturdy shelter, according to Sirach 6:14. Yet even on our best days, our doorways, inboxes and calendars can be too full, and the needs too great for the shelter of one heart. Rather than thinking we can do it alone, let’s do it together and then invite the Holy Spirit to shore up the structure of sanctuary and the blessings we have to offer.

Meditation on Healing and Sacred Spaces Page 44 DAVID J. SHUCH — Healing is a broad term that can cover everything from a cut finger to a damaged planet. The author explores two points of human healing, remote from each other: from the bruised knee to the broken heart of a young girl. The child scrapes her knee as she’s playing outside. There is a kind of communication between the cells of the skin that senses every kind of stimulation.

Some of these messages rise to the level of our awareness, but many don’t. The fabric of cells that form our surface have a keen sense of integrity, one we can think of as a kind of harmonic sound, like a church choir toning a long harmonious chord that alerts the cells that all is well. When there is a breach, the tone changes. If the girl’s skin cells don’t get out the signal to repair,

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help can come from a reassuring kiss she receives from her mother, a prayer offered for her healing, a trusted pediatrician who treats her and tells her she is brave and her knee will be good as new in a week.

When the girl is older, she is heartbroken over a breakup with her first boyfriend. At the right time, an internal tone will sound and remind her of wholeness, of joy in life. She visits a church and trades a bit of her grieving for a bit of solace.

Whether in churches and monasteries, grottos and clearings within a forest, a treatment room in a doctor’s office, what is important is that within a space, a particular intention is held again and again by a group of like-hearted people or maybe just a single soul. A space can resonate with a sacredness that can knit a broken soul. And like a choirmaster toning a heavenly pitch, it can signal the start of healing.

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P R AY E R

SERVICE

God of Details: A Blessing of Space CARRIE MEYER McGRATH, MDiv, MAS DIRECTOR, MISSION SERVICES, THE CATHOLIC HEALTH ASSOCIATION, ST. LOUIS

Leader: Let us be still in the presence of God and one another.

(Pause) Study the space we share at this moment. Note the windows, fixtures and furniture. Consider their color and size. Visualize what is behind the walls, under the floor, above the ceiling.

Imagine what materials were used in crafting this space and the process and people who put it together.

We are quick to see God’s work in the natural world, but what of our built environments?

How do the rooms in which we live speak to us of God? Is God concerned with these rooms in which we move and live and have our being?

Reader 1: God said to Noah, “Make yourself an ark of cypress wood; make rooms in it and coat it with pitch inside and out. This is how you are to build it: The ark is to be three hundred cubits long, fifty cubits wide and thirty cubits high. Make a roof for it, leaving below the roof an opening one cubit high all around. Put a door in the side of the ark and make lower, middle and upper decks.” (Genesis 6: 14-16) Reader 2: God said to Moses, “Then have them make a sanctuary for me, and I will dwell among them. Make this tabernacle and all its furnishings exactly like the pattern I will show you.” (Exodus 25: 8-9)

Leader: Most of our spaces are not designed on the divine drafting table, but God’s attention to the details in designing Noah’s ark, the Ark of the Covenant and Tabernacle of Moses remind us that the small things matter. They are both functionally and spiritually significant — the use of natural materials and light, the dignity of the laborers, the beauty and functionality of the furnishings can create a peaceful, sacred healing space.

Pray with me a blessing for this space.

All: Loving God, be close to those who dwell in this room.

May its walls be a reminder of the strength and shelter you offer to your people. May they remain strong to provide sanctuary and peace to all who enter.

May its windows invite us to look out into the world and seek ways to serve. May they remain clear and bright, undimmed by anxiety or despair.

May its door be a reminder that you stand waiting at the door of our hearts and may it always remain open in hospitality to the stranger and the outcast.

May the fullness of peace and joy embrace all who come here. May good conversation, willing collaboration, hearty laughter and love of you rest on all who enter this space. Amen.

“Prayer Service,” a regular department in Health Progress, may be copied without prior permission.

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Resources on Catholic Health Care and the Social Determinants of Health H E A L I N G T H E M U LT I T U D E S

HEALING THE MULTITUDES

Catholic Health Care’s Commitment to Community Health

HEALING THE MULTITUDES

Catholic Health Care’s Commitment to Community Health: A Resource for Boards

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Addressing the root causes of health issues is part of the tradition of Catholic health care.

Our faith compels us to give special attention to our neighbors who are economically poor and vulnerable and to work for the common good.

CHA has developed a set of resources that explains why Catholic health care is called to take a leadership role in addressing the social determinants of health. This work is not new to the Catholic health ministry, it is part of our heritage, started by our founding congregations who often addressed the social needs of those in their care alongside the medical needs. It is also part of our future, as our knowledge of health and well-being evolves, so must our approach to carry on the healing ministry of Jesus.

ACCESS THEM ALL AT

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THE HEART OF...

2019 AWARD RECIPIENTS

Catholic Health Assembly JUNE 9 – 11 | DALLAS

S I S T E R C O N C I L I A M O R A N AWA R D For demonstrated creativity and breakthrough thinking Holly Austin Gibbs, Director, Human Trafficking Response Program, Dignity Health, San Francisco, a member of CommonSpirit Health

L I F E T I M E A C H I E V E M E N T AWA R D For a lifetime of contributions Fr. Francis G. Morrisey, OMI, Ph.D., JCD, Professor Emeritus of Canon Law; Saint Paul University, Ottawa, Canada

TOMORROW’S LEADERS PROGRAM Honoring young people who will guide our ministry in the future Tiffany Capeles, Director, Health Equity, CHRISTUS Health, Irving, Texas W. Carson Felkel, II, MD, Lead Physician, Behavioral Health Program, Bon Secours St. Francis Health System, Greenville, S.C. Jenna K. Floberg, Executive Director, Villa Loretto Nursing Home and Villa Rosa Assisted Living, Mt. Calvary, Wis., a member of SSM Health Sunny Lay, Director, Nursing Operations, St. Anthony Hospital, Gig Harbor, Wash., a member of CHI Franciscan Health/CommonSpirit Health Bryan Lee, President and Chief Executive Officer, Our Lady of Lourdes Regional Medical Center, Lafayette, La., a member of Franciscan Missionaries of Our Lady Health System

Sponsor of the 2019 Tomorrow’s Leaders Program

Cody McSellers-McCray, Regional Director, Community Health, AMITA Health, Chicago, a member of Ascension Scott O’Brien, Chief Operating Officer, WashingtonMontana Region, Providence St. Joseph Health, Spokane, Wash.

Peter Powers, Chief Executive Officer, St. Anthony Hospital, Lakewood, Colo., a member of Centura Health/CommonSpirit Health Sara Vaezy, Chief Digital Strategy Officer, Providence St. Joseph Health, Renton, Wash.

Heather Wall, Chief Nursing Officer, PeaceHealth Sacred Heart Medical Center at RiverBend, Springfield, Ore.

Abby Lowe McNeil, Vice President, Communications and Public Affairs, CHRISTUS Health, Irving, Texas

SAVE THE DATE! Assembly 2019 | June 9-11 Join us in Dallas where CHA will celebrate these and the other award recipients on June 10, during the Awards Banquet.