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By JUDITH VANDEWATER

SCOTTSDALE, Ariz. — Chief executives, sponsors and senior mission leaders of some of the country's largest Catholic health systems met here last month at the invitation of CHA for a focused conversation about Catholic identity and institutional integrity at a time of rapid change and corresponding challenge in health care delivery.

The meeting, "Catholic Identity and Integrity: A Critical Conversation," explored open-ended philosophical questions related to what distinguishes Catholic health care as a ministry of the church and practical matters such as how different systems are ensuring, monitoring and measuring Catholic identity, fidelity to mission and the effectiveness of formation programs.

Sr. Mary Haddad, RSM, CHA senior director of sponsor services, and Brian Smith, CHA senior director of mission integration and leadership formation, said there is an increasing focus on mission assessments that parallel health systems' financial and quality assessments and help maintain accountability in this critical area. They also help demonstrate that accountability to sponsors and the local bishops.

A proactive declaration and maintenance of Catholic identity in the Catholic health care ministry became increasingly important as the number of women religious working in hospitals has declined in the past few decades and new forms of sponsorship have evolved, but a number of factors have conflated more recently that added urgency to the discussions at the invitation-only meeting, Feb. 2-3. Among them are the changes in health care and its delivery as well as the commitment to maintaining Catholic identity in health care in the U.S.

Forming leaders
Sr. Carol Keehan, DC, CHA's president and chief executive officer, told the 128 meeting participants that the current generations of lay leaders had the advantage earlier in their careers of working alongside women religious, who taught them about health care as a ministry. In the next generation of leaders, "we will have many people who have never seen a sister."

Many systems rely on formal formation programs to pass on the values of the sponsoring congregations to lay sponsors, executives, managers and physicians. In addition, many offer mission-focused programs for all staff. Formation programs usually follow the core content outlined in CHA's "Framework for Senior Leadership Formation." Generally speaking, formation program participants learn about Catholic theology; the intrepid women religious who founded Catholic hospitals; the charisms of those religious congregations and how those values shape the culture, values, choices and daily work of ministry health care providers. In addition, formation programs for senior leaders include Catholic social teaching, ethics, leadership style and church relations. Many formation programs also are intent on opening participants to a deeper experience of their own spirituality, their call to the health ministry and God's vision in the world.

"Formation is a journey from head to heart to feet," Fr. Joseph Driscoll said during a panel discussion on varied approaches to formation. Fr. Driscoll is vice president of the Center for Ministry Leadership at Bon Secours Health System in Marriottsville, Md., a system that recently increased its commitment to physician formation.

Philip Boyle, senior vice president of mission and ethics at Livonia, Mich.-based Trinity Health, said personal transformation is not the most important goal of formation. Rather, he said, formation is about sustaining the core Catholic values of the institution into the future. At Trinity, the long-term measure of success of formation programs will be whether the institution sustains its Catholic identity, and whether it grows, he said.

Church and society
In his keynote presentation on Catholic health care as a ministry of the church, Fr. J. Bryan Hehir, a professor of religion and public life at Harvard University and secretary for health and social services for the Archdiocese of Boston, described the paradoxical desire of Catholic health care, schools and social services agencies to maintain a separateness from their secular counterparts while consciously pursuing pluralism, inclusiveness and a seamless place in the fabric of the broader American culture.

Fr. Hehir said that while Catholic health care and social service agencies are rooted in the church, they are also a bridge between the church and the wider society. "We want to serve it. We want to participate in it. We want to foster it. We want to change it in many ways," he said of American society. Assimilation allows Catholic institutions to influence the culture at large, he said.

He put forth a test for assessing whether an organization is maintaining its institutional integrity as a Catholic ministry. Integrity requires coherence between the origins of an institution and what it has become or aims to be. "Who are we? Where have we been? What do we seek to be? Answer those questions first, they are the most important," Fr. Hehir said. He added, "Consistency does not mean you rule out all change, but it does mean you accept some changes and not others."

Integrity in Catholic institutions also requires adherence to high professional standards. And, particularly in health care, he said, integrity requires that new technology be assessed in the context of a "moral framework" consistent with church teachings. Lastly, Fr. Hehir said for Catholic institutions, integrity requires a recognition of the faith and reason underpinning Catholic culture and a commitment to serve everyone in the broader culture.

Catholic identity
Several sessions broached the subject of Catholic identity in order to encourage an ongoing dialogue in the ministry.

Fr. Thomas Kopfensteiner, executive vice president of mission for Englewood, Colo.-based Catholic Health Initiatives, said Catholic identity is living and dynamic, not a static target. The work of Catholic health care is sacred, even sacramental, he said, but he thinks that it is counterproductive and confining to give in to a temptation to say Catholic health care offers the public something distinctive that is unavailable elsewhere. The sisters who started Catholic hospitals did not compare themselves to others; rather, they responded to shifting needs of the vulnerable, he said.

Anthony R. Tersigni, president and chief executive of Ascension, based in St. Louis, added that Catholic health care has survived for centuries by adapting and meeting changing needs, just as the founding sisters had. "Maybe a community doesn't need a hospital anymore, but it needs some other aspect of caregiving. We ought to be open to that; it's difficult to do. It is fraught with emotion around the board table, but it is what made our fore-sponsors so successful; and I think it is what will make Catholic health care successful in the future," he said.

Fr. Kopfensteiner and Tersigni spoke on a panel titled "Stewarding Catholic Health Care through Transformation." They were joined by Sr. Juliana Casey, IHM, the sponsor president of Providence Ministries in Renton, Wash. Sr. Casey brought with her a copy of "Catholic Identity in Health Care," a CHA document published in 1986 that describes Catholic identity "as the essence of who we are."

"We are a vital presence of God in the world," Sr. Casey said, and added that belief motivates Catholic health providers and sets them apart. She said that risk taking and innovation are central to the origins and growth of Catholic health care, just as care of the poor, compassion and nonjudgment of people who lie outside of the mainstream culture and suffer as a result are central to Catholic identity, she said.

Tersigni said Ascension is clear its identity is as a ministry of the church. "We believe we are touching Christ when we take care of the sick and the poor and we ourselves are acting as the body of Christ in the world. When we reach out to heal and comfort the sick, we are restoring people's relationship with their God, with their families, with their loved ones, with their community. I believe those are things that set the Catholic ministry apart in this country," he said.

Kevin Lofton, chief executive of CHI, commented from the audience that Catholic health care has been distinguished for its focus on end-of-life care. Lofton, one of the few African Americans to lead a large U.S. health system, proposed that Catholic health care could distinguish itself going forward by tackling race-based disparities in care and improving health outcomes for minorities. He also called out the need for racial diversity in Catholic health leadership, a sentiment that was echoed by several people during the conference.

Ernie Sadau, chief executive of CHRISTUS Health, said that drive for inclusiveness and diversity in Catholic health care organizations should extend to those of other religions. CHRISTUS is based in Irving, Texas, and its facilities are concentrated in Texas and Louisiana. "In many of our markets the Catholic population can be 2 to 3 percent of the overall population of who we are ministering to as a Catholic organization," he said. "Interfaith dialogue is critical in every conversation we have."

Collaboration
Sr. Casey said Catholics have to guard against a sense of superiority when they work with partners. She added that collaboration is necessary to survive and thrive as a ministry. She said that the founders didn't ask people whether they were practicing Catholics before they asked for help and support from community members.

Fr. Kopfensteiner said CHI considers partnerships among health providers essential to the continuation of its mission. Tersigni agreed: "I don't believe we can do it ourselves. We need to partner." He said Ascension spends much time and effort up front assessing potential partners to determine whether there is compatibility of values.

CHA's Smith said participants' input at the Scottsdale conference related to distinctive elements of Catholic identity was expected to inform a meeting in late February of a CHA task force studying the possibility of creating a common Catholic identity assessment tool for use by CHA members.