BY: CATHY SULLIVAN CLARK
Ms. Clark is senior principal, Mitretek Healthcare-Jennings Ryan & Kolb,
West Springfield, MA.
Representatives of Nine Catholic Systems Describe Their Experiences with
Existing Models
"Sponsorship" of the Catholic health ministry — including the
use of the term and its definition — has been through an extraordinary process
of evolution.1 The ministry continues to explore new approaches,
and those approaches currently in use remain under scrutiny. Throughout this
progression, CHA has worked to facilitate the dialogue on models of sponsorship
and the theology behind it.
CHA's current strategic plan includes among its six focus areas one on sponsorship:
"ensur[ing] a vital future for the sponsored work of health care within
the [Catholic] Church by increasing understanding of and support for appropriate
sponsorship models."2 This charge to better understand alternative
approaches — in part by reviewing current models of sponsorship and identifying
successful practices — led CHA to engage Mitretek Healthcare-Jennings Ryan
& Kolb (JRK) to conduct a study regarding the lived experiences of current
models of sponsorship. Although not a scientific study, the JRK research was
designed to be representational, reflecting the experiences of systems of different
sizes with varied histories of, approaches to, and lessons learned regarding
sponsorship.
By telephone, we interviewed 35 people at nine systems in order to explore
the diversity of models that exist today. We strove to uncover multiple perspectives,
including those of sponsors, executive leaders, and board members. Included
in the study were single-sponsor systems, cosponsored systems, and public juridic
persons (PJPs) (see box).
The interviews covered a variety of topics. To inquire about a particular model,
we asked about the decision-making process that led to that approach and solicited
advice that others might use in exploring various models. We also made inquiries
regarding the model's current expression and evolution over time, including
what is working well and what continues to be difficult. Finally, we asked about
likely future changes and challenges. Not every interview covered every topic.
We were most interested in hearing from participants what they personally have
taken away from their experiences to date. Our interviews were conversational,
rather than prescriptive.
Analyzing the Results
CHA often uses a framework-Four Requirements for Effective Change-to support
discussion/discernment regarding the process of change; this framework was used
to analyze the results of the sponsorship interviews. The premise underlying
this framework is that all change requires four elements. If any one of these
elements is missing, regardless of the presence or strength of the others, the
change process is not likely to be successful. The four requirements are:
- Pressure for Change Objective information is needed about the current
situation that points to the need for a different approach. Such information
must be translated into a common definition of opportunities and challenges.
- Capacity for Change Also needed is a shared belief that there is
a compelling reason to change or to consider change.
- Clear, Shared Vision Required, too, are a common view of the desired
end and agreement on how success will be measured.
- First Steps The final element is a specific plan for implementing
the vision.
This framework provides a useful foundation for evaluating the evolution of
sponsorship. Accordingly, the key findings from our research study are organized
around these four requirements.
Pressure for Change
Virtually all interviewees recognized continued pressure for change related
to sponsorship, although a consistent theme was that of evolutionary,
not revolutionary, change. Representatives of each of the nine systems identified
pressure for change from both internal and external sources, including a declining
and aging population of sisters; changing church dynamics (both in the United
States and abroad); and fundamental health care market pressures, including
payment constraints, regulatory requirements, not-always-favorable public perceptions
of Catholic health care, and the need for partnerships with other-than-Catholic
organizations.
Although Catholic providers throughout the nation experience similar pressures,
they often respond to them in different ways. For single-sponsor systems, the
focus has been on changes in governance composition or functioning, along with
a renewed emphasis on clarifying authority, accountability, and sponsor expectations,
rather than on alterations to the sponsorship structures themselves. In contrast,
both structural changes and cultural changes have been pursued in the cosponsored
systems and PJPs. Importantly, PJP leaders are quick to point out that the PJP
model, although effective for them, is not for everyone.
Capacity for Change
The interviewees provided important advice about building the capacity for change
related to sponsorship. Above all, they said, the change process must start
with the current sponsors — in most cases, women religious — and must
build on a shared belief that the sponsored organization is a ministry of the
Catholic Church, not of individual congregations or sponsors. We also heard
repeatedly of the importance of timing. For many of those congregations that
have successfully changed their sponsorship approaches, a critical success factor
was pinpointing the right time for change. We frequently heard stories
concerning change processes that did not work the first time because the key
participants were not yet ready for them. Equally important, interviewees said,
is allowing leaders adequate time to work through and build support for change.
In some cases, for example, the organization involved took a year or more to
build trust among potential partners and to learn one another's perspectives
and heritages.
Many interviewees underscored the value of finding and using outside help to
manage the sponsorship-change process. As part of their planning, they engaged
outside facilitators or canon law experts; they also sought advice from people
who had been through similar change processes. These interviewees recognized
the wisdom of not attempting to reinvent the wheel.
Finally, many interviewees said that where there is a will, there is a way.
In the words of one person, "If sponsors want to make it happen, it will
happen. If not, it won't happen." This was a common refrain throughout
the interviews.
Impact on the Sponsoring Congregations
Clearly, changes in sponsorship will affect all involved in a sponsored work,
but the original sponsors themselves are often most strongly affected. For sponsoring
congregations, a new approach to sponsorship can at first lead to a sense of
loss or distancing. Such changes require new ways of thinking. For example,
sponsors of cosponsored systems must begin to consider the whole system, not
just an individual institution. Doing so is often easier in theory than in practice.
In cosponsored systems, making decisions about particular local ministries can
be especially difficult. As one sister noted, "It tugs at your heart when
someone tries to do something to one of your original hospitals. It hurts."
We learned from many interviewees that the new models of sponsorship are not
necessarily time-savers. Often, the fact that a congregation's membership is
dwindling is one of the motivations for taking a new approach to sponsorship.
But making the new approach work can take more time than maintaining the old
one. In some cases, the remaining women religious are stretched thin, with more
work to do and fewer individuals to do it. On the plus side, many of the women
religious we interviewed noted that their personal relationships with sisters
from other congregations have grown.
For some congregations that have transformed ministries into PJPs, the changes
have been more dramatic. In some cases, for example, congregational leaders
have become less involved with the church on health care issues; instead, the
PJP itself has taken on responsibility for that relationship. Even in cases
where this transition has occurred, however, the original sponsors have had
to invest time and energy in preparing church leaders for the change.
A Clear, Shared Vision
In all cases, the interviewees agreed, the development of a new approach to
sponsorship must be grounded in a shared vision for the future that is different
from the current reality. In sharing the lessons they have learned regarding
a vision of sponsorship for the future, interviewees stressed:
- The need to emphasize always the ministry of the church.
- The imperative to be truly open to something new and, as leaders, to avoid
getting in the way of whatever new forms appear; "creation of something
new" should be the mantra.
- The reality that our understanding of sponsorship continues to change. Many
cosponsored systems, for example, are deliberately moving away from the term
"cosponsorship," preferring instead the notion of sponsorship as
a whole.
Several interviewees from cosponsored systems also cautioned against focusing
too much on structure rather than on a foundation of shared values. Their advice
to others contemplating a similar approach is to seek cultural compatibility
first and then take the time to build trust. All must be respectful of the past,
but the emphasis must be on a shared and more vibrant future.
Implementing the Vision
As they look to the future, interviewees anticipate some significant challenges.
Among these are the formation and education of lay leaders, the strengthening
of relationships with the church, and an ongoing exploration of sponsorship.
Interviewees anticipate a future in which sponsorship will be transferred to
a new generation of sponsors, but they also recognize that the current sponsors
must truly understand sponsorship before they can pass it along. The interviewees'
commitment to develop effective structures for future sponsorship is motivated
by an intense desire both to serve patients and communities directly and to
leverage the ministry's voice for advocacy and human dignity.
An important theme in the stories shared was the need to create new, supportive
cultures. Culture must be recognized as a priority, and deliberate processes
must be developed for culture development. Recognizing that the creation of
a new culture can take years, it is often wise to start with an up-front assessment
of the current culture and — in situations in which multiple organizations come
together — of existing cultural differences. Leaders or "champions"
also must be identified, although the change process should be broadly inclusive,
involving everyone at all levels of the organizations.
Open to the Spirit
One is tempted, when studying the various approaches to sponsorship that exist
today, to focus most on the differences among models. Even so, the models seem
more alike than different, and they share, at their cores, the same requirements
for continued success. Among these are:
- A continued focus on mission
- People in leadership roles who have been adequately prepared for success
in these roles
- Strong communications and relationships among all who have been entrusted
with the stewardship of the ministry
- Clear roles, expectations, and mutual accountability
- Effective working relationships with the church
As the system leaders included in this study have worked to refine their own
approaches to sponsorship, they have recognized that this evolutionary process
is truly hard work. Yet they have begun to see the fruits of their labors and
would acknowledge that their continued commitment and efforts already have had
a substantial impact on the ministry and on the communities served. At the same
time, these leaders know that their work is not done, and they call for continued
efforts to better understand sponsorship and what it entails.
They agree that we must continue to have the courageous conversation about
sponsorship and be open to the Spirit, with whose help we will ensure a continued
vibrant Catholic health ministry in the United States.
Health Progress is publishing the results of the JRK research as part of
CHA's ongoing effort to continue the dialogue on sponsorship in the Catholic
health ministry. This article is being published in conjunction with a new DVD
resource that offers commentary — by Sr. Katherine Gray, CSJ, general superior,
Sisters of St. Joseph of Orange, Orange, CA; Clarke E. Cochran, PhD, professor
of political science, Texas Tech University, Lubbock, TX; Sr. Teresa A. Maltby,
RSM, leadership team, Sisters of Mercy, Chicago; and Sr. Teresa Stanley, CCVI,
senior director, sponsorship services, CHA, St. Louis — on the document Toward
a Theology of Health Care Sponsorship. A work in progress, the document, together
with a facilitator's guide and annotated bibliography, is offered as a resource
the ministry can use as it develops a deeper understanding of sponsorship.
For more information about the JRK study, or to receive a complimentary
copy of the study when it is released in late January, please contact Sr.
Teresa Stanley, CCVI, at 314-253-3507.
Type of Systems in Study
Single-Sponsor Systems
Franciscan Sisters of Christian Charity, Manitowoc, WI
Sisters of Mercy Health System, Chesterfield, MO
Cosponsored Systems
Ascension Health, St. Louis
Avera Health, Sioux Falls, SD
Catholic Healthcare West, San Francisco
CHRISTUS Health, Irving, TX
Provena Health, Mokena, IL
Systems with PJPs
Catholic Health Initiatives, Denver
Trinity Health, Novi, MI
NOTES
- See John J. McGrath, Catholic Institutions in the United States: Canonical
and Civil Law Status, Catholic University Press, Washington, DC, 1968.
This work was the first to use the phrase "sponsoring body" in its
current sense.
- Catholic Health Association, Uniting for Transformation: FY2003-05 Strategic
Plan for the Ministry Engaged, St. Louis, 2002.