BY: RANDY SHOOK and LAURIE FOJUT
Mr. Shook is director of media relations for Catholic Health Initiatives, Denver; Ms. Fojut is a freelance writer based in Rochester, MN.
Shared Values and a Pioneer Spirit Unite One of the Nation's Largest Not-for-Profit Systems
Just a little more than five years ago, Catholic Health Initiatives (CHI), based in Denver, was a vision in the minds and hearts of the members of its founding congregations of women religious. Today, it is one of the nation's largest not-for-profit health systems and a model of how a modern religious-lay partnership can advance the health ministry of the Catholic church.
"When I look back at the beginning of CHI, I see two values that characterize
our journey," said Sr. Maryanna Coyle, SC, chair of the Board of Stewardship
Trustees of CHI. "The first is the trust we had in each other and in our shared
gospel values. The second is the pioneer spirit — the willingness to take risks — that
has shaped our institutions from the beginning. Because three health care systems
and 10 religious congregations were willing to embrace the vision, it became
something that we believed we could accomplish."
The organization that celebrated its fifth anniversary on May 1, 2001, began
as a consolidation of the former Catholic Health Corporation, Omaha; Franciscan
Health System, Aston, PA.; and Sisters of Charity Health Care Systems, Cincinnati.
A year later, the Sisters of Charity of Nazareth Health System, Bardstown, KY,
merged with CHI, followed by the Sisters of St. Francis of the Immaculate Heart
of Mary, Hankinson, ND, in March of 1998, which brought the total number of
founding congregations to 12.
Today, CHI has not only knitted together the cultures, resources, and balance
sheets of five different and geographically dispersed health systems, but has
done so with a focus on high-quality care. This April, CHI was named the winner
of the 2001 National Quality Health Care Award, which honors providers that
improve health care through high-quality performance and innovative leadership.
"We are thrilled by this recognition," said Patricia A. Cahill, JD, president
and CEO of CHI. "We believe that it honors not only our organization, but all
the partnerships that help us deliver high-quality care within our facilities
and throughout the communities we serve."
Equal Sponsorship Partners
Mutual trust and a pioneer spirit were important in the early days of CHI because
the organization was breaking new ground. The organization's Board of Stewardship
Trustees, which serves as the canonical sponsor of its facilities, is divided
equally between religious and lay members. In this way, CHI set a precedent
by giving laity a sponsorship role in its facilities. "Serving as canonical
sponsor can be a formidable challenge for lay members of the board," said Marjorie
Beyers, RN, PhD, a health care consultant and a lay member of the board. "In
contrast to well-established governance models, there were no rules or conventions
to be followed. The partnership works because there is candid discussion of
the issues and a strong sense of accountability to Catholic health care."
Trust was also essential because the women religious and lay leaders who composed
the steering council that created CHI did not want to issue directives as to
how the organization would be structured or managed. "It was as though we created
a design, much like an architect does, but did not fill in the colors, shapes,
or arrangements," said Sr. Coyle. "We recognized that those who would implement
our design would need a certain amount of flexibility in order to make it a
reality."
Sr. Peggy Martin, OP, JCL, was a member of the steering council and recently
joined the CHI leadership team as senior vice president of sponsorship and governance.
She believes the council's trust in CHI's leadership is being rewarded. "The
leadership and staff pay great attention to our original mission and vision,"
she said. "Everyone constantly talks about the original intent of the women
religious who founded CHI, and leadership ensures that the decisions made today
are consistent with the steering council's intent."
Establishing a National/Local Partnership
The foundresses envisioned CHI as a single national organization designed to
serve its local facilities, which it calls "market-based organizations." CHI
defines market-based organizations as the basic service units of its system.
They provide direct health care services within defined market areas and are
governed locally by a board of directors or trustees. Some are individual, stand-alone
facilities, and others are integrated networks of different kinds of health
care facilities.
Although the intent was always to have just two levels — national and local — within
the CHI organization, that took some time to achieve. The facilities belonging
to the predecessor systems had been loosely grouped into regions. Then, through
a multistage process of restructuring, the organization simplified its structure
into national and local levels of governance and management. "I think the evolution
of CHI gives a message about the ability of our local and national leaders to
work together in direct partnership," said Sr. Coyle.
Creating Healthy Communities
At the time CHI was formed, the steering council's members realized that the
future of health care may not lie within the walls of institutions. They formed
the organization's Mission and Ministry Fund to provide grants to organizations
that are experimenting with different structures to improve the health of their
communities. "Improving community health has been a major theme of CHI from
the outset," said Beyers. "Strategically, it may prove to be the single most
important challenge in health care."
During the last four years, the fund has presented 91 grants that total nearly
$8.5 million to CHI facilities and founding congregations or associated organizations.
"Wonderful things are happening as a result of these grants," said Sr. Martin.
"To give just a few examples, disadvantaged children are receiving health and
dental care at school, communities have new places to meet and play, and end-of-life
care programs are helping people exit this life with dignity and comfort."
The Mission and Ministry Fund also recently started a new track of planning
grants intended to encourage comprehensive and collaborative efforts to achieve
healthy communities. "Some of the grant recipients are new collaborations, whereas
others are mature organizations that want to expand or diversify their efforts,"
said Cahill. "What they have in common is the potential to effect profound,
systemic change in the health and well-being of the larger communities they
serve."
CHI also pursues an agenda of social justice in other ways. The organization's
social responsibility investment policy provides guidelines for three areas
of mission-based investing:
- The direct community investment program, which provides
zero- to low-interest loans to not-for-profit institutions or projects that
provide individuals in need with access to jobs, housing, education, and health
care
- Shareholder activism, exemplified by filing shareholder
resolutions in collaboration with other mission-based investors
- Social screens to exclude certain companies, such as
those that manufacture tobacco products, from its investment portfolio
Rebounding from Operations Performance
CHI's financial road has not always been smooth. After showing net income during
its first two years, the organization was buffeted by the changes in acute care
patterns and reimbursement levels that swept through the health care industry
during the late 1990s. "There were external factors that were beyond our control,
and they added stress during a time of great change for the organizations that
had formed CHI," said Sr. Coyle. "The very fact that we have survived contributes
to our belief that coming together as one large organization was the right direction
to take. And, through all the financial difficulties, CHI never wavered in its
commitment to charity care and programs such as the Mission and Ministry Fund.
Our leaders continued to meet those obligations as they worked for the survival
and stability of CHI."
Through stringent cost controls, revenue enhancements, and performance management
initiatives, the organization rebounded and posted a positive operating margin
for the fiscal year ended June 30, 2000. "In September 1999, we set operating
performance improvement as our highest priority," said Kevin Lofton, executive
vice president and chief operating officer of CHI. "We established an internal
performance management function that establishes benchmarks and additional resources
for the good work our facilities were already doing in this area. We see this
effort as a mission enabler — it helps us maintain the financial stability needed
to carry the mission of CHI forward."
In some cases, achieving financial stability has meant changes in leadership
at the local and national levels and even the separation of some facilities
that were no longer viable members of the CHI system. Currently, the organization
is in the process of transferring seven of its facilities in the eastern United
States to Catholic Health East, based in Newtown Square, PA. "The reason that
we all came into CHI was for the overall good and survival of the healing ministry,
and we all realize that survival sometimes requires letting go," said Sr. Martin.
When CHI sold one facility to a for-profit provider, it also took steps to
ensure that the Catholic health ministry would continue to have a presence in
the local market. Last June, CHI sold St. Joseph Hospital in Lancaster, PA,
to Health Management Associates of Naples, FL, but then created St. Joseph Health
Ministries, which continues to provide community-based health education and
services, spiritual care, and advocacy in the local community (see box below).
Core Values Helped Define Common Ground
Sr. Coyle recalled that an important step in unifying the disparate elements
that formed CHI was the process of determining the organization's core values:
reverence, integrity, compassion, and excellence. "The process took more than
a year and involved almost 800 people throughout the organization," she said.
"It helped identify the common ground among so many different groups with different
histories."
Sr. Coyle believes that CHI is a better organization as a result of its challenges.
"A great deal of energy has gone into the organization of CHI and into dealing
with unpredictable changes in the marketplace," she said. "We did not deny the
problems we faced, but dealt with them in a way that resulted in the greatest
amount of good for this ministry. And, we've certainly celebrated many achievements
along the way. Now, I think we've reached a level of stability and integration
that will hold us in good stead as we move into the future."
St. Joseph Health Ministries
When the board of St. Joseph Healthcare Network recommended to the CHI board
the sale of St. Joseph Hospital in Lancaster, PA, it raised a question about
the continuation of the Catholic health ministry in that community. The hospital
would be sold to Health Management Associates, a for-profit firm that owned
another Lancaster hospital. The sale would leave the area without a Catholic
health provider for the first time in more than 115 years.
"We do a lot to encourage and support the development of new ministries that
enable the delivery of health care outside the walls of our facilities," said
Cahill. "We decided the time had come to create a new type of organization that
could continue the mission of Catholic health care, and of CHI, in Lancaster
without the presence of a Catholic acute care facility."
To accomplish this, CHI created St. Joseph Health Ministries, which Cahill
calls "our first nonfacility market-based organization." Funded by a portion
of the proceeds of the sale of St. Joseph Hospital, St. Joseph Health Ministries
is carrying on many of the community-based health and wellness programs established
by the hospital. These include:
- The Children's Health Achievement and Motivational Program
(CHAMP), which teaches health, nutrition, and first aid skills to children
from low-income households
- A parish nurse ministry program, which collaborates with
area churches to provide nursing guidance and education to parishioners in
need
- The Life Enhancement Center, which offers support, exercise
programs, and workshops for cancer survivors
- The Wellness Information Network, which provides every
library in the county with a comprehensive collection of health and wellness
books, audiotapes, and videotapes
- The Lancaster County SAFE KIDS Coalition, which provides
education and safety programs designed to reduce the number of childhood injuries
and deaths
- Supportive Care for People with Life-Threatening Illness,
a program that helps people with life-threatening illness to evaluate their
options and make choices for the care of their minds, bodies, and spirits
"St. Joseph Health Ministries is doing a wonderful job with the programs that
transferred from the hospital," said Sr. Peggy Egan, OSF, vice president of
mission integration for CHI. "They have a great balance between continuing those
programs and planning for what they want the ministry to become in the future."
Sr. Egan says the community has been accepting and supportive of the new ministry.
"In their communications, the staff is always very clear that St. Joseph Health
Ministries is not another social service agency, but a ministry of health and
healing," she said. "That identity is going to serve them well as they continue
to grow in ways that will meet the needs of the community."
CHI At A Glance
- 68 Hospitals
- 48 Long-term care, assisted living, and residential facilities
- 22 States: Arkansas, California, Colorado, Delaware,
Idaho, Iowa, Kansas, Kentucky, Maryland, Minnesota, Missouri, Nebraska, New
Jersey, New Mexico, North Dakota, Ohio, Oregon, Pennsylvania, South Dakota,
Tennessee, Washington, and Wisconsin
- 71 Rural and urban communities
- 72,000 Full- and part-time employees
- $6.4 Billion in assets
- $5.5 Billion in annual operating revenues
- $549 Million in total measurable benefits for the poor
and the broader community