BY: MICHAEL ROMANO
Ask a secular audience for the definition of the word "formation," and you are likely to wind up with answers touching on everything from military troop configurations to the structure of a building to a picture-perfect configuration of clouds in the sky.
In fact, the word has a number of connotations and interpretations. To Catholics, however, the term is much more distinct, meaningful and recognizable — at its core, formation represents the foundation of faith rooted in Christian spirituality and Catholic theology.
For Catholic health care organizations, including large systems such as Englewood, Colo.-based Catholic Health Initiatives (CHI), formation is an intrinsic element of leadership and learning, a process that integrates the spiritual journey into daily work and ensures a sharp organizational focus on four principles: mission, vision, values and legacy.
"The work we all do in our health care ministry is ennobling and enriching — we share the work of God as we focus on our core values of reverence, integrity, compassion and excellence," said Tom Kopfensteiner, CHI's executive vice president for mission. "Our goal is to embed formation into everything we do, each and every day, ensuring that our leaders understand their sense of call to the ministry."
More than five years ago, CHI embarked on its own specific spiritual journey in this key area, creating an internal Center for Formation to provide leaders with a richer understanding of the healing ministry of the Catholic Church and its connection to the health care industry. Formational experiences are incorporated into everything from behavior at business meetings to the care for patients. This connection allows leaders to understand and appreciate how their spiritual journeys are inextricably linked to their professional roles and responsibilities.
Since its creation, the center has worked with hundreds of individuals in every area of leadership to help enrich this understanding of how a faith-based organization like CHI perpetuates the legacy of its foundresses. The formational experience is designed to last for an entire career — and an entire life.
"The process of formation begins on the first day a leader joins our organization," said Kevin Lofton, CHI's chief executive officer and a driving force behind the center's creation. "And it continues through their careers. We all become more effective leaders when we continue to embrace a true sense of our personal calling to this ministry."
Lofton and other leaders envisioned a twofold role for the center: Establish a workforce whose daily activities are suffused with the organization's mission, vision and values; and develop the organizational capabilities and visionary leaders to ensure the success of strategic initiatives so vital to the ministry's future in a period of dizzying change.
Recognized as a trailblazer in the formation of Catholic health care leadership, CHI has a process that is disciplined, formalized, structured, consistent and never-ending. Formation is intended to help individuals articulate their call to the health care ministry, identify their role and integrate this spirituality into their work. Formation, in fact, leads to a transformation in personal and spiritual growth, exemplified by greater consistency in behaviors that parallel CHI's core values and leadership competencies.
The organization also pinpoints several key outcomes of successful ministry formation, including the ability to:
- Articulate a theological understanding of mission in CHI
- Apply Catholic teachings to organizational and business practices
- Commit to advancing core values, cultural attributes and mission standards
- Seek opportunities to improve as a servant leader in health care
- Lead prayer and theological reflection
- Facilitate generative dialogue and appreciative listening
"The focus of formation is to help leaders tap into the power of 'why' as the core to the meaning, identity and role in our health care ministry," said Patrick Gaughan, vice president of the Center for Formation and a longtime leader in CHI's mission group. "We feel like we're doing more than just integrating spirituality and business. Through our formation process, we've sharpened awareness among leaders of how their spiritual journey is already permeating their work — and making very explicit connections between their work and the legacy of our ministry."
CHI offers an array of formation programs across the system, including an introductory, two-day orientation; the day-long "Foundations of Leadership in Catholic Health Care" that includes interactive presentations and reflections; a four-day program called "Leadership by Design" that provides a deeper knowledge, understanding and appreciation of the Catholic health care ministry; and the "Transformative Leadership Development" program for senior leaders that stretches over more than a year. Some executives also attend a program sponsored by several Catholic organizations, including CHI, which features four intensive weekend sessions of work and study.
The Center for Formation, a "virtual organization" housed in CHI's national office, provides a comprehensive, career-long program with a mix of approaches and includes everything from instructor-led courses to mentoring and coaching. It's virtual in the sense that Gaughan collaborates with mission leaders and executives from across CHI's national network of 89 hospitals and hundreds of other health care facilities in 18 states, overseeing on-site programs and providing guidance for many individual formation efforts at any given time.
Throughout CHI, the program touches everyone in some way.
"My own participation in the formation process has shaped my perspective as a leader at CHI," said Patricia Webb, executive vice president and chief administrative officer/chief human resource officer. "And it has a tremendous impact across the system. Human resources and mission have partnered to create the kind of culture that provides the opportunity to demonstrate the difference between being a leader here and being a leader at other organizations."
Webb, who joined CHI in January 2011 after nearly a quarter-century career as a human-resource executive in secular health care facilities, spent part of her first week on the job in a two-day, introductory leadership orientation program for new executives. For Webb, that early exposure helped clarify the culture and smooth her transition.
"CHI is my fourth health system and my first faith-based system," she said. "My spirituality is very important to me. At other places I've worked, when I needed a moment to reflect or pray, I would have to retreat to my office to get myself in that space. Here, that sense of spirituality is who we are. It's something you do every day — with colleagues."
Core content areas in CHI's formation program include heritage and tradition with a focus on health care as a ministry of the church and Catholic identity; mission and values — that is, why CHI exists; spirituality; Catholic social teaching, with an emphasis on care for the poor and issues around social justice and human dignity; ethics, strategy and performance management; servant leadership; holistic health care; diversity; and church relations.
This work focuses on four expectations of all CHI leaders: Managing the legacy of care; managing relationships; managing results; and managing the common good. In CHI's leadership matrix, those four expectations are intentionally and explicitly connected to core leadership effectiveness, collaboration and competencies around each leader's specific position and job description.
However, the work of formation is not strictly about modules, rigid programs and instruction — it is focused on designing formational opportunities that build upon and integrate the daily work experiences at CHI with the God-given talents of leaders who can demonstrate those four expectations and competencies. In fact, many stories of how employees integrate their spirituality into their daily work experiences and find higher meaning in their jobs are published each year in Sacred Stories, a bound book now in its 15th edition.
"There are many Catholic health care organizations that approach formation almost in an academic fashion," Gaughan said. "Leaders go off to a site or a program for this work. What we do is use the actual work milieu — we work hard to utilize real work-life experiences to aid in formational development."
"Education is focused on the head," he added. "What we're trying to do is touch the heart."
Explained Kopfensteiner, "We explicitly decided we did not want an academic model. I didn't want people 'going to school' to learn formation. Instead, formation is built around daily activities. So team building becomes a formational exercise. So does strategic planning and discernment, especially as it applies to major decisions such as acquisitions or divestitures. These transactions become opportunities for leaders to understand that these are more than simply business decisions — they are mission and ministry decisions."
Theological reflection extends to such basic business matters as the annual review of capital spending allocations — in other words, which projects do and don't receive funding. "Everybody is asking for something good — they're all requests that will benefit the organization," Gaughan said. "But we do have limits, and we must make tough decisions. And when we make those decisions, we invite the wisdom of our higher power to help us — we reflect on how we are experiencing God in these decisions, we listen to the Holy Spirit and then we discern what is the right thing to do for the right reason."
These formational opportunities, along with more conventional instructional methods, mirror the continuum of a leader's experience within the CHI ministry — from the recruitment and hiring through initial orientation and ongoing formation, right until the day the leader leaves the ministry. In between, the process is aligned with strategic talent-management efforts, leadership-effectiveness reviews and cultural assessments as a way to help gauge success.
"Formation is not about just your work," said Alan Bowman, CHI's vice president for ministry formation who works hand-in-hand with Gaughan on the center's many activities. "It's about helping you become a better person, a better human being as a result of delving deeper into our spirituality, our own meaning and purpose in life. It really is a matter of how we connect those important personal characteristics with our professional ones."
For his part, Gaughan has a personal definition of formation: "I consider it an ongoing process that is grounded in Catholic theology and Christian spirituality that allows an individual to acknowledge and articulate the connections between the work they do, their values, the legacy they wish to leave and its connection to the values and the legacy of the organization."
As one example, Gaughan cites the case of a relatively new chief executive officer at one CHI facility whose first responsibility was to establish the local ministry's vision for the future. Instead of a unilateral decision, the executive opted to work with a collection of colleagues at the facility to create a common, collaborative vision for the future, a decision that provided a formational experience for everyone involved.
"Instead of one individual declaring, 'OK, this is what we're going to be — this is our vision,' the process became a formational opportunity," Gaughan said. "So, those involved are able to form their own, very personal connection to CHI's legacy. That, in turn, creates and sustains the kind of culture we want at CHI."
In January 2014, Gaughan and Bowman traveled to Louisville, Ky., to meet with about 40 leaders of KentuckyOne Health, a CHI joint operating partnership formed in 2012 through the combination of Saint Joseph Health System, Jewish Hospital & St. Mary's HealthCare and the University of Louisville Hospital–James Graham Brown Cancer Center. The session included a celebration of distinctly separate cultures embodied in two faiths, as well as the secular focus on academics and administration by the chief executive officer of the big safety-net university hospital.
"At the end of our time together," said Gaughan, "this is what people said: 'We are not as different as we thought we were.' In formation work, one universal truth becomes evident: When it comes down to what is meaningful and purposeful, we have so much more in common than we could ever imagine."
In one form or another, formation has always been an essential part of the Catholic health care ministry in this country. The women religious who founded the ministry in the United States understood the importance of providing lay leaders with a solid understanding of Catholic doctrine and social teaching. As the number of women religious has decreased over the years, the sponsoring congregations who formed CHI almost two decades ago identified ongoing leadership formation as a specific, non-negotiable priority. And as the organization grew and health care become more complex, CHI's leadership turned to the national mission group to develop and sponsor this process.
Now, Gaughan and Bowman work closely with Webb and CHI's human resources department in leadership development across all levels of the organization. This partnership is supported by an executive leadership coaching program, launched in 2011, that incorporates a holistic teaching model into spirituality and Catholic legacy.
Scores of executives have graduated from the program in the last three years, absorbing values that include ensuring that CHI develops the right leaders who can sustain the ministry into the future, inspire innovation and build on personal strengths while increasing capabilities and competence.
"It's all about how we show up as leaders," said Webb. "Formation helps us sustain an environment that supports our mission in terms of creating healthy communities, in terms of social justice and in terms of taking care of those who are most vulnerable."
That deep sense of mission filters down to all levels of the organization. Nigel Guyot, a manager in grant development and administration in the CHI Colorado Foundation, said his experience in the orientation program was far more valuable than the traditional leadership development program available to most middle managers.
"It really spoke more to the heart of what is needed to be a successful leader at CHI," he said.
Jonathan Timmis, a CHI employee for nine years and who has worked for other Catholic health care systems, said he has never before felt such a close connection between his daily work and his own spirituality. "The revelation for me," said Timmis, senior vice president and chief strategy officer for St. Vincent Health System in Little Rock, Ark., "was the ability to directly apply Jesus' life and actions to our daily life and actions at CHI. We talk about Jesus' miracles, and the healing and the touch of Jesus, and how that power is instilled in each of us today. Our formational experiences are geared toward helping us understand and apply the calling above and beyond the profession."
The timing of the center's debut nearly five years ago coincided with the big final push in Washington, D.C., for the Patient Protection and Affordable Care Act, which became law in March 2010 and altered the landscape for health care organizations across the industry. Almost immediately, executives were confronted with significant changes in how health care is delivered and how health care systems like CHI are paid for it.
"Suddenly, we had a wide range of dramatic changes to manage," said Lofton. "From the start, we felt that the Center for Formation would help CHI's leaders meet the many challenges that resulted from health care reform."
Known in its infancy as the Center for Formation and Organizational Effectiveness, the ambitious project ultimately dropped the second part of the title without losing its key elements, including areas of leadership and growth focused on organizational change leadership, project management and initiatives such as LEAN Six Sigma concepts and training. "We became more agile," said Gaughan.
Kopfensteiner said the success of CHI's Center for Formation is evident in many ways — including required annual leadership-effectiveness reviews of top executives, overall retention rates and a system-wide culture of inclusion, caring and compassion. An annual performance culture assessment asks employees to rate their supervisors in areas such as their level of inspirational leadership and whether their leaders exhibit — and connect — integrity and spirituality.
"I feel that there's a sense that people at CHI are able to talk about their work as not a job, but a ministry — work that is not only noble, not only good — but sacred," Kopfensteiner said. "I think our success over the past few years can be seen in our strategic talent reviews, cultural metrics and the overriding sense that people do find real meaning in their work."
As CHI continues to evolve and adapt to changes in the health care industry, it is creating a far more diverse mix of partnerships and collaborations with organizations that include Conifer, a for-profit provider of revenue-cycle services, and MedSynergies, another for-profit that is helping to oversee a national physician-services organization called CHIPS. The Center for Formation also is working with officials from the Cerner Corp., a global provider of health care information technology that is providing much of the infrastructure for sharing electronic health records in CHI's OneCare program. All of this work is part of what CHI describes as the "Next Era of Healthy Communities," a strategic plan meant to position the organization as a leading health care provider well into the future as the industry continues to face changes and challenges.
"What does this mean for CHI — and for Catholic health care in general?" Gaughan asked. "When the sisters founded CHI in 1996, part of the rationale for bringing four systems together into a national organization was the understanding that health care was changing — quickly and dramatically.
"Formation is the vehicle that allows us to stay integral to who we are as a ministry of the church in expressing what we know and do today — and what we will know and do long into the future."
MICHAEL ROMANO is national director of media relations for Catholic Health Initiatives, Englewood, Colo.
FITTING CORE VALUES INTO BUSINESS STRATEGIES
For Catholic Health Initiatives, the seamless integration of ministry and mission into vital business strategies was especially important for one of the organization's most challenging investments: the deployment of a $2.2 billion, system-wide information technology platform across the national enterprise. Now in its fourth year, the OneCare project will provide shared health records for all patients served by CHI.
As part of this huge undertaking, leaders at CHI's national office have worked closely with chief medical officers and chief nursing officers to underscore how stewardship and formation — all wrapped up in a heightened organizational focus on core values — complement efforts to improve clinical quality through the expansion of health records and data. In fact, they say, the two areas are inseparable.
"Ordinary business practices, processes and care-delivery protocols in our daily work life provide a rich source for formational experiences," said Gaughan. "And these experiences can be made more developmental — formational — when they enhance a leader's awareness of how their spiritual journey is permeating their work responsibilities and helping to sustain CHI's legacy of care."
The massive OneCare project represented an expensive and intrinsic part of CHI's recent focus on a strong employed-physician enterprise. In about two years, the system has more than doubled the ranks of its employed physicians to more than 2,000 while simultaneously ramping up its corps of advanced-practice clinicians, which now number approximately 1,000. As those numbers grew, so, too, did the Center for Formation's focus on the strictly clinical side of the health care operations.
The center's "Transformative Leadership Development" program, created to provide physicians, nurse-executives and other clinicians with a comprehensive orientation into CHI's mission and culture as part of their leadership training, graduated its first, 19-member class in 2013. The rigorous, 15-month program includes the assignment of an executive coach and the selection of an individual strategic learning objective. It hews to one key principle espoused by the Center for Formation: Catholic identity is embedded into every aspect of the program.
"A key focus has always been incorporating leadership principles important for Catholic health care leaders — and stressing their importance to clinical leaders," said Manoj Pawar, MD, vice president for clinical operations and physician leadership development. "So it wasn't a matter of just bolting on a session that includes Catholic identity and the expression of that identity at CHI."
"These changing times really call for a transformational approach to leadership," he added. "We're reinventing our capabilities as a Catholic health system."
The program's second class, which began its work in 2014, grew to 25 participants and includes a wider cross-section of leadership, including top-level executives and market leaders who are non-clinicians. "We have to have leaders who see new ways of innovating, new ways of mobilizing for a new era in health care," said Pat Patton, vice president of nursing operations, acute care, and co-leader of the leadership program with Pawar.
One participant, Louis Lim, MD, medical director of quality and care management at the Tacoma, Wash.-based Franciscan Medical Group, a CHI affiliate, said the 15 months of work with his colleagues in the first cohort concentrated on two key areas — leadership development and change management. But the focus on mission connected every discussion, session and lecture.
Lim called working with colleagues from across the system for more than a year an extremely valuable experience. "We discovered how much we had in common as we look to the future and carry out our mission to create healthier communities," he explained.
"It was a learning experience about how we — CHI specifically, and the Catholic health care ministry in general — came about," he said. "There was a focus on the sisters, our foundresses, who made this a reality in their time, and the risks they took and the dangers they faced. And those risks were considerable — a lot more than we face in our time. The courage and commitment they demonstrated were remarkable."