BY: FR. MICHAEL D. PLACE, STD
Fr. Place is the former president and chief executive officer, Catholic Health Association, St. Louis.
As has often been the case, I am beginning these reflections while on an airplane.
What is different is that this will be my final column for Health Progress.
My first column appeared in the March-April 1998 issue and was entitled "Toward
a Common Vision for the Catholic Health Ministry." Since then, there
have been 43 columns, covering a diverse range of topics. Although I did not
always appreciate the pressure of deadlines, I have enjoyed the opportunity
to step back on a regular basis and reflect on issues facing the ministry. I
am deeply appreciative to my colleagues, who work to make Health Progress
the successful journal that it is, for their patience and careful editing.
Obviously, the occasion of leave taking is an opportunity for a great deal
of reflection. Not surprisingly, it has proven difficult to sort through the
myriad thoughts that have crossed my mind in order to prepare these reflections.
Almost in desperation, I finally decided to take a look at my inaugural remarks
at the 1998 Catholic Health Assembly in New Orleans to see if they might stimulate
an approach. Thankfully, they did.
The title of those remarks was "The Faces of a Community in Ministry:
Passionate, Determined, and Responsible." After seven years of service
to CHA, I find that title to be as true today as it was then. Catholic health
care is not an "it" but an "us," a pilgrim people who by
our words and our actions make present, make real, the healing touch of Jesus.
Catholic health care is the faces of those who serve and the faces of those
who are served—"faces that, when viewed through the eyes of faith,
reveal to us the face of God."1
As a passionate, determined, and responsible community, we continue to build
on the incredible accomplishments of those who have gone before us. Working
together to support and strengthen the ministry, we have focused more intently
on understanding and integrating our Catholic identity as a ministry into all
that we do; we have attended to the reality of sponsorship theologically and
structurally; we have responded to the complex theological issues associated
with the principle of cooperation and pursued theological reflection on such
issues as the provision of nutrition and hydration and the emerging opportunities
and challenges of genomics; we have intensified our advocacy efforts, with particular
attention to the morally unacceptable reality of millions of uninsured and underinsured,
and, at the same time, sought to protect our freedom to serve in a manner consistent
with our faith. In so many ways, we have been about both service and transformation
by building partnerships that allow us to do more together than we could separately.
But we continue to face many challenges. In 1998 I identified four of our many
challenges. Not surprisingly, although much has been accomplished, the challenges
remain. In what follows, I will offer some current observations on those challenges.
Strengthening Ministry Identity
In my 1998 assembly remarks, I suggested that a quotation from the theologian
Raimon Panikkar could be of assistance as we thought about our Catholic identity.
Panikkar noted that "a Christian is one who both confesses oneself to be
such and as such is accepted by other people." In recent years, we have
spent a great deal of time and energy on what it is that we "confess"
as Catholic health care. We have a statement of identity and core commitments
as a ministry gathered and engaged. Individual systems and institutions have
clarified their core values and commitments. In so many ways, we are quite clear
about what we confess.
I have suggested that we can distinguish between the "how" and the
"why" of Catholic health care. Our "why," our mission, is
the call, the vocation to carry on the healing ministry of Jesus. Our "why"
is distinguished by a sense of transcendence. Our "how" is the contemporary
practice of medicine and health care delivery, with all of its complexity along
the entire continuum of care. Could it be that the questions or suspiciousness
we experience from theological and public—policy spheres are not about what
we profess or confess but about how that confession is incarnated, enfleshed,
made real in the clinical and business dimensions of the ministry?
In thinking about that question, I am reminded of a recent conversation with
a diocesan bishop, a friend of Catholic health care. While speaking of his regard
for the ministry, he also mused about whether it really could be distinguished
from other health care delivery in the United States. After posing the question,
he went on to note that the same could be asked about many of the structures
and functions of a diocese. Without being critical, and admitting that he himself
had no easy answers, the bishop said he thought it was important that we engage
the question. He said that he sometimes encourages such reflection among diocesan
leaders by asking, "What would you do differently if Jesus had not been
born?"
I found this to be a fascinating question, one that has not left my mind. What
would we in Catholic health care do differently if Jesus had not been born?
This is a more effective way of asking whether the "why" of Catholic
health care makes any difference in the "how" of what we do every
day. Cardinal Joseph Bernardin was struggling with that question when he proposed,
in A Sign of Hope, that "our distinctive vocation in Christian healthcare
is not so much to heal better or more efficiently than anyone else; it is to
bring comfort to people by giving them an experience that will strengthen their
confidence in life."2
Challenging as it is to consider what bringing such comfort would mean in the
clinical setting, it might, for Catholic health care, be even more challenging
to consider what bringing comfort means with regard to our institutions' role
as "public actors" or corporate citizens.
Fostering Ministry Leadership
The second challenge I noted at the 1998 assembly was ministry leadership for
the future. Clearly, a great deal has been accomplished in this area, and the
level of intentional activity in the leadership arena is growing. Distinguishing
between being a leader within the ministry and a "ministry leader"
has proved to be of some help in clarifying what is required for us to have
effective and dynamic leaders who will have "fire in the belly" and
vision in the mind similar to the fire and vision of those who came before us
and entrusted this ministry to us.
That being said, the challenges before us are daunting. The ecclesial context
in which the ministry is situated is as complex as any in our history in the
United States. Those we serve, and those with whom we serve, reflect an incredible
diversity of cultures, beliefs, and attitudes—a diversity that stretches
the understanding of pluralism. Our society—from which, of course, potential
leaders come, and which influences those potential leaders every day—celebrates
the primacy of the individual over the common good and refuses to accept the
reality of normative truth or moral absolutes. The church clearly celebrates
different values.
In such an environment, it seems to me, it is critically important that we
continue our search for what it will take to ensure that we have within our
institutions a "thick" culture that clearly provides an alternative
perspective on life and meaning, as well as leaders who can form, shape, and
nurture that culture. As we know, culture is much more than rules and statements.
Culture is the expression of an organization's most deeply held beliefs and
values. It is expressed most profoundly in that which is unspoken and presupposed.
Culture is a shared affective sense of the way things ought to be. And the "thicker"
the culture, the more unspoken it is, the more it is second nature.
Even though it is largely unspoken, culture needs to be celebrated and nurtured.
Such celebration and nurturing is best accomplished through the medium of the
symbolic and the imaginative. In many ways, the world of institutional culture
is the world of social imagination. And it is in that world that we find what
we might describe as our problem or our opportunity. In so many ways, the world
of health care is a world of science and business. We are quite comfortable
speaking of "measurable" outcomes and "value—added" results—which
are hardly the "stuff" of social space or collective imagination.
Another important component of culture is that which provides part of the context
and framework for decision making and, in our case, for ethical decision
making. In the shared values and beliefs of a culture are found the principles
and categories that form the basis for discerning what is right and what is
wrong. Culture also is the bearer of a collective wisdom that is accumulated
as a result of previous decision making. In addition, culture provides support
and encouragement for the development and maintenance of a community of ethical
discourse. All three of these realities—principles and categories, collective
wisdom, and a community of discourse—are essential if leaders and organizations
are to be able to act in a manner consistent with our beliefs.
According to this perspective, it would follow that the successful ministry
leader would have to be comfortable developing a culture—grounded in the beliefs
and teachings of the church—that sustained all three of these realities.
Consequently, I would propose that, in thinking about the future of ministry
leadership, it will be critically important that we consider how we can ensure
that our leaders and our culture are more than adequate to meet the challenges
we face.
Reinforcing Ministry Structures
The third challenge I identified in 1998 was strengthening the structures that
support the ministry. Again, so much has been accomplished by so many. In many
ways we now have a new generation of systems (e.g., Ascension Health, Bon Secours
Health System, and others) that have become so critically important to, and
in some ways distinctive to, Catholic health care. We also are in more mature
relationships with Catholic Charities USA and other parts of ecclesial life.
"Ministering Together" (formally known as New Covenant) has
developed as a "movement" that continues to encourage opportunities
for greater collaboration with and among church ministries.
As regards structures, there clearly remains a great deal of interest in and
attention paid to the future of sponsorship. While sponsorship is more than
a structure (it is a relationship), it is expressed, in part, in and through
structures. Currently, the ministry is blessed to have a variety of approaches
to the way those structures can be constructed and maintained. And there is
every reason to believe that this will remain the case for the foreseeable future.
As we know, governance and sponsorship are essentially related. In fact, in
some settings, the same people exercise both responsibilities. It would seem
that there are possibilities for future reflection on how best to structure
governance as sponsorship evolves.
Emphasizing Health Care as a Social Good
The final challenge I commented on had to do with how we as a nation understand
health care. From the Catholic perspective, access to health care is a fundamental
human right that is also a social good that should be rendered on the basis
of need, rather than on the ability to pay. This perspective has been the motivation
for our continuing attention to the issue of the uninsured and underinsured.
Although the intensity of our efforts has varied because of the evolving political
landscape, our passion has never lessened. In fact, "inside the beltway"
the Catholic health ministry is known for its ongoing commitment to this issue,
as well as for its commitment to the other needs of the poor. On numerous occasions,
I have been told that we are a good partner on these and other issues because
we do not shift our perspective according to our political calculations. We
are a respected and trusted partner in the complex—and at times messy—process
of developing public policy and law.
As you know, your board has decided that we need to intensify our efforts with
regard to the uninsured, paying particular attention to how we might contribute
to the development of a social movement that could result in a change in public
policy. Clearly, this is a new venue for Catholic health care. There is much
that we must learn about why our country has tolerated what we consider to be
morally unacceptable. Similarly, we need to learn from other social movements
in the United States and elsewhere about successful and unsuccessful practices.
Finally, in light of what we learn, we will have to develop a cohesive strategy
for individual and collective activity.
I believe that, as a nation, we are in a vitally important conversation, the
result of which could profoundly affect both how we proceed and the potential
approaches to resolving the issue of the uninsured. A few years ago, I would
have described the terms of that conversation as being about the nature
of health care. For example, is health care a commodity or a social good? Is
it best provided in society's business sector or in its voluntary sector?
Over the course of the last few years, the terms of the conversation have been
expanded, I believe. Without becoming partisan, I would suggest that a phrase
such as "ownership society" is a reflection of this deeper conversation.
For example, some in our society are questioning the role of government vis-à-vis
individual economic achievement. We are beginning to ask ourselves how much
economic inequality a society can sustain. Ought not there be a role for the
government in providing a safety net for those who, for whatever reason, are
not able to gain access to basic social goods? How do we understand the concepts
of human solidarity and shared responsibility? Are health insurance,
unemployment insurance, and retirement plans necessary to the nation's welfare—or
do they, instead, contribute to increased medical costs, greater unemployment,
and reduced savings? When the focus is on health care, some participants in
this conversation describe health savings accounts and catastrophic insurance
coverage as opportunities to control the escalating cost of health care by encouraging
individual responsibility, whereas others speak of the importance of maintaining
a large enough pool of insured people in order to adequately spread the risk.
Because this conversation can easily become partisan, many people might choose
not to become engaged in it. Similarly, because the terms of the conversation
can sound so abstract and philosophical, other people might decide to "take
a pass," especially when they know they must fight to maintain current
federal and state reimbursement. From my perspective, it would be quite unfortunate
if that were to happen, as understandable as it might be. I say this because,
as a ministry, we are informed by the richness of the Catholic theological tradition,
which has a very definite perspective on the meaning of human personhood as
well as on the social order. In other words, we have both the analytical tools
and an approach to social analysis that allow us to have a coherent perspective.
We have the capacity to participate in public discourse in a way that can make
a difference. Although our goal, in a pluralistic society, is not to oblige
everyone to accept our perspective, we can insist that our perspective
be part of the public discourse and that we be judged on the quality of our
reasoning and not on our religious preference.
My concern is that if we do not exercise this right and aggressively participate
in the public discourse, the resulting public policy and social conventions
of our nation could become inimical to those about whom we care the most—the
poor and the marginalized. Although we, as Catholic health care providers, bring
a definite expertise to such discourse, we will need, if we are to be successful
in the public square, to act in concert with other parts of the Catholic community
in a way we have not done to date.
We have been living it for several centuries in the persons of the religious
women and men who established this ministry and in the institutions they established.
Like the ministry's founders, we are active in the public square because of
who we are and what we believe, and without seeking to impose our beliefs on
others. Whether on a Civil War battlefield, in a public hospital caring for
victims of an epidemic, in a sanitarium for TB patients, or in a contemporary
safety—net hospital, we have been a living incarnation of the role of institutional
religion in the United States. Our challenge is to bring to the current debate
the strength of that rich tradition in a way that identifies radical secularism—not
Catholic health care or other Catholic ministries that serve in the public square—as
the outsider.
As we think of the future, we will clearly need to pay a great deal of attention
to the public square in regard to such "macro" issues as the uninsured,
the philosophical underpinnings of public policy, and the role of religious
institutions, as well as to "micro" issues such as government reimbursement
and regulations. An overarching challenge will be to focus on the macro and
the micro at the same time and with the same effectiveness. I am confident we
can do both. And, in doing both, we will demonstrate something that we might
not have done if Jesus had not been born.
Until We Meet Again
The plane is landing and so is my tenure in service to all of you. I hope these
reflections and the others published over the years have been of some help to
those who have read them. As great as the challenges might be, we have a confidence
whose origin is the gift of the Holy Spirit who is always in our midst.
In closing, let me express my gratitude to the women and men who have been
my colleagues on your CHA staff and to those who have served on your board.
The successes of the past years are due to them, and I am deeply grateful. I
also thank all of you who are the faces of Catholic health care. Thank you for
your passion, your determination, and your sense of responsibility. In so many
ways, they provided me the motivation to dream and work with and for you. Be
assured of my continuing prayers. Though I do not know the specifics of my future
ministry, I am confident it will include some presence to this great and vital
ministry. So this is a time to say, not "Goodbye," but, rather, "God
speed" until we meet again.
NOTES
- Michael D. Place, "The
Faces of a Community in Ministry: Passionate, Determined, Responsible,"
Health Progress, July-August 1998.
- Joseph Bernardin, A Sign of Hope, Office of Communications, Archdiocese
of Chicago, 1995, p. 5.