BY: FR. GERARD T. BROCCOLO, STD
Fr. Broccolo is vice president for spirituality,
Catholic Health Initiatives, Denver. This article is adapted
from his presentation to the 86th Annual Catholic Health Assembly
in Atlanta in June 2001.
We who work in contemporary Catholic health
care tend to be nostalgic about the past, when things were simpler.
We realize, of course, that times have changed, that today we
must behave as good business people. But the more businesslike
we become, the more we like to reminisce about the days when
the ministry's focus was on the spirit. We envy the sisters
of an earlier day, who, dedicating themselves to serving the
ill and injured, also soothed and inspired the larger society
around them with the spirituality they embodied. We sometimes
feel like the disciples on the road to Emmaus, walking away
from the world we knew, feeling deserted and lost in a harsh
new world.
Perhaps the time has come for us to put our heritage — our
Catholic imagination — to work. We know that people come to work
in Catholic health care because it is a ministry, rather than
a business. They feel called to this ministry by what some would
call a vocation. And that call to ministry, deeply rooted in
our heritage in health care delivery, is about being called
to build relationships that heal. We believe that our business
is not just about market strategy, cost containment, staffing
ratios, the newest technology, building projects, reimbursement,
the latest regulations, or even managing disease. We believe
that what we are about is helping people come to wholeness.
What if we really took this conviction — that we
have been called to a ministry that builds healing relationships — and
made it more than just pious words? What if we made it the principle
of organizational alignment, integration, strategy, and
performance? What if we made it the measure of organizational
performance?
I realize that talk like this makes some people
nervous. They feel that spirituality cannot be a measure of
performance. They say that spirituality is too soft to put your
hands on, too shapeless to measure.
I disagree. I believe that it is possible to
understand mission as more than assurance of a legacy, as more
than care of the poor or those who are marginalized, as more
than just the good intentions or motives we bring to work every
day. I believe it is possible for mission to become the principle
of organizational alignment, performance, and development.
I believe that the spirituality of a distinctive
culture can be assessed and developed, provided that one first
finds behavioral indicators that demonstrate the core values
underlying the culture. Once you have identified those indicators,
you can hold people accountable for their performance in terms
of customer relations, staff relationships, community partnerships,
and effectiveness of leadership, or whatever other areas you
decide are important.
Catholic Health Initiatives
Let me offer some examples of what I mean from
my own organization, Catholic Health Initiatives (CHI), Denver.
I've heard it said that cultures take five years to build. In
2001, CHI celebrated its fifth year as a national health care
system, so I guess it is now possible to use CHI as a case study.
My boss, Sr. Diana Bader, OP, PhD, CHI's senior
vice president for mission and ministry, had the foresight several
years ago to structure a position — my own — that would address
organization development in terms of a culture grounded in spirituality.
"You're actually called a 'vice president for spirituality?'"
people often ask me. "Do you get paid for that?" And
then, of course, they ask: "Well, what do you do?" The
truth is, I do a little bit of everything.
Leadership Development At CHI, we conduct
leadership orientation programs for the senior managers of each
of our facilities. In these programs, we teach managers a style
of ethical decision making, a methodology to be used for all
major decisions. We have a 360-degree performance evaluation
tool for measuring development. With this tool we can evaluate
not just leaders' technical competency and performance, but
also their behavioral indicators of spirituality. Leadership
development is an integrated effort of both our Human Resources
and Mission departments. Leadership development at CHI is thus
not "either/or"; it's integrated.
Mission Audits Most Catholic health care
organizations now have mission audits or assessments. In these
audits, a team visits the facility and measures certain indicators
to see whether it is indeed "living the mission." Our CHI mission
assessment team was expanded last year to represent a variety
of disciplines — including people from clinical, legal, finance,
and business strategy departments, as well mission people.
Lately we have taken our mission assessment a
step further, asking ourselves whether we might integrate it
with other culture initiatives — for example, those involving
leadership development and customer service excellence. Leaders
are often viewed as having responsibility for financial and
operational measures. However, we are now trying to make the
mission-assessment process an integral part of a larger template
for assessing and developing ministry culture, clinical quality,
and market measures of strategy as well as indicators
of financial and operational performance. If we could monitor
measures in all these sectors comprehensively, we could produce
an integrated assessment to focus a development plan of overall
top priorities for a given facility.
Hiring the Right People Above all, we
need leaders who take this ministry seriously. We want lay managers
who are just as serious about our work being a ministry as were
the sisters who used to manage Catholic hospitals. The sisters
believed that their call to ministry was also a principle of
organizational focus and alignment, and they lived that belief.
Today there are many laywomen and laymen who live that same
conviction. They have the same ability to make their commitment
to ministry the framework for practical work. At CHI, we know
that all we have to do is find them.
But what are the implications of all this for
you? What are some practical things you might do to "unleash"
a Catholic spirituality that shapes your organizational culture
and — if truly allowed to influence processes and measures — a distinctive
market niche as well?
Practical Implications
We Must Integrate the Sacred and the Secular
My first suggestion, and perhaps the most difficult
to carry out, is that each of us integrate the sacred and the
secular in our worldview and in our daily behaviors. The operative
word here is "integrate." Most of the people I know in Catholic
health care, regardless of their religious backgrounds, tend
to live compartmentalized lives.
We who work in health care are no strangers to
compartmentalization. You can go into any hospital cafeteria
and, noting how the people there are dressed and who they are
sitting with, guess fairly accurately which department they
work in — that's how compartmentalized we are. But spirituality
can be compartmentalized, too. I know many people who are personally
devout, active in their churches, generous in their volunteer
work, and absolutely committed to integrating their faith with
their family life. But when they get to the office, they're
all business, like everybody else.
Many such people work in Catholic health care.
They often say, "I don't allow that part of my personal life
to affect how I do business. It certainly influences my motivation,
why I'm in this business, and why I view it as a ministry.
But in terms of what I do every day and how I
do it, my faith makes me no different from any other corporate
executive." I am amazed that we in the ministry can talk so
much about having a "distinctive culture," and, at the same
time, every day engage in business processes that are not distinctive,
using measures that are common to the industry. In fact, most
of the processes and measures we use are not different from
those used by other businesses.
The problem, many times, can be found within
our own souls. If we truly want to be distinctive, we must integrate
the sacred and the secular. The issue is not one about "mission
or margin." I don't believe that the issue is mission versus
margin. If one really takes the incarnation of Jesus Christ
seriously, if one takes seriously the Second Vatican Council
message about the church being the leaven of society, mission
and margin are no longer separate. They are integrated; they
are intermeshed. They are one because we are both sacred
and secular. Individuals do not have a secular part and a sacred
part. The integration that matters involves the way one views
the world.
Not long ago, I visited a Catholic health care
facility on a day when its CEO happened to be interviewing a
candidate for the mission leader position. I was privileged
to sit in for part of the interview. At one point, the CEO described
for the candidate what he expected of a mission leader. I have
never heard such deep conviction about our ministry as I heard
from that CEO. "When I walk the halls in this hospital," he
said, "I expect to feel the soul of what we are all about
in our staff work and our patient relations. If I hire you,"
he told the candidate, "I'll expect you to make that happen."
And I thought, listening to the CEO, that he would make
a wonderful mission leader himself. This was a person who was
very savvy about finance, community relations, operations, and
performance improvement. But he was also very savvy in how he
had integrated within himself the secular and the sacred.
Can we measure that kind of integration? I believe
we can. Arthur Anderson, for example, has a process called Value
Dynamics that allows companies to monitor and measure such intangible
assets as customer, patient, and staff relations.1
If we can measure these assets, we can monitor their growth
or diminishment in reports to our boards. Equipped with these
reports, boards can guide the integration of the sacred and
the secular at the institutional level.
We Must Do Business Differently
Catholic health care must do business differently
in three different ways:
- We must be collaborative and comprehensive and
deliver personalized care.
- We must be reflective and strategic.
- We must be magnanimous.
Collaborative, Comprehensive, and Personalized
Now the truth is, most of us know little about collaboration.
We do know how to be competitive. We are used to competing
with other providers in the marketplace, and we are also adept
at competing within our organizations and among ourselves. So
how do we become collaborative instead?
Let me give an example. At St. Vincent Infirmary
Medical Center, Little Rock, AR, the senior leadership team
has launched a program called "Share the Care," which is intended
to strengthen culture and build relationships. Under "Share
the Care," at least once a month, each member of the team steps
out of his or her usual routine and spends a half-day working
in one of the hospital departments. The departments they choose
to work in are usually those they know little about, so they
often have to ask the regular employees there to show them how
to do those jobs. After their half-days are done, the executives
go back to their desks and write a one-paragraph e-mail describing
what they've learned.
St. Joseph's Area Health Services, a small hospital
in Park Rapids, MN, has a CEO who rose to that position after
working in every department of the facility. He is able to function
in nearly every department. And he continues to spend a part
of most days working in one of those departments. People like
these, the Arkansas executive team and the Minnesota CEO, show
their coworkers that Catholic health care has no room for "we"
and "they" categories. They demonstrate what collaboration really
means. If the rest of us took collaboration seriously — if we
learned about and better appreciated what others are contributing
to our daily activities — we would really quickly start to change
culture.
What about comprehensive services? What
does that mean? Hal Ray, MD, CHI's chief medical officer, likes
to say that comprehensive health care is what physicians used
to call "bedside manner." He's absolutely right. In providing
comprehensive care, we are concerned with the whole person.
I frequently hear physicians complain of patients
being "noncompliant." In my experience, noncompliance usually
means a failure to communicate. A "noncompliant" patient may
simply be one with psychiatric symptoms the physician has failed
to note. Or one who has no capable caregiver at home. Or one
who lacks the money to pay for the medication the doctor prescribes.
I don't suggest that the physician should step out of his or
her realm of expertise in such cases. But the physician can
certainly ask questions concerning the different areas of the
patient's life, and, if it seems appropriate, make a referral
to a psychiatrist, social worker, chaplain, or other specialist.
Are our physicians trained to ask patients about
their relationships? Do they ask to see patients' behavioral
indicators? Do chaplains chart on the patient record? Do our
facilities have single, unified care plans? Is the care we provide
truly comprehensive?
And is it personalized? Not long ago,
I stayed at a hotel in Lincoln, NE, where the service was absolutely
wonderful. A colleague and I were so impressed that we went
to the front desk and asked to see the manager. The desk clerk
phoned the manager and told her that a guest wanted to speak
to her. We expected the clerk to put down the phone and tell
us, "I'm sorry, but the manager is in a meeting and can't see
you." No. The manager immediately came out to see what we wanted.
We told her that we had been highly impressed
by the hotel's service and asked her what business philosophy
she followed. In response, she took us into the hotel's back
areas and began introducing us to her employees. She greeted
every single environmental services person by name. She knew
everyone in dietary services by name. And the way the hotel
manager treated her staff was the way that the staff treated
the hotel's guests.
The patient care we provide in our hospitals
should be personalized in the same way. To ensure that, we must
give all staff members customer service training.
Reflective and Strategic The second way
we need to do business differently is by being reflective and
strategic. Most of us who work in Catholic health care are good
at operations, and, being good at it, we tend to focus on it
and to shy away from reflective and strategic thinking.
Strategic thinking, of course, is thinking about
long-range goals: Where do we want to go? What about this new
business opportunity? Should we merge with another organization?
Reflective thinking is thinking about the values and ethics
of a proposed strategic initiative.
The Catholic Church has a long tradition of balancing
action with contemplation. Contemplation, incidentally, does
not mean going off to a monastery. It means finding equilibrium
in what you do by balancing reflective processes with active
involvement. Many companies in the for-profit sector do this
nowadays; they call themselves "learning organizations." Anyone
who has ever served on a continuous quality improvement (CQI)
committee knows what it means to be reflective: It means analyzing
what you're doing so that you can do it better. But CQI is just
the beginning of being reflective on the job.
Catholic organizations should make theological
reflection, perhaps led by a mission leader or chaplain, an
element of weekly staff meetings. Once this becomes part of
the senior management team's routine, team members will begin
thinking reflectively about strategy. The team should also make
time for annual retreats at which it does not discuss
business. Such retreats help build a sense of community, and,
perhaps more importantly, give participants an opportunity to
restore balance to their lives.
Magnanimous The third way we must do business
differently is by being magnanimous. I think, for example, of
Seton Cove, the retreat house that St. Vincent Hospitals and
Health Services created in Indianapolis several years ago for
its staff.2 St. Vincent is, in effect, paying for
its employees to get away from their jobs and spend some time
in peaceful reflection. Penrose–St. Francis Medical Center,
Colorado Springs, CO, gives its employee of the month a paid
day off for a personal day of retreat. Those are two good examples
of corporate magnanimity.
We who are leaders in Catholic health care should
ask ourselves how magnanimous we are. Are we magnanimous about
staffing, for example, or do we follow the same staffing ratios
used by our competitors? Are we magnanimous in our personal
relations with employees? Patricia A. Cahill, JD, CHI's president
and chief executive officer, always takes the time, when she's
walking around the building, to stop and ask people how they're
doing. She may have 50 things on her mind, but she takes an
interest in people. Some executives, when they see you, automatically
think of some agenda item. Not Pat — she's interested in people
as people. That's also a kind of magnanimity, and I think that
Catholic health care leaders should display more of it.
We Must Develop an Affiliative Style
In the early 1990s, the Catholic Health Association
sponsored original research on the competencies of Catholic
health care leaders. The report, in summing up those studies,
had a good deal to say about what it called "the affiliative
management style."3 A leader who possesses the affiliative
style is basically a "people person." My personal mantra of
advice for leaders: Ask, listen, and affirm. If you're a leader
who wants to have a strategic market niche, then all you have
to do is ask, listen, and affirm. Ask people how they're doing.
Ask their opinion on some project your organization is planning.
Then listen to the responses and find something in those responses
that you can affirm.
If, as a leader, you make a practice of asking,
listening, and affirming in your interactions with people, you
will start to develop what Pat Cahill calls "a territory of
trust." This territory of trust allows for constructive feedback.
I have been in Catholic health care for some
time. My observation is that a key problem in Catholic health
care leaders is that we are conflict adverse. As a result, we
tend to avoid disagreement, tensions, or contentions and to
create avoidance cultures. Unfortunately, however, an avoidance
culture is the antithesis of what we need to produce a strategic
market niche. In an avoidance culture, people never get to the
real issues that they must work through if they are to grow.
But if we ask, listen, and affirm, we make it
okay to disagree, okay to have a difference of opinion. An outdated
style of leadership would react to differences of opinion by
saying, "No discussion! This is the will of the sponsors, the
trustees, the CEO!" But show me leaders who go around asking,
listening, and affirming — establishing a territory of trust that
allows for constructive feedback — and I will show you an affiliative
leadership style that encourages honest feedback and an atmosphere
of mutual trust.
The Challenge Today
The challenge today for the Catholic sector of
U.S. health care is the same as it was for Jesus' disciples
on the road to Emmaus. Like them, we need to restructure our
imaginations. We need to imagine what this ministry could
be like — what our workplaces would be like if only we were to
recognize the power and the presence of the risen Lord among
us in a new way, according to a new game plan. If each of us
is faithful to our calling to bring healing and wholeness to
those we serve by making their lives better, and if this shows
in how we do what we do every day, we will indeed have struck
gold!
NOTES
- See Teresa A. Maltby and John F. Tiscornia, "The Dynamics
of Value," Health Progress, September-October 2001,
pp. 46-51.
- See Sharon Richardt, "A Clearing in the Woods," Health
Progress, March-April 2000, pp. 20-21.
- See John Larrere and David McClelland, "Leadership for
the Catholic Health Ministry," Health Progress, June
1994, pp. 28-33.