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BY: ROSEMARY HUME, RN, MSN; SR. SHARON RICHARDT, DC, PhD; and BETH APPLEGATE, RN, MSN

Ms. Hume is director and Ms. Applegate is program coordinator, Seton Cove Spirituality Center; Sr. Richardt is senior vice president, St. Vincent Health, St. Vincent Hospitals and Health Services, Indianapolis.

Indianapolis's Seton Cove Center Seeks to Integrate Spirituality into the Workplace

"Spirituality in the workplace" is fast becoming a cliché, albeit one with numerous interpretations, especially in health care. A quick scan of the literature reveals articles and workshops that identify "spirituality" with sexuality, corporate models of enhancing productivity, "soul making" in leadership and entrepreneurship, and holistic health care. New variations and definitions of workplace spirituality seem to appear every day. How can we hope for consistency in understanding this important concept?

For the novice, a number of questions soon emerge. How does spirituality in the workplace—especially the health care workplace—relate to that workplace's pastoral care department? What is the distinction between spirituality and religion? How is spirituality in the workplace related to "complementary medicine"? How might it be related to "healing touch"? Is workplace spirituality related to an interest in integrating organizational mission, vision, and values? How is it related to stress reduction, or management, or behavioral medicine?

Is there a body of knowledge, a science that provides an intellectual foundation for workplace spirituality? Or, on the other hand, is some of the workplace spirituality we hear about merely a kind of pseudo-spirituality developed for corporate reasons? Is it possible that academic courses, complete with degrees, will eventually prepare people to be workplace spirituality specialists? If so, what will the curriculum look like?

The authors of this article contend that a body of knowledge called "formative spirituality" provides a foundational methodology for a holistic spirituality in the workplace, at home, and in the wider world.

The St. Vincent Story
In 1998 St. Vincent Hospitals and Health Services, Indianapolis, formally adopted a set of assumptions, definitions, and principles concerning spirituality in the workplace. St. Vincent's approach may be helpful to others as they work to discern a path forward regarding workplace spirituality. We have felt compelled to put our program on paper so that (as the authors of a related program have put it) "there can be criteria for the discovery and evaluation of the fundamental insights explicitly or implicitly present in all spiritualities and especially to clarify how special spiritualities stem from one foundational spirituality."¹

St. Vincent opened its Seton Cove Spirituality Center in September 1998.² After almost four years of experience with the center, which is based on the art and discipline of formative spirituality, we have become aware that there are many approaches to and various definitions of spirituality. We also recognize that the members of most organizations come from many varied faith traditions. We have found a definite hunger for meaning and purpose in the workplace as well as at home. When an organization, having decided to make workplace spirituality a high priority, opens a spirituality center, outsiders will naturally be curious about the concepts used in that center. Those of us who launched Seton Cove have become used to hearing people ask, "What is it?" "Why is it needed?" "Is it worthwhile?" and "How will it make a difference?"

Organizational leaders often put a premium on the development of mission and vision statements identifying a set of values that they want the organization's employees to follow. They also often develop strategic plans that contain initiatives for the organization itself to pursue. As one writer has said, "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."³ We contend that growth in individual and communal spiritual maturity will help an organization stick to its mission, a mission that has God as its central focus rather than some ideology.

We believe that an organization seeking to integrate spirituality into its work should establish a unified foundation of concepts and constructs. This unifying foundation can be the basis for integrating spirituality, just as it can be the basis for integrating mission, vision, and values. Without such a set of foundational concepts, the organization may adopt an eclectic, fragmented approach and fail to mesh spirituality with its culture. We believe that an organization seeking to integrate spirituality and work must have a unified foundation for its activities and programs.

A Few Definitions
Before proceeding, we would like to offer a few definitions.

Spirituality "Spirituality is what makes us distinctively human. It is our birthright as a human person—body, mind and spirit. Rather than a doctrine, it is a way of living that promotes an awareness of meaning in life, love, relationships and a priority of values. It is an unfolding of our awareness of God's (or the Mystery's) presence in our life and world and reflects our ongoing relationship with that Mystery."⁴

Formative Spirituality "Formative Spirituality is a discipline, a body of knowledge that provides a way of seeing self and others, life and world, in the light of which we most deeply are in God. Such a way of seeing spills over into our way of being and becoming, and subsequently into our way of doing."⁵ Formative spirituality has three parts: formation science, formation anthropology, and formation theology (which is served by the first two parts).

Formation Science "Formation Science is a theoretical and practical approach to living the life of the spirit. It is founded on the insight that what makes us distinctively human is our spiritual dimension. It awakens us to the deepest truth of our human existence and invites us to grow toward spiritual maturity over a lifetime."⁶

Formation Anthropology "Formation anthropology is the systematic critical study of the distinctively human empirical-experiential formation of character and personality. It examines this formation insofar as it can be known from the formationally relevant symbols, practices, experiences, findings and insights of human formation history, form traditions, arts and sciences."⁷

Formation Theology Formation theology is rooted in our common Judeo-Christian heritage: the Ten Commandments, the evangelical beatitudes and counsels, the Lord's Prayer as taught by Jesus Christ, the Apostles' Creed, and the teachings of the early church councils. Borrowing from these and other sources, formation theology emphasizes human character and personality formation, reformation, and transformation.

A faculty engaged in training for workplace spirituality will use as its primary sources the informational and formational messages of Holy Scripture, the Eastern and Western church fathers, Catholic Church doctrine (especially as expressed in catechetical theology), and the basic classical as well as classical-compatible writings of church-acknowledged saints and masters of spiritual formation.⁸

The Health Care Workplace and Spirituality
Many people are confused about spirituality and its relationship to religion. In fact, one of the major hindrances to defining spirituality is its relationship with religion. Concerning this topic, we would like to make several points.

Spirituality and Religion Spirituality is what makes a person distinctively human. It differs from religion, which is a particular belief and faith tradition, a social institution in which a group of people participate, rather than an individual search for meaning. Religion is more about systems of practices and beliefs within which a social group provides for itself a platform for the expression of spirituality.⁹ Although not everyone practices a formal religion, all people do have a spiritual dimension.

Universal Human Understanding In order for health care to be holistic, the spiritual dimension must be integrated into it. A universal human understanding, respectful of all faith traditions and formation traditions, should be promoted in the workplace, so that staff, physicians, and volunteers might embrace spirituality.

A Safe, Affirming Place In order for everyone to bring his or her whole self into the workplace, the workplace must welcome and nourish those selves. A spiritual workplace must exhibit clear indicators (perhaps through various rituals and rewards) that it is a safe place, a place where all are welcome to share themselves, body, mind, and spirit. If staff, physicians, and volunteers feel safe and affirmed, patients and their family members will be more likely to experience holistic care.

Patient and Family Satisfaction One way of measuring patient and family satisfaction with holistic care is through a survey developed by Press Gainey Associates, a South Bend, IN, firm. Particularly important is the survey question that asks whether "staff were sensitive to my spiritual and emotional needs."

Integration of the Spiritual Dimension Continuing staff education and ongoing spiritual integration will transform the workplace into an environment in which the culture itself is transformed and new staff, physicians, and volunteers will seek to be a part of the culture and keep it alive with the spirit. The spiritual dimension must be thoughtfully and carefully integrated into a work environment that, left to itself, is increasingly dominated by a controlling, "bottom line," linear, functional, achievement-focused mentality, rather than by a transcendent dimension that is receptive, qualitative, nourishing, relational, and collaborative.

Human and Material Resources What is needed is an awareness rooted in and shaped by the current health care structure and yet appreciative of the countercultural importance of infusing operations with inspiration, mission, and vision. Human and material resources must be budgeted and made available for the work involved in integrating spirituality into the workplace. A sound methodology will be based on the realization that spirituality in the workplace is not a mere buzzword signifying unconnected "programs" that may or may not have universal appeal. Such a methodology will also respect the diverse faith and formation traditions found in the typical health care workplace.

Formative Spirituality We believe that the discipline called formative spirituality, founded by Fr. Adrian van Kaam and Susan Muto of Epiphany Academy, Pittsburgh, offers this sound methodology.*

Seton Cove In workshops and retreats, educators at Seton Cove employ formative spirituality in introducing physicians, hospital staff, and volunteers to workplace spirituality. We have found that, in organizations that lack both a general understanding of spirituality and leaders who actively practice spirituality in the workplace, many employees avoid using the words "spirituality" and "soul."¹⁰ We believe that the two-year certification program in formative spirituality† not only educates potential faculty and provides for their ongoing formation, preparing them to serve as mentors and role models, it also gives health care organizations further opportunities to integrate concepts of formative spirituality into their everyday environment and operations. Seton Cove offers a safe and inspirational place for this work.

Workplace Spirituality Measurements Ongoing education in workplace spirituality is measured through patient, physician, and employee satisfaction; program attendance; and the visible integration of the spiritual dimension into all policies, programs, and measurements; as well as through increased staff retention and recruitment, philanthropy, and resources made available to render the workplace more aesthetically beautiful and quiet.

Competency of Faculty The competencies needed by a faculty person working with the spiritual formation of individuals, groups, or organizations include those found in a good leader, counselor, or educator. However, "to be competent is to be willing to grow continually in the wisdom, knowledge, and skills given to us by God, so that we can be more effective in our formation. We must point others toward the 'more than' for which we all hunger and thirst, while remembering that we are only servants through whom others might come to believe."¹¹ Holistic competency of this type might provide the organization with more effective planning, assessment, design, implementation, and evaluation of its activities. Organizational development and instructional design competencies are also very helpful.

But the competencies involved transcend these functional tasks. A person who integrates spirituality with his or her work will have a passion for mission and core values and a desire to further mission, vision, and core values. Such a person will have a spiritual life and will understand organizational structures, facilitate, teach, network with staff, and integrate concepts and constructs. He or she will also very likely have intuitive skills, common sense, good judgment, patience, willingness, and mentoring ability in both mission and spirituality. He or she will continue learning formative spirituality as it evolves—along with role modeling, creativity, and flexibility—and will live core values to a high degree. He or she will promote dialogue, use storytelling around vision, share vulnerabilities as well as ideas, be a community builder, find humility in daily activities, will not call attention to him- or herself, will be alert to the common good, inspire others, and handle adversity.

Formation of Community One of the many outcomes of a unified approach to spiritual formation is the formation of community. True community differs from "team building" in that its members:

• Support each other personally and professionally
• Commit to individual and group ownership and accountability
• Strive for ongoing formation
• Continually appreciate unity in diversity

Guidance by the Holy Spirit Ultimately, we believe, the Holy Spirit guides competence through common experience and understanding, which lead to common judgment and decision making. In the certification program, what follows formative spirituality is a process of common decision making and common action in the work of a spirituality center attached to a specific health care organization.

Though we should not underestimate the importance of competency, there are, according to Muto and van Kaam, three other dispositions of the heart that form good faculty members for spirituality centers. Congenial persons will strive for who they are most deeply in God and remain faithful to their call at any moment. He or she needs the capacity to be "at home" with others, the quality we know as compatibility. He or she must show compassion for him- or herself and for others. The three "c"s—congeniality, compatibility, and compassion—add up to competence and ultimate consonance. They direct our whole being toward integration.¹²

We noted in an earlier article, "We believe that God ultimately intends for us lives that are whole, complete, and at peace; this happiness can only be ours if we follow the lead of grace and begin to sound together in harmony with the Divine Forming Mystery at the center of the field; Formation Science uses the word consonance to capture such a transcendent way of living."¹³ By"center of the field" we mean that God the Mystery is at the center of our life. Therefore, we should not place ourselves, our work, or other people at the center of our lives. The "c"s of consonance, along with courage, direct our whole being toward‰ integration. This belief goes beyond a merely functional view, allowing spirituality in the workplace to develop in a holistic manner.

We have chosen a foundational framework of formative spirituality, and formation science is part of formative spirituality that is built on a common understanding and experience. Common experience can become common understanding, common judgment or decision making, and, finally, common action.

The Testimony of Graduates
The following descriptions, by graduates of the two-year certification course in formative spirituality, may help illustrate the process leading to an experience of community.

Common Experience/Preparation/Language of Faculty/Facilitators "I learned the common language of spirituality [in the certification program on formative spirituality], unfettered by my faith tradition and religious affiliation," said one graduate. The employees of most organizations come from a variety of faith and formation traditions. The formative spirituality approach that we use is ecumenical and helpful for organizations that need an ecumenical approach.

Common Framework of Formative Spirituality "This course has significantly enriched my life in a personal and spiritual sense," said another graduate, "and I can see how formative spirituality can be applied in my business environment."* This framework fits the corporate world as well as the health care world. The formative spirituality approach to spiritual integration is infused with practical, concrete, and specific behaviors and dispositions. It fosters, in day-to-day work and life, an integration of spirituality based on sound spiritual principles.

Common Experiences of Participants in Formative Spirituality-Based Programs "This day was spiritually cleansing and reconnecting," said another graduate. "[It is] a wonderful experience that touches to the depth of the soul." As the participants and faculty experience a common language of formative spirituality in the workplace,they work with each other toward common action. During needs appraisal, planning, and implementation, the integration of common knowledge and experience moves methodology toward synchronicity.

One group of students wound up writing a vision statement for their department. Using the formative spirituality framework and such spiritual experiences as reflection and retreat, the group found its way past various barriers and became a compassionate presence for its organization's patients. Its members found they could then do the work of reformation and transformation. Another group, whose members included physicians, began identifying those times when they had met the spiritual and emotional needs of patients or their co-workers. Common and shared experiences helped them to move together as a group toward better outcomes for patients and families. Those scores on the patient satisfaction survey that related to "meeting the spiritual and emotional needs of patients and families" increased significantly in the areas where staff and physicians had been part of a common experience of formative spirituality.

Common Judgment/Decision Making of Participants at the Spirituality Center "A different kind of hunger has been activated through this program," said still another graduate. "It is a hunger for wholeness . . . through the integration of life-giving values." Decision making around nourishment of the spirit affects not only the individual but also other people in his or her environment and work space. A person who is both a physician leader and an educator participated in a project that worked to integrate mission and spirituality in the workplace of medical students. The physician chose to change his organization's medical education curriculum for family-practice residents. That changed curriculum has since brought wholeness to the program, attracting to it applicants who hunger for the integration of spirituality in their own lives and, ultimately, in the lives of their patients and families. The curriculum has been adopted by the organization's internal medicine program as well.

Common Action Students who participate in the sessions called "Mission Mentoring Year Long" and "Mission Mentoring Intensive" learn how to integrate spirituality and mission into their work-life communities by beginning with a common set of knowledge and experience.¹⁴ During their formation process, they identify a spirituality/mission project to work with. Leaders who bring their staffs to Seton Cove want to move the group to a more consonant action approach to the very complex problems they have with patient care and patient satisfaction. Patients and families evaluate both the effectiveness of the technology and the extent to which their emotional and spiritual needs were supported. Staff, physicians, and volunteers all need a common approach that is mission driven and spiritually focused and integrates strategic initiatives. Health care organizations constantly look for ways to distinguish themselves from competitors. At Seton Cove, some of the distinguishing characteristics we prize are:

• Public recognition for clinical excellence. (For the past five years, St. Vincent has been included among U.S. News & World Report's "Top 100 Hospitals;" the facility has also received awards for its intensive care unit, stroke treatment, and joint-replacement surgery.)
• The overall trend of increase in satisfaction of spiritual and emotional needs on the Press Gainey satisfaction survey score. (Since 1998, St. Vincent's overall score on the question "Have we met your spiritual and emotional needs?" has climbed from 78.2 to 82.2.)
• Overall attendance by staff, physicians, and volunteers at programs integrating spirituality. (Since opening in 1998, Seton Cove has had more than 26,000 participants in its activities.)
• Employee satisfaction scores. (In the past three years, scores in the area of spirituality have been especially improved.)
• Physician satisfaction scores. (Physician participants rank spirituality programs especially high.)
• Successful partnerships formed. (St. Vincent Health has numerous partnerships throughout a 45-county area of central Indiana.)
• Financial indicators. (Over the past two years, financial indicators have suggested that St. Vincent Health is a well-run system.)
• Charity care and community benefit. (St. Vincent Health invested more than $50 million in charity care and community benefit in 2002.)
• Leadership development/formation. (Leaders from all over central Indiana attend Seton Cove's "Mission Mentoring Year Long" and "Mission Mentoring Intensive" programs during the summer months. During these sessions, each leader completes a project integrating mission or spirituality in his or her workplace.)

Moving Forward
At St. Vincent Health, our common experience, understanding, decision making, and actions have shown us that a strongly identified foundation in formative spirituality—one, that is based on a set of guiding definitions, principles, and key elements concerning spirituality and spiritual formation—is vital for the facilitators and faculty who work here. The design and implementation of the system's activities and programs flow from this foundational work.

As Muto and van Kaam have written, "Formative spirituality transcends many popular contemporary meanings of the amorphous term 'spirituality,' [which] often refers only to an emotional climate to be filled with all sorts of badly defined concepts in accordance with the dreams and wishes of those who use this vague term arbitrarily."¹⁵

Because faculty need nurturing through a formative process of the individual in alignment with the formative processes of other people, these processes necessarily involve communal relationships and community building. Those who attend a certification course in formative spirituality are prepared in common experience, common language, and common judgment; and they ultimately come together in creative preparation of transcendent activities that are a common-action approach, not one that is disjointed and multifractional in nature.

It has been our experience that when a faculty has been prepared with a common understanding of formative spirituality, it is able to plan, design, and implement activities and programs that are not only congruent with the organization's direction and destination statement but are also based on a common set of foundational concepts and constructs of spirituality acceptable to all participants, no matter what their faith or form tradition may be. As programs are designed, the faculty have a common basis for deciding whether to use specific videos, quotes, reflections, and prayers that connect to the wholeness of the common experience and understanding. Seton Cove's overall action is thus consonant and in balance, rather than eclectic and potentially disjointed.

We would like to hear from other people who are trying to integrate spirituality into their workplaces. Are they, for example, using a single approach to spirituality or a combined approach? We hope to continue this dialogue as we move forward with this work of spirituality in the workplace.

NOTES

1. Susan Muto and Adrian van Kaam, Epiphany Certification Program Workbook Module VI, Epiphany Association, Pittsburgh, 2002, p. 4.
2. See Sharon Richardt, "A Clearing in the Woods," Health Progress, March-April 2000, pp. 21-21.
3. Gerald T. Broccolo, "Integrating Business and Spirituality," Health Progress, May-June, 2002, p. 36.
4. Daughters of Charity of St. Vincent de Paul, Spirituality and Spiritual Formation: On the Path of Wholeness, Daughters of Charity East Central Province, Evansville, IN, 1996, p. 3.
5. Susan Muto and Adrian van Kaam, Formation Guide for Becoming Spiritually Mature, Epiphany Association, Pittsburgh, 1991, p. 6.
6. Muto and van Kaam, Formation Guide.
7. Muto and van Kaam, Epiphany Certification, p. 51.
8. Muto and van Kaam, Epiphany Certification, p. 2.
9. J. Dyson, M. Cobb, and D. Forman, "The Meaning of Spirituality: A Literature Review," Journal of Advanced Nursing, vol. 26, no. 6, pp. 1,183-1,188.
10. See I. Mitcoff and E. Denton, "Finding Meaning and Purpose in One's Work: Spirituality in the Workplace," The Newsletter of Trustee Leadership Development, Winter, 1998.
11. Muto and van Kaam, Formation Guide, p. 142.
12. Muto and van Kaam, Formation Guide, p. 90.
13. Muto and van Kaam, Formation Guide, p. 89.
14. Mary Elizabeth Cullen, Sharon Richardt, and Rosemary Hume, "Mentoring Mission Leaders of the Future," Health Progress, September-October 1997, pp. 36-38, 43; and Sharon Richardt and Jude Magers, "Spirituality for Lay Leaders," Health Progress, November-December 1997, pp. 18-19, 34.
15. Muto and Van Kaam, Epiphany Certification, p. 135.