REVIEWED BY SUZY FARREN
American Catholic Hospitals: A Century of Changing Markets and Missions
By Barbra Mann Wall
Rutgers University Press, 2011
260 pages, $45.95
In 1985, when I had just been hired by the Catholic Health Association, there was considerable controversy over whether or not Catholic hospitals should advertise. One advertisement in particular evoked heated comments. The newspaper ad showed an old black-and-white photograph of a nun, with the text: "Mother Frances wants to have your baby." The ad promoted maternity services at Mother Frances Hospital in Tyler, Texas. It was a harbinger that Catholic health care was adapting to an increasingly secular world.
In American Catholic Hospitals: A Century of Changing Markets and Missions, Barbra Mann Wall, Ph.D., RN, traces the ways Catholic hospitals have accommodated changes both within the church and in society over the last century. Wall is associate professor of nursing at the University of Pennsylvania School of Nursing in Philadelphia, and her book is well researched and a fascinating read. I found it particularly interesting because I like the topic — I've always been enthralled by the concept I used to hear nuns express: Catholic health care was in this world but not of it. The book would suggest that Catholic hospitals acclimated quite well, thank you, to the world they were in.
Because it gives such strong context, American Catholic Hospitals is ideal reading for formation programs and for leaders new to Catholic health care. It provides a feel for the history of Catholic hospitals in the 20th century and places them in the broader American culture, exploring the events that have shaped Catholic health's 21st century iteration.
Early in the 1900s, Catholic sisters who were hospital administrators wielded considerably more power than most women in society, Wall observes. But today, only a few sisters remain in those positions. Wall demonstrates that a variety of changes — Vatican II, the civil rights movement, the enactment of Medicare and Medicaid and the growing market forces that have come to dominate health care — have forced Catholic hospitals to adapt. Yet adapt they have. While fewer and very different than they were a century ago, Catholic hospitals are still a significant presence in health care, and they still advocate for the poor and powerless.
In chapters with such telling titles as "From Sisters in Habits to Men in Suits," and, "S Stands for ‘Sister,' Not ‘Stupid'," Wall uses examples of Catholic hospitals in four cities — Austin, Chicago, Pittsburgh and Seattle — to cover more than a century of change.
Her story culminates in the active involvement of CHA's chief executive officer, Sr. Carol Keehan, DC, and the support of 61 religious orders across the nation in the 2010 passage of the Affordable Care Act. Years of working "in the trenches with women, children, and the poor" and often witnessing the "fatal results of denying or delaying care to those in dire needs" had made Catholic sisters familiar with "the tragic misfortunes that often resulted when the sick were left alone to care for themselves," Wall observes .
As she examines the social history of the last century, Wall doesn't blink when it comes to the treatment of African-Americans at Catholic hospitals. She points out that the institutions came late to race relations. While acknowledging there was some activism among Catholic sisters and brothers, most Catholic hospitals, religious orders and nursing schools remained segregated until integration reached mainstream society, she writes. Nonetheless, she points out, hospital work was a way for the sisters to "bear witness" against social injustice, a term that came into the sisters' lexicon in the 1960s.
In addition to encountering sisters in every department, "a visitor to a Catholic hospital in the early twentieth century saw fonts of holy water and paintings of the bishop, the Virgin Mary and saints," Wall writes. Today, she says, Catholic identity is less the physical trappings and more a product of the "pastoral care ministers and directors of mission effectiveness who are charged with carrying out the hospitals' original missions."
Health care has evolved in the public eye from a public good to a marketable commodity, notes Wall, quoting Sr. Sheila Lyne, a prominent Sister of Mercy who has held a variety of health care leadership positions over the last half-century. Catholic hospitals continue to adapt so they can balance mission and margin.
Wall concludes that the role of the religious in Catholic hospitals today is perhaps less about authority than about influence. Although their numbers have declined dramatically within the hospitals they once ran, women religious still remain influential on hospital boards, and they continue to be a voice for the poor and vulnerable in our society.
EXCERPT FROM
AMERICAN CATHOLIC HOSPITALS
Catholic hospitals had to find new ways to operate in a changed, secularized society. ... Would the current trend in larger systems lead to a Catholic health care system that was too large and too corporate? Would systems stray too far from the congregation's special ministry to the poor? What were the roles of sisters and brothers in health care and in the ongoing Catholic identity of their hospitals?
SUZY FARREN is vice president of corporate communications, SSM Health Care, St. Louis. She is the author of A Call to Care: The Women Who Built Catholic Healthcare in America.