Health Progress - Summer 2022 by Catholic Health Association

JOURNAL OF THE CATHOLIC HEALTH ASSOCIATION OF THE UNITED STATES

HEALTH PROGRESS www.chausa.org

SUMMER 2022

GUIDED BY

FAITH

2 22 AWARDS

CHA Congratulates the 2022 Award Recipients WISH Center, SSM Health St. Mary’s Hospital

ACHIEVEMENT CITATION For innovative programming that changes lives

LIFETIME ACHIEVEMENT AWARD For a lifetime of contributions

SISTER CAROL KEEHAN AWARD For boldly championing society’s most vulnerable

SISTER CONCILIA MORAN AWARD For demonstrated creativity and breakthrough thinking

TOMORROW’S LEADERS HONOREES Honoring young people who will guide our ministry in the future

Sr. Maureen McGuire, DC, Former Executive Vice President and Chief Mission Integration Officer, Ascension, St. Louis, Missouri Alexander Garza, MD, Chief Community Health Officer, SSM Health, St. Louis, Missouri

Mary Anne Sladich-Lantz, Senior Vice President, Mission and Formation, Providence St. Joseph Health, Renton, Washington

Andrew G. Ochs, Regional Director, Mission Integration, SSM Health, Oklahoma City, Oklahoma Sarah Reddin, Vice President, Ministry Formation– Mission Integration, Ascension, St. Louis, Missouri

Dave Benner, Chief Ancillary Officer, CHRISTUS Health, Irving, Texas Jacquelyn Bombard, Executive Director, Federal Relations, Providence St. Joseph Health, Renton, Washington Amanda Bottolfson, Director, Medical/Surgical, Swingbed, ICU, and PCS Staffing, Avera Sacred Heart Hospital, Yankton, South Dakota Ashley Brand, System Director, Community Health, Integration & Housing, CommonSpirit Health, San Francisco, California

Andrew Ritz, Vice President, Operations, Mercy Hospital, Durango, Colorado Heather Runnels, Vice President, Patient Care Services, Our Lady of the Lake Ascension, Gonzales, Louisiana Ryan E. Stuhlreyer, Vice President, Service Line Strategy, Bon Secours Mercy Health, Richmond, Virginia Adrienne Webb, Director, National Communication, Issues and Reputation Management, Providence St. Joseph Health, Renton, Washington

A Passionate Voice for Compassionate Care®

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SUMMER 2022

FEATURE

GUIDED BY FAITH

43 HOW TO BUILD EXECUTIVE PRESENCE: A MESSAGE FOR MISSION LEADERS Celeste DeSchryver Mueller, DMin

DEPARTMENTS 2 EDITOR’S NOTE BETSY TAYLOR 48 COMMUNITY BENEFIT Community Engagement: Using the Evidence JULIE TROCCHIO, BSN, MS 50 HEALTH EQUITY Catholic Social Teaching as a Road to Equity FR. CHARLES BOUCHARD, OP, STD 53 ETHICS The International Good Samaritan BRIAN KANE, PhD 56 THINKING GLOBALLY Relief Efforts for Ukraine: What To Weigh When Asked for Donations RACHELLE BARINA, PhD, and ERICA SMITH, MPH 59 MISSION TENDING TO MISSION: LISTEN, LEARN, RESPOND JILL FISK, MATM 61 AGING Two Calls for Nursing Home Reforms JULIE TROCCHIO, BSN, MS

Illustrations by David Senior 4 WHY A HABIT OF DISCERNMENT IS CRUCIAL FOR CATHOLIC HEALTH CARE Scott Kelley, PhD, MA, HEC-C, and David Nantais, DBe 12 CHALLENGES FOR SPONSORSHIP TODAY Sr. Doris Gottemoeller, RSM

17 POPE FRANCIS — FINDING GOD IN DAILY LIFE 64 PRAYER SERVICE

18 HIRING FOR MINISTRY FIT IN CATHOLIC HEALTH CARE Tom Bushlack, PhD, and Tom Edelstein, MAHCM, MBA, MA 23 PROVIDENCE CULTIVATES LEADERS FOR FORMATION THROUGHOUT ORGANIZATION: BUILDING ON LEGACY SO MISSION CAN FLOURISH Mary Anne Sladich-Lantz, MTS, John Shea, STD, and Darren M. Henson, PhD, STL 29 CHA ADVOCACY: FAITH AND REASON IN ACTION Lucas Swanepoel 33 FERTILITY OPTIONS OFFER HOPE FOR YOUNG ADULT CANCER PATIENTS Rob Hanson, MD, PhD 36 HARNESSING THE POWER OF CHAPLAINCY THROUGH AN ELECTRONIC MEDICAL RECORD Bartholomew Rodrigues, MDiv, MBA, BCC, William Vaughan, MA, BCC, and Jessica Moore

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IN YOUR NEXT ISSUE

CARE COLLABORATIONS

SUMMER 2022

EDITOR’S NOTE

hose employed in Catholic health care know that our work environments are distinctive, but it can take a little time — along with some learning from our more experienced colleagues — before we can articulate why that is. We don’t just show up and do our jobs. We’re called to reveal the love of Jesus in the care we provide. It’s a tall order, right? But it doesn’t feel like a burden, especially not these days. To exhibit, or at least to constantly strive to demonstrate, love for others in the workplace can be a challenge, but so worth the effort. This issue of Health Progress focuses on how our work is Guided by Faith. Our beliefs turn jobs into vocations. Meaningful labor can bring us fulfillment, because we know when done well the work of the ministry can, and does, change lives. While the BETSY Catholic identity of the ministry TAYLOR remains a constant, its leadership frequently refines the ways in which it is preserved, taught and shared with staff members, patients and their families. Much of this journal is focused on that refinement. What aspects of health care do sponsors, who ensure fidelity to the ministry’s mission and Catholic identity, most need to consider these days? What are the latest ways of making sure quality formation opportunities are available to more employees, so that they better understand connections between what’s personally meaningful to them and how their gifts can contribute to the healing purpose of their organizations? When is a quick decision needed, and when should a group take time to commit to a discernment process? And how, exactly, do you do that?

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I’m often surprised by what passes as customer service these days when I interact with other industries. I tell myself to lower my expectations, that I’m only setting myself up for frustration when experiences don’t match my perceptions of what they could be: the checkout person who doesn’t say “hello” or “thank you” at the grocery; the lengthy phone call to a business that doesn’t resolve what I think will be a simple fix. Conversely, my expectations are often exceeded in my encounters with those who work in Catholic health care. Because you already know your colleagues, I’m probably not telling you much that’s new. But the smart, capable and sometimes joyful people we work with amaze me on a regular basis. Certainly not everyone who works in Catholic health care shares the same beliefs. But part of our work is to cultivate environments where all feel loved, welcomed and cared for. The articles in this Health Progress show a variety of ways Catholic health care systems are doing this, from their first interaction with job candidates to the groundbreaking treatment provided to patients with complex cases. It’s a marvel what we can do for others when we do it with love.

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VICE PRESIDENT, COMMUNICATIONS AND MARKETING BRIAN P. REARDON EDITOR BETSY TAYLOR btaylor@chausa.org MANAGING EDITOR CHARLOTTE KELLEY ckelley@chausa.org GRAPHIC DESIGNER NORMA KLINGSICK

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EDITORIAL ADVISORY COUNCIL Kathleen Benton, DrPH, president and CEO, Hospice Savannah, Inc., Savannah, Georgia Sr. Rosemary Donley, SC, PhD, professor of nursing, Duquesne University, Pittsburgh Fr. Joseph J. Driscoll, DMin, director of ministry formation and organizational spirituality, Holy Redeemer Health System, Meadowbrook, Pennsylvania Marian Jennings, MBA, president, M. Jennings Consulting, Inc., Malvern, Pennsylvania Tracy Neary, regional vice president, mission integration, St. Vincent Healthcare, Billings, Montana Sr. Kathleen M. Popko, SP, PhD, president, Sisters of Providence, Holyoke, Massachusetts Laura Richter, MDiv, system senior director, mission integration, SSM Health, St. Louis Gabriela Robles, MBA, MAHCM, vice president, community partnerships, Providence St. Joseph Health, Irvine, California Fred Rottnek, MD, MAHCM, director of community medicine, Saint Louis University School of Medicine, St. Louis Becky Urbanski, EdD, senior vice president, mission integration and marketing, Benedictine Health System, Duluth, Minnesota

ARTICLES AND BACK ISSUES Health Progress articles are available in their entirety in PDF format on the internet at www.chausa.org. Photocopies may be ordered through Copyright Clearance Center, Inc., 222 Rosewood Dr., Danvers, MA 01923. For back issues of the magazine, please contact the CHA Service Center at servicecenter@chausa.org or 800-230-7823. REPRODUCTION No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording or any information storage and retrieval system, without permission from CHA. For information, please contact Betty Crosby, bcrosby@ chausa.org or call 314-253-3490. OPINIONS expressed by authors published in Health Progress do not necessarily reflect those of CHA. CHA assumes no responsibility for opinions or statements expressed by contributors to Health Progress. 2021 AWARDS FOR 2020 COVERAGE Catholic Press Awards: Best National Magazine, First Place; Best Special Issue, First Place; Best Layout – Scholarly Magazine, Second and Third Place; Best Color Cover, First Place; Best Column – General Commentary, Second Place; Best Pandemic Coverage, Third Place; Best Essay – Professional and Special Interest Magazine, First and Third Place, Two Honorable Mentions; Best Feature Article, First, Second and Third Place; Best Feature Article on the Election, Second Place; Best Feature Article on Racial Inequities, First and Second Place; Best Writing Analysis, Second Place and Honorable Mention; Best Reporting on Social Justice Issues on Option for the Poor and Vulnerable, First Place and Honorable Mention; Best Reporting on Rights of Workers, First Place and Honorable Mention; Best Title and Lead-In, Third Place. Association Media and Publications EXCEL: Feature Article, Gold; Feature Article Design, Silver.

CHA EDITORIAL CONTRIBUTORS ADVOCACY AND PUBLIC POLICY: Lisa Smith, MPA COMMUNITY BENEFIT: Julie Trocchio, BSN, MS CONTINUUM OF CARE AND AGING SERVICES: Julie Trocchio, BSN, MS ETHICS: Nathaniel Blanton Hibner, PhD; Brian Kane, PhD FINANCE: Loren Chandler, CPA, MBA, FACHE INTERNATIONAL OUTREACH: Bruce Compton LEADERSHIP AND MINISTRY DEVELOPMENT: Brian P. Smith, MS, MA, MDiv LEGAL: Catherine A. Hurley, JD MINISTRY FORMATION: Diarmuid Rooney, MSPsych, MTS, DSocAdmin MISSION INTEGRATION: Dennis Gonzales, PhD THEOLOGY AND SPONSORSHIP: Fr. Charles Bouchard, OP, STD

Produced in USA. Health Progress ISSN 0882-1577. Summer 2022 (Vol. 103, No. 3). Copyright © by The Catholic Health Association of the United States. Published quarterly by The Catholic Health Association of the United States, 4455 Woodson Road, St. Louis, MO 63134-3797. Periodicals postage paid at St. Louis, MO, and additional mailing offices. Subscription prices per year: CHA members, free; nonmembers, $29; foreign, $29; single copies, $10. POSTMASTER: Send address changes to Health Progress, The Catholic Health Association of the United States, 4455 Woodson Road, St. Louis, MO 63134-3797.

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GUIDED BY FAITH

Why a Habit of Discernment Is Crucial for Catholic Health Care SCOTT KELLEY, PhD, MA, HEC-C Mission Leader, Loyola University Medical Center, Trinity Health DAVID NANTAIS, DBe Mission Leader, St. Joseph Mercy Ann Arbor/Livingston, Trinity Health

iscernment, a deliberative process long used by Christian religious communities, has been increasingly used in business settings because of its capacity to broaden the discussion beyond technical frameworks that shape business disciplines. At the same time, however, the assumptions and practices that were foundational for religious communities in the past need to be critically reexamined to allow the tradition of discernment to enrich decision-making in contemporary Catholic health care. For this reason, Trinity Health recently updated and revised its framework and guidelines for discernment, helping to further actualize its mission and values in service to the common good.1 FRAMING THE PROBLEMS

The study of decision-making is a complex, evolving and crowded field ranging from cognitive neuroscience to psychology to management. Although its study has grown considerably over the last few decades, management scholars have also noted that increasing specialization within business disciplines has led to fragmentation, leaving executives and managers poorly prepared to make the kind of decisions that effectively respond to complex challenges. Business decisions can be hampered by premature commitments; an overemphasis on or misuse of analytic evaluations; insufficient search/investigation and innovation; investment in the wrong things; and use of failure-prone decision-making practices. The events of 2020, including the COVID-19 pandemic and the increased awareness of racial injustice, have highlighted that many of the challenges in the health care landscape can be described as “wicked” problems because they are complex,

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open-ended and seemingly intractable. Often there are unintended harmful consequences to any intervention, regardless of how noble the intent.2 The insight from management scholars is not that business leaders can be flawed, myopic or self-interested at times. Rather, there is humble recognition of what good decision-making requires of today’s leaders who operate under great scrutiny. As the preamble to the Ethical and Religious Directives for Catholic Health Care Services describes, health care in the United States is marked by changes in clinical practice due to technological advances and by changes in the institutional and social conditions that shape the health care landscape. Furthermore, developments within the Catholic Church — including changes in religious orders and congregations, the increased involvement of lay men and women and a heightened awareness of the Church’s social role in the world — complicate business decisions

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in a mission-driven environment. Today’s health WHAT IS DISCERNMENT, AND WHY BOTHER? care landscape, professionally and institution- Popular definitions and descriptions note that ally, is far more complex than it has ever been.3 As discernment can be an “individual” or a “collecsuch, strategic plans require not only a “vision” tive” endeavor. Although there are important for the core business of an organization and its distinctions to be made between these different key business practices, but also a more “holistic decision-making contexts, there are significant assessment” of complex business environments. similarities worthy of consideration. First and “When there is no vision, the people perish … .” foremost, discernment is not another decision(Proverbs 29:18 MEV) It is increasingly more dif- making tool, algorithm, technique or process ficult for today’s health care leaders to connect alongside others. It should not add to an already crowded toolbox. Rather, discernment is best the dots and to chart a path forward. Pope Francis has voiced a critique similar to understood as a “habit of mind and practice” that of management scholars, recognizing spe- to better understand what our health care miscifically the harm to the poor and to the envi- sion requires of us in response to the particular ronment when leadership vision becomes tech- challenges and opportunities that emerge in the nocratic and fragmented. For the Pope, today’s course of organizational life. Discernment can problems call for a leadership vision “capable enhance a decision-making lens, tool or process of taking into account every aspect of the global by constantly inviting those who discern into a crisis” because of the deep interconnections deeper, broader and more reflective relationship that exist between economic, social and envi- to the evidence gathered, the people engaged in ronmental systems.4 Today’s leaders, often inun- the process and the good that is imagined. dated with information, can lack wisdom that There is no blueprint or decision-making “demands an encounter toolkit for our collective work in health with reality,” 5 particularly when those encouncare; we must “discern” what our mission ters conflict with deeply held assumptions. Realrequires of us in response to the particular ity is bigger than ideas.6 challenges and opportunities that present In Let Us Dream: The Path to a Better Future, themselves in the course of our ministry. Pope Francis warns of an “existential myopia” Discernment functions like a pair of scissors that encourages us to defensively select what we see and to hold on to things we are afraid to that has an upper blade in ideas, language, valrelease. Coupled with information pathologies ues, mission and narrative, and a lower blade in such as disinformation, defamation and fascina- the data.7 Its power to arrive at insights comes tion with scandal, facts can become subservient from its distinct capacity to collect, analyze and to incomplete or misguided narratives. We must synthesize a broad range of ideas and facts and remove the log in our own eye, before attempting to interpret them in light of a common vision. At to “remove the splinter” from the eye of someone its core, discernment is about openness to expeelse. (Matthew 7:5) rience, others, data, ideas and solutions that are Today’s Catholic health care leaders navigate often dismissed, ignored or overlooked. It serves a fine line between the rhetorical aspirations of as a contrasting optic to decision-making that a Gospel vision of healing and the extraordinary is closed off prematurely in a rush to judgment. demands of successfully managing health care in In a fast-paced, time-constrained environment, the 21st century. There is no blueprint or decision- discernment invites participants into a different making toolkit for our collective work in health frame of reference. As Pope Francis described, it care; we must “discern” what our mission requires is a choice of courage to go out of the world of of us in response to the particular challenges and one’s convictions and prejudices, to expose one’s opportunities that present themselves in the assumptions to scrutiny and to seek what we are course of our ministry. called to do in a specific set of circumstances.

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GUIDED BY FAITH

In the Catholic tradition, an “individual” dis- tives have been sufficiently considered and, most cernment often refers to one’s decision-making importantly, that the decision-making rationale is process of whether or not to enter a religious consistent with the espoused values of the orgacommunity. Religious communities in the Cath- nization. The more consequential the decision for olic tradition have well-established protocols so the organization, the more intentional and collecthat a candidate and the community can mutu- tive the decision-making process should be. The ally determine if entrance into the community is aim of collective discernment is to ensure that authentic or if there is something else driving the stakeholder perspectives have been sufficiently decision: family pressure, a mistaken notion of considered, that the proposed course of action the realities of religious life, grief or other moti- is supported by available evidence and that the vations that are not conducive to the free and decision is aligned with the organization’s values generous spirit that animates The more consequential the decision for communal life. Discernment is, simply put, the exercise of pruthe organization, the more intentional dence, which Thomas Aquinas describes in the Summa Theoand collective the decision-making logica as “wisdom concerning process should be. human affairs”8 or a “right reason with respect to action.”9 In the context of today’s workplace, individual dis- in ways that can be clearly articulated and credcernment is best understood as a habit of mind ibly presented. Communal discernment is useful and practice relevant to many aspects of work life: not only for considering a new endeavor, but also how to engage colleagues, how to lead a team and for improving existing practices or operations. A how to address the challenges that surface daily. habit of discernment in this context describes the In this regard, discernment does not sit alongside ongoing effort to align vision, strategy and tactics other tools, protocols or practices. Rather, it deep- or operations. ens and enriches them through the wisdom that comes from the critical reflection of experience. CONCEPTUAL FOUNDATIONS OF DISCERNMENT “Collective” discernment refers to the deci- IN THE CATHOLIC TRADITION sion-making process of a team that is animated Discernment has many roots in the Catholic traby a shared vision and set of values. Inherited dition, but in the context of health care decisionfrom decision-making models in religious life, making, three are most notable: it is a developcollective discernments have been used to make ment of the wisdom tradition in Judeo-Christian significant organizational decisions.10 In Catholic scripture, a spiritual practice and part of the Cathhealth care specifically, collective discernments olic moral tradition. Like many traditions in the ancient Near East, have been used to carefully evaluate the merits of mergers and acquisitions, the sale of property, the the Hebrew tradition included a genre of wisdom creation or termination of new lines of service and literature that collected statements by sages and many other types of decisions that have a signifi- wise elders about the nature of the divine and cant impact on the future of the organization. In human virtue, often presenting them in narrative each of these types of decisions, leadership deci- form, as for example, in the Book of Job. The Wission-making brings into being the mission of the dom figure, personified as a woman, revealed the organization. How such decisions are made, how mysteries of God, made all things new, and was they are communicated and how they are imple- superior to “scepter and throne.” (Wisdom 7:8) mented embody the actual values of the organiza- The wisdom tradition complemented the law and tion relative to the espoused values found in mis- the prophets as part of the revealed Word of God. sion statements. Business ethics scholars have Christian scripture describes Mary, the mother long recognized the gap that can exist between of Jesus, as the seat of wisdom. The Gospel writoperative and espoused values, a rift that can lead ers positioned Jesus in the wisdom tradition, who frequently notes that wisdom is much more than to the demise of the organization itself. In its collective context, discernment follows sensory data or sense perception: “Do you have a set of practices that ensure multiple perspec- eyes and not see, ears and not hear?” (Mark 8:18)

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The wisdom tradition describes a way of seeing reality, of conducting oneself in relation to others and of engaging the Divine.11 Discernment can also be viewed as a spiritual practice of self-integration and self-transcendence in response to ultimate values.12 Religious communities throughout Christian history have practiced discernment as a model for authentic decision-making. Among the most notable figures in this regard is Ignatius of Loyola, whose framework for discernment in The Spiritual

Exercises became foundational for the development of the Society of Jesus (the Jesuits) in 16th-century Spain as part of a reform movement in early modern Catholicism.13 Many other communities of religious women and men rely on the habit of discernment to ensure that communal decisions reflect the core mission and identity of the organization. In the Quaker tradition, practices such as interior and exterior silence highlight the value placed on personal and collective experience in the context of authentic

EFFECTIVE DISCERNMENT MODELS INCLUDE SIMILAR ELEMENTS NATHANIEL BLANTON HIBNER, PhD

hrough the spiritual discipline of discernment, the Spirit guides and influences us to be compassionate and thoughtful in our responses so that we can better our communities. To facilitate this process, many Catholic health care systems have created formal discernment models to assist them when processing difficult institutional decisions. CHA, too, has published a model that outlines key aspects of discernment.1 In the adjoining article, we learn about the why and when regarding discernment. Through the following outlined steps, we examine the central pieces of this process; while not every discernment process is the same, they do often contain similarities.

Define Fundamental Questions First, the group must identify the primary question at hand. Most tools recognize that when people from diverse backgrounds come together, they might have different perspectives regarding how they see the problem. Some may even completely disagree with one another when attempting to arrive at a decision. Therefore, the group must ask itself: “What exactly will we consider?”

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What is consistent in this first step is the importance of everyone being on the same page. We cannot answer a question if we do not name it correctly. This clarity eliminates future confusion and ensures that the question up for debate meets the level of importance needed for such a rigorous discernment process.

Gather Information Second, the group gathers facts. CHRISTUS and Providence Health ask succinct questions: Who? What? Where? When? Why? How? These get to the heart of the information required to properly evaluate the situation. Most of the discernment tools urge the group to include various experts in the dialogue, who will be able to enrich the bare data. The majority of models recommend inclusion of the stakeholders. This upholds our ministries’ commitment to subsidiarity. Some questions for the consideration of this might include: Who is most directly affected and how? Who has proper authority? In this step, the stakeholders can share how they believe the different decisions would impact them and their work. The discernment tools

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recognize that merely discussing facts and figures can make us distant to the people impacted by our work. This attention should be praised as an appropriate way to live out our responsibilities toward our neighbors and fellow ministry colleagues.

Communal Dialogue Third, the discerning group is encouraged to turn their discussion toward the relevant values, the mission of the organization, principles of morality, The Ethical and Religious Directives for Catholic Health Care Services and other teachings of the church. Some examples of reflection questions include: Which values relate to or appear to conflict with this issue? What are some key principles? This step filters out those solutions that do not align with our ministry’s purpose. What often happens, however, is the need to pick one value over another. The group must also determine whether more information is required, or if new voices need to be added to the table. This step serves as an assessment on whether the group and the process are moving correctly ahead.

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decision-making. Discernment is also part of a complex, dialogical, dynamic and evolving Catholic moral tradition shaped by the ongoing engagement with people and ideas both inside and outside of the tradition. Over the course of many centuries, the Catholic moral tradition has critically examined the notions, intuitions, sentiments, consequences and principles that form a communal life that shapes — and is formed — by values.14 Many contemporary thinkers have been increasingly criti-

Prayer and Reflection Fourth, the tools set aside time for meaningful prayer and reflection. After the possible decisions have been filtered through the lenses of mission, values and Church teaching, the group is encouraged to take time and reflect. The group members open themselves to the Spirit moving within them and listen to their hearts. Time for quiet reflection and prayer is encouraged and, in most cases, required. Afterwards, the members come together and share their decision. Through this collective sharing, the goal is that a choice will appear and a consensus will be achieved.

Assessment and Consensus The fifth step includes listing tentative decisions. This approach will show the most desired decision by the group but also give an alternate plan/other prospects that can be reexamined should the decision not meet its desired effect. The discussion about alternative solutions might reveal whether the group needs to start the discernment process again should members feel strongly that one option was not given proper vetting.

cal of the Enlightenment project justifying such moral norms relying exclusively on conceptual principles or on the rational analysis of consequences. Ethics in the Catholic tradition requires much more than adherence to universal principles or an examination of consequences in a particular situation. Modern neuroscience has reaffirmed the centrality of emotion in brain function, which contributes to the renewed focus on virtue and narrative in the field of ethics. This renewed focus points to the enduring wisdom of Thomas

Should the group finalize a decision, one more review is required. The group assesses the impact of the decision on the common good and our ministry’s commitment to the poor and marginalized.

Communication and Implementation The sixth stage concerns implementation, as once a decision has been made, its execution must also be well planned. A decision can lose its impact should the execution fail. Therefore, the discernment tools recommend constant updates, periods of review and receptiveness by the group to alter course should their decision fail. It encourages self-reflection by all as to whether the decision they made is meeting the expected goals.

lead our organizations should also be encouraged to practice prayer and reflection. It is a skill that needs constant attention, even more so as our days remain filled with complex responsibilities and stress. Our “discernment muscles” need to be stretched so that when we meet in a group, we have the ability to see clearly and to sit quietly, allowing the Spirit to be heard. Regardless of our roles, we should all be encouraged to read the discernment model of the system where we work — or the one provided by CHA — become familiar with the steps, and begin to ask ourselves how we can be better prepared for when the Spirit calls us. NATHANIEL BLANTON HIBNER is director, ethics, for the Catholic Health Association, St. Louis.

Ongoing Discernment As noted in the accompanying article, discernment has been with the Church for centuries. The process continues to guide the faithful on the road to the coming Kingdom of God. Though the process is often done in a group setting, as individuals in the health care ministry we can prepare ourselves for discernment. Those who help

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NOTE 1. Cooperating With the Spirit: CHA Discernment Model and Facilitator’s Guide (St. Louis: Catholic Health Association), https://www.chausa.org/ store/products/product?id=4653.

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Aquinas, who integrated the work of Aristotle, Augustine of Hippo, the Muslim philosopher Ibn Sina and many others into a Christian worldview that positioned the virtue of prudence as an irreplaceable foundation for moral discernment. The virtue of prudence illuminates the single course of action that is most appropriate for achieving a goal through an examination and selection of available and most appropriate tools, and their faithful application.15 The cultivation of virtue is particularly relevant to organizational life.

Ensure Robust Data An effective facilitated discernment process requires reliable, current information and sound data. Establishing a prediscernment work group is a constructive mechanism for collecting the necessary data and verifying that the most important information is available to the discernment group. It will be helpful for those preparing for the discernment to ensure that all the relevant data is collected and that any information gaps are named and addressed. Take Adequate Time All discernment participants must be willing to set aside ample time for a facilitated discernment to work well. Two or more meetings may be required, depending on the potential impact of the decision on the ministry. The time between meetings can offer opportunities for reflection as the group prepares for the next gathering. During the discernment, the facilitator should offer time for brief mindfulness exercises and for participants to pause and reflect on what has been discussed.

Discernment carefully examines the moral dimensions of business decisions and leadership recognizing that rules and principles are necessary but not sufficient for determining the right course of action. Communities of trust are not formed on the basis of explicit rules and regulations, but out of a set of ethical habits and reciprocal moral obligations internalized by each of the community’s members.16 Such an internalized sense of reciprocal moral obligation is a form of virtue that ought to guide decision-making. Discernment carefully examines the moral dimensions of business decisions and leadership recognizing that rules and principles are necessary but not sufficient for determining the right course of action.

IMPERATIVES FOR A GOOD DISCERNMENT

Express Hopes and Fears Honestly Communal discernment is best achieved when participants are open to ideas and resist coming to conclusions prematurely. One way to approach this subjective dimension and to grow freely is for individuals to identify and discuss their hopes and fears about the issue being discerned. This exercise encourages transparency and selfreflection and will assist the discernment group in understanding the data and information more objectively. By listening to the hopes and fears of other group members, each participant will better understand the assumptions everyone brings to the process. This exercise will ideally encourage participants to keep one another accountable during the deliberation.

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Invite Diverse Perspectives Gathering a diverse group of colleagues will broaden the spectrum of ideas and perspectives to serve the ministry better by discerning the best options. Implicit bias that is often present in all of us can be corrected through multiple ideas representing different perspectives, and a diverse group more effectively represents the reality of our ministries. Additionally, no one’s experience encompasses the complete truth; we can all learn and grow from each other. Imagine Multiple Possibilities While it may seem that a discernment is focused on two possibilities, an effective process may result in several possibilities for conversation. Discernment will ideally encourage participants to tap into their creative imaginations and express ideas that are new and exciting. Make a Recommendation and Articulate Reasons If the discernment process has been deliberate, reflective and honest, colleagues will grow to trust one another and understand how organizational values are informing the decision. This does not

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mean that there will be unanimous agreement, but the trust that the group has cultivated will allow for conversations about personal reservations. A byproduct of a healthy discernment process may well be that participants discover not only new insight into themselves, but also a newfound appreciation for other colleagues along the way. SCOTT KELLEY is mission leader for Loyola University Medical Center, a member of Trinity Health, and adjunct assistant professor for the Neiswanger Institute for Bioethics and Healthcare Leadership, Stritch School of Medicine, Loyola University Chicago. DAVID NANTAIS is mission leader for St. Joseph Mercy in Ann Arbor/ Livingston, Michigan, part of Trinity Health. NOTES 1. This article includes excerpts from two documents related to discernment produced by Trinity Health. The first document outlines conceptual foundations for Catholic health care; the second outlines the process of facilitated discernment. To request a copy of the Trinity Health documents, please email discernment@trinity-health.org. Scott Kelley and Cory Mitchell, “Trinity Health: Building a Culture of Discernment,” Trinity Health, November 15, 2021; “Facilitated Discernment: A Guide for Trinity Health Participants and Facilitators,” Trinity Health, 2022. 2. Sumantra Ghoshal, “Bad Management Theories are Destroying Good Management Practices,” Academy of Management Learning & Education 4, no. 1 (2005): 75-91; Henry Mintzberg, Managers Not MBAs: A Hard Look at the Soft Practice of Managing and Management Development (San Francisco: Berrett-Koehler Publishers, 2005); Andre’ L. Delbecq et al., “Discernment and Strategic Decision Making: Reflections for a Spirituality of Organizational Leadership,” in Spiritual Intelligence at Work: Meaning, Metaphor, and Morals (Bingley, England: Emerald Publishing Limited, 2003); Brian W. Head, Wicked Problems in Public Policy: Understanding and Responding to Complex Challenges (Cham, Switzerland:

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Springer Nature, 2022). 3. Paul Starr, The Social Transformation of American Medicine: The Rise of a Sovereign Profession and the Making of a Vast Industry (New York: Basic Books, 1982). 4. Pope Francis, Laudato Si’, paragraph 137, https://www.vatican.va/content/francesco/en/ encyclicals/documents/papa-francesco_20150524_ enciclica-laudato-si.html. 5. Pope Francis, Fratelli Tutti, paragraph 47, https://www.vatican.va/content/francesco/en/ encyclicals/documents/papa-francesco_20201003_ enciclica-fratelli-tutti.html. 6. Pope Francis, Evangelii Gaudium, paragraph 231. 7. Fr. Bernard J. F. Lonergan, SJ, Method in Theology (Toronto: University of Toronto Press, 1990), 281-293. 8. Thomas Aquinas, Summa Theologica, Second Part of the Second Part, question 47, answer 2. 9. Thomas Aquinas, Summa Theologica, Second Part of the Second Part, question 47, answer 4. 10. Fr. Ladislas Orsy, SJ, Discernment: Theology and Practice, Communal and Personal (Collegeville, Minnesota: Liturgical Press, 2020). 11. Richard J. Clifford, The Wisdom Literature (Nashville: Abingdon Press, 1998); Silvia Schroer, Wisdom Has Built Her House: Studies on the Figure of Sophia in the Bible (Collegeville, Minnesota: Liturgical Press, 2000). 12. Sandra Marie Schneiders, “Religion and Spirituality: Strangers, Rivals, or Partners?” The Santa Clara Lectures 6, no. 2 (February 6, 2000). 13. Fr. Michael Ivens, SJ, Understanding the Spiritual Exercises (Leominster, England: Gracewing, 1998). 14. Servais Pinckaers, The Sources of Christian Ethics (Washington, DC: Catholic University of America Press, 1995); John Mahoney, The Making of Moral Theology: A Study of the Roman Catholic Tradition (Oxford: Clarendon Press, 1987); Charles Taylor, Sources of the Self: The Making of the Modern Identity (Cambridge, Massachusetts: Harvard University Press, 1989). 15. Thomas Aquinas, Summa Theologica, Second Part of the Second Part, question 47, answer 8. 16. Francis Fukuyama, Trust: Social Virtues and the Creation of Prosperity (New York: Free Press, 1995).

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Challenges For Sponsorship Today SR. DORIS GOTTEMOELLER, RSM Bon Secours Mercy Health Board Member and PJP Chair

ne of the achievements of the post-Vatican II health care systems was to develop the concept of “sponsorship.” As long as institutions were founded and owned by dioceses, parishes or religious congregations, and led by priests or religious, their Catholic identity was secure. However, the aggregation of health care institutions into systems, at times involving more than one religious congregation and spanning multiple dioceses, called for a more creative approach. Hence, the idea of sponsorship was born. As defined today by CHA, “sponsorship is a structured relationship through which the sponsor, in the name of the Church, directs and influences a ministry that meets an apostolic need and furthers the mission of Jesus.”1 A typical sponsor is a specific group of religious (sometimes including lay people) recognized and chartered by the Dicastery for Institutes of Consecrated Life and Societies of Apostolic Life at the Vatican. The canonical designation for such a sponsor group is “public juridic person (PJP)” or, more recently, “ministerial juridic person.” For several decades, this structured relationship has grown and matured, providing effective ecclesial accountability and mission oversight to health care in the United States.2 But as in any living relationship, time brings new challenges. What follows are five questions identified for the future. Examining these queries provides an opportunity to address them with the creativity and purpose that has characterized Catholic health care until now. Will sponsorship become a predominantly lay ministry?

The concept of sponsorship was originated by religious women and men, and they populated

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the earliest PJPs.3 In time, though, some qualified Catholic lay people were invited to join the PJPs. However, the charters or bylaws of most PJPs still specify that a majority of the members must be religious or that they must be chaired by a religious. Today, the number of women or men religious has declined precipitously, leaving fewer qualified to serve in health care sponsorship roles. Also, the areas of ministerial interest or preparation for today’s younger members may lead them in different directions. At the same time, PJPs are accountable to the Dicastery for Institutes of Consecrated Life and Societies of Apostolic Life, a situation that could become quite anomalous if the membership did not include mostly religious. Will the specific charisms of the religious congregations have any enduring influence?

Each religious congregation is characterized by a founding grace or “charism,” defined as a gift of the Holy Spirit for the sake of building up the Reign of God for the good of the Church.4 Expressions of the sponsoring congregation’s charism typically influenced the statement of the health ministry’s mission. When two or more congregations joined in a co-sponsorship arrangement — for instance, in a single PJP — careful

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human resources, legal, marketing, etc. They receive accountability from the CEO and management leaders in the various areas. Among the management areas is mission integration. Mission executives oversee or contribute to multiple areas. To illustrate, below are the seven areas of mission competency identified by CHA. Each of these competencies reflects the skills needed at different levels, or tiers, of the organization with appropriate actions for each.10 (For example, strengthening Catholic relations might occur at a local [parish] level, a diocese, nationally or with the Vatican.) Catholic Identity: Stewards CathoExpressions of the sponsoring lic identity and strengthens Church relations. congregation’s charism typically Strategy: Ensures the centrality of influenced the statement of the health mission in strategy. Operations: Incorporates the misministry’s mission. sion and values into all operations of the organization. Moreover, in its “Dogmatic Constitution on Formation: Champions formation at all levels of the Church,” the Second Vatican Council affirmed the organization. the holiness of the whole people of God and the Spirituality: Nurtures spiritual health. graces distributed to all. 5 It notes, “… all the faith- Ethics: Promotes organizational and clinical ful of Christ of whatever rank or status, are called ethics. to the fullness of the Christian life and to the per- Advocacy: Represents the needs of persons who fection of charity.”6 Further, “this holiness of the are affected by poverty and are marginalized. Church is unceasingly manifested, as it ought to As noted above, mission is an area of managebe, through those fruits of grace that the Spirit produces in the faithful. It is expressed in multiple ment, accountable to the board of trustees. The ways in those individuals who, in their walk of life, board is appointed by the sponsors, hence they strive for the perfection of charity … .”7 Thus, the are accountable to them. What looks like a clear laity who serve in a sponsorship role as an exer- delineation of responsibilities is, in fact, somecise of their own Christian vocation are guaran- times confusing or conflictual, as when the board and sponsor are the same individuals, or when teed the grace (charism) to discharge it. sponsor representatives oversee or participate What relation should sponsorship have to in management areas such as mission formation within the organization. While mission is charged trusteeship and mission integration? Having worn all three hats (sponsor, trustee with stewarding Catholic identity and strengthenand chief of mission integration), I am sensitive ing Church relations, the sponsor exercises final to the distinctiveness of each. The sponsor’s role, accountability to Roman officials. Who should as defined earlier, is typically expressed through appropriately deal with local bishops, a sponsor specific authorities reserved to them, such as or a mission representative? appointment of board members, approval of the president and CEO, change of mission or bylaws, What are the questions sponsors should be askand oversight of stable patrimony,8 all by accounting about services provided by businesses either ability to the Dicastery for Institutes of Conse- owned or created by the health care system, crated Life and Societies of Apostolic Life.9 when those working for the businesses are not The trustees, in turn, have oversight and legal system employees? responsibility for the enactment of the mission, This query relative to sponsorship arises including areas such as strategy, quality, finance, because of the growth of diversified operations wordsmithing expressed a mission inclusive of both charisms. On reflection, however, we might observe that congregational charisms — such as mercy, charity, divine providence, bringing good help (Bon Secours) and imitation of the devotion of the Blessed Mother or St. Joseph — are not exclusive to any religious institute. They are gifts and ideals held in common by all those baptized. While the heritage of the founding congregations deserves to be honored, the current mission of the health ministry is what should be guarded and promoted by the current sponsors.

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GUIDED BY FAITH

within health care systems. These diversified and financial viability. Therefore, sponsors examoperations include a portfolio of businesses ining whether these employees’ business environdeveloped or acquired by the system. Such oper- ments reflect their system’s model of workplace ations may include health care services such as dignity is essential to sound operations. An area urgent care; ambulatory surgery centers; outpa- like patient billing and insurance may require tient imaging centers and other lower-cost sites thousands of employees given the convoluted of care; nonacute services such as home care, hos- state of health care insurance in the United States. pice and behavioral health; and even business services such as revenue cycle management and sup- What is the role of sponsors in regards to digital ply chain consulting. These services may be far operations? outside the geographic footprint of the inpatient Digital operations can include any instance operations of the system, even extending inter- when a patient or a provider is touching a screen. nationally. They can serve to offset profitability Examples include personalized patient tools deterioration in the traditional acute care services that enable mobile health, such as smart phones, since they generate higher margins with less cap- wearables and even telehealth, as well as physiital investment. Furthermore, they may be orga- cian-facing applications that enable more effecnized as for-profit subsidiaries in order to provide tive and efficient clinical outcomes. All of these market-based benefits and compensation. Thus, are constantly improved and updated by machine their personnel are not technically employees of learning and artificial intelligence. As much as a the system, and their services often do not carry quarter of the system’s income may be derived the system’s brand. from diversified and digital operations, thus supOne place to begin might be to think of the porting the core operations, which may be underportfolio company as an agent of the Catholic funded by Medicaid and Medicare and include health care system. Hence, it would be appropri- uninsured patients. ate to ask if its employees are guaranteed a work environCatholic health care is a ministry of ment characterized by social the Church, an expression of Jesus’ principles of human dignity and respect, even if they are description of the Final Judgment: When not considered to be working for a Catholic organization. I was sick, you ministered to me. The fact Some diversified services that this ministry has evolved into new are provided entirely via phone or computer (for examways of serving the sick, while maintaining ple, patient scheduling, nurse triage and patient transfer). traditional patient-centered care, doesn’t Employees of these operatdetract from its fundamental premise: ing units never see a patient in person, nor ever visit a “You ministered to me.” clinical setting. In fact, in this post-COVID-19 world, they may even work from home and rarely see other As sponsors view the consolidation of smaller employees in person. systems and free-standing health care centers into While there have always been back-office larger growing systems with multiple diversified employees who were isolated from bedside businesses, the question of their competency and care, their numbers were small compared to the responsibility arises. How much do they have to amount of caregivers, and their offices were often know about the clinical, legal, financial and techin a section of or nearby the hospital itself. A nical intricacies of health care services as they are big difference today is that the number of such evolving? What qualifications will sponsors of the employees has grown astronomically, and the future need? entire health system, including the acute care Catholic health care is a ministry of the Church, ministry, depends on their efforts for efficiency an expression of Jesus’ description of the Final

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Judgment: When I was sick, you ministered to me. The fact that this ministry has evolved into new ways of serving the sick, while maintaining traditional patient-centered care, doesn’t detract from its fundamental premise: “You ministered to me.” Whether lay persons or religious, sponsors carry this mandate as a sacred trust. It is their responsibility to direct and influence the ministry so that it furthers this mission. One way they do this is by appointing trustees who are not only knowledgeable of the various technical areas, but who also honor and serve this sacred trust. At the same time, sponsors need to attend to their own growth in understanding changing health care needs and resources so that they can authentically serve the sacred mission. We can be sure, though, that the same grace that inspired the creation of “sponsorship” will also be available to guide its evolution to address new needs in health care’s ever-changing environment. The author wishes to thank Andre Maksimov, chief diversified growth officer at Bon Secours Mercy Health, and Jason Szczuka, chief digital officer at Bon Secours Mercy Health, for their helpful review of this article. SR. DORIS GOTTEMOELLER is a member of the

board of Cincinnati-based Bon Secours Mercy Health and chair of Bon Secours Mercy Ministries, the system’s public juridic person. She is a former chair of the Catholic Health Association Board of Trustees. NOTES 1. Guide for Sponsors in Catholic Health Care (St. Louis: Catholic Health Association, 2021), 5,

https://www.chausa.org/docs/default-source/ sponsorship/cha-sponsorship-guide.pdf?sfvrsn=0. 2. Many of the observations and questions to follow apply as well to educational institutions at all levels and to other Church works, but the focus here is health care institutions. 3. Guide for Sponsors, 3. 4. U.S. Catholic Church, Catechism of the Catholic Church: Second Edition (Washington, DC: United States Catholic Conference, 2011), 799-800. 5. Second Vatican Council, “Lumen Gentium: Dogmatic Constitution on the Church” in Vatican Council II: The Conciliar and Postconciliar Documents, ed. Austin Flannery (Wilmington, Delaware: Scholarly Resources, 1975), Chap. V, “The Universal Call to Holiness.” 6. Second Vatican Council, “Lumen Gentium,” paragraph 40. 7. Second Vatican Council, “Lumen Gentium,” paragraph 39. 8. “The patrimony or temporal goods of a public juridic person in the church, such as a religious institute or one of its parts, is usually classified either as ‘free’ or ‘liquid’ capital, or as ‘stable’ capital or patrimony. Stable patrimony is that which is destined for the long-term security of the members (in the case of a religious institute) and of the sponsored works. In general, it can be said that stable patrimony consists of lands and buildings, of certain other types of property (such as a specialized library, historical or cultural items), long-term investments and endowments, and restricted funds set aside for a specific purpose.” From the following: Fr. Frank Morrisey, “What Is Stable Patrimony?” Health Progress (March/April 2008): 14-15. 9. Guide for Sponsors, 10. 10. “The Mission Leader Competency Model,” Catholic Health Association, https://www.chausa.org/mission/ mission-leader-competencies.

QUESTIONS FOR DISCUSSION In this article, author Sr. Doris Gottemoeller, RSM, addresses the importance of charism in the sponsorship of the Catholic health care ministry. 1. Are you familiar with the charisms of your founding congregations? How do these charisms inform your work in health care? 2. How can sponsors, trustees and mission leaders work together in order to ensure that the health care ministry not only remains true to its Catholic identity, heritage and mission but also is able to adapt and thrive in the ever-changing, complex industry of health care? 3. If you are a sponsor, how have you seen your role or responsibilities change over time? What have you learned most from that? 4. When you consider the questions posed in this article, how do they prompt you to think about the future of the ministry? How is your system preparing for this future?

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Reuters/Alamy Stock Photo

Finding God in Daily Life “The process of healing also needs to include the pursuit of truth, not for the sake of opening old wounds, but rather as a necessary means of promoting justice, healing and unity.” — Pope Francis’ address at welcome ceremony in Colombo, Sri Lanka, January 13, 2015

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Hiring for Ministry Fit in Catholic Health Care TOM BUSHLACK, PhD, and TOM EDELSTEIN, MAHCM, MBA, MA Mercy

t Mercy, the hiring process includes conversations and assessment to determine if candidates have qualities that will make them a good fit for the Catholic health care system. While many employers discuss the workplace culture with candidates, Mercy engages candidates in discussions specific to the system’s Catholic identity.

Job candidates notice, with one commenting, employment with Mercy. “The recruiter spoke about the mission; the hiring leader talked about Mercy’s values, and now I’m WHAT’S A “MERCY FIT” APPROACH? here speaking with a mission leader, talking about Mercy has been conducting system-wide organithe meaning and purpose of my work as [part of] a zational fit assessments along with evaluations ministry. I love that you guys care so much about of candidates’ qualifications and talent for more your culture.” than 20 years. We identified some essential attriAnother candidate sent an email to a mission butes for candidates to be successful in our minleader following his interview, saying he hadn’t istry, such as having a kind and caring disposition fully thought of his career as a form of steward- toward others and an appreciation that one’s work ship, until the two had a discussion: “Therefore, I in Catholic health care is imbued with higher thought you would appreciate knowing that you meaning and purpose. reached deep within me to help me clearly realize that important Hiring for fit signals to all involved — connection.” The candidate said candidates, recruiters, hiring managers whether or not he joined Mercy, he would start to think about his and mission leaders — that formation work as a way to “glorify God.” Sr. Anita DeSalvo, RSM, prebegins even as someone applies for viously a Mercy board mememployment with Mercy. ber, explained that hiring for fit is fundamental to the ability to sustain the culture and charism of Mercy: The process evolved from a “you know it “Through formation, we can fan the embers and when you see it” discernment model to a formal stoke the fire of passion for ministry, but I don’t system for all candidates in the hiring process. think we can really start that fire.” Hiring for fit New, structured protocols were developed that signals to all involved — candidates, recruit- included training for hiring managers and recruiters, hiring managers and mission leaders — that ers, along with online documentation to track data formation begins even as someone applies for and outcomes. This data allow us to further refine

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the “Hire-for-Fit” process and develop predictive ter) to measure the internal validity of Mercy fitanalytics of employee success, tenure, promotion assessed categories and the defining characterisand satisfaction based on initial and, in the case tics of each. Overall, the Hire-for-Fit assessment displayed a very high degree of reliability, and of potential promotion, subsequent assessments. The impetus for this standardization was the subsequent studies found 80% “inter-rater relitransfer of the health ministry’s sponsorship ability,” which means multiple assessments of the to a public juridic person, including more lay same candidate resulted in similar conclusions leadership, in 2008. With that transition came the among different interviewers who completed the responsibility to sustain Mercy as a ministry of ratings on the assessments. the Catholic Church in the tradition of the Sisters of Mercy. To honor Since its inception, more than 40,000 this commitment, a new objective around hiring decisions was develassessments have been documented oped in which a candidate’s inclinawith preliminary studies supporting tion for ministry would factor as a primary qualifying requirement. intuitions that those who demonstrate Recruiters, hiring leaders and mission leaders are trained in what high levels of ministry fit tend to to listen for in interviews and the perform better, experience higher process of how to conduct, score and document the assessments. levels of employee satisfaction and Interviewers ask specific questions focused on five key areas of minisremain longer with the organization. try fit: understanding health care as a ministry; justice as a right relationship; common We found that providing adequate training for good; care for those who are poor; and service.1 hiring managers, recruiters and mission leaders on Based on the candidate’s response, the inter- use of the Hire-for-Fit tool and process is essential viewer scores each category on a defined scale to ensuring consistency of ratings across the minfrom one to five: 1 = lacking; 2 = inconsistent; 3 = sat- istry. This training continues through a collabisfactory; 4 = consistent; and 5 = exemplary. Using orative relationship between the Mission departa weighted algorithm, each candidate receives a ment and the Office of Talent Excellence (human total score, and the interviewer provides a cate- resources). Hire-for-Fit training is included as gorical rating of “yes,” “no” or “conditional” as a part of new leader formation programs since leadcandidate fit for Mercy. Interviewers submit writers (managers, supervisors, directors and executen notes on the candidate’s responses in support tives) have the greatest responsibility to screen of the scoring. These notes include suggestions and hire employees who are most likely to thrive for further assessment by other interviewers and and contribute to our ministry’s culture. for future personal formation plans, especially if the candidate is deemed “conditional.” DATA FINDINGS This system allows for sharing of assessments A small study of providers in our urgent care cenamong interviewers and for longitudinal out- ters, Mercy|GoHealth, demonstrated positive corcomes research. Since its inception, more than relations between Mercy fit score and key mea40,000 assessments have been documented with sures of performance, including: net promoter preliminary studies supporting intuitions that score (a customer loyalty and satisfaction score); those who demonstrate high levels of ministry fit door-to-provider time (time from when a patient tend to perform better, experience higher levels arrives to first interaction with a health care proof employee satisfaction and remain longer with vider); door-to-door time (based on when the the organization. patient is discharged); and likelihood of remaining in their position for the coming year. There is a consistent trend with the top 25% group (median ASSESSMENT VALIDITY AND RELIABILITY In 2018, Mercy partnered with Cornell Univer- Hire-for-Fit score of 68.1) outperforming the botsity’s Office for Research on Evaluation and tom 25% group (median Hire-for-Fit score of 44.4) MLC (formerly the Ministry Leadership Cen- on all four measures. This suggests the Mercy fit

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MERCY FIT — NEW EMPLOYEE TENURE AVERAGE INITIAL TENURE LENGTH/DAYS

200

150

100

595 HIRES

15,254 HIRES

112 HIRES

CONDITIONAL

YES

Those who rate as a “yes” or as “conditional” on the organizational fit evaluation tend to stay longer at Mercy, based on the averages of candidates’ first months with the organization.

assessment may be associated with better performance outcomes from providers, however more data is needed for definitive conclusions. Furthermore, an internal study was conducted of tenure among 16,000+ employees hired between January 1, 2020, and March 30, 2022. The data (see graph above) demonstrated trends that candidates who are assessed to be a Mercy fit (rated as “yes” or “conditional”) are more likely to have longer initial tenures than those who were assessed as not being a fit for the ministry. (In some cases, the system does hire those who score a “no” on the assessment.) Our review also indicated that Hire-for-Fit assessments conducted by mission leaders provided the most accurate predictive data for employee tenure and retention. While these initial trends are promising, a longer-term study is necessary to determine the predictive validity of the Hirefor-Fit assessment.

HIRING FOR FIT AS A FORMATIVE EXPERIENCE

Aside from helping to predict potential employees’ long-term success with Mercy, the practice of hiring for ministry fit is also a formative experience for candidates, as hiring leaders and recruiters weave this element into interview discussions. It introduces and reminds candidates of who they are called to be in their work as a ministry. While some come to the health ministry with a bit of

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knowledge of Mercy’s culture and reputation in the community, they arrive to their interview primarily prepared to speak of their experience and qualifications. Those who we conclude are a fit for ministry frequently become more engaged as they respond to questions pertaining to the meaning they experience in their work, how they were called to this career and where they find the greatest joy. As they come to learn from the interview process that they will be working alongside others who share a higher sense of purpose, their appreciation of the culture deepens. Recently, an instructor at a local school of nursing was interviewing for an urgent care nurse practitioner opportunity with Mercy. During her Hiring-for-Fit assessment, she shared a conversation she had with one of her graduating students, who was interviewing with Mercy and other area hospitals. When asked which hospital she decided on, the student said that during a job interview at a secular hospital, they started by talking about the job responsibilities and hours. At Mercy, she explained, they began by “wanting to make sure they understood what I was looking for and why. They wanted to know I was going to be happy doing what I love. The kindness and caring they showed made all the difference.”

APPRECIATING DIVERSE BACKGROUNDS

While the Hire-for-Fit process can lead into a discussion of one’s individual faith, it is important to respect the diversity of candidates and their right to maintain professional boundaries as it relates to disclosing personal information. Interviewers are trained to assure the candidate that the purpose of the interview is to assess their fit with our ministry culture, regardless of their personal spiritual or faith commitments. The same is true of those who do not identify with a faith tradition or who have chosen not to religiously affiliate as adults. It is important that the Hire-for-Fit process invites the candidate to be fully authentic and honest about their professional identity. Doing so invites both them and the interviewing team into a process of mutual discernment. The goal of the process is to assess a candidate’s openness, curiosity and willingness to work in a ministry context; to integrate meaning and purpose into their work; and to serve others with dignity. Candidates from a multitude of spiritual or religious backgrounds and traditions — or those who do not identify religiously — have been identified as a good fit and have had successful careers with Mercy.

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CONCLUSION

Hiring for ministry fit provides many benefits that sustain and promote organizational culture, ministry identity, mission integration, formation, employee recruitment and talent development goals. The process engages interviewers and candidates in a shared process of discernment regarding the potential coworker’s fit within a distinct ministry culture. It allows the candidate to enter the workplace with “eyes wide open,” knowing they are stepping into a unique environment that is infused with ministry values and expectations. Our initial data suggest that hiring for fit may lead to higher rates of retention and improved performance. A well-designed and documented Hire-forFit process becomes the baseline for future formation, and establishes an appreciation for the higher meaning and purpose of employees’ efforts, in addition to helping to assess a path for future career growth. The process honors the trust of the Catholic Church and the founding religious order(s), ensuring that all colleagues recog-

nize that the work of ministry continues today as a lay ministry for which they assume responsibility. One of the surprising benefits of our experience doing Hire-for-Fit interviews for more than two decades is that new coworkers who are hired for ministry fit recognize these same qualities and characteristics in their colleagues. We have found that this process reinforces the ministry culture in a virtuous cycle, and through doing so, ensures our identity as a Catholic health care ministry. TOM BUSHLACK is vice president of mission and formation for Mercy in St. Louis. TOM EDELSTEIN is vice president of mission for Mercy in St. Louis. NOTE 1. The original assessment included a sixth category called “Catholic worldview.” After conducting an exploratory factor analysis, it was determined that this area is already reflected in responses received in the other five categories. Catholic worldview was therefore dropped from the assessment tool.

“

For I am convinced that neither death, nor life, nor angels, nor principalities, nor present things, nor future things, nor powers, nor height, nor depth, nor any other creature will be able to separate us from the love of God in Christ Jesus our Lord.” (Romans 8:38-39)

Please join with CHA in remembering the more than one million people who have died thus far from COVID-19. Know that we pray for you, remembering especially the sacrifice of health care workers, and all those who have lost loved ones. May we have comfort and strength and trust in God’s love for us.

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Providence Cultivates Leaders for Formation Throughout Organization

Building on Legacy So Mission Can Flourish MARY ANNE SLADICH-LANTZ, MTS, JOHN SHEA, STD, and DARREN M. HENSON, PhD, STL Developers of Providence Forming Formation Leaders Program

here is an ongoing appetite for formation programs and experiences, and it never seems to be enough. Participant evaluations of formation offerings consistently express the desire for more opportunities to connect one’s work and personal meaning to the mission of the organization. Many years ago, Providence St. Joseph Health, like most Catholic health care ministries, began programs we called “leadership formation” to equip our leaders with the working knowledge, understanding and skills to ensure Catholic health care would flourish for generations to come. It didn’t take long before a slot in one of our formation programs became coveted. What leaders experienced for themselves in formation, they then also wanted for their teams. We not only felt an obligation to respond, but we also had a deep desire to do so. We wanted to meet the demand that formation be made available to everyone throughout the organization. In order to grow our formation offerings, we first needed to increase our bench strength. To address this, the Providence Formation Institute team had to creatively respond to the groundswell of requests for formation throughout our seven-state, 120,000-caregiver footprint. Knowing that leading formation requires certain competencies and personal characteristics, we asked ourselves: How can we help others, especially mission leaders, get smarter and better at leading formation experiences so that Providence St. Joseph Health could remain faithful to its mission, while still responding to the signs of the times?

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CULTIVATING LEADERS TO LEAD FORMATION

In 2017, the Providence Formation Institute responded to this call for formation by initiating Forming Formation Leaders, an 18-month program with nine two-day sessions and nine onehour individual coaching sessions. Offered to mission and other aligned leaders, the program provides opportunities to create and present formation experiences and to carry the formation agenda, which involves advancing formation practices into the workplace. To date, two cohorts (30 people) have been through the program, with a third cohort of 18 people currently participating in it. At the program’s conclusion, the leaders are invited into an organization-wide “Community of Formation Practice,” which gathers quarterly for a year — followed by ensuing biannual meetings — to continue to hone formation-leading skills and to share best practices and resources. The goals of Forming Formation Leaders are: 1) to get smarter and better at doing formation; 2) to share, develop and collect formation resource materials and experiences; and 3) to strengthen collaborative support and mutual learning among those leading formation activities. These objectives are achieved through interacting with established formation approaches; listening to and dialoguing with seasoned formation leaders; and

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GUIDED BY FAITH

designing, implementing and evaluating formation activities. As experienced with many other disciplines during the pandemic, the need to get smarter and better at formation accelerated the past two years. The days of merely being invited to an executive meeting and offering an inspiring quote as the reflection are a bygone era. Our ministry has evolved to a new place. Leaders and frontline caregivers now bruised and broken by the pandemic

equip and strengthen mission and other aligned leaders with working knowledge, skills and competencies to lead effective and meaningful formation activities.

FORMATION OPPORTUNITIES

The central process of Forming Formation Leaders is reflection on the engagement experiences of participants in formation opportunities, which come in all shapes and sizes. We discovered the need to show participants how to readily identify formational opportunities; they The days of merely being invited are frequent and situational. to an executive meeting and offering Formation opportunities can involve the following: 1) “asks” to lead a formaan inspiring quote as the reflection tion activity or an activity with a formational component; 2) serve as faculty for are a bygone era. ... Leaders and one of our core formation programs; and frontline caregivers now bruised 3) carry the formation agenda in meetand broken by the pandemic cry out ings, interpersonal encounters and a variety of work situations. These opportunities help bring formation experifor much more. ences throughout the many organizacry out for much more. They want to connect with tional departments and operations. and embody the mission, vision, values and promAsks ise of the organization earnestly and concretely. Over the years, we have realized that many Most mission leaders, chaplains, spiritual care other leaders throughout our system engage in leaders, ethicists and other leaders working formation activities apart from formal programs closely with mission activities can expand on the led by the Formation Institute.1 We have found many types of “asks.” One mission leader recalled that most often they are mission leaders.2 In addi- his recent ones: “A case management team asked tion, it also includes other mission-centered part- for a formation experience that would help them ners, such as ethics or spiritual care leaders, or cope with persons suffering with addictions. Sevphysician leaders and other clinicians, such as eral of our caregiver resource groups requested formative experiences which would assist them palliative care team members. CHA and Providence St. Joseph Health Forma- with feelings of inclusion and acceptance.” tion Institute share the definition of ministry for- Another mission leader identified some of her mation as creating experiences that discover con- formation requests ranging from “brief reflecnections between personal meaning and organi- tions for recurring leadership and board meetzational purpose. These connections inspire and ings (5-15 minutes) to thematic extended reflecenable participants to articulate, integrate and tions for leadership teams (20-45 minutes) to mini implement the distinctive elements of our minis- retreats (one or more hours).” “Asks” arrive. When they are effectively met, try, so that it flourishes now and into the future.3 But how will this “now and future” fidelity they keep coming. Every “ask” pulls formaand flourishing happen? Through our insight and tion leaders into a planning mode that includes guidance by faith, we hoped that by responding to the knowledge and skills of facilitation and the expressed yearning for formation throughout resourcing. the organization, that fidelity and flourishment would then follow. Forming Formation Leaders Faculty Presenter at a Core Formation Program was a response to what we observed emerging Key themes such as vocation/call, tradition, spirin the organization.4 We saw the opportunity to ituality, the Catholic social tradition, ethics and

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discernment are foundational elements to any formal formation program. The ability to craft a formation experience around these programmatic themes requires the ability to understand the subject matter and to engage participants beyond an academic exercise so that they are able to articulate and integrate the concepts into organizational life. Carrying the Formation Agenda This entails a proactive approach in bringing formation perspectives and strategies into all aspects of organizational life. The issues may be organizational change, decision-making meetings, reductions in workforce, interpersonal encounters and a variety of other work situations. However, everything is part of the organizational purpose, and formation leaders are called to make that connection in a way that is relevant and inspiring.

WORKING KNOWLEDGE, SKILLS AND COMPETENCIES

The challenges in “asks” and “carrying the formation agenda” are related but different. “Carrying the formation agenda” may require some preparation, but mainly it is the ability to have formation knowledge available in the moment, being attentive and bringing it forward at appropriate and critical times in leadership discussions. “Asks” on the other hand, whether for a reflection or a core formation program, demand considerable preparation to create distinctive designs for specific situations. They also require facilitation and resourcing skills to implement them. This entails a process of preplanning, planning and debriefing (see sidebar on page 27). As leaders engaging in formation experiences, there is a need for working knowledge and skills to address the “asks” and the situations of carrying the formation agenda. Some of these entail the proficiencies below: 1. Facilitating and Resourcing Skills: These include developing relevant designs and strategic messaging, creating and using prompts, understanding how workers create a sense of meaning and belonging, providing interpersonal support and empowerment, and speaking with authenticity and integrity. Crafting prompts to elicit deeper personal and communal reflection is an art. The leader of the formative experience needs to anticipate how to reach more deeply into the particular group of gathered individuals through pointed reflection questions.

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2. Sharing Stories to Illustrate the Bigger Picture: This encompasses the ability to tell stories

of individual experiences and heritage moments in story/point form. (Story/point telling keeps attention and communicates what is important by using the narrative as a tool to paint the larger picture, and leads naturally into analysis and strategy.) Also, it is an invitation for those who hear story/point telling to contribute their own experiences and to tell them in a story/point format. 3. Ability to Readily Articulate the Ministry’s Mission: This includes the aptitude to develop

working knowledge of the tradition and articulate it so it connects to the strategy and leadership conversation at hand. This can be described as a type of “backpack knowledge” that is neither general nor academic. We use the image of a backpack to describe knowledge that we carry with us, ready to be pulled out and used when needed. This available knowledge has the intent of being relevant to the organizational dynamics of health care. In this way, it is poised to be used in “asks” and in carrying the formation agenda. For example, when discussing strategic impacts on hourly caregivers or services offered to marginalized populations, the leader articulates how the policy or strategy reflects Providence St. Joseph Health’s mission statement that we are “steadfast in serving all, especially those who are poor and vulnerable.” This phrase within the mission builds from the tradition that Divine presence imbues all human life. 4. Inclusive Language: This involves being able to use the religious language of the Catholic Church and Providence St. Joseph Health in a way that welcomes all people and is ecumenical, interfaith-minded and secular. In particular, it must be able to avoid any hint of proselytizing or indoctrination. The faith grounding of the Catholic Church/Providence St. Joseph Health must be stated in such a way that it affirms not just all in the organization, but everyone whom the organization serves. 5. Incorporating Values Systemically: This entails the skill to facilitate the process of moving the five values of Providence St. Joseph Health — compassion, dignity, justice, excellence and integrity — into policies and behaviors. This is one way that we stay true to our ministry’s health commitment by promising to be present throughout the life and operations of the organization. 6. Correlation of Mission and Strategy: This includes integrating ideas bought or borrowed

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CREATING A FORMATIVE EXPERIENCE

rovidence St. Joseph Health implements and follows a three-step planning process when receiving an “ask” for a formation activity. The steps appear simple, however breaking down the components and giving due attention and focused planning is critical to an effective formation experience. The following outlines the necessary actions to properly address and respond to these requests.

Preplanning Eliciting as much information as possible from the requester and other stakeholders is an essential step to inform the design of the formation experience. This involves the following: 1. Identify who is making the ask. Clarify and negotiate the ask from the requester, invite them to collaborate on the design, and enroll them in the implementation of the formative experience. Furthermore, clearly identify the purpose of the meeting. 2. Gain a clear sense of the people in attendance. What are their roles and responsibilities? Are they executives and decision-makers? Are they middle managers and supervisors? Are they board or community members? What might be their perspectives as they come into the meeting? 3. Size up the situation: How many people will attend? How much time do you have, and can you negotiate adequate time to fit the design of the formative experience? Is this a one-time experience, or is this part of a larger program or vision?

Planning This stage adapts CHA’s and Providence St. Joseph Health’s definition and vision of formation to the particular people and situation where the formative experience will occur. It consists of the steps below: 1. Identify the central theme or issue that the content will address within the formative experience. Also, identify what primary aspect from the tradition will be used to illuminate the central topic. For example, this could be a principle or quote from Catholic social teaching, a sacred

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text, heritage story or a quote from a foundress, etc. 2. Determine how the time will be allocated. How will the participants be engaged? What will be the exact prompt to them, and what response might be desired? 3. Rehearse the presentation. Consider recording yourself and playing it back. Is the pace too fast or slow? Does the prompt come at the right time? Does the setup adequately address the main theme? What challenges and concerns arise for you? When needed, consider connecting with a thought partner.

Debriefing In this stage, the leader of the formative experience seeks feedback with the intent to “get smarter and better” at doing formation through the following actions: 1. At the conclusion of the formative experience, ask for written or oral evaluations. A simple Plus/Delta assessment can be conducted. (This involves asking participants to share the pluses from the event — what went well and should be continued further going forward — and the deltas, or what they would recommend changing for future meetings.) In virtual experiences, invite participants to include their thoughts in the chat feature or to send to you directly. Seek out two or three individuals in attendance and ask them how they experienced the formative portion of the meeting. 2. Seek out trusted colleagues, other mission leaders and key people to review the evaluations and feedback. Ask them what they hear and see, and together, identify areas for possible improvement in the future. Did the prompt work in the way intended? How could it be sharpened in the future? Did the connection with the tradition resonate as anticipated? Did insights arise for other aspects of the tradition that might be used in a similar future formative experience? 3. Identify means available to share the content and successes of this experience with other leaders steering formation.

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from the larger health care world into the organization. Effective secular ideas and strategies (such as quality and performance improvement, safety first initiatives, emotionally intelligent leadership and trauma-informed care, among many others) are put in dialogue with the mission and faithbased identity. This skill involves the ability to create connections between the language of mission and the organization’s strategies. 7. Adaptability to Groups: Leading formation experiences involves adjusting and designing experiences for different and diverse groups within the ministry. For example, leading an experience for seasoned executives is different from conducting one for a group of new community members appointed to an advisory board. Leading an experience for core leaders supervising patient-facing caregivers will also be different. A key differentiator in the formation preparation is determining how to make the knowledge available and applicable in a way that will be impactful and relevant to the receivers.

CONCLUSION

The qualities needed for leading formation experiences are robust, and the previous skills mentioned are just a few. These ideas and strategies come from the pilot efforts of the first two cohorts of Forming Formation Leaders. Everyone in the program is both a participant and a partner. Together, we create the program as we go through it. We build the sidewalks as we walk on them. The third cohort of Forming Formation Leaders is walking and building now. As we look into the future, many see only change. But change is not a stranger to Catholic health care. Catholic health care is a tradition of the Spirit and forms. It is always holding together the changeable (forms) and unchangeable (Spirit). The inherited forms are transitioning, and the Spirit is guiding the transition and developing new forms. Fidelity and flourishing are the Spirit and forms at work. It is how the essential and provisional join together, how a timeless revelation (Spirit) and time-bound transitions (forms) are both respected and included. The Spirit and forms are a “deep take” on the work of formation. But “deep takes” are needed to empower our perseverance and creativity in the work of formation. Whatever language is used,

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if we are in formation, it is helpful to love and be committed to the struggle that the mission of Providence St. Joseph Health articulates: “As expressions of God’s healing love, witnessed through the ministry of Jesus, we are steadfast in serving all, especially those who are poor and vulnerable.” MARY ANNE SLADICH-LANTZ is senior vice president of mission and formation and leads the Formation Institute at Providence St. Joseph Health. She is the recent recipient of the 2022 CHA Sister Concilia Moran Award. JOHN SHEA is a consultant to faith-based organizations, dioceses and parishes, and provides theological, mission and formation services. Presently, he is working with Providence St. Joseph Health on Forming Formation Leaders and the Community of Formation Practice. DARREN M. HENSON is associate vice president of the Formation Institute at Providence St. Joseph Health. NOTES 1. At Providence St. Joseph Health, two formal initial formation programs guide senior and core leaders on how to articulate the system’s faith-based identity and mission and integrate it into the life and operations of the organization. Ministry Leadership Formation engages not only executive team members and senior leaders at local ministries, system divisions and system offices, but also other leaders whose scope and responsibility places them in contact with many in the ministry and/or with community and external executive or civic leadership. Core Leader Formation engages all managers and supervisors at local and divisional ministries, directors at the local ministry or system level, and any exempt caregiver. 2. “The Mission Leader Competency Model,” Catholic Health Association, https://www.chausa.org/mission/ mission-leader-competencies. 3. Framework for Ministry Foundation (St. Louis: Catholic Health Association, 2020): https://www.chausa.org/ store/products/product?id=4363. 4. For other examples of the changing and growing need for formation, see the following: David Lewellen, “Shaping Ministry Formation Across Catholic Health Care,” Health Progress 103, no. 2 (Spring 2022): 23-26, https://www.chausa.org/publications/health-progress/ archives/issues/spring-2022/shaping-ministryformation-across-catholic-health-care.

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CHA Advocacy: Faith and Reason in Action LUCAS SWANEPOEL Director of Government Relations, Catholic Health Association

o much of today’s national discourse seems to revolve around politics; not politics in the idea of policies changed or laws created and enforced, but rather, in the sense of it being a sport — one where we cheer our “team,” whether Red or Blue, and all else has little value or meaning. It’s a sport where we see the “winner” as a validation of our sense of being, rather than as an affirmation of our contribution to making a more fair or just world. In this politically charged environment, CHA remains rooted in its mission, listens to its membership and strives to find common ground by seeking the common good in its health care advocacy work. A MISSION BEYOND OUR WALLS

consensus in a time when partisan divides often We don’t need some political expert to explain drive daily media coverage. The reality remains: the realities of today’s vastly divisive society, as Senate rules and narrow party control of each the truth is we all see them. It’s apparent to us in chamber mean bipartisan support is needed in our social media feeds, where it feels like cute order to pass most legislation. Therefore, orgapictures of dogs and cats are the only thing we nizations capable of building bridges and undercan agree on, while everything else seeks to cre- standing between political parties play a critical ate division in the name of a partisan interest. We role in enacting change for our communities. see it in our school board meetings, where once well-meaning individuWe don’t need some political expert to als who volunteered their time to explain the realities of today’s vastly make schools a better place for children to thrive have now devolved divisive society, as the truth is we all into shouting matches where dissee them. trust and conspiracies replace working together. And we see it in some CHA’s advocacy efforts are a unique voice in of our churches, sanctuaries which once brought people of all social and economic backgrounds the halls of Congress and in the various institutogether to worship; they now sometimes can feel tions of our nation’s government. This voice is like another place where faith is subservient to rooted in Jesus’ mission of love and healing. It seeks not only to lift the experience and chalone’s political views. These realities highlight a particular challenge lenges facing Catholic health care providers for our nation, and more specifically, a real quan- across the country, but also to challenge policydary to Catholic health ministries’ efforts to pro- makers and our society as a whole on how we can mote human dignity and access to affordable and build a more just and equal society. In his seminal work, Summa Theologica, St. quality health care for all. However, this challenge also provides an opportunity to build bipartisan Thomas Aquinas said that the first precept of the

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GUIDED BY FAITH

law is that the “good is to be done and pursued, and evil is to be avoided.”1 While this principle serves as a foundational value upon which laws and policies are built, it provides little on its own in helping us identify specific ones that serve the good of society in a highly complicated and everevolving health care policy landscape. However, it is in this simple maxim where the seeds of CHA’s advocacy efforts take root and grow. The Catholic health care ministry has a unique vantage point — to look to communities we serve to identify injustices and those in need, to use our knowledge and experience on how to best address these challenges, and to remain vigilant that these efforts remain grounded in the need to respect human dignity and promote the good of society.

ADVOCACY WORK IN ACTION

This mission-informed and faith-based approach to advocacy often means that CHA’s efforts are inherently distinct compared to the advocacy and talking points one typically sees coming out of Washington. It requires us to continually convene and listen to those who work each day on the front lines of Catholic health care so that we can understand and give a voice to the needs of their communities. CHA advocates not only to provide greater access to affordable health care, but also to promote a more just and equitable society in areas beyond health care. It is why CHA’s 2021-2022 advocacy agenda focuses on:2 Ensuring access, coverage and affordability for everyone. Eliminating disparities in health care access, quality and services. Maintaining a strong safety net (to serve those in need throughout every stage of life). Strengthening aging and chronic care services. Protecting life and ensuring conscience protection. Improving the health and well-being of communities. CHA’s advocacy is therefore grounded in the values that form our vision for U.S. health care: human dignity, concern for the poor and vulnerable, justice, the common good, stewardship and pluralism.3 These values recognize that access to health care is not only good policy, but a funda-

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mental human right and necessary for the promotion of the common good. It is these values which also mean we have a responsibility and capability to advocate in ways that seek to build understanding with people of all political, racial and religious backgrounds. It is precisely this effort to combine our mission with our experience that is at the heart of CHA’s efforts to confront racism and promote health equity. The “We Are Called” pledge is an example of how our mission to promote human dignity and our continued experience in seeing the ongoing health and racial disparities in our communities call us to become advocates for change and to end health disparities and systemic racism.4 This effort is a concrete example of how the ministry’s advocacy efforts must surpass the day-to-day challenges facing Catholic health care and confront key challenges in our communities that are an affront to the core values of Catholic social teaching and a continued driver of ill-health and injustice in our society. Throughout the COVID-19 pandemic, CHA’s advocacy focused on not only meeting the urgent needs facing providers trying to expand their services to address COVID-19 patients, but it also advocated for policies to make vital investments to address the root causes of poor physical health and economic instability as a result of the pandemic.5 Through these efforts, Congress passed critical funding for health care programs with nearly $185 billion in financial support through the Provider Relief Fund and billions more in increased Medicaid and Medicare payments.6 In addition, Congress expanded lower-cost health care coverage by making zero-premium or lowcost coverage available to millions of Americans. As a result, nearly 15 million uninsured people became eligible for increased savings on their health insurance premiums, with nearly 1.8 million becoming eligible for coverage at no cost.7 Furthermore, CHA also advocates in areas well beyond those traditionally linked to health care providers. Through our support for strengthening the social safety net, the incredible frontline work of Catholic health care providers, and as part of our broader efforts with the Catholic Cares Coalition,8 we provided a distinct voice for a more robust national and global response to the COVID-19 pandemic. Our representation on behalf of food assistance, housing, homelessness prevention and maternal and child support — to

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name a few — allowed us to contribute toward Congress passing legislation for programs long in need of additional funds. Members of Congress expect advocates for housing or food assistance to ask for greater support for those programs; however, when that message is reinforced by health care providers or other nontraditional food or housing advocates who reinforce the importance of meeting basic needs for people’s health, we provide a greater contribution to addressing the underlying needs in our society. In order to listen and learn from the experience of those working in Catholic health care — while at the same time providing a unified voice — CHA furnishes its members across the country a platform to share their experiences. CHA’s monthly advocacy calls and its meetings with system, hospital and long-term care leaders all provide important opportunities for receiving input on the needs of local communities and CHA’s advocacy priorities. At the same time, CHA’s newsletter, Washington Update, policy briefs and advocacy directories provide tools for members to not only stay informed on Capitol Hill and administration developments, but also on opportunities for contacting their Congressional delegation on policy issues. These resources are just some of what we offer to understand the needs of Catholic health membership and the communities we serve in our national policy-making conversations.

CONCLUSION

So, what makes Catholic health care advocacy different? Is it the number of hospitals, long-term care institutions, clinics and other health care organizations? Is it our long history of practice? While these are all critical parts of why we advocate and what we advocate for, the reasons go far beyond this. Fundamentally, it is the recognition that those in need who come to Catholic health care facilities are much more than their ailments. They are parents, family members, community members and people born with the dignity that comes as a child of God. Therefore, as we advocate on their behalf, we remember that Christ’s healing

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love requires us not only to heal their wounds but also to work tirelessly to mend the legal, social, economic and spiritual detriments of our society that continue to leave far too many sick and alone. It is this mission that makes CHA’s advocacy not only different, but a voice capable of healing the sources of division in our society. LUCAS SWANEPOEL is director of government relations for the Catholic Health Association, Washington, D.C. NOTES 1. Thomas Aquinas, Summa Theologica, First Part of the Second Part, question 94, article 2. 2. “The Catholic Health Association Advocacy Agenda: 2021-2022 (117th Congress)” Catholic Health Association, https://www.chausa.org/docs/ default-source/advocacy/2021-advocacy-agenda. pdf?sfvrsn=7ef3cef2_0. 3. “Our Vision for U.S. Health Care,” Catholic Health Association, https://www.chausa.org/docs/defaultsource/advocacy/cha_2019_visionforushealthcare_ print.pdf?sfvrsn=2. 4. “We Are Called,” Catholic Health Association, https:// www.chausa.org/cha-we-are-called/. 5. Sr. Mary Haddad to Charles E. Schumer, Nancy Pelosi, Mitch McConnell, and Kevin McCarthy, Catholic Health Association, Washington, D.C., January 27, 2022, https://www.chausa.org/docs/default-source/ advocacy/012722-cha-letter-on-supplemental-funding. pdf?sfvrsn=2. 6. Nancy Ochieng et al., “Funding for Health Care Providers During the Pandemic: An Update,” Kaiser Family Foundation, January 27, 2022, https://www.kff.org/ coronavirus-covid-19/issue-brief/funding-for-healthcare-providers-during-the-pandemic-an-update/. 7. “Fact Sheet: The American Rescue Plan; Reduces Health Care Costs, Expands Access to Insurance Coverage and Addresses Health Care Disparities,” U.S. Department of Health & Human Services, March 12, 2021, https://www.hhs.gov/about/news/2021/03/12/ fact-sheet-american-rescue-plan-reduces-health-carecosts-expands-access-insurance-coverage.html. 8. Catholic Cares Coalition, https://catholiccares.org.

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Fertility Options Offer Hope for Young Adult Cancer Patients ROB HANSON, MD, PhD Pediatric Hematologist-Oncologist and Director of the Cardinals Young Adult Cancer Program, Mercy

hink back on the best times you had as a teen and young adult. Now, imagine being that age and hearing the words: “You have cancer.” Patients between the ages of 15 and 30, known in the medical world as adolescents and young adults (AYA), are a distinctively vulnerable population. When a cancer diagnosis suddenly turns their world upside down, this age group needs holistic, life-changing care to meet their unique needs. There is newfound attention being brought to AYA cancer treatment in recent years,1 with many opportunities to provide this population with comprehensive care. One area specifically that is very important to these patients is the impact of cancer treatment on their fertility,2 further adding to the medical, psychosocial and financial issues presented by a cancer diagnosis. However, through new fertility preservation options available now to patients, these alternatives can assist those wishing to reach the milestone of one day starting a family and also address their fertility and reproductive health — an essential part of optimizing outcomes for AYA cancer patients.

NAVIGATING THE ROAD TO ONCOFERTILITY

Over the last several decades, young adult patients have not seen the improvements in cancer outcomes that have occurred in the older adult and younger pediatric populations. While the reasons for this involve multiple factors, one barrier can be attributed to lack of access to clinical trials, as availability has been dramatically lower in the AYA group.3 Recognizing this disparity, in 2005 the National Cancer Institute and national advocacy groups began focusing attention and fund-

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ing on AYA cancer research in order to advance oncology for this population.4 In the years since, AYA oncology has become recognized as a sub-subspecialty in the cancer care world, and national programs have been developed to optimally support these patients by improving survival and quality of life. Fertility preservation is one of the five fundamental pillars of AYA cancer care.5 Others include access to clinical trials, management of financial burdens, education and career development during and after cancer treatment, and psychosocial and emotional health. When AYA patients who have completed cancer therapy are asked about their biggest concerns, the most common one expressed is: “Will I be able to have children?”6 Even more than the risk for cancer recurrence or issues of disability or disfigurement, the desire to build a family is their highest priority. When a young adult patient first receives a diagnosis of cancer, they are typically dazed, disoriented and confused. During the whirlwind of discussions about cancer type, further testing, the types of therapy that will be administered and overall prognosis, the topic of future fertility can be forgotten, buried or seem inconsequential.

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This stands in stark contrast to the patient’s fears and worries that come after treatment. Personal observation and published studies have shown that women, in particular, benefit from separate and extensive discussion of fertility risks and options, which need to occur outside of the oncologist’s exam room and apart from the “Day 1” cancer conversation.7 Most male patients with any infertility risk from treatment will be successfully guided to sperm banking, a process that is less complex than steps that may be taken to preserve female fertility. Conversations with female patients can be more complicated and nuanced. Such discussions will need to include specific considerations: the patient’s age, diagnosis and treatment plan; the necessity for starting cancer treatment quickly; desire for future family-building; and patient financial resources. The care team of the medical institution making the cancer diagnosis may need to discuss how to best meet each individual patient’s needs prior to any fertility preservation referral. In many cases, nonaffiliated fertility centers may offer limited fertility options due to their outpatient structures or not be supportive of approaches available elsewhere.

OVARIAN TISSUE CRYOPRESERVATION

One such fertility preservation approach available for AYA female cancer patients is the technique of ovarian tissue cryopreservation (OTC), which has become widely available and accepted as a standard of care for these patients. This technique has been used for more than 25 years, with the first successful live birth reported in 2005.8 The procedure was officially deemed “nonexperimental” by the American Society for Reproductive Medicine in 2019.9 OTC involves removing one healthy ovary before cancer treatment begins, cutting the tissue into strips and cryopreserving the pieces. If the patient subsequently experiences failure of the remaining ovary, the stored tissue can be reimplanted and will almost always restore ovarian function for a period of one to several years.10 During this time, the patient can become pregnant by natural means, and additional strips of ovarian tissue can be implanted if additional pregnancies are desired. OTC, ovarian tissue reimplantation and subsequent natural egg fertilization and pregnancy are all aligned with the Catholic Church and to Catholic health care ministries. This stands in contrast to the other standard approach to fertility preservation in post-pubescent women: oocyte harvesting

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and cryopreservation. Furthermore, OTC is considered to be as effective in achieving successful childbirth results as oocyte cryopreservation,11 which is more expensive and time-consuming due to several weeks of hormonal hyperstimulation, followed by surgical removal of matured eggs. From there, the eggs can be immediately frozen or fertilized in vitro with subsequent cryopreservation of the resulting embryo. Overall, the process can cost in excess of $5,000 per treatment. For young adult patients facing the financial burden and stress of medical bills and lost wages, this monetary barrier is often insurmountable, and many choose not to undergo this type of fertility preservation procedure.12 In contrast, OTC can potentially have a much lower cost and does not impose any delay in cancer treatment. For example, at Mercy, ovary removal is typically carried out in conjunction with another procedure, such as a biopsy or central line placement. This eliminates most of the surgical cost, which is rarely covered by insurance. Mercy partners with a fertility preservation clinic that donates its services to prepare and freeze the ovary tissue, and as a result, patients typically owe much less — between nothing and $1,000 — for the peace of mind of future fertility protection. When and if the patient does decide later in life to start a family, she will need to consider the costs involved in ovary thawing and the surgical reimplantation, which can amount to several thousand dollars depending on where the procedure is done. However, this typically occurs at a time when financial stress is far less for the patient.

MULTIDISCIPLINARY TEAM APPROACH

Young cancer patients and their families often navigate an array of radiologic, surgical and medical services. Therefore, holistic and comprehensive support services are key to providing optimal care for AYA cancer patients. Successful AYA cancer programs have a dedicated navigator or coordinator who meets with patients as early as possible and introduces them to AYA supportive services. This navigator is highly educated and trained in the field of oncofertility and provides the initial counseling for patients whose fertility is at risk. One example of this approach is embodied through Mercy’s Cardinals Young Adult Cancer Program in St. Louis, Missouri, which is one of approximately 50 AYA programs in the United States. The treatment team includes medical, pediatric

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and gynecologic oncologists, a social worker, an AYA navigator, a psychologist, art and music therapists, and even a therapy dog. Patients receive cancer treatment in a distinct and separate clinical infusion space, which is adjacent to the pediatric infusion center and clinic. Opened in October 2020, the AYA infusion center offers integrated therapy and support services, and has treated more than 25 patients to date. For nearly every patient treated, fertility preservation is an issue, and thus far, the program has successfully performed OTC for about 10 patients. Future growth plans for the program — which will be facilitated by a move to a larger space in 2023 — include adding “family-centered care” that will enable AYA patients with children to receive treatment with their family present.

CONCLUSION

AYA patients with cancer have a high probability of successful treatment and cure, with 85% fiveyear survival rates after diagnosis.13 As a result, the life expectancy of these patients is long, and their quality of life and survivorship critically important. Chronic health conditions can occur in the aftermath of any cancer treatment protocol, and infertility is among the most common of long-term complications. A consistent focus of health care centered around the healing ministry of Jesus calls for a longrange view of patients’ lives after cancer. Ensuring a future that includes the possibility of childbirth/ family-building is a high and necessary calling for every provider in the AYA oncology world, helping to keep forthcoming options open for patients. ROB HANSON is a pediatric hematologist-oncologist with Mercy and director of the health system’s Cardinals Young Adult Cancer Program in St. Louis. NOTES 1. “New Task Force Focuses on Quality of Life for AYAs with Cancer,” National Cancer Institute, August 4, 2021, https://www.cancer. gov/news-events/cancer-currents-blog/2021/ aya-cancer-patient-reported-quality-of-life. 2. H. Irene Su, Yuton Tony Lee, and Ronald Barr, “Oncofertility: Meeting the Fertility Goals of Adolescents and Young Adults with Cancer,” The Cancer Journal 24, no. 6 (November/December 2018): 328-35, https://doi.org/10.1097/ PPO.0000000000000344.

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3. Teresa de Rojas et al., “Access to Clinical Trials for Adolescents and Young Adults With Cancer: A MetaResearch Analysis,” JNCI Cancer Spectr 3, no. 4 (December 2019): https://www.ncbi.nlm.nih.gov/pmc/articles/ PMC7050014/. 4. U.S. Department of Health and Human Services et al., “Closing the Gap: Research and Care Imperatives for Adolescents and Young Adults With Cancer,” August 2006, https://www.cancer.gov/types/aya/research/ayaoaugust-2006.pdf. 5. Damon R. Reed et al., “Sink or Collaborate: How the Immersive Model Has Helped Address Typical Adolescent and Young Adult Barriers at a Single Institution and Kept the Adolescent and Young Adult Program Afloat,” Journal of Adolescent and Young Adult Oncology 6, no. 4 (December 2017): 503-11, http://doi.org/10.1089/jayao.2017.0051. 6. Su, Lee, and Barr, “Oncofertility.” 7. Jackelyn B. Payne, Christopher R. Flowers, and Pamela B. Allen, “Supporting Decision-Making on Fertility Preservation Among Adolescent and Young Adult Women With Cancer,” Oncology 34, no. 11 (November 2020): 494-99, https://www.cancernetwork.com/view/supportingdecision-making-on-fertility-preservation-amongadolescent-and-young-adult-women-with-cancer. 8. Loris Marin et al., “History, Evolution and Current State of Ovarian Tissue Auto-Transplantation with Cryopreserved Tissue: A Successful Translational Research Journey from 1999 to 2020,” Reproductive Sciences 27, no. 4 (January 2020): 955-62, https://doi.org/10.1007/ s43032-019-00066-9. 9. Practice Committee of the American Society for Reproductive Medicine, “Fertility Preservation in Patients Undergoing Gonadotoxic Therapy or Gonadectomy: A Committee Opinion,” Fertility and Sterility 112, no. 6 (December 2019): 1022-33, https://doi.org/10.1016/j. fertnstert.2019.09.013. 10. Erin E. Rowell, Francesca E. Duncan, and Monica M. Laronda, “ASRM Removes the Experimental Label from Ovarian Tissue Cryopreservation (OTC): Pediatric Research Must Continue,” Fertility and Sterility (March 2020): https://www.fertstertdialog.com/posts/asrm-removesthe-experimental-label-from-ovarian-tissuecryopreservation-otc-pediatric-research-must-continue. 11. Rowell et al., “ASRM Removes the Experimental Label.” 12. Matteo Lambertini et al., “Cancer and Fertility Preservation: International Recommendations from an Expert Meeting,” BMC Medicine 14, no. 1 (December 2015): https://doi.org/10.1186/s12916-015-0545-7. 13. “Cancer Stat Facts: Cancer Among Adolescents and Young Adults (AYAs),” National Cancer Institute, https:// seer.cancer.gov/statfacts/html/aya.html.

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Harnessing the Power of Chaplaincy Through an Electronic Medical Record BARTHOLOMEW RODRIGUES, MDiv, MBA, BCC, WILLIAM VAUGHAN, MA, BCC, and JESSICA MOORE Catholic Health

t has long been recognized that emotional and spiritual care plays an important role in one’s well-being. Professionals in spiritual care and chaplaincy services who work in health care settings receive academic preparations and clinical training for this specialized healing ministry. They are a vital part of the health care team who contribute to a patient’s overall health and wellness.

Nevertheless, the persistent stereotype of cated to spiritual care and enhance quality outa hospital chaplain is someone who sits, listens comes by improving communication and coordiand offers some philosophical platitudes to help nation in the delivery of patient care. ease the distress of a patient or client. However, there is more to it than simply “being present.” A TRANSITION TO TRANSFORM PATIENT CARE Evidence-based ministry requires demonstrat- Health care is evidence-based. Unless professioning how chaplaincy encounters help in the heal- als in spiritual care and chaplaincy services proing and recovery process and why these services vide evidence of the benefits of their work, it will must be established, maintained and integrated go unrecognized. An EMR is a place to record that into the total interdisciplinary health care contin- evidence. uum. Spiritual care and chaplaincy should be an important part of the ... the persistent stereotype of a clinical documentation process. hospital chaplain is someone who sits, To further advance an evidence-based approach to health listens and offers some philosophical care ministry for spiritual care and chaplaincy services, elecplatitudes to help ease the distress of tronic medical records (EMR) a patient or client. However, there is can be a helpful tool to document encounters, interventions and outmore to it than simply “being present.” comes. Done right, an EMR can harness the power of evidencebased health care chaplaincy through spiritual After nearly three years of due diligence, care assessments (including interventions and Catholic Health in Buffalo, New York, embarked on outcomes) and dashboards. Moreover, EMRs can an initiative to uniformly manage and implement serve as a platform to optimize resources allo- a new EMR system, using technology provided

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by Epic, across the organization’s five hospitals, ambulatory clinics, home health agencies and other service locations. The primary goals were to create an integrated, standardized EMR platform across its ministries and to use this transition as a catalyst for operational improvement and performance transformation. All applications launched across the health system on November 1, 2020, creating a unified EMR. The project had six phases, beginning with preplanning activities in February 2019 and ending with post “go-live” optimization, which continues today.

DESIGN: SPIRITUAL CARE ASSESSMENT, INTERVENTION, OUTCOMES TOOL AND WORKFLOW

ond, we aimed to ensure documentation screens would require minimal time to complete at the point of care (a few minutes per patient). Third, we sought to implement a documentation system that allowed spiritual care providers to enter information relevant to the patient’s plan of care and was visible to and easily accessed by all clinical team members. This was important for the spiritual care providers because members of the interdisciplinary team did not easily view their documentation in the previous EMR, often going unnoticed or disregarded. Finally, one of our goals was to develop a dashboard in Epic. In an environment that embraces an interprofessional, medical-psychosocial and spiritual model of care, a dependable chaplain assessment plan of care with interventions and outcomes is critical. Accurate and consistent assessments and plans of care clearly communicate the spiritual needs of patients/families to the entire health care team and other chaplains who also provide care. With Epic, Catholic Health had the Spiritual Services Interventions Flowsheet documentation tool created, which includes five screens that identify the reason for the visit, the spiritual assessment of the patient or family, the chaplain intervention(s), the outcome of the visit and the ongoing plan of care.

The first step in the EMR design phase was to meet with the inpatient clinical documentation analyst, the inpatient clinical documentation principal trainer and the interdisciplinary Clinical Decision Support team to evaluate the initial documentation screens and map workflows, defining the care variables by engaging those who would use the system. Doing so also helped to reveal common language across disciplines, ensuring clear communication in the records. Adapting standardized nursing terminology also helped to support and strengthen chaplain/spiritual care documentation and allowed us to better communicate spiritual assessments, In an environment that embraces interventions and outcomes to nurses and physicians. an interprofessional, medicalFor spiritual care providers, the psychosocial and spiritual model planning process included evaluating the current chaplain reporting of care, a dependable chaplain needs and workflows; identifying assessment plan of care with key variables; reviewing system functionality and documentation interventions and outcomes is critical. needs; and picking spiritual care assessments, interventions and Once this information is documented by the outcomes already utilized across the country in the Epic system. Several different documenta- chaplain, it can then be used by the patient’s tion models were available in the Epic UserWeb health care team to assess their spiritual needs, to choose from. The UserWeb is a virtual home and per the evaluation, the findings that affect where the Epic community can share information, health and healing are then incorporated into the assessment tools and ideas across organizational care plan. Such an assessment includes data about specific religious beliefs and practices, the role of borders. During this phase, we had a few objectives. First, spirituality and religion in coping with illness, and we wanted to choose documentation screens used spiritual and existential suffering caused by illin practice by others with minimal change. Sec- ness, accident or the anticipated death of a loved

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ASSESSING SPIRITUAL NEEDS Figure 1: Spiritual Needs Metrics This is an example of the type of information gathered on the spiritual care dashboard at Catholic Health in Buffalo, New York. These dashboards are generated at the system level, at the hospital level and for individual chaplains, and go into greater detail than shown here. Crisis Type

Feb.

MTD

(month to date)

Rapid Response End of life Code Stroke Alert Death

25.67% 27.85% 22.99% 20.09% 19.79% 18.72% 16.04% 19.63% 13.90% 11.42%

Pastoral Interventions Prayer Active Listening Provided Reading/Devotional List Blessing Explored Feelings Discussed Illness/Injury/Impact Outcomes Gratitude Engaged in Conversation Comfort Expressed Feelings/Needs/Concerns Receptive

59.28% 57.38% 57.38% 38.01% 30.62% 27.67%

50.16% 57.10% 57.10% 45.42% 31.43% 25.97%

47.29% 48.11% 43.66% 44.04% 32.31% 27.98% 23.85% 22.71% 21.99% 29.61%

Source: Catholic Health

one. Further, the inclusion of the spiritual needs of both patient and family is considered essential to whole-person care1 and is increasingly recognized as a key factor impacting length of stay, aggressive/life-prolonging care and patient/family satisfaction.2 Highlighting the importance of the Spiritual Services Interventions Flowsheet, Catholic Health Chaplain Jonathan Moran says, “I have found flowsheets helpful in capturing the spiritual care assessment. In many ways, the flowsheet format builds on and expands similar concepts chaplains were used to reporting in our previous EMR.” Spiritual services are available to all patients — whether they identify as religious, spiritual, both or neither — and are offered with-

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out preconceptions or judgment. Healing has always been a vital ministry of the church, and institutional chaplaincy plays a pivotal role in its mission in reaching all community members, including those untouched by the parish. The EMR can also generate monthly reports that describe the number (percentage of inpatients seen, percentage seen within 24 hours) and type (crisis, routine, sacramental) of chaplain visits, time spent with patients, and type of care provided (pastoral interventions and outcomes). This documentation redesign integrated spiritual information in patient care and provided timely, asynchronous communication between chaplains, nurses and other interdisciplinary team members to promote holistic care. The chaplain enters information into the EMR relevant to the patient’s medical, psychosocial and spiritual/religious goals of care. Documentation should only include factual details and should keep information pertinent, clear and informative without violating patient privacy or clergy-congregation relations.3 A chart note enables chaplains to provide the team useful information about the patient that they may not be aware of. For example, a patient may say to the chaplain that his/her spouse died recently and may not have mentioned this significant life event to medical staff during previous treatments. Charting is a way for the rest of the team to see how the spiritual needs and issues of the patient can impact the outcome of their health care experience. Documentation based on reliable measures contributes to developing evidence-based practice and enhances interprofessional communication and collaboration in achieving desired patient care outcomes. This streamlined communication between chaplains and the clinical care team benefits all patients, including those receiving palliative care and those in critical care units where timeliness is essential to delivering the highest quality of care.

DASHBOARDS AND OUTCOMES

Dashboards and outcomes are analytic tools that allow health care professionals to make real-time, data-driven decisions by compiling information from multiple sources into one view. Dashboards offer insights into organization/department

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performance compared to benchmarks — and automatically display those metrics in real-time. Almost all Epic applications have Epic-released dashboards and reports to support workflows and analyze areas for improvement. We reached out to the company and learned that there was no Epic-released dashboards and reports related to spiritual care. With the help of one of this article’s authors, Jessica Moore, senior clinical and business intelligence technical analyst, we devised a plan to design a dashboard within Epic itself. The dashboard was largely based on a study previously conducted by Providence Health System in 2000, called Spiritual Needs and Chaplaincy Services: A National Empirical Study on Chaplaincy Encounters in Health Care Settings, with some new metrics added.4 The dashboard is comprised of two sections. (See Figure 1 on page 38). The left section displays “spiritual needs metrics.” The metrics include the type of visit (crisis or routine), the pastoral interventions during the visit and visit outcomes. A dashboard user can sort the responses by percent, to easily view the top five responses for each category. Data like this enables mission and spiritual care leadership to prioritize patients’ values and to customize ongoing education for chaplains. While prayer, blessings, active listening and providing presence are common, we also see that chaplains discussed an illness/injury and its impact about 27% of the time. Chaplains have these discussions to help patients, their families and the clinical team when there are questions or disagreements about treatment options and care plans. Furthermore, it is especially significant during end-of-life care planning and palliative care conversations as chaplains help patients identify their hopes and goals related to their current admission. The dashboards track more than what’s shown here, and some of the data relates to other factors. The right section of the dashboard (see Figure 2 on this page) starts with “chaplain performance metrics” and is designed to analyze the performance of our staff chaplains within our hospitals. This gives leadership, including the nursing, mission leader and senior executives, the ability to monitor the percentage of patients seen, the average time spent with patients, usage of different sec-

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Figure 2: Chaplain Performance Metrics The dashboard has detailed data, not all shown here, that records the length of a chaplaincy encounter by crisis type, the average interventions per encounter and more.

71.51% Inpatient Admissions Seen by Spiritual Care

11.7 Minutes

Average Length of Encounter

Feb.

MTD

Percentage of Patients Seen 73.83% Percentage Seen Within 24 Hours 38.46% Average Interventions Per Encounter 3.0 Average Outcomes Per Encounter 2.6 Average Length of Encounter (minutes) 12.3

71.51% 40.91% 2.9 2.6 11.7

Source: Catholic Health

tions of the flowsheets and more. These metrics help identify areas of strength and improvement. For example, our chaplains currently see between 70-80% of inpatients in our hospitals, spending an average of 12 minutes with each patient. Leadership can analyze these numbers against goals for the chaplains and take action as needed. On a practical level, this data can be used by chaplains in their daily ministry. With the information available from the dashboard shown in Figures 1 and 2, they can more effectively customize their lists and prioritize patients needing to be seen, providing a better experience and improved outcomes for patients. Furthermore, these dashboards provide chaplains the ability to better plan their days. This is especially beneficial on weekends, when there are fewer chaplains in-house. It allows them to triage and prioritize their visits as they respond to numerous codes, rapid responses and deaths. The data previously described is displayed at an overall system level or by a hospital, and many metrics are available to view for an individual chaplain’s performance. The data can be aggregated over days, weeks, months, quarters and years, allowing leadership to monitor trends across various periods of time. There are also a few detailed reports that are linked on the dashboard, helping leadership

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understand more specific information about our patients and chaplains. These reports show the progress notes that chaplains are writing; the patients in our hospitals who identify as Catholic, better enabling us to identify those who may like to receive Communion or the sacrament of the Anointing of the Sick; and the patients who have passed away in the last week with their next of kin referenced, helping to assist in sending condolences. In order to effectively utilize the data gathered on the dashboard, the Spiritual Care departments began receiving weekly electronic reports of chaplain documentation chart notes indexed by, among other fields, individual users. Reports enabled the department to identify key delivery metrics of chaplain productivity and compliance with the scope of service expectations (for example, attendance at every trauma, code and death). They also allowed for the examination of documentation patterns for individual chaplains and clinical pastoral education students, in addition to composite department patterns.

OTHER FINDINGS

Another key component of the weekly report is the tracking of “flowsheet timeliness,” which shows the duration of time between the visit and when the chaplain documents it in the patient’s chart. Epic thrives on the timely charting of patient encounters so the interdisciplinary team can have a complete snapshot of all caregivers’ interactions with the patient. Since all users in Epic can easily find and view a chaplain’s documentation, the old practice of waiting until the end of a chaplain’s shift to chart is no longer practical. This information has gone beyond data collection and is now being used to improve daily charting practices for chaplains. Having information to share with the chaplains on ways they could improve the timeliness of charting and flowsheet usage has proven to be extremely valuable. Catholic Health Chaplain Cindy Short says she finds Epic to be a “very helpful tool both in communication for timely follow-up with patients and seamless flow of services, as well as for my own accountability and progress in charting.” An initial review of the reports revealed considerable user variance in spiritual assessment documentation patterns despite similar training at orientation. These weekly reports serve as more than data

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collection, allowing for ongoing learning opportunities and professional development. As a pilot program to improve documentation and charting practices at one of our hospitals, the mission leader held one-on-one meetings with chaplains from their team with a specific focus on reviewing the dashboard and weekly Epic reports. The mission leader and chaplains reviewed the dashboard from a system perspective, the individual hospital perspective and finally from the individual chaplain’s viewpoint. In reviewing the weekly reports, the mission leader and chaplain discussed previously mentioned adherence to the scope of service and observed any noticeable trends with the chaplain’s charting practices (for example, if they only charted in certain flowsheet rows while overlooking others, and if chaplains were writing progress notes for each of their encounters). Initially, the chaplains viewed these meetings with a bit of skepticism and anxiety, not knowing if the mission leader would use the weekly reports in a punitive manner. After explaining and demonstrating that the meetings were for individual professional growth and team building to deliver more efficient, patient-centered care, the chaplains embraced the opportunity to review the data. To promote a more consistent system-wide approach, the other mission leaders were encouraged to hold similar meetings with their Spiritual Care and Chaplaincy Services teams once the pilot program was shown to be successful, resulting in improved documentation outcomes.

RECOMMENDATIONS

Spiritual care and chaplaincy services perform a variety of roles in today’s complex health care system. Through the EMR, chaplains can demonstrate how valuable the full range of provided psychosocial and spiritual care services are — from assessments, plan of care and outcomes. The daily workflow of chaplains, what they do and the variety of roles performed must be clear. Unclear or confusing roles result in decreased use of spiritual care services, fewer referrals, less participation on committees and diminished credibility within the institution. The EMR provides a doorway to various scientific methods, such as quantitative and qualitative case studies, scientific baselines and evidencebased data that can springboard further research. A dashboard can serve to stratify patient needs

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to prioritize follow-up chaplain visits, quantify Aside from being involved in advance care chaplain visits to determine individual and over- planning conversations, chaplains also serve as all patient needs, and measure the effectiveness of facilitators in resolving conflict and negotiatthese visits on a patient’s spiritual needs. ing meaningful goals, especially when patients The professionals in spiritual care and chap- and families want “everything done” and such laincy services need to continue to chart and doc- requests are medically nonbeneficial. Providing ument the visits they make and the services they care for patients and families at the end of life, provide as part of their daily routine. While chart- including palliative care, is frequently a priority ing is a requirement by the Joint Commission for spiritual care and chaplaincy services. With and other regulating bodies, chaplains are often the data now available by using a dashboard, spirso caught up with the daily pressures of their job itual care providers — who may have been prethat they tend to neglect to chart, depriving care- viously undervalued by their organization — are givers of good data on which policy decisions can now better able to show their worth and impact in be made. the care of patients and families. In an environment of cost-cutting measures, declining reimbursement and high economic NEXT STEPS pressures, justification for clinical chaplaincy In-depth assessments, consultations and counselservices requires accountability for the services ing services provided by professional chaplains and their effectiveness. Dashboards that clarify are a necessary part of an integrated and comwhat chaplains do, how they do it, how they comprehensive biopsychosocial-spiritual approach pare to their peers and that establish baselines and to assessing a patient’s needs, preferences and thresholds of performance can not only advance goals of care. An EMR can inform evidence-based their work but shift to an evidence-based model. practice, and research elsewhere has shown that Fulfilling the potential of the evidence- the services provided by professionals in spiritual based paradigm would require chaplains to be care and chaplaincy services are measurable and research literate. They would need to be familiar provide significant benefits. with the existing body of chapThrough the EMR, chaplains can laincy research, critically read, understand basic research and, demonstrate how valuable the full if indicated, apply the findings of research studies to one’s practice. range of provided psychosocial Correspondingly, the Association and spiritual care services are — of Professional Chaplains does require board certified chaplains from assessments, plan of care and (BCC) to do at least five hours of research annually as part of their outcomes. continuing education. Therefore, we highly recommend that a conOne direction for ministries moving forward certed effort be made to benchmark some of the might be developing spiritual care services as a services provided by spiritual care departments. reimbursable service, like other aspects of health Doing a deeper dive into the data can help chap- care. An attempt must be made to explore a case lains be better engaged through a process of dia- for reimbursement from payers and insurers for logue with leadership, administrators, sponsors services provided. For example, hospices are and the community who can be advocates for an required to provide an assessment of the patient expanded vision of pastoral and spiritual care. and their family’s spiritual needs, provide counAlthough some chaplain visits (initial and follow- seling to address them and make reasonable up) are more time-consuming and involve many efforts to facilitate visits by local clergy, pastoresources, numerous studies and research shows ral counselors or other qualified individuals. In the correlation between these visits and a better hospice, the chaplain is the only member of the overall patient experience and shorter length of interdisciplinary team who cannot report visits stay.5 on the claim form, and this needs to change. An

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EMR can communicate the value of spiritual care to patients and payers. Chaplains have entered a paradigm in which they can demonstrate how integral they are to an interdisciplinary team of health care professionals providing services to patients, long-term care residents and their families. An EMR can provide sufficient empirical clinical evidence to support spiritual care as a legitimate and positive component of the patient’s holistic treatment plan. The moment has come to ask: What kind of future can chaplains look forward to? The future depends, as it always has, on how much chaplains are willing to critically review the assumptions, models and structures under which they operate. The road ahead for chaplaincy will largely depend on the quality of both charting and the data entered in an EMR. Properly utilized, dashboards can provide greater accountability, requiring chaplains to be more intentional in their practice and focused on outcomes than they have been in the past. The extent to which chaplains utilize intentional, outcome-focused or evidencebased practices and dashboards will largely determine the degree to which spiritual care is established, maintained and integrated into the total interdisciplinary health care continuum. Budgets for clinical professional chaplaincy services need to be based on value, sponsorship and the reputation of the mission and identity of an institution. While Catholic health care ministries focus on the quality of our pastoral care services and hold this work in high esteem, reputation alone isn’t enough. Clinical professional chaplaincy services need to be based on value and measurable ways to track that value. Having good empirical data can only strengthen the need for clinical professional chaplaincy services during a time of continued economic challenges. Through the proper use of data-driven tools and resources,

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the future role of professional clinical chaplains in health care can be elevated beyond an ornament of mission and identity, and instead as an integral part in the transformation of patients’ health and healing. BARTHOLOMEW RODRIGUES is executive vice president and chief mission officer for Catholic Health, Buffalo, New York. WILLIAM VAUGHAN is vice president of mission integration for Mercy Hospital of Buffalo, Buffalo, New York. JESSICA MOORE is senior clinical and business intelligence technical analyst, information technology, Catholic Health, Buffalo, New York. NOTES 1. Judy E. Davidson et al., “Clinical Practice Guidelines for Support of the Family in the Patient-Centered Intensive Care Unit: American College of Critical Care Medicine Task Force 2004–2005,” Critical Care Medicine 35, no. 2 (February 2007): 605-22, https://doi.org/10.1097/ 01.CCM.0000254067.14607.EB. 2. Tracy Anne Balboni et al., “Provision of Spiritual Care to Patients With Advanced Cancer: Associations With Medical Care and Quality of Life Near Death,” Journal of Clinical Oncology 28, no. 3 (January 2010): 445-52, https://doi.org/doi:10.1200/jco.2009.24.8005. 3. Rabbi Stephen B. Roberts, Professional Spiritual & Pastoral Care: A Practical Clergy and Chaplain’s Handbook (Nashville: SkyLight Paths Publishing, 2011): 81-91. 4. Bartholomew Rodrigues, Deanna Rodrigues, and D. Lynn Casey, Spiritual Needs and Chaplaincy Services: A National Empirical Study on Chaplaincy Encounters in Health Care Settings (Medford, Oregon: Providence Health System, 2000). 5. Paul Alexander Clark, Maxwell Drain, and Mary P. Malone, “Addressing Patients’ Emotional and Spiritual Needs,” Joint Commission Journal on Quality and Patient Safety 29, no. 12 (December 2003): 659-70, https:// doi.org/10.1016/s1549-3741(03)29078-x.

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How To Build Executive Presence: A Message for Mission Leaders CELESTE DeSCHRYVER MUELLER, DMin Consultant for Leadership Formation, Mission and Catholic Identity

ear Colleague, Congratulations! You have been appointed to serve as a mission leader. Your education, formation and experience have equipped you well for this. Through your professional leadership role, you have developed important competencies in ministry, theology and spirituality, as well as expertise in Catholic identity. In your conversations with other leaders, you’ve probably heard the phrase “executive presence,” and may have even noticed articles referring to this term in online business journals and occupying a significant share of the shelf space in airport bookstores. You may have seen a post from Forbes Coaches Council, saying that executive presence is “most importantly, inspiring confidence among senior leaders that you have the potential for great achievements. … [because] Your executive presence determines whether you gain access to opportunity.”1 You want the chance to use your gifts most effectively, and you wonder if it really is about “how you control a room, the impressions you make … how you communicate verbally and through your appearance and physicality.”2 But are these tips really the path to building executive presence? What these articles, and unfortunately some leaders, miss is that executive presence cannot be simply a projection of confidence and control, but needs to be an expression of their leadership integrity. If you attempt to develop executive presence by focusing solely on the external aspects,

you risk a kind of fragmentation — what author and educator Parker Palmer famously describes as the “divided life”— which is more likely to communicate disintegration than integrity.

What these articles, and unfortunately some leaders, miss is that executive presence cannot be simply a projection of confidence and control, but needs to be an expression of their leadership integrity.

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You are called to carry out a profound responsibility tied to the integrity and mission of Catholic health care. In a world sometimes skeptical of institutions and religion, you carry a message that all of our facilities — even virtual sites of care — and processes can be sacramental, that is, can be occasions to encounter the loving presence of God. In a world skeptical of and sometimes wounded by religion, you carry the message that Catholic tradition and teaching offer a professional

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and organizational path to all that we are called to be as a Catholic ministry. Along the way, you embody these messages in multiple settings and with diverse groups of people, introducing them to a vision they may have only glimpsed. The executive presence you embody flows from the integration of your inner life, behavior and interactions and expresses the fullness of your integrity as a leader. The word “authentic” represents ways to develop an executive presence that is shaped by your leadership integrity. Although authenticity is sometimes treated as a fairly anemic quality — for example, “I think authenticity is really important … Hopefully, you’re a positive person … but if you’re all warmth and fuzziness, people ... might perceive that you lack substance.”3 Examining additional layers of meaning, however, reveals authenticity as essential, both in the sense of being necessary and being “the essence” of executive presence. Far beyond positivity and sentimentality, authenticity empowers executive presence through dimensions that are critical for you in mission leadership: identity, authority and responsibility.

differences, a desire to honor others’ gifts, and a willingness to seek and offer forgiveness. The more that you follow the path of identity, the more you recognize and experience your connections to your colleagues and those you serve. Far from needing to control the room or their impressions of you, you realize the deep human connections you share. You recognize that you are part of them, and that they are part of you, which then communicates empathy and mutuality. At

Far beyond positivity and sentimentality, authenticity empowers executive presence through dimensions that are critical for you in mission leadership: identity, authority and responsibility.

BE AUTHENTIC IN YOUR IDENTITY

Authenticity in executive presence is powered first by a deep awareness of your identity, what many spiritual writers refer to as the “true self.” This includes awareness and acceptance of your personal qualities, attitudes, habits of mind and patterns of emotions and behavior, as well as awareness of your connection to and impact on colleagues and those being served. As you examine your strengths and weaknesses, you build the virtue of humility, which keeps you grounded in the truth of who you are as a gifted and limited human being. Honest self-appraisal also reveals your more or less resourceful attitudes and reactions, and enables you to cultivate the virtue of temperance, especially where it is needed to modulate and/or set limits in your emotional responses and even in the use of your strengths. As awareness of your identity deepens, humility and temperance build an executive presence marked by confidence, an ability to be fully present, an understanding to hold an acceptance of

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the center of your exploration of identity, you recognize the significance of your own leadership being made in the image of God, and from there, you develop a quality of presence that is steadfast, other-centered and an expression of complete integrity.

BE AUTHENTIC IN YOUR AUTHORITY

Reflecting on your identity as an individual within the community of Catholic health care leads naturally to questions of authority. By what or by whom are you authorized to lead? What is the nature of your authority as a mission leader? These questions may be complicated by a tendency to put more emphasis on “mission” than on “leader” at the core of your professional identity. Further, depending on your background and experience, you may have reflected more on being called to your specific area of expertise rather than on the question, “Are you called to lead?” As a leader, however, your executive presence will communicate your understanding and integration of your authority. The authorization of mission leaders can be traced to the vocational call that echoes through the founding history of Catholic health care to the present moment. Rooted in the universal Catholic Church and its profound vision of the human

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person, authority comes not just from “your” story, it comes from “our” story, the story of God’s call through the ages to honor and preserve the dignity of all persons and to foster conditions in the world that enable the flourishing of all individuals and creation. Recognizing this deeper source of authority activates the virtues of fortitude and justice, and enables your prophetic witness to the movements of the Spirit and where it may be leading through complex situations. Recognize you could fall into one of two traps regarding the nature of your authority: imagining that your power comes from external recognition, or that its source stems from your ability to control. The clues to the first trap are heard in discouraged comments: “I’m not at the table,” or “I’m not seen as an essential member of the team.” To counter those fears, mission leaders occasionally fall into the second trap, positioning themselves as the sole and zealous protectors of the mission in ways that quickly become divisive and counterproductive. In contrast, when you recognize that you are authorized by your identity, your vocation and by the roots and breadth of the mission, the nature of your authority is hospitality and invitation. Through trust and relationship, you draw other leaders, coworkers and caregivers into an expanding circle of shared authority. You come to see authority as an act of cocreation, or shared “authorship” of an organization directed by and toward mission. Authentic authority is demonstrated in your ability to influence, guide and enroll others in the Catholic vision of persons and community in ways that are profoundly self-effacing. Beyond the adage, “make them feel like it was their idea from the beginning,” the most effective mission leader catalyzes in others a degree of competence and passion that borders on making the mission leader seem redundant or invisible. Because you have internalized a profound authority, invisibility does not trouble you, and your authority enables those around you to see themselves as creators of a world made possible by commitment to the mission.

present through action. As you explore and understand your internal authority by expanding and sharing it with wider circles, your executive presence produces the quality of freedom — freedom to be discerning, to act and to let go of attachments. The earlier stages of development that cultivate deeper awareness of your identity and integration of authority, and which produce that freedom, are critical because there is no single list of required tasks to integrate mission into the organization. Instead, the responsibility of a mission leader is always an exercise of prudence or practical wisdom, being attentive to lessons of the past, trajectories heading into the future and the exigencies of the present moment.

Beyond the adage, “make them feel like it was their idea from the beginning,” the most effective mission leader catalyzes in others a degree of competence and passion that borders on making the mission leader seem redundant or invisible.

BE AUTHENTIC IN YOUR RESPONSIBILITIES

Another dimension that is key to executive presence for mission leaders is the quality of being

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You provide access to Catholic health ministry’s founding mission, legacy and spiritual and theological teachings and practices, and translate them for current circumstances. You can see the not-so-apparent complexities in situations that may impact the broader health care and community environments, and anticipate the likely consequences of current decisions toward that horizon. You highlight connections between decisions and organizational identity — keeping what is most human at the forefront — and you connect people. You discern the good and identify appropriate decisions and actions through discourse with other leaders and associates, and offer creative and innovative approaches to advance the mission. You are able to unite the perspectives of past and future because you remain free and true in the present moment. And, prudence calls you to act even without absolute certitude: speaking, building relationships, teaching, influencing, collaborating and, at every turn, reflecting.

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CONCLUSION

The unique paradoxes of your responsibilities as a mission leader in Catholic health care shape the development of your executive presence. Mission leaders don’t “own” the mission, nor could you alone fully achieve its integration, as ideally, everyone who serves in Catholic health care plays a part. However, without mission leaders — without you — the drift from those principles of identity is usually swift. Furthermore, another paradox of your service is that executive presence is usually developed while observing other leaders and learning the culture of an executive team. Although many mission leaders do hold executive positions and serve with other peer or senior leaders, some still do not (for example, those whose primary responsibility is for ethics education, community benefit, ministry formation or spiritual care) and may exercise leadership among those who are far senior to them. The formation necessary for mission leaders to develop an executive presence marked by authentic identity, authority and responsibility requires spiritual practices of ongoing reflection on one’s inner life and actions in community. By

doing so, you embody and model what all leaders and the whole organization are called to do and be. And through your presence, you sustain and deepen the integrity of the ministry, its authority as an agent of healing, and its responsibility to honor and preserve human dignity and advance the common good. CELESTE DeSCHRYVER MUELLER consults with organizations on topics of leadership formation, mission and Catholic identity. She retired last year as vice president of ministry formation for Ascension in St. Louis. NOTES 1. Gerry Valentine, “Executive Presence: What Is It, Why You Need It and How to Get It,” Forbes Coaches Council, July 31, 2018, https://www.forbes.com/sites/ forbescoachescouncil/2018/07/31/executive-presencewhat-is-it-why-you-need-it-and-how-to-get-it/. 2. Mary Duan, “Improve Your Executive Presence,” Insights by Stanford Business, September 27, 2017, https://www.gsb.stanford.edu/insights/ improve-your-executive-presence. 3. Duan, “Improve Your Executive Presence.”

QUESTIONS FOR DISCUSSION Author Celeste Mueller describes executive presence as a multidimensional way of being a fully present and authentic leader in the workplace. 1. What did she describe about executive presence that may be different from what you previously thought about it? 2. How can mission leaders effectively navigate the traps regarding the nature of authority that Mueller discusses? How can they exercise authority through their identity, vocation and ministry heritage? How can mission leaders serve as catalysts of competence for other leaders and agents of collaboration for the ministry? 3. When have you seen a leader demonstrate executive presence in a meaningful way in a Catholic health care setting? Did you bring anything away from that person’s example that you try to model in your own work? 4. Mueller talks about cultivating an inner life as an important foundational aspect of developing executive presence. What are some ways that you can incorporate silence, reflection and prayer into your daily routines and work? 5. Do you have other favorite ways of enriching your inner life that you’d like to share with colleagues as a successful tool, whether reading broadly about health care, journaling about your own day or something of that nature?

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COMMUNITY BENEFIT

COMMUNITY ENGAGEMENT: USING THE EVIDENCE “Knowing is not enough; we must apply. Willing is not enough; we must do.” — Johann Wolfgang von Goethe

ngaging community members who need and use community benefit services can improve how we assess needs, plan to meet community needs and implement programs. Health care organizations may think they are connecting with their community, but do community members think they are engaged? This topic was explored by a National Academy of Medicine (NAM) initiative to assess the extent and impact of community engagement.1 NAM developed a new model for assessing community engagement after analyzing public health and other literature and consulting experts. The model, “Achieving Health Equity and Systems Transformation Through Meaningful CommuniJULIE ty Engagement,” is also known as TROCCHIO “Assessing Community Engagement.” The model is built on the core principles that community engagement must be: Grounded in trust. Designed for information to flow to and from the community and its partners. Inclusive. Culturally centered. The model also says that participants should be equal and that relationships should be ongoing, continuing beyond specific projects. The Assessing Community Engagement model will help assess the goals of community engagement, which are: strengthened partnerships and alliances, expanded knowledge, improved health and health care programs and policies, and thriving communities.

Strengthened Partnerships and Alliances

To examine whether community engagement is strengthening partnerships, the NAM model sug-

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gests looking at these indicators: Diversity and inclusivity: Partnerships should be intentionally diverse, including persons and groups not traditionally invited or involved in improving community health. Partnerships and opportunities: All engaged in partnerships and alliances should fully benefit from their participation. This could include gaining new information or skills, or financial opportunities. Acknowledgment, visibility and recognition: Community partners should be recognized

as contributors, experts and leaders. This would include public acknowledgement of participants’ contributions. Mutual value: The community should benefit from the partnership, not just contribute to the effort. The value gained could be financial or nonfinancial. Trust: Trust is a core component of community engagement. It requires showing up authentically and following through with commitments. Shared power: Partnerships should demonstrate that community participants are involved in leadership activities and decision-making. Structural supports for community engagement: Partnerships need an infrastructure that in-

cludes adequate financing and policies on board composition, management and decision-making.

Expanded Knowledge

Another area to examine when assessing commu-

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nity engagement is expanded knowledge. Partnership should create new insights and resources for participants. They can create new thinking and cover new ground, revealing information not recognized outside of the community. The model identifies three indicators of expanded knowledge: New curricula, strategies and tools that can be disseminated, accessed, replicated and scaled. Bidirectional learning, when participants gain knowledge about the culture and practices in the community, including stories and information about the lived experience. Community-ready information and recommendations that the community can understand and use.

Improved Health and Health Care Programs and Policies

The goal of community benefit partnerships is to create programs that the community can use to improve health. An indicator of success in this area is that the solutions align with the community priorities. This happens when partnerships work on community-identified programs, using shared decision-making and agreement on metrics of success. Partnerships aimed at improving health should come up with solutions that are implemented with and endorsed by community members. They should build on community assets and show measurable growth. Another assessment factor is sustained relationships. Partnerships should extend beyond initial support by having an infrastructure and resources that can sustain programs and permit adjustment or refinement over time.

Thriving Communities

While there may be various definitions of thriving communities, the NAM model identifies these five indicators to evaluate the success of partnerships and alliances. Physical and mental health, including awareness of health and health-related activities and self-efficacy in managing well-being and chronic conditions. Community capacity and connectivity, including how engaged community members are

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and development of new community leaders. Community power, meaning that health improvement programs are favored, initiated and guided by the community. This might also include greater expectations that the community will be involved in all aspects of the partnership’s programs. Community resiliency, which involves assessing the overall strength of the community and its capacity to self-manage. Life quality and well-being, including improvements in the following drivers of health: education, racial justice, economics and housing.

CONCLUSION AND NEXT STEPS

The NAM community engagement model is based on the premise that community engagement does not supplement community health improvement activities, but rather, is foundational. It posits that the processes needed to engage communities are essential to achieving equity and that only by assessing and evaluating engagement will we be able to understand program impact and know where to focus efforts. “Health and health care stakeholders,” it says, “must measure what matters — community engagement — and ensure that it is meaningful.”2 As next steps, the committee that developed the model will be publishing stories and assessment instruments for users who want to measure community engagement. CHA’s community benefit staff will watch for these next steps and share resources as they are available so CHA members can consider ways to build more purposeful community engagement. JULIE TROCCHIO, BSN, MS, is senior director of community benefit and continuing care for the Catholic Health Association, Washington, D.C. NOTES 1. Sergio Aguilar-Gaxiola et al., “Assessing Meaningful Community Engagement: A Conceptual Model to Advance Health Equity through Transformed Systems for Health,” NAM Perspectives, February 14, 2022, https://doi.org/10.31478/202202c. 2. Aguilar-Gaxiola et al., “Assessing Meaningful Community Engagement.”

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H E A LT H E Q U I T Y

CATHOLIC SOCIAL TEACHING AS A ROAD TO EQUITY

quity is a slippery concept. It is not the same as equality, where two plus two always equals four. It is also not static. It changes according to time and place so that what was once considered equitable may no longer be seen as equitable today. It is difficult to define and sometimes may not be apparent to us until we see it in front of us. Yet equity — a kind of pro- but they are not sectarian. They are built on our visional and flexible concept natural law tradition, our belief that moral knowlof justice — is the foundation edge is available through reasoned reflection on of the justice system. It is the human experience. This means any person of state where each has received good will can read and consider the Church’s arhis or her due, not necessarily in guments. Human dignity and the common good equal measure, but in a way that are the linchpins of this tradition, even in cultural milieus like the United States, where the common matches needs and aspirations. Equity is why sentences are good — although gaining favor among some — is FR. CHARLES not imposed by computers and still highly suspect and often rejected as socialBOUCHARD why two juries can reach differ- ism. These teachings also have wide applicability. ent verdicts on the same crime. They developed in a global context and in politiIt all depends on who, where and how. Equity is a cal systems that ranged from monarchies to desmoving but essential target, and achieving it re- pots to Christian socialism. In his article, Rocca quotes constitutional law quires a lot of different tools, many of which are found in Catholic social teaching. Sometimes re- professor Adrian Vermeule, who says Catholic ferred to as “the Church’s best-kept secret,” Cath- social teaching is “becoming something like an olic social teaching has been underappreciated, organizing common language for a great deal of but I believe it is gaining traction in the Church American public life.”2 as well as in society in general. It has been invoked in some unEquity is why sentences are not likely places. imposed by computers and why two As an example, I was surprised to see an article last year juries can reach different verdicts on in The Wall Street Journal titled “Can Catholic Social Teaching the same crime. It all depends on who, Unite a Divided America?” by where and how. Francis X. Rocca.1 In it, Rocca argues that the church’s social teaching is key to bringing divisive sides together I’m not quite as optimistic as Vermeule, but I in conversation. Centuries in the making, Catholic have to admit that when it comes to finding a solusocial teaching coalesced in a series of encyclicals tion to our fragmentation and polarization, there starting in 1891 with Pope Leo XIII’s Rerum No- are not a lot of other comprehensive systems of varum. These documents addressed every major thought that we can turn to. The principles of social issue: workers’ rights, war and peace, the Catholic social teaching provide a foundation as economy, racial inequality, democratic capitalism we work to build a world with greater equity. and, most recently, the environment. I was surprised again when I saw a second arThese teachings are rich in scriptural language, ticle, this time in The New York Times, titled “This

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is Why America Needs Catholicism” by Matthew set of principles, but many of them (for example, Walther.3 In his piece, Walther echoes many of justice and solidarity) are also virtues, acquired Rocca’s themes. He stresses the fact that Catho- qualities of character that are perfected by grace. I lic social teaching not only developed an impor- thought if I could explain them and get these exectant body of thought, but also led to important utives to internalize and cultivate them as virtues, social movements. Catholic sisters, for example, then we could really make a difference. I believe we are making an impact. I now hear were leaders in the civil rights movement in the 1960s. Walther notes that in 1967, the editors of board members and executives use words like justhe conservative Catholic journal Triumph even tice, solidarity, dignity and even equity as easily as endorsed Black Power, the original editorial going they use words like strategy, days cash on hand, on to explain it as a possible way to “… play a lead- debt service and LIBOR (London Interbank Ofing role in breaking up the secular behemoth and fered Rate, an interest rate). I know too that our so restore liberty and human dignity to America.”4 hospital systems required vaccination even when Today, we are addressing the COVID-19 pan- it was unpopular because of their commitment to demic with traditional thinking about justice, the common good. equity and the common good. We have polarization, too, but I have helped them [leaders] see that Catholics are being vaccinated the work we call “the ministry of at a higher rate than the population in general (Latino Catholics Catholic health care” doesn’t just mean are vaccinated at an even higher internal ministry, but the external rate than Catholics in general).5 Despite the weakness of catministry, bringing the Gospel to society echesis, especially for adults, something about the common through our sponsored ministries good and solidarity must have of health care education and social gotten through. Pope Francis has been a beacon, encouraging vacservice. The goal of these ministries is cination as an act of love. Who else could speak to the whole ultimately equity. world with even a chance of beSolidarity is important both domestically and ing heard or respected? During much of the last 15 years I have worked globally. As we face racism, solidarity helps me as an ethicist and a formation leader in Catholic see difference and not ignore or suppress it. Solihealth care. I have worked with executives, board darity reminds me that despite racial, economic members and sponsors, helping them to under- or cultural differences, we are more alike than not. stand what “Catholic” means and why it is impor- It helps me see immigrants as children of God, tant. Furthermore, I have helped them see that remembering that we too were once immigrants the work we call “the ministry of Catholic health in a strange land. And today, it can help us identify care” doesn’t just mean internal ministry, but “ex- with the suffering of the Ukrainian people even if ternal” ministry, bringing the Gospel to society we’ve never been to Central Europe. In his 2022 address to the Association of through our sponsored ministries of health care education and social service. The goal of these Catholic Colleges and Universities, Eboo Patel, founder and president of Interfaith America (forministries is ultimately equity. When I started this work, the idea of lay formerly Interfaith Youth Core), set out to remind mation was new. The notion of lay formation for us of some strengths that we may not always be leadership was even newer. I eventually learned mindful of. He described how virulent anti-Cathat Catholic social teaching was at the heart of tholicism forced us to build thousands of schools my formation efforts. It is often described as a in the 19th century. That was an accomplishment,

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HANDBOOK FOR

but Patel, who is Muslim, said there is something even more significant. Despite our own history of exclusion, he said, we had “a theology of pluralism” that led us to open our own schools and then give them to others as a gift. He noted that the Church built “institutions that virtually across the board let everybody in.”6 This too was all for the sake of equity. It is also important to remember that we achieved this openness while we were quite obviously Catholic, especially the sisters, who never compromised their own faith. Their openness was part of their faith. These threads of Catholic social teaching weave the fabric of equity. They are inclusive and respectful of difference, but they also pull us together and shape a common life in which each person and group has a fair share of the goods of the earth, including education and health care. Let’s embrace this transformative tradition, share it with the world and see what it can really do. FR. CHARLES E. BOUCHARD, OP, STD, is senior director, theology and sponsorship, for the Catholic Health Association, St. Louis.

NOTES 1. Frances X. Rocca, “Can Catholic Social Teaching Unite a Divided America?”, The Wall Street Journal, February 5, 2021, https://www.wsj. com/articles/can-catholic-socialteaching-unite-a-dividedamerica-11612540382. 2. Rocca, “Can Catholic Social Teaching Unite a Divided America?” 3. Matthew Walther, “This Is Why America Needs Catholicism,” The New York Times, July 30, 2021, https:// www.nytimes.com/2021/07/30/ opinion/catholic-church-politics.html. 4. “Present Imperfect,” Triumph 2, no. 1 (January 1967): 8. 5. Alejandra Molina, “Latino Catholics Are among the Most Vaccinated Religious Groups. Here’s Why,” National Catholic Reporter, October 15, 2021, https://www.ncronline.org/news/ coronavirus/latino-catholics-areamong-most-vaccinated-religiousgroups-heres-why. 6. “ACCU 2022 Annual Meeting–Plenary 2–Eboo Patel,” YouTube, March 1, 2022, https://www.youtube.com/ watch?v=4nu9VEb9HH8&t=910s. Interfaith America is based on the idea that religion should be a bridge of cooperation rather than a barrier of division. Patel is inspired to build this bridge by his identity as an American Muslim navigating a religiously diverse social landscape.

Ministers of Care Third Edition

Marilyn Kofler, sp, and Kevin E. O’Connor, csp

Available in English and Spanish, the third edition of this award-winning resource provides lay ministers of care with a formational and training tool as they prepare to serve those who are sick and homebound.

Visit LTP.org to preview and order. $14.95

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ETHICS

THE INTERNATIONAL GOOD SAMARITAN

he synoptic Gospels (Matthew, Mark and Luke) are so named because they “see alike.” They tell the same stories, but with slight differences. Despite these variations, they reveal lessons that parallel the Catholic health care ministry’s response to needs in our communities, both nationally and globally. In our response to strive for the common good, what can we draw from Scripture to not only bring forth a compassionate response, but an effective one as well?

BRIAN KANE

For example, let’s look to the story about Jesus speaking to a very large crowd, and feeding them, early in his ministry. St. Matthew represents this as the “Sermon on the Mount,” while St. Luke writes about the “Sermon on the Plain.” Both shaped their telling of this event with broader themes. St. Matthew wrote to the Jews, while St. Luke wrote to the Gentiles, those who

the immediate needs of his listeners. Notice also the difference between Matthew’s version and Luke’s in terms of who is addressed. Matthew has Jesus speaking about a group of people who may or may not be present. Luke’s version describes Jesus as speaking directly to those who are present: “You will be satisfied.” One of the enduring images for Catholic health care has been the parable of the Good Samaritan, which is only found in Luke’s Gospel. So, its interpretation should be through his emphasis on the poor — those who need immediate assistance to sustain themselves. For the Catholic health care ministry, what are the lessons we can learn from this story?

were not Jewish. In Matthew’s Gospel, the “Sermon on the Mount” evoked themes from the Torah, the Jewish scriptures. The likeliest image that inOne of the enduring images for fluenced him was another mountain, Mount Sinai, where Moses received Catholic health care has been the the Ten Commandments. Jesus, like Moses, speaks from an elevated poparable of the Good Samaritan, sition. Part of this story is the Bewhich is only found in Luke’s Gospel. atitudes — lessons to be learned for the listeners of the story. What does So, its interpretation should be Matthew teach? His lessons are spiritual: “Blessed are the poor in spirit, through his emphasis on the poor for theirs is the kingdom of heaven. — those who need immediate Blessed are they who mourn, for they will be comforted.” (Matthew 5:3-4) assistance to sustain themselves. Luke has a different view. In his For this reflection, let’s look at actions. In anGospel, Jesus speaks to the dispossessed, those at the margins of Roman society. Jesus is “on the swering the question, “Who is my neighbor?” by a Plain,” at the same level as his listeners. “Blessed scholar of the law, Jesus sets the scene like this: “A are you who are poor, for the kingdom of God is man fell victim to robbers as he went down from Jeyours. Blessed are you who are now hungry, for rusalem to Jericho. They stripped and beat him and you will be satisfied.” (Luke 6:20-21) He addresses went off leaving him half-dead.” (Luke 10:29-30)

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He then describes a priest and a Levite who neglect to act. The next person to encounter the robbery victim is a Samaritan, who offers compassionate and effective care to the wounded man, despite facing personal risk on a dangerous road. The empathic response of someone who would have been reviled in the Jewish community is deliberate in this parable. To have a Samaritan in Luke’s Gospel as the one who acts ethically, when those who were faithful to the law did not act morally, points to a dissonance in the interpretation of how we should act. The conclusion of the parable in Luke 10 is that the person who treats another with mercy is the most faithful person. Actions, not identities, are the determining measures. So, Scripture, and its lessons, are paired with our desire to respond to the many human needs that we see internationally. In the face of these needs, how should we act? In crisis, those afflicted will often reach out to others to alleviate their suffering. It is natural to empathize with those calls to help. How can we be the Good Samaritan in our international activities, both individually and as Catholic organizations? How can we offer compassionate, and still effective, care? The answer is found in prudence, authenticity, honesty, patience, excellence and humility, six principles for action that CHA highlights in its Guiding Principles for Conducting Global Health Activities.1

Honesty

Honesty is about trust and communication. Do both partners agree on common goals while also having the same perceptions of potential risks? This level of dialogue requires an understanding of culture, and how what is and is not communicated contributes to the success of project outcomes.

Patience

Patience is the capacity to think about the future. While natural disasters and human conflicts set up “emergency situations,” success in changing those circumstances are often long-term goals. International partnerships should foster capacity, not dependency. Those who have the ability to give resources may fall into the false promises of technology as solutions to human problems. Life, as it is lived by those who we seek to assist, is the measure of success.

Excellence

Prudence requires that action is directed toward accomplishing what is good. Action without assessment, planning and then evaluation may result in not only being ineffective in achieving the good that we intend, but perhaps creating a worse situation than when we first acted. Our efforts should be thoughtful in order to have the ability to do well.

Excellence means to adopt a standard of quality work. Doing something that is ineffective and not thoughtful is often worse than doing something limited and of quality. We should never adopt standards that are less than what we ourselves would want. For example, dispensing out-of-date medications or allowing untrained and unlicensed personnel to perform medical procedures would never be permitted in the United States, and neither should it be done in other nations.

Authenticity

Humility

Prudence

Authenticity means that the work that we do involves a partnership with those whom we serve. To give without an invitation presumes knowing what assistance is needed, and how to best accomplish our goals. Instead, we should be listeners and understand what motivations and purposes the local partner has. The Catholic social teaching of both solidarity and subsidiarity are necessary.

We should share the work, and we should favor local influence of any international project. In the words of Pope Paul VI, we need to grow in a solidarity which would allow “all peoples to become the artisans of their destiny,” since every person is called to self-fulfillment.2

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Humility, our concluding principle, requires cultural competence and the ability to respect our partners. A true collaboration means that there is mutual learning. Both the planning and evaluation of successful partnerships have space for considering how our own experiences shape the ways in which we presume to know how to best accomplish our goals.

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CONCLUSION

To be a Good Samaritan in the international community means to act compassionately. Individual acts of mercy must be understood in terms of a communal vocation to be benevolent persons for others. As Pope Francis wrote: “We were put in this world to love him (God) and our neighbors. Everything else passes away, only this remains. … (tragedy) summons us to take seriously the things that are serious, and not to be caught up in those that matter less; to rediscover that life is of no use if not used to serve others. For life is measured by love.”3 BRIAN M. KANE, PhD, is senior director, ethics, for the Catholic Health Association, St. Louis. NOTES 1. Guiding Principles for Conducting Global Health Activities (St. Louis: Catholic Health Association, 2022): https://www. chausa.org/docs/default-source/ international-outreach/cha_ guidingprinciples_2022-update_lr_ single.pdf?sfvrsn=7370c7f2_3. 2. Pope Paul VI, Populorum Progressio, paragraph 65, https://www. vatican.va/content/paul-vi/en/ encyclicals/documents/hf_p-vi_ enc_26031967_populorum.html. 3. Pope Francis, “Homily of His Holiness Pope Francis,” April 5, 2020, https://www.vatican.va/content/ francesco/en/ homilies/2020/documents/ papa-francesco_20200405_ omelia-palme.html.

Upcoming Events from The Catholic Health Association Long-Term Care Networking Zoom Gathering July 12 | 3 – 4 p.m. ET Members Only

United Against Human Trafficking Networking Zoom Call July 14 | Noon ET

Faith Community Nurse Networking Zoom Call July 20 | 1 – 2 p.m. ET

Deans of Catholic Colleges of Nursing Networking Zoom Call July 26 | Noon–1 p.m. ET

Global Health Networking Zoom Call Aug. 3 | Noon ET

Long-Term Care Networking Zoom Gathering Oct. 11 | 3 – 4 p.m. ET Members Only

Webinar: Community Benefit 101 Oct. 25 – 27 | 2 – 5 p.m. ET

Diversity & Disparities Networking Zoom Call Oct. 25 | 1 – 2 p.m. ET

Global Health Networking Zoom Call Nov. 2 | Noon ET

HEALTH PROGRESS

A Passionate Voice for Compassionate Care® chausa.org/calendar

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T H I N K I N G G L O B A L LY

RELIEF EFFORTS FOR UKRAINE: WHAT TO WEIGH WHEN ASKED FOR DONATIONS RACHELLE BARINA, PhD, AND ERICA SMITH, MPH

any Americans respond to the call “… to do good, to be rich in good works, to be generous, ready to share.” (1 Timothy 6:18) And so when crisis or disaster strikes — as it tragically has for the war-ridden lands of Ukraine and the more than 7 million refugees fleeing the country1 — it is the collective instinct of Americans to want to help. One of the ways that we often seek to do this is by sending material goods. In fact, we tend to equate “sending stuff” with “helping.” While good people with noble intentions want to aid those impacted by the Ukrainian conflict, we tend to underappreciate the many steps involved in effectively leveraging donations within disaster relief efforts. During a disaster — particularly an ongoing military conflict — the logistics involved with transporting, storing, sorting and distributing material donations are exceedingly complex and expensive. Moreover, it is challenging to have an accurate and up-to-date understanding of needs experienced by affected people and the infrastructure available to support these initiatives. When material donations are gathered and shipped without sufficient planning and coordination, our “generosity” can add to a crisis rather than alleviate it. We challenge leaders of Catholic health care to achieve a level of professional rigor before joining material donation campaigns to support disaster aid efforts. As a means of support, we offer three areas of aptitude for leaders considering donation campaigns. We believe having these aptitudes allows an organization to assist vulnerable regions, including those in Ukraine, without exacerbating the crisis.

UNDERSTAND THE POTENTIAL FOR A ‘SECOND DISASTER’

During the past decade, it has become more commonly recognized that altruistic efforts to help can sometimes be ineffective, counterproductive and even harmful. Local and global altruism does not always successfully reduce poverty, improve health outcomes or advance sustainable com-

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munity and economic development. Multiple accounts have demonstrated these points and have inspired a renewed commitment to ensure responsible engagement in charitable work.2 Amidst this growing understanding, efforts in disaster aid are sometimes perceived as immune to the same pitfalls because they are about simply meeting basic and imminent needs. This perception is misguided. In fact, the urgency and constraints that arise with disaster make it even more difficult to minimize waste, empower people and avoid harm. In disaster relief, dozens and sometimes hundreds of nonprofits, nongovernmental organizations (NGOs) and governmental agencies work in parallel to coordinate logistics, which range from understanding rapidly changing needs to procuring and transporting needed goods to affected areas. Large nongovernmental organizations in partnership with local government are typically best positioned to facilitate the coordination and prioritization of aid efforts amidst devastated infrastructure. Sending the most critical goods in the right quantities and in the most efficient ways is exceedingly challenging. Despite coordination initiatives, disaster zones are often inundated by useless or low-priority goods. Seemingly essential items must be received, classified, reviewed for quality, repacked, stored and mobilized, constraining logistical resources that are already in high demand. Managing these items amidst limited capacities burdens the supply chain of disaster-stricken areas, clogging the sole pathways

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not only for other essential goods, but also for the ASK KEY QUESTIONS BEFORE AGREEING TO PARTICIPATE transport of people. It may seem that a small local campaign to gather For example, after a 2004 tsunami in Indone- material donations is innocuous, but even these sia, widespread shipments of medical supplies can become a recipe ingredient for a second disasarrived, including many drug donations. Seventy ter. However, this shouldn’t dissuade our desire percent of the drugs that arrived were labeled in to serve others. Instead, when approached by rea foreign language, many drugs were expired, and questing organizations looking for support, leadcertain drugs were received in extreme quantities ers within Catholic health ministries should dive (for example, a five- to eight-year supply of oral into key questions before agreeing to campaign rehydration salts). There was not adequate stor- for material donations: age capacity or temperature-controlled spaces, and drugs were left in courtyards, open sheds Is the requesting organization designed to provide, and cluttered hallways. In addition to the wasted and experienced in, disaster relief efforts? time and money lost gathering and shipping these Experience in disaster aid matters. Question ordrugs, millions of dollars had to be spent sorting ganizations that do not have a history and central and disposing them — all of this amid the fact mission focused on disaster relief. Organizations that no local health authorities had ever asked for new to disaster relief must demonstrate deep drugs.3 competency in the unique realm of disaster aid Similar stories can be told of the earthquakes and have a solid understanding of the roles, rein Haiti (2010) and Japan (2011), as 60% of dona- sponsibilities and authority of key stakeholders. tions given were not needed, and only 5-10% addressed urgent needs.4 Items The problem of receiving, storing at the top of the United Nations Office for the Coordination of Humanitarian and disposing unnecessary Affairs’ list of most frequently unsodonations after a crisis has even licited donations are: medical products, food/drink (especially bottled earned its own name: the second water) and nonfood items (clothing, disaster. cooking and hygiene).5 The problem of receiving, storing and disposing unnecessary donations after a crisis has even earned its own name: the second With whom is the requesting organization working? disaster. This reflects relational, financial and en- Disaster relief is best guided and coordinated by vironmental harm done to an already burdened large stakeholders who have resources and expearea due to the untimely arrival of inappropriate rience, such as the United Nations, World Health donations. In addition to the challenges of man- Organization, International (or in-country) Red aging these donations, the time and labor spent Cross, Catholic Relief Services, etc. How is the reduces the personnel and supply chain capacity requesting organization working within coordifor the delivery of other aid. nated effort and logistics collaboratives? An orgaIt is not always better to send something than nization worthy of material or financial donations to send nothing. In most cases, organizations aid- will be able to readily demonstrate that they are ing in disaster should only send goods that have working along established channels and under been requested by vetted, on-the-ground part- the direction of large nongovernmental organizaners who have assessed needs and are positioned tions. within established infrastructure to ensure coordinated receipt and use of goods. How is the requesting organization addressing In areas of disaster or conflict, including in the need and potential barriers? case of Ukraine, goods often can still be purchased The organization should have a clear explanation in areas outside the epicenter of crisis. Sending of how it has identified the specific need requested goods that are already available in an area can be for material or financial donations. Further, those economically debilitating to local economies that assessments should not be outdated, as needs people depend on. change quickly in disaster contexts. Alongside

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identifying need, how are storage and transportation challenges being managed? Is the organization adhering to guidance from nongovernmental organizations about what should and should not be sent? Is it likely some of the requested supplies might be sent from a closer area or sourced from a more optimal channel?

Overall, is the requesting organization demonstrating evidence that it is trustworthy?

It must be mentioned that opportunistic campaigns are common and can be problematic. Sometimes, funds raised to help in present-day disasters never end up aiding that community. Campaigns seeking to “Help New Orleans/Haiti/ Indonesia/Ukraine” can lack integrity if not done with a transparent acknowledgement of fund restrictions and the organization’s plan for responsible use of material or financial donations. Worse yet, fraudulent fundraising is real, and caution and investigation can help to ensure the trustworthiness of charitable organizations. Potential donors should look for evidence solidifying the organization’s track record, active work or partnerships, and quantifiable impact.

REDIRECT ENERGY ELSEWHERE WHEN ‘NO’ IS THE BEST ANSWER

Asking these kinds of questions is not rude; it is diligent leadership indicative of a commitment to ensure that efforts result in quality work. In some cases, a requesting organization might demonstrate that its efforts are well-established and warrant support. In other cases, important questions may be unanswered or leaders may even get a sense that the requesting organization does not have a strong awareness of its obligations. While evaluating requests, it may be determined that cash donations to well-established international relief organizations are more helpful to the intended recipients impacted by disaster. Regardless of what action is decided, leaders have a responsibility to exercise appropriate caution, and if determined through that discretion, to decline assisting the requesting organization. When it is necessary to decline the request for help, we need not stifle that amazing human spark to act in love and compassion. Communities, local and global, cry out each day with needs arising from injustice, loss, grief and poverty. There are ways for each of us and our ministries to collaborate in serving local and global communities in need, and sometimes in declining one thing, we find we have energy for another.

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CONCLUSION

Exercising caution does not mean that leaders in health care and all those who want to give do not care, are apathetic or paralyzed by fear. And it does not mean that we must insist on perfection — any well-organized response to disaster will admittedly have a certain degree of complexity, waste and imperfection. Instead, exercising caution means that we recognize the real challenges of effectively delivering aid amidst disaster because we are listening to the voices of our intended recipients. It means that we focus on how to best meet the needs of others, recognizing the constrained capacities within which aid is being delivered. It means that we are humble enough to listen and we acknowledge that the story of aid does not end in a celebration of what we have given to others. It means that we prioritize service of those experiencing disaster over the individual satisfaction that we can do something to help. Ultimately, taking a thoughtful and cautious approach demonstrates that Catholic health care is committed to never creating a secondary disaster that burdens a country. We want to donate in ways that are responsible and recipient-focused, which lies at the heart of truly doing good, being rich in good works and giving generously with all that we can share. RACHELLE BARINA is chief mission officer of Hospital Sisters Health System in Springfield, Illinois. ERICA SMITH is executive director of Hospital Sisters Mission Outreach, a medical surplus recovery organization located in Springfield, Illinois. NOTES 1. “The UN and the War in Ukraine: Key Information,” United Nations, https://unric.org/en/ the-un-and-the-war-in-ukraine-key-information/. 2. Robert D. Lupton, Toxic Charity: How Churches and Charities Hurt Those They Help (And How to Reverse It) (New York: HarperOne, 2011); Steve Corbett, When Helping Hurts: How to Alleviate Poverty Without Hurting the Poor . . . and Yourself (Chicago: Moody Publishers, 2014). 2. Pierre Boulet-Desbareau, “Unsolicited In-Kind Donations and Other Inappropriate Humanitarian Goods,” May 2013, United Nations Office for the Coordination of Humanitarian Affairs, https://emergency-log.weebly. com/uploads/2/5/2/4/25246358/ubd_report_eng_-_ final_for_printing_2.pdf. 3. Boulet-Desbareau, “Unsolicited In-Kind Donations.” 4. Boulet-Desbareau, “Unsolicited In-Kind Donations.”

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MISSION

TENDING TO MISSION: LISTEN, LEARN, RESPOND

e never know where the Spirit may lead us on our path to continue Jesus’ mission of love. As CHA’s new director of mission services, I am honored to serve you and help strengthen your commitment to Catholic health care. Together, we tend the vision and values planted by our founders as we carry on the healing ministry of Jesus. It is an overwhelmingly generative call, and I look forward to cultivating this ground with you. In my role at CHA, I support mission integration, spiritual/ pastoral care and well-being. In my former position with Mercy’s system office, I standardized personal formation for leaders at the director-and-above levels across the ministry, developed leader formation content and JILL FISK identified best practices in formation facilitation. I wanted to provide an update on some of CHA’s recent work in the mission department.

HEALTH EQUITY, MISSION LEADERSHIP AND WELL-BEING DEVELOPMENTS

This past spring, we welcomed back the return of in-person gatherings. In March, Fr. Charles Bouchard, OP, STD, and Dennis Gonzales, PhD, co-hosted CHA’s Critical Conversations meeting in Dallas. At the gathering, CEOs, sponsors and chief mission officers focused on caregiver wellbeing, the ministry’s work as part of the “We Are Called” pledge to end systemic racism, and other pressing theological, political and ethical issues facing our ministry. Through a conversation led by members of CHA’s Well-Being Task Force to address the necessity of mental health welfare for caregivers, four crucial areas of focus were identified: psychological/mental well-being, psychological safety, purpose/mission and people. Other highlights included a thought-provoking presentation by LivingUNDIVIDED, a national faith-based group specializing in diversity, equity and inclusion, and guest speaker and liturgy celebrant Bishop Daniel Flores of Brownsville, Texas. He and Sr. Mary Haddad, RSM, CHA’s president and CEO, led a

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panel discussion on critical ministry topics. Additionally, in April, CHA hosted a trilogy webinar series for new and newer mission leaders to discuss the Mission Leader Competency model in the areas of strategy and operations, advocacy and executive presence.1 Participants were encouraged to strengthen relationships with executive partners by offering open-ended inquiry, cross-departmental mentoring and continually returning to the vision and values of Catholic health care’s identity as incarnational, communal and sacramental. Other significant moments included an advocacy session that discussed ways to engage with community stakeholders. The final session addressed the essentials needed to embody mission in the everyday presence of our ministries. Looking ahead, CHA will once again convene mission leaders from across the ministry during our annual Mission Leader Seminar. Taking place in early November, this virtual experience will inspire and cultivate a renewed sense of purpose that will sustain and inspire leaders in their work and call to serve. Heightening a rapid response to whole-person care, the pandemic has called us to care for patients, coworkers, providers and communities as one health care ministry. Through our distinct Catholic lens, flourishing and well-being can be seen and understood holistically and communally. In this important work, CHA’s Well-Being Task Force continues to actively seek input from members to identify and share strategies and outcomes that address well-being for systems and individual coworkers. To further expand on this effort, the task force is conducting a well-being assessment of the entire ministry, and results will be shared in the future.

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PASTORAL/SPIRITUAL CARE FUTURE GROWTH

PAU S E . B R E AT H E . H E A L .

Similar to the work of well-being, CHA’s Spiritual Care Advisory Council has identified future priorities, with staffing, standards and benchmarking remaining a focus as our ministries look to ensure identity beyond the scope of the acute care setting. Our Catholic covenant to care for persons young and old calls us, as Pope Francis notes, to “a fuller vision of our life together,”2 as we support those serving or residing in continuing care communities. The council will also explore what is needed for professional development, as senior roles in spiritual care are increasingly being filled by nonCatholic leaders. Succession planning is vital to sustain our identity as both inclusive and deeply Catholic, and the National Association of Catholic Chaplains will be a vital partner in this endeavor.

Finally, we aim to identify and equip members around standards of spiritual care designed for newer models across the continuum that have emerged in the last few years. As you continue to innovate, we will continue to listen, learn and respond. Together, we are called. JILL FISK, MATM, is director, mission services, for the Catholic Health Association, St. Louis. NOTES 1. “The Mission Leader Competency Model,” Catholic Health Association, https://www.chausa.org/mission/ mission-leader-competencies. 2. Pope Francis, Cathechesis on Old Age - 2, (Vatican 2022), https://www.vatican.va/content/francesco/ en/audiences/2022/documents/20220302-udienzagenerale.html.

Your Steadfast Love For just this moment, bring your attention to your breath. INHALE deeply and settle yourself into your body. EXHALE the stress and tension you feel.

On your next inhale, pray, Your Steadfast Love And as you exhale, Endures Forever. Your Steadfast Love Endures Forever KEEP BREATHING this prayer for a few moments.

(Repeat the prayer several times.) CONCLUDE, REMEMBERING:

Even now, God is with you, as near to you as your breath. Continue giving yourself the gift to pause, breathe and heal, knowing you are not alone. The Lord will fulfill his purpose for me; your steadfast love, O Lord, endures forever. Do not forsake the work of your hands. PSALM 138:8 (ESV) © Catholic Health Association of the United States

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AGING

TWO CALLS FOR NURSING HOME REFORMS

here is no doubt that COVID-19 was devastating in long-term care facilities with significant sickness, hospitalization and even death among staff and residents. Why? One reason is that most nursing home residents are over 80 and have multiple preexisting conditions. In addition, nursing home leaders point out that the federal help to nursing homes was late and insufficient. They were among the last to get personal protective equipment (PPE) and information about how to fight the disease. While some blamed poor quality in nursing homes, research eventually revealed that the volume of COVID in nursing homes actually mirrored the rate of the virus in communities: when it was in communities, it was in its nursing homes.1 As the pandemic receded, safety and quality of care, which stated: “The pandemic has highlighted the tragic imtwo efforts were announced to improve nursing home quality pact of substandard conditions at nursing homes, and to prevent the COVID ex- which are home to many of our most at-risk comperience from being repeated. munity members. More than 1.4 million peoA fact sheet released earlier this ple live in over 15,500 Medicare- and Medicaidyear by the White House, called certified nursing homes across the nation. In the “Protecting Seniors by Improv- past two years, more than 200,000 residents and JULIE ing Safety and Quality of Care in staff in nursing homes have died from COVID-19 the Nation’s Nursing Homes,”2 — nearly a quarter of all COVID-19 deaths in the TROCCHIO revealed how the federal govern- United States.”4 ment — through regulation and policy changes — inWhile some blamed poor quality in nursing tends to address nursing homes, research eventually revealed that home quality. Soon after, the National Academies of the volume of COVID in nursing homes Sciences, Engineering, and Medicine published the actually mirrored the rate of the virus in results of its study, The Nacommunities: when it was in communities, tional Imperative to Improve Nursing Home Quality: it was in its nursing homes. Honoring Our Commitment to Residents, Families, and Staff.3 Both efforts are aimed at setting the path The federal reforms proposed are aimed at forward to reform our nation’s nursing home care. improving the quality and safety of nursing home care, enhancing oversight and accountability, and making facility ownership more transparent. FEDERAL PROPOSALS During this year’s State of the Union address, President Joe Biden announced that he will be propos- Improving Care ing a set of nursing home reforms for the Depart- Four new initiatives are directed at improving ment of Health and Human Services (HHS) and quality care. First, HHS will study the adequacy its Centers for Medicare and Medicaid Services of nursing staffing and consider strengthening (CMS) to implement. These were outlined in the minimum staffing levels. (Currently, some states White House fact sheet related to nursing home go beyond the federal staffing requirements of

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providing 24-hour licensed nursing services. The federal government is considering stronger RN staffing requirements.) Second, there will be efforts to reduce what the administration calls “resident crowding,” which can lead to increased risk of contracting infectious diseases, such as COVID-19. Third, HHS will strengthen its skilled nursing value-based purchasing program, adding metrics such as weekend staffing and turnover. There might be higher reimbursement from the government for nursing homes that meet some additional quality measures. A fourth initiative will be aimed at reducing the use of antipsychotic drugs in nursing homes in order to bring down the inappropriate use of antipsychotic medications.5 Enhancing Oversight The administration plans to strengthen its compliance program with additional funding for inspections and imposing new penalties on poor performers. It will ask Congress to provide an increase of nearly 25% for nursing home health and safety inspections. To address the issue of the poorest performers, CMS will strengthen its Special Focus Facility Program, which identifies and increases scrutiny of problem facilities. It will also add new financial penalties and other sanctions and will ask Congress to raise the dollar limit on penalties from $21,000 to $1 million. More Transparency In announcing the nursing home reform proposals, the White House expressed concern that corporate owners have not been accountable for poor performance. As a result, CMS will create a database registry of owners and operators to give states and the public information about the violation history of these companies. The administration also plans to examine the role of private equity in nursing home ownership.

NATIONAL ACADEMIES OF SCIENCES, ENGINEERING, AND MEDICINE STUDY

The National Academies of Sciences, Engineering, and Medicine convened an expert panel to examine how to improve nursing home quality with an emphasis on challenges that have arisen in light of the COVID-19 pandemic. Noted earlier, its report, The National Imperative to Improve Nurs-

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In the area of improving care, quality of life and safety, the report recommends more government oversight to ensure that the priorities of residents and their families are included in decision-making.

ing Home Quality: Honoring Our Commitment to Residents, Families, and Staff, concludes that the way our nation finances, delivers and regulates care in nursing homes is inefficient, fragmented and unsustainable. The report calls for immediate action to initiate fundamental change, and identifies seven broad goals for improving quality care in nursing homes. These objectives concern person-centered care that ensures the health, quality of life and safety of nursing homes residents; a well-prepared workforce; increased transparency of nursing home finances, operations and ownership; a more rational financing system; an improved quality assurance system; additional quality measures; and improved health information technology.6 Improved Quality of Care, Life and Safety In the area of improving care, quality of life and safety, the report recommends more government oversight to ensure that the priorities of residents and their families are included in decision-making. It also recommends greater attention to nursing homes in disaster preparedness and response. Workforce/Staffing On workforce, the study said that current staffing requirements need to be enhanced. It calls for 24-hour RN coverage, a full-time social worker with a social work degree and an RN or physician infection prevention and control specialist. It urges that there be opportunities for certified nursing assistants to have career advancement and mentoring, in addition to more education and training for all staff.

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Transparency In calls for more transparency, the report says the HHS should collect, audit and make public detailed facility data on operations and ownership. It also asks the government to assess the impact of nursing home real estate ownership models on the delivery of quality care. Financing: Adding a Federal Benefit While funding for long-term care financing has been the subject of numerous studies and reports, the committee called for yet another study of how to finance long-term care. Noting that the current approach to financing nursing home care is fragmented, the report says that quality nursing home care needs a more stable system of financing. It urges changes in both Medicare and Medicaid payments. It also says that while enacting a new long-term care benefit will be politically challenging, a federal benefit has the most potential to increase access, reduce unmet need and reduce inequities in access by guaranteeing that payments are adequate to cover quality care. Continuous Quality, Better Measures and Health IT In another goal for nursing home quality as it relates to continuous quality, the report says CMS must make sure that state survey agencies have the resources they need and should study how to make the survey system more efficient. For example, there could be modified oversight of highperforming facilities and more robust oversight of poor performers. Additional goals relate to the need for better quality measures and information technology. The report says quality data should be collected by independent reviewers and that there should be more and better publicly reported measures. On technology, the report says there should be incentives for nursing homes to adopt electronic health records.

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CONCLUSION

The quality and oversight of America’s nursing homes grabbed the attention of researchers, policymakers and the public as vulnerabilities were unveiled during the pandemic. With the country’s booming aging population and as the need for aging services continues to grow, the timing could be right for the recommendations of these two initiatives to change the long-term care landscape for the better. JULIE TROCCHIO, BSN, MS, is senior director of community benefit and continuing care for the Catholic Health Association, Washington, D.C. NOTES 1. David C. Grabowski, R. Tamara Konetzka, and Vincent Mor, “We Can’t Protect Nursing Homes from COVID-19 Without Protecting Everyone,” The Washington Post, June 25, 2020, https://www.washingtonpost.com/ opinions/2020/06/25/we-cant-protect-nursing-homescovid-19-without-protecting-everyone/. 2. “FACT SHEET: Protecting Seniors by Improving Safety and Quality of Care in the Nation’s Nursing Homes,” The White House, February 28, 2022, https:// www.whitehouse.gov/briefing-room/statementsreleases/2022/02/28/fact-sheet-protecting-seniorsand-people-with-disabilities-by-improving-safety-andquality-of-care-in-the-nations-nursing-homes/. 3. National Academies of Sciences, Engineering, and Medicine, The National Imperative to Improve Nursing Home Quality: Honoring Our Commitment to Residents, Families, and Staff (Washington, DC: The National Academies Press, 2022). 4. “Protecting Seniors by Improving Safety,” The White House. 5. “Monitoring Psychotropic Drug Use in Nursing Homes,” Office of Inspector General: U.S. Department of Health & Human Services, https://oig.hhs.gov/reportsand-publications/workplan/summary/wpsummary-0000470.asp. 6. “Recommendations: The National Imperative to Improve Nursing Home Quality: Honoring Our Commitment to Residents, Families, and Staff,” National Academies of Sciences, Engineering, and Medicine, April 2022, https://nap.nationalacademies.org/resource/26526/ Nursing_Homes_Recommendations.pdf.

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P R AY E R

SERVICE

By Day and by Night JILL FISK, MATM DIRECTOR, MISSION SERVICES, THE CATHOLIC HEALTH ASSOCIATION, ST. LOUIS

OPENING PRAYER AND READING Leader: God is our steadfast guide and constant abiding presence. Let us set our minds, hearts and bodies on the Eternal’s goodness and hear a song of trust and security in God from the words of the psalmist: (Pause) Reader: “I bless the Lord who counsels me; even at night my heart extols me. I keep the Lord always before me; with him at my right hand, I shall never be shaken.” (Psalm 16:7-8) Reader: A reading from the Acts of the Apostles: “He made from one the whole human race to dwell on the entire surface of the earth, and he fixed the ordered seasons and the boundaries of their regions, so that people might seek God, even perhaps grope for him and find him, though indeed he is not far from any one of us.” (Acts 17:26-27) The Word of the Lord. All: Thanks be to God. (Pause) REFLECTION As forgetful beings, we need reminding. We rely on our calendar apps to keep our schedules ever before us. We set alarms to determine our waking and for reminders as we go about our days. Notifications even prompt us when to stand or breathe or practice mindfulness.

Yet, it is sacred scripture that returns us to an eternal but all-too-quickly-forgotten reality that God is right here. The God who nudges us by day is the same God who guides us by night. God is on the job, whether we realize it or not. Our ability to remember God’s presence does not determine God’s faithfulness toward us. Think for a moment: In what circumstances do we forget God’s presence? How might an awareness of our forgetfulness awaken us to God’s faithfulness? (Pause) Leader: Let us draw near to God as God draws near to us. INTERCESSION For those we hold close to our hearts who don’t know where to find you, we pray: O God, be their guide. For our leaders, those within our health care systems, our communities and at state and national levels, we pray: O God, be their guide. For those who know deeply the fatigue in the world, complacency, indifference, hatred and silence, we pray: O God, be our guide. For all peoples from all nations to live together in union with one another and with you, we pray: O God, be our guide. CLOSING PRAYER Wake us up, O God, to your faithfulness and our forgetfulness. Whether we turn to the right or the left, it is you who is there. When we discern and steward and promote the dignity of the voiceless, you are at our right hand. By your grace, help us receive your wisdom by day and by night. And teach us to live in the fullness of joy as you guide us on the path to life. Amen.

“Prayer Service,” a regular department in Health Progress, may be copied without prior permission.

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COMMUNITY BENEFIT 101: THE NUTS AND BOLTS OF PLANNING AND REPORTING COMMUNITY BENEFIT OCTOBER 25, 26 & 27, 2022 Each day from 2 to 5 P.M. ET

Join us for the Virtual Program! CHA’s CB 101: The Nuts and Bolts of Planning and Reporting Community Benefit, a virtual conference, will provide new community benefit professionals and others who want to learn about community benefit with the foundational knowledge and tools needed to run effective community benefit programs.

Attendees will receive a copy of CHA’s A Guide for Planning and Reporting Community Benefit.

“CHA has great resources that were used as part of the program, and I can already use the information presented in my day-to-day activities.”

“The information about the CHNA and CHIP was so essential and will be invaluable in my role.”

What you will learn: Taught by community benefit leaders, the program will cover what counts as community benefit; how to plan, evaluate and report on community benefit programs; accounting principles; and a public policy update.

Who should attend: New community benefit professionals who want a comprehensive overview of all aspects of community benefit programming. Staff in mission, finance/tax, population health, strategic planning, diversity and inclusion, communications, government relations and compliance who want to learn about the important relationship of their work and community benefit/community health. Veteran community benefit staff who want a refresher course to update them on current practices and inspire future activities.

NEW 22! O F R 20

SPECIAL OFFER FOR COMMUNITY BENEFIT REPORTERS

We’ve added single-day registration with special pricing for community benefit reporters who want to focus on what counts, accounting and how to tell the community benefit story. Whether you are new to reporting or need a refresher, check out this option.

WE HOPE TO SEE YOU THERE! LEARN MORE AT CHAUSA.ORG/COMMUNITYBENEFIT101

Thank You, Friends of the Assembly ASSEMBLY 2022 WAS MADE POSSIBLE IN PART BY GENEROUS SUPPORT FROM: GOLD FRIENDS

SILVER FRIENDS ApolloMD

Catalyst Learning

EWTN Global Catholic Network

HealthTrust

Huron

The Innovation Institute

Key Green Solutions

TRIMEDX

Ziegler

Loyola University Chicago

Health Progress - Summer 2022

Articles inside

AGING Two Calls for Nursing Home Reforms

MISSION TENDING TO MISSION: LISTEN, LEARN, RESPOND

THINKING GLOBALLY Relief Efforts for Ukraine: What To Weigh When Asked for Donations

PRAYER SERVICE

HEALTH EQUITY Catholic Social Teaching as a Road to Equity

ETHICS The International Good Samaritan

COMMUNITY BENEFIT Community Engagement: Using the Evidence

HOW TO BUILD EXECUTIVE PRESENCE A MESSAGE FOR MISSION LEADERS

FERTILITY OPTIONS OFFER HOPE FOR YOUNG ADULT CANCER PATIENTS

CHA ADVOCACY: FAITH AND REASON IN ACTION

CHALLENGES FOR SPONSORSHIP TODAY

WHY A HABIT OF DISCERNMENT IS CRUCIAL FOR CATHOLIC HEALTH CARE

PROVIDENCE CULTIVATES LEADERS FOR FORMATION THROUGHOUT ORGANIZATION: BUILDING ON LEGACY SO MISSION CAN FLOURISH

HIRING FOR MINISTRY FIT IN CATHOLIC HEALTH CARE

HARNESSING THE POWER OF CHAPLAINCY THROUGH AN ELECTRONIC MEDICAL RECORD

EDITOR’S NOTE