Health Progress - Fall 2024

Bridging Divides

Our ministry is an enduring sign of health care rooted in the belief that every person is a treasure, every life a sacred gift, every human being a unity of body, mind and spirit. This vibrant video series shines a spotlight on the contributions of CHA member ministries in promoting human dignity and the common good.

HEALTH PROGRESS®

BRIDGING DIVIDES

Illustrations by Andrew Baker

4 CATHOLIC HEALTH: HEALERS AND BRIDGE BUILDERS IN A DIVIDED SOCIETY Lucas Swanepoel, JD

10 FOSTERING TEAMWORK TO PROMOTE HARMONY IN THE WORKPLACE

Kelly Bilodeau

16 MOBILE CLINICS: DRIVING TOWARD HEALTH EQUITY

Mary Kathryn Fallon, MSA, CPA

22 THE RIPPLE EFFECT OF ‘WASH’ IN CATHOLIC HEALTH CARE

Susan K. Barnett

30 BRIDGING RELIGIOUS IDENTITY IN HEALTH CARE: THE TIME IS NOW

Eboo Patel, PhD, and Suzanne Watts Henderson, PhD

37 MISSION ACROSS THE MILES: MISSION INTEGRATION IN AMBULATORY SETTINGS

Nancy Jordan, EdD, and Nan Onest, MA

FEATURES

41 HOW DO WE AVOID THE MISUSE OF DISCERNMENT IN DECISION-MAKING?

Fr. Michael Rozier, SJ, PhD

46 FINE-TUNING A REGIONAL RESPONSE TO AID HUMAN TRAFFICKING SURVIVORS

DEPARTMENTS

2 EDITOR’S NOTE BETSY TAYLOR

52 MISSION Finding a Path Forward Through Synodality DENNIS GONZALES, PhD

55 ETHICS Keeping the Person at the Heart of Decision-Making NATHANIEL BLANTON HIBNER, PhD

57 FORMATION Lights, Camera and Spirit in Action DARREN M. HENSON, PhD, STL

62 THINKING GLOBALLY

Rethinking Global Health Partnerships: Embracing The Four Es BRUCE COMPTON

65 AGING

Ensuring Integrated Palliative Care for an Aging America MARK KANTROW, MD, FAAHPM

69 COMMUNITY BENEFIT Demonstrating Community Benefit in Action Through the Power of Storytelling MEGAN McANINCH-JONES, MSC, MBA, and ADRIENNE WEBB

29 FINDING GOD IN DAILY LIFE

72 PRAYER SERVICE

Holly Gibbs IN YOUR NEXT ISSUE

EDITOR’S NOTE

I’m not the world’s largest fan of “free” hotel breakfasts. A free breakfast is, of course, better than no breakfast and sounds good in theory. But hopes are dashed with every lift of a chafing dish lid. Rubbery, bland eggs, leaden pastries that couldn’t show their faces in Paris, and coffee that simpers rather than shines turn the idea of a hot, delicious morning meal into wishful thinking.

While on the road recently, staring at my sad suitcase that has shed each and every one of its zipper pulls over the years while debating if I’d left my phone on the nightstand or if it was hiding in the recesses of my shoulder bag, I saw a sight that can invigorate any morning. It was — a baby at breakfast!

Traveler after traveler headed to contemplate oatmeal, yogurt or the ballooning line for the make-your-own waffle machine. But they paused on their way in or to a table to greet the baby. They smiled at the baby. They waved at the baby. A woman a few tables away talked to the baby about her day, or the weather or the cuteness of said baby. All probably wanted a reaction: a light in the baby’s eyes, a shy tuck of the chin or, the ultimate reward, the baby’s grin and laugh. I don’t think there’s a better sound.

But it got me thinking, as these human interactions do, about when and why we stop greeting one another in this manner. A baby, this new life (and the biological processes that encourage us to care for children), make us feel some sort of baby camaraderie. We all — or most of us, anyway — feel a little responsible for that baby, for making an infant feel welcome in the world, if only for a

moment. We’re the adult ambassadors for society in those minutes, letting that baby know the world can be a welcoming place, that we hope for the best and wish that child well.

It would be odd, right, if we treated everyone this way? You can’t go around waving furiously at fellow drivers in traffic, lest your hand gestures get misconstrued, or babble to the person bagging your groceries; it’s not going to go over well. But I do think it’s worth reflecting on if we can bring a little of that goodwill we offer to a baby to everyone else in our own personal ways; a social nod to our shared humanity.

This issue of Health Progress looks at Bridging Divides, and I hope you’ll find the authors’ inquiries into what unites us illuminating, and perhaps their writings provide a means to reflect on what the work of Catholic health care means for healing in our society.

Issue spoiler alert: As we looked at religious, geographic, economic, racial and ethnic, workplace and other differences, we found plenty of people doing wonderful work to build bridges, from interfaith organizations to policy advocates to the healers and human resources departments in your own environments. Good work is being done all around us to recognize and respect the humanity in one another. So that’s a hopeful realization — maybe not as hopeful as waving at babies at breakfast, but not far off.

BETSY TAYLOR

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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2024 AWARDS FOR 2023 COVERAGE

Catholic Press Awards: Magazine of the Year — Professional and Special Interest Magazine, First Place; Best Special Section, First Place; Best Special Issue, First Place; Best Coverage — Political Issues, First Place; Best Essay, First and Second Place; Best Feature Article, Third Place; Best Reporting on Social Justice Issues — Dignity and Rights of the Workers, Second Place; Best Reporting on Social Justice Issues — Life and Dignity of the Human Person, First Place; Best Reporting on Social Justice Issues — Option for the Poor and the Vulnerable, Third Place; Best Reporting on Social Justice Issues — Rights and Responsibilities, Third Place; Best Writing — In-Depth, Honorable Mention.

American Society of Business Publication Editors Awards: All Content — Enterprise News Story, Regional Gold Award; All Content — Government Coverage, Regional Silver Award; All Content — Editor’s Letter, Regional Silver Award.

Produced in USA. Health Progress ISSN 0882-1577. Fall 2024 (Vol. 105, No. 4).

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 (domestic and foreign); single copies, $10.

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EDITORIAL ADVISORY COUNCIL

Trevor Bonat, MA, MS, chief mission integration officer, Ascension Saint Agnes, Baltimore

Sr. Rosemary Donley, SC, PhD, APRN-BC, professor of nursing, Duquesne University, Pittsburgh

Fr. Joseph J. Driscoll, DMin, director of ministry formation and organizational spirituality, Redeemer Health, Meadowbrook, Pennsylvania

Tracy Neary, regional vice president, mission integration, St. Vincent Healthcare, Billings, Montana

Gabriela Robles, MBA, MAHCM, president, St. Joseph Fund, Providence St. Joseph Health, Irvine, California

Jennifer Stanley, MD, physician formation leader and regional medical director, Ascension St. Vincent, North Vernon, Indiana

Rachelle Reyes Wenger, MPA, system vice president, public policy and advocacy engagement, CommonSpirit Health, Los Angeles

Nathan Ziegler, PhD, system vice president, diversity, leadership and performance excellence, CommonSpirit Health, Chicago

CHA EDITORIAL CONTRIBUTORS

ADVOCACY AND PUBLIC POLICY: Lisa Smith, MPA; Kathy Curran, JD; Clay O’Dell, PhD; Paulo G. Pontemayor, MPH; Lucas Swanepoel, JD

COMMUNITY BENEFIT: Nancy Lim, RN, MPH

CONTINUUM OF CARE AND AGING SERVICES: Indu Spugnardi

ETHICS: Nathaniel Blanton Hibner, PhD; Brian Kane, PhD

FINANCE: Loren Chandler, CPA, MBA, FACHE

GLOBAL HEALTH: Bruce Compton

LEADERSHIP AND MINISTRY DEVELOPMENT: Diarmuid Rooney, MSPsych, MTS, DSocAdmin

LEGAL, GOVERNANCE AND COMPLIANCE: Catherine A. Hurley, JD

MINISTRY FORMATION: Darren Henson, PhD, STL

MISSION INTEGRATION: Dennis Gonzales, PhD; Jill Fisk, MATM

PRAYERS: Karla Keppel, MA; Lori Ashmore-Ruppel

THEOLOGY AND SPONSORSHIP: Sr. Teresa Maya, PhD, CCVI

BRIDGING DIVIDES

Catholic Health: Healers and Bridge Builders in a Divided Society

LUCAS SWANEPOEL, JD Senior Director of Government Relations, Catholic Health Association

“Blessed are the peacemakers, for they will be called children of God.” — Matthew 5:9

The Catholic health ministry has long used its healing presence in communities to help build peace in society. Today, that presence and ministry are as critical as ever. It requires Catholic health providers and all those who support or work within the ministry to understand the unique role and opportunities that exist to help heal the political divisions in society, just as the ministry heals the physical needs of our communities.

Today, the divisions within our society feel more extreme and angrier, with the current political landscape marked by deep-seated divisions that transcend mere disagreement. This reality is reflected not only in the ever-growing militant or reactionary takes on social media or the evening news, but also in our parishes, local school boards and even in the day-to-day realities of running a health care system with patients and providers who reflect the growing divisions in our society.

According to a Pew Research Center report, the partisan divide in the United States has reached historic levels, with fundamental values and beliefs increasingly polarized along party lines. This polarization threatens not only democratic processes but also societal cohesion. In the run-up to the 2020 election and at the height of the COVID-19 pandemic response, Pew Research found that 77% of Americans saw the nation as more divided than ever.1 Additionally,

both Republicans and Democrats increasingly view people with opposing political views highly unfavorably (62% for Republicans and 54% for Democrats), perceiving them as less moral, lazy, dishonest and close-minded.2 This is further exacerbated by the reality that 54% of Americans view their political identity as central to who they are, surpassing religious identification for many, and only 4% of marriages take place between Democrat and Republican partners.3

However, while the divisiveness in our society is growing, Catholic health care is not new to serving as a source of healing among societal divisions. Much of Catholic health care can trace its roots to moments throughout our nation’s history when individuals and organizations were called to be sources of healing and bridge-building in communities.

During the Civil War, our nation’s greatest moment of division, more than 700 religious

sisters tended to wounded soldiers of both the Union and Confederate Armies.4 This led a Union soldier to write, “I am not of your church, and have always been taught to believe it to be nothing but evil; however, actions speak louder than words, and I am free to admit, that if Christianity does exist on the earth, it has some of its closest followers among the Ladies of your Order.”5

Similarly, Catholic hospitals, like St. Vincent’s Hospital in New York City, stepped in to care for HIV/AIDS patients when society remained frozen by fear and political divisions. 6 Even today, Catholic hospitals continue to be caught between cultural, religious and political forces that criticize them for being insufficiently or too sufficiently committed to their efforts to protect life while simultaneously providing care to all those in need.7

marginalized. At the heart of this teaching and work, Catholic health care is dedicated to upholding life and human dignity, promoting social justice and offering compassionate care to all individuals, regardless of background or belief. The Catholic health ministry, through its daily work in hospitals, clinics and community outreach programs, not only provides essential health care services, but also extends a compassionate hand to those in need.

This service is not merely an institutional role

By looking at our faith and the history of Catholic health care in our country, we will find that during our nation’s most divided and difficult times, we can serve a fundamental role in bridging divides and healing our society.

This call to be bridge builders to promote peace is not only in our history but is also a direct call from Pope Francis’ message in early 2024 to the world’s diplomats accredited to the Holy See: “Peace is primarily a gift of God, for it is he who has left us his peace (cf. John 14:27). Yet it is also a responsibility incumbent upon all of us.”8 This requires recognizing that promoting peace by building bridges is not something that is merely bestowed upon society but rather is something those of us in Catholic health care must work on each and every day to address the social and economic divisions that give rise to the increasing distrust and hate in our society.9

These realities ask us to reflect on how Catholic health care can reduce divisions and create bridges of understanding in our communities. By looking at our faith and the history of Catholic health care in our country, we will find that during our nation’s most divided and difficult times, we can serve a fundamental role in bridging divides and healing our society.

PRINCIPLES TO ADDRESS DIVISION, BUILD BRIDGES

1. Commitment to Service Service lies at the heart of the Catholic health ministry and Catholic social teaching, reflecting Jesus’ call to love one another and care for the

or a matter of an employee/employer relationship but extends to every person working in the Catholic health ministry, whose different yet shared responsibility gives real life to the ministry’s goal of providing Jesus’ healing love. Therefore, Catholic hospitals — through free or subsidized care, community health programs for underserved populations, engagement in outreach activities and the daily dedication of all those in service to the Catholic health ministry — provide large and small contributions to help break down barriers of distrust and create opportunities for genuine human connection. This commitment to service transcends divisions and fosters a sense of unity and shared humanity among patients and caregivers alike.

Service is not only the day-to-day reality of health care providers but also plays a key role in breaking down divisions and building bridges in communities. One way this work can be directed is through community outreach efforts by Catholic health care providers. Studies from Points of Light and the Corporation for National and Community Service have found that volunteerism in politically neutral settings promotes greater social cohesion and trust, reduces political divisions and promotes greater understanding between people.10 Therefore, the continued efforts of Catholic

BRIDGING DIVIDES

THREE PRACTICAL WAYS TO BUILD BRIDGES

In today’s politically charged climate, the role of Catholic health ministries in bridging divides and advocating for justice and compassion is more crucial than ever. Here are practical ways the Catholic health ministry can put these principles into action in its own facilities and communities.

1. Use your convening power.

By harnessing your staff’s expertise, community relationships, community health needs assessment and your role as an anchor institution, a Catholic organization can serve as neutral ground for bringing together patients, community members, and political and religious leaders to address a common challenge or need. Through dialogues, conferences, community outreach efforts, or by inviting your bishop or elected leaders to visit your facility, you can build trust and relationships while providing opportunities for people of different backgrounds and political beliefs to work together on a common cause across ideological divides. With the continued breakdown in trust of religious and governmental institutions, health care settings remain one of the few places where people of all backgrounds can come together.

2. Be resolutely nonpartisan.

Adhering to nonpartisanship is not only a legal requirement for nonprofits during elections but also a powerful tool for advancing needs and issues without regard to the left/right dichotomy that breeds divisions. By maintaining neutrality in political affiliations but not neutrality on people’s

health care providers to bring the ministry’s work beyond hospital walls and into the community will not only promote greater community health, but can also be a foundational stone for building bridges in our society.

2. Embracing Synodality: Walking Together

The concept of synodality, rooted in the Greek word for “walking together,” emphasizes the communal discernment and dialogue essential for addressing divisions. Pope Francis has made synodality a central element of his vision of a church that listens, promotes participation and co-responsibility, and provides a mission-focused means for discerning and building consensus

needs, Catholic health ministries can uphold their mission and preserve their credibility as a source of greater unity.

3. Get involved.

CHA provides a wide variety of policy briefs, backgrounders and other advocacy materials to help audiences understand the issues impacting Catholic health care in the U.S.1 These materials will help you build knowledge and relationships to take action on policy issues that impact your community. CHA also offers an easy-to-use e-advocacy system for getting involved in policies that impact the collective Catholic health care ministry.2 By getting involved, you can amplify your voice for those in need and demonstrate that policies that improve human dignity and health are a stronger bridge for unity than partisan politics.

NOTES

1. “Advocacy Overview,” Catholic Health Association, https://www.chausa.org/advocacy/ advocacy-overview.

2. “Contact Congress,” Catholic Health Association, https://www.chausa.org/advocacy/ contact-congress#/.

among people.

At the heart of this effort is the willingness to listen rather than “tell,” providing an opportunity for people to voice their deepest thoughts and concerns. We see this model of listening throughout Scripture, where Jesus frequently uses questions to teach, provoke thought and engage in meaningful dialogue.

For instance, we see this in the story of the Good Samaritan, when the lawyer asks Jesus, “And who is my neighbor?” Jesus provides a parable of the Good Samaritan and ends the story by asking the lawyer, “Which of these three, in your opinion, was neighbor to the robbers’ victim?” (Luke 10:29-37) By doing so, Jesus does not tell the

lawyer to go and show mercy and love to those most in need in society, but rather invites the listener to discern the answer and take responsibility for the action to be lived out.

In the caregiving setting, listening, discussing and discerning the proper course of action is fundamental to providing care. However, Catholic health care providers, often as central anchor institutions in their communities, can go beyond this by using their role in society and their trust among communities to serve as a model for convening and discerning broader community responses to challenges. Catholic hospitals have already started this work through their efforts to implement their community health needs assessments and can further build upon these efforts by bringing more people and institutions into the conversation, solving problems, and building greater trust and understanding to reduce divisions in our communities.

3. Fostering Integral Development

Integral human development is a cornerstone of Catholic social teaching. It emphasizes the need to place the human person at the center of society to promote the holistic growth of individuals in all dimensions — physical, emotional, intellectual and spiritual. Catholic hospitals contribute to this development by supporting education, advocating for social justice and nurturing spiritual growth. Pope Francis, in his encyclical Laudato Si’, promotes the importance of a holistic response to avoid minimizing the fullness of needs and challenges, and instead provides a framework for understanding that individual

for complete healing. Similarly, by committing to addressing systemic challenges in our society — through advocacy or fulfilling promises to address environmental impact and making right relationships with those who have been marginalized — we can take concrete steps to promote social justice for those who rely on our ministry to be a voice for those most in need.

4. Upholding Truth

Finally, the work of being a bridge builder in a divided society requires that Catholic hospitals be willing and able to speak uncomfortable truths when people are marginalized or lack the basic needs to live in accordance with their God-given dignity.

In a world rife with misinformation and ideological echo chambers, the courage to speak the truth is paramount. Pope Benedict XVI, in his encyclical Caritas in Veritate (Charity in Truth), emphasized that defending the truth and articulating it with humility and conviction are “indispensable forms of charity,” which is at the heart of the Church’s social doctrine.11 This “fidelity to the truth” is at the service of humanity to guarantee human freedom and the possibility of a society that is physically, socially, economically, culturally and spiritually healthy (integral human development).12 As one of the largest social ministries of the Church, the Catholic health ministry gives life to this teaching by working each day to ensure that charity and truth are at the heart of our work, promoting healthy people, families and communities.

In a world rife with misinformation and ideological echo chambers, the courage to speak the truth is paramount.

patient, community and global needs are “all interconnected.”

The Catholic health ministry, by providing patients with social workers, counselors, chaplains and caregivers, gives reality to this calling by recognizing that a patient is more than their physical ailment or needs. Patients have social, spiritual and other needs that directly relate to the physical but also require care and concern

These statements are reminders that in an age of deep division and misinformation, and at times even hate and violence, Catholic health care, at all levels of its work, can help heal communities, promote trust and reduce divisions by continuing to speak the truth about the needs of those whom society has forgotten or whose voices have been silenced in the name of political expediency.

The willingness to speak difficult truths is not new to Catholic health care. Whether it was standing boldly to promote access to health care through the Affordable Care Act, adopting CHA’s We Are Called pledge to confront rac -

BRIDGING DIVIDES

ism and achieve health equity, or leading as a beacon of truth to provide accurate information and care during the COVID-19 pandemic, the Catholic health ministry continues to demonstrate its commitment to speaking truths with tangible outcomes that address human needs when a divided society preferred disunity and disinformation. While speaking these truths is difficult at times, in the long arc of human history, it is at these moments that the Catholic health ministry can heal divisions by being bold enough to address the real underlying causes of disunity and distrust.

EMBRACING THE CALL TO PEACEMAKING

The Catholic health care ministry has a long legacy of being a source of healing and unity during our nation’s most challenging times. Through service, synodal dialogue, integral development and truth, the Catholic health ministry can once again provide a unique voice for significantly addressing the societal and political divisions in our nation. In so doing, we can yet again demonstrate that healing people doesn’t end at the hospital door but extends to our call as peace builders in society.

LUCAS SWANEPOEL is senior director of government relations for the Catholic Health Association, Washington, D.C.

NOTES

1. Michael Dimock and Richard Wike, “America Is Exceptional in the Nature of Its Political Divide,” Pew Research Center, November 13, 2020, https://www. pewresearch.org/short-reads/2020/11/13/america-isexceptional-in-the-nature-of-its-political-divide/.

2. “As Partisan Hostility Grows, Signs of Frustration with the Two-Party System,” Pew Research Center, August 9,

2022, https://www.pewresearch.org/politics/2022/08 /09/as-partisan-hostility-grows-signs-of-frustrationwith-the-two-party-system/.

3. Wendy Wang, “Marriages between Democrats and Republicans Are Extremely Rare,” Institute for Family Studies, November 3, 2020, https://ifstudies.org/blog/ marriages-between-democrats-and-republicans-areextremely-rare.

4. David Power Conyngham, Soldiers of the Cross, the Authoritative Text: The Heroism of Catholic Chaplains and Sisters in the American Civil War (Notre Dame, Indiana: University of Notre Dame Press, 2019).

5. Conyngham, Soldiers of the Cross, the Authoritative Text

6. Michael J. O’Loughlin, Hidden Mercy: AIDS, Catholics, and the Untold Stories of Compassion in the Face of Fear (Minneapolis: Broadleaf Books, 2021).

7. Michael J. O’Loughlin, “The Controversial History of the U.S. Bishops’ Catholic Health Care Guidelines,” America: The Jesuit Review, June 22, 2023, https://www.americamagazine.org/politics-society/ 2023/06/22/ethical-religious-directives-revisioncatholic-health-care-245541.

8. Pope Francis, “Address of His Holiness Pope Francis to Members of the Diplomatic Corps Accredited to the Holy See,” The Holy See, January 8, 2024, https:// www.vatican.va/content/francesco/en/speeches/2024/ january/documents/20240108-corpo-diplomatico.html.

9. The Roman Catholic Church, Catechism of the Catholic Church, Second Edition (Vatican: Libreria Editrice Vaticana, 2000).

10. “Volunteering and Civic Life in America,” AmeriCorps, https://americorps.gov/about/our-impact/ volunteering-civic-life; “Global Volunteerism Journey Report,” Points of Light, April 2018, https://www. pointsoflight.org/wp-content/uploads/2019/03/Pointsof-Light-Global-Volunteerism-Journey-Report-FINAL.pdf.

11. Pope Benedict XVI, Caritas in Veritate, 1.

12. Pope Benedict XVI, Caritas in Veritate, 9.

BRIDGING DIVIDES

Fostering Teamwork to Promote Harmony in the Workplace

KELLY BILODEAU Contributor to Health Progress

“Everyone brings something with them when they come to work,” said Odesa Stapleton, chief diversity and inclusion officer at Bon Secours Mercy Health in Cincinnati. People are a collection of different work styles, lifestyles, needs and preferences, and it’s up to organizations to help them all get along.

The stakes in health care are high when it comes to ensuring teamwork and communication. Disconnects put patients at risk for medical errors, which affect one in 10 patients worldwide, according to the World Health Organization. 1 They can also drive long wait times, delayed hospital discharges and staff turnover, presenting a significant problem as many facilities still struggle to fill positions after the COVID-19 pandemic.2 Replacing a single nurse can cost a health care facility up to nearly $68,000.3 A recent retention and staffing report shows turnover has dropped but still hovers around 20% for hospitals overall and about 18% among nurses.4

While collegiality and collaboration are crucial, fostering them is not always easy in a highpressure environment with a clearly defined hierarchy. The same social, generational and political differences that roil relations outside health care also seep inside its walls.

While those who work in Catholic health care have a clearly defined mission and values, “That does not shield us from the same culturally, socially divisive experiences of the rest of the world,” said Jenna Speckart, vice president of

mission and ethics operations at St. Louis-based Mercy. However, keeping the focus on values can help the ministry stay true to the Catholic mission. “We always start with the fundamental principle of dignity,” she said.

UNDERSTANDING DIFFERENCES

The ideal work environment looks different to everyone, and differences in people’s personal lives can affect on-the-job relationships. “Some things that we notice when it comes to common workforce conflicts have to do with communication styles, workplace habits, and lack of role clarity and hierarchical challenges,” said Raj Ramachandran, a senior partner at WittKieffer, an executive search and advisory firm.

People often want different things from their careers. “Some people value workplace balance, or finding meaningful work or professional growth,” he said. For a single parent, the priority might be flexibility, said Speckart. But a worker without children may chafe at the idea they are the default to pick up extra shifts because they don’t have a family. Policies need to be supportive but also equally applied, Speckart said.

People also have communication and technology preferences. Some want to talk in person, while others prefer electronic methods. “We are very flexible in meeting people where they are,” Stapleton said. “If someone prefers to communicate via text, that’s fine. If someone prefers email, that’s fine. If some leaders prefer to have a phone call, that’s fine.” The goal is to harmonize the communication channels, taking advantage of all of them and respecting people’s partialities.

This extends to other differences as well. “The more you can improve relations, the more we can actually create better outcomes for our patients,” Ramachandran said. “There’s data that shows that more effectiveness happens when you’re collaborating.”

HIERARCHICAL STRUCTURE, INDIVIDUAL CHALLENGES

Health care’s hierarchical structure can pose a barrier to collaboration on interdisciplinary teams that form the backbone of patient care. Job titles in a hospital run the gamut from executives to housekeepers, physicians to phlebotomists. “Truthfully, we’re all a team trying to care for a patient,” said Katelyn Quarry, an assistant professor in the nursing school at Notre Dame of Maryland University. Care requires a unified effort. “The hospital cannot run without environmental services, dietary and the lab. We need those people so, so badly,” Quarry said. “And the physicians have realized they cannot run a hospital without nurses. We’re the ones who are at the bedside.”

juggles a lot, Quarry said. “You are like a cruise director. The phone is ringing off the hook; families have questions,” said Quarry. Patients need care. “I think the patients are sicker than they’ve ever been, so the stress level is higher.” It’s easy to snap at someone from pharmacy or phlebotomy who makes a request, she said.

Individual personalities also play a role. “You’re going to have a huge chunk in the middle that are just incredible at working with each other. But it’s always kind of the fringes that create a little bit of turmoil,” said Allan Calonge, chief people officer of core operations at Bon Secours Mercy Health in Cincinnati.

Politics isn’t typically at the forefront of conflicts, but it can be a factor, Mercy’s Speckart said. “I have not encountered a lot of conflict where we’ve had direct political divides. I have encountered conflict where you have folks who are clearly aligned with one political space, and they’re really trying to make more of an issue out

Care requires a unified effort.

“The hospital cannot run without environmental services, dietary and the lab. We need those people so, so badly. And the physicians have realized they cannot run a hospital without nurses. We’re the ones who are at the bedside.”

— KATELYN QUARRY

of what is happening because of this more subtle political tone,” she said.

Even so, differences in clout make it harder for some to speak up or have an equal voice. “But eliminating the hierarchies and acting as a team is the challenge,” she said.

A high-stress workplace further raises the stakes for staff interactions. “When I get called into a situation, it’s mostly because of a communication breakdown,” said Marisa Hiatt, director of disability, equity, inclusion and belonging at Mercy. “Our leaders and managers sometimes forget that we all have different learning styles. We’re all pressed for time. Health care is very fast-paced.”

As an example, a nurse working a 12-hour shift

Social media presents a double-edged sword, Calonge said. “It does complicate, but it also does help in some ways,” he said. Social media can fan controversy, but it’s also bringing new hires into the organization. “Our greatest recruitment tools right now are our YouTube shorts and TikTok,” he said.

PROMOTING A LEARNING CULTURE

Since the pandemic, many organizations have lost a lot of older workers who help maintain institutional memory and provide important contributions to the workplace. This is a blow to age diversity, which is critical to a well-balanced team.5 A survey highlighted by the AARP found that while

83% of global executives saw the importance of a multigenerational workforce, more than half don’t include age in diversity initiatives.6

However, while age differences can add value, generational training differences can present challenges in a health care workplace, Notre Dame’s Quarry said. There is sometimes, for instance, a disconnect between nurses who went through older training models and newer nurses coming into the profession.

“There was always this notion that you needed to prove yourself. So, you have to handle that ‘no good, very bad day’ without help to gain the respect of the senior nurses,” Quarry said. Today’s nurse trainers who experienced more of a hardline approach to their early workplace environments sometimes expect that younger or newer staffers should be tested in the same manner. “That still happens, and really it threatens patient safety,” she said. In extreme cases, these attitudes can drive new nurses out of the field, Quarry said. “It’s subtle. It’s the passive-aggressive eye-rolling when somebody asks a question for clarification, for safety. It’s making assignments unfair. Sometimes nurses want the new grads to sink or swim,” Quarry said.

Physician residency training, like nursing, has come a long way. “There’s been a lot of changes in medical education, for the better, to make it safer for the doctors. They don’t need to be working 90 hours a week; that’s not safe for anybody,” Quarry said. “And they need to be able to ask questions.” However, a true culture shift can be elusive. This clash of generational training attitudes can prevent people from speaking up or asking questions and undermine safety, especially in the intensive care unit (ICU), formerly the domain of highly experienced personnel. Since the pandemic, the ICU has seen an influx of inexperienced nurses out of necessity. In this pressure cooker environment, a misstep can be costly. “I think the culture of a unit is one of the most difficult things to change,” Quarry said. If not, you could lose staff. “You have to hold people accountable. And also work to people’s strengths.” If a nurse isn’t preceptor material, assigning them to another job is in everyone’s best interest.

ADDRESSING BIAS AND CULTURE

Generational differences also arise around unconscious bias training, aimed at making people

BRIDGING DIVIDES

aware of the potential harms of ingrained stereotypes about racial, cultural or other differences. Unchecked bias can influence hiring, promotions and patient care.7, 8

A topic not discussed much in the past, bias may be a more familiar concept for younger workers. “I have experienced that some of our younger generations are more willing to accept that they have unconscious bias, versus some of our older generations who may say, ‘I don’t know what that is,’ and, ‘No, I don’t have that,’” Speckart said. “I think it’s easier for some to accept that they have bias because they’ve been talking about it.”

Addressing issues around diversity can benefit patients by improving access to care and health outcomes, as well as their attitudes about the care they receive and the staff who provides it, according to the Commonwealth Fund.9 For example, an Annals of Internal Medicine study found that Black patients treated by doctors of the same race were more engaged in treatment and satisfied than those whose doctors were a different race.10 And diverse care teams often have better outcomes. Creating an inclusive environment can boost team performance by up to 30%, and companies with more diversity can see a payoff to the bottom line. Those with the most diversity see 36% higher profits when compared to those companies with the least.11

Diversity also extends to other types of differences. “One in 4 Americans identify as a person with a disability,” Hiatt said, which can sometimes affect team interactions. “I had a gentleman who was on the autism spectrum, a social communication disorder,” she said. “He was great at his job, the hard tasks.” However, he struggled to navigate social norms in the workplace, triggering conflicts. Staff members didn’t know he had autism. “He didn’t understand why the team didn’t like him,” she said. The employee opted to share his diagnosis, and the hospital system brought in an autism specialist to help mediate. “Once the coworkers understood he communicated differently, we saw a huge shift,” she said.

Neurodivergence — which affects 15% to 20% of the population and includes conditions such as autism spectrum disorder, attention deficit hyperactivity disorder, dyslexia, dyspraxia and some mental health conditions, such as obsessivecompulsive disorder — is sometimes an invisible problem, making it difficult to address, Hiatt

“You have to have the mindset that differences are acknowledged and valued in the organization, as opposed to just checking a box. This is not a quota system. We’re actually saying we need to bring diverse perspectives into the workplace, because that’s what’s going to allow us to be better.”

— RAJ RAMACHANDRAN

said.12 People with visible differences also face unique challenges. “When it’s an apparent disability, it’s a little easier to identify the support they need. However, a lot of times, there’s a bias,” she said. For example, some employees were skeptical that a blind employee could do the job because they couldn’t imagine themselves doing it without being able to see, Hiatt said. “That’s where we have to shift and say, ‘This is how we may think this job is done, but it can be done with assistive technology or a little flexibility,’” Hiatt said. It just takes some creativity.

Many workers with disabilities are part of the workforce. According to the U.S. Bureau of Labor Statistics, in 2023, nearly 23% of people with a disability were employed.13 Making adaptations and accommodations isn’t always easy, but it can pay off. “When leaders can shift and be flexible and creative, which I know takes time, that’s when you see people flourish,” Hiatt said. And often these are people who might otherwise have left the organization. “Every place is losing good people because we’re not having that interactive conversation,” she said.

FINDING SOLUTIONS TO CULTIVATE INCLUSIVITY

Maintaining a culture that fosters teamwork can be challenging. It requires ongoing vigilance. “I think a lot of this starts with the leader, and it creates the right culture, the right vibe, the right environment,” Calonge said. While it’s important to establish guardrails to set expectations and provide structure, flexibility is crucial.

Higher-ups are also focused on retention in a tight job market. “Leaders are realizing that there are options out there, so [they’re more motivated] to give people more of that work-life balance, more of that professional growth. I think that’s really key,” said Ramachandran. “We do a lot of leadership development work, and this idea of

creating avenues for staff members to grow and develop in their roles is really important.”

Leaders help set the tone for others, so sharing their own stories and differences is crucial to opening up a dialogue, Ramachandran said. Leaders can start that conversation themselves and acknowledge that, talk about the challenges they’ve endured and how they’ve overcome them, and then give them spaces for those dialogues, Ramachandran said. “That’s really promoting that open communication, creating more of that inclusivity. But really being willing to put themselves out there is a first step so that others can understand that that’s part of their culture.”

People need to know that their differences are valued. “You have to have the mindset that differences are acknowledged and valued in the organization, as opposed to just checking a box. This is not a quota system. We’re actually saying we need to bring diverse perspectives into the workplace, because that’s what’s going to allow us to be better,” Ramachandran said.

There’s no comprehensive guidebook for managers. “Because of the breadth of the types of situations that you may encounter as a manager, I don’t know if there’s any one manager who is prepared to encounter all of them,” Speckart said. “But I think the types of things that we would train for, or the types of things that we would look for, is how do we increase an openness to communication?”

Recognizing the complexities also requires a basic commitment to respect others, who they are and what they bring with them into the workplace.

“We are so blessed within Catholic health care to be able to use these deeply rooted principles and ideals to navigate these challenges. When we can constantly go back to that, it makes all the uncertainty of what is to come a little bit easier to navigate,” Speckart said.

BRIDGING DIVIDES

KELLY BILODEAU is a freelance writer who specializes in health care and the pharmaceutical industry. She is the former executive editor of Harvard Women’s Health Watch. Her work has also appeared in The Washington Post, Boston magazine and numerous health care publications.

NOTES

1. “Patient Safety,” World Health Organization, September 11, 2023, https://www.who.int/news-room/ fact-sheets/detail/patient-safety.

2. Jeff Niles, “The State of Healthcare Staffing in 2024,” Healthcare Workforce Logistics, January 25, 2024, https://blog.hwlworks.com/state-of-healthcarestaffing-2024.

3. Molly Gamble, “The Cost of Nurse Turnover in 24 Numbers | 2024,” Becker’s Hospital CFO Report, April 7, 2024, https://www.beckershospitalreview.com/finance/ the-cost-of-nurse-turnover-in-24-numbers-2024.html.

4. “2024 NSI National Health Care Retention & RN Staffing Report,” NSI Nursing Solutions, Inc., March 2024, https://www.nsinursingsolutions.com/ Documents/Library/NSI_National_Health_Care_ Retention_Report.pdf.

5. Debra Sabatini Hennelly and Bradley Schurman, “Bridging Generational Divides in Your Workplace,” Harvard Business Review, January 5, 2023, https:// hbr.org/2023/01bridging-generational-divides-in-yourworkplace.

6. “Global Insights on the Multigenerational Workforce,” AARP, https://www.aarpinternational.org/File%20

QUESTIONS FOR DISCUSSION

Library/Future%20of%20Work/2020-Global-InsightsMultigenerational-Workforce-Infographic.doi. 10.26419-2Fres.00399.002.pdf.

7. “Unconscious Bias Resources for Health Professionals,” Association of American Medical Colleges, https://www.aamc.org/about-us/equity-diversityinclusion/unconscious-bias-training.

8. Ursula Meidert et al., “Unconscious Bias among Health Professionals: A Scoping Review,” International Journal of Environmental Research and Public Health 20, no. 16 (August 20, 2023): 6569.

9. Laurie C. Zephyrin, Josemiguel Rodriguez, and Sara Rosenbaum, “The Case for Diversity in the Health Professions Remains Powerful,” The Commonwealth Fund, To the Point (blog), July 20, 2023, https://www.commonwealthfund.org/blog/2023/ case-diversity-health-professions-remains-powerful.

10. Dr. Lisa Cooper et al., “Patient-Centered Communication, Ratings of Care, and Concordance of Patient and Physician Race,” Annals of Internal Medicine 139, no. 11 (December 2, 2003): 907-915.

11. Hennelly and Schurman, “Bridging Generational Divides in Your Workplace.”

12. DCEG staff, “Neurodiversity,” National Cancer Institute, Division of Cancer Epidemiology & Genetics, April 25, 2022, https://dceg.cancer.gov/ about/diversity-inclusion/inclusivity-minute/2022/ neurodiversity.

13. “Persons with a Disability: Labor Force Characteristics — 2023,” U.S. Bureau of Labor Statistics, February 22, 2024, https://www.bls.gov/news.release/pdf/ disabl.pdf.

Author Kelly Bilodeau notes in this article, “While collegiality and collaboration are crucial, fostering them is not always easy in a high-pressure environment with a clearly defined hierarchy. The same social, generational and political differences that roil relations outside health care also seep inside its walls.” Yet, the article also explains that effective teams and workplaces where diversity is celebrated can benefit patient care and can allow for greater employee retention.

1. Have you given any thought to how you can improve your approach and relationships with those you work with for a more harmonious professional environment? How do you encourage greater diversity in your team and organization?

2. What does your organization do to accommodate employees with disabilities? What about differing communication styles or priorities?

3. If a workplace policy seems ineffective or unfair, is a system in place to provide feedback about it without retaliation? Are employees aware of how to raise concerns?

4. What’s one quality in a co-worker from a different background that you really appreciate and try to emulate?

BRIDGING DIVIDES

Mobile Clinics: Driving Toward Health Equity

MARY KATHRYN FALLON, MSA, CPA

Harvard Medical School’s The Family Van and Mobile Health Map

Health care is multifaceted, but the overall goal is to help people live their healthiest lives, regardless of who they are or where they live. This takes many forms, from prevention and health education, to clinical care and connection, to social and community-based services. Understanding patients, their cultures and preferences, their barriers and levels of health literacy is part of the equation that must be considered when working toward this goal.

Mobile clinics are an essential part of this solution, bringing access, trust and equity directly into communities. They ensure that everyone has access to lifesaving preventive, primary care and specialty services. As trusted providers of quality health care, mobile clinics reach marginalized communities and advance health equity. There are approximately 3,000 mobile clinics in the United States, providing 10 million visits each year.1

Mobile Health Map is a program of Harvard Medical School and the national research collaborative that studies mobile clinics and their impact. It is a free resource that works to promote and share the work of mobile clinics.

WHAT IS A MOBILE CLINIC?

So, what exactly is the mobile clinic care model, and how does it deliver quality care? Mobile clinics are similar to traditional health care settings, like a medical or dental office or emergency room. They have exam tables, medical equipment, supplies and health care personnel — everything you would expect from your traditional doctor’s office. But they are on wheels. Mobile clinics come in all shapes and sizes, from a large 40-foot camper-size vehicle to a small van. There is also great diversity in who runs and funds them, including university medical centers, hospitals, community health

centers, religious organizations, federal and state departments, nonprofit organizations and other philanthropic sources. Despite their diversity, mobile clinics share a common feature with one another: They provide high-quality health care.

SERVICES PROVIDED BY MOBILE CLINICS

Mobile clinics offer a variety of services tailored to the needs of the communities they serve. They provide services such as behavioral health, dental care, mammography, maternal and infant health, pediatrics, vision care and health prevention, according to Mobile Health Map’s data. Other mobile clinics provide health education and prevention services. Some clinics focus on specialized populations, such as people who are unhoused, uninsured or underinsured. Examples of specialized clinics include Stony Brook University Cancer Center’s mobile mammography van in New York and Virtua Health’s pediatric mobile health clinic in New Jersey. Some provide multiple types of services for marginalized populations, like The Night Ministry in Illinois.

The top five services currently provided by mobile clinics in the United States who have shared data are:

1. Immunizations

by

2. Obesity screenings

3. Social determinants of health screenings

4. Hypertension screenings

5. Mammograms

These services are accompanied with health education, often in the client’s native language. This type of health care can be lifesaving. The Family Van is a mobile health clinic that provides free health screenings, education and referrals to under-resourced neighborhoods in Boston, and is run by the same individuals who administer Mobile Health Map.

In addition to supporting individuals who have chronic diseases with health education, medication management support and tracking their numbers, the van also serves a significant number of walk-up clients who had no medical diagnosis of hypertension or diabetes but may be at risk for a chronic disease. Last year more than 170 people screened high for hypertension (49% of those screened who had not previously been identified and referred) and 140 people were found to have high blood glucose levels (53%). This type of early

intervention allows people to take control of their health, understand their risks and take action, often before ending up in the emergency room or having a significant health episode.

WHO DO MOBILE CLINICS SERVE?

Mobile clinics welcome anyone but are particularly skilled at reaching individuals disengaged or disenfranchised by the current health care system. They remove barriers to care, such as transportation, time, cost and language. Often, they serve people not connected to a health system, providing essential safety net services.

Understanding the culture and language of each community, as well as the resources available, is imperative for a clinic to be successful and to earn trust. A needs assessment is often performed to identify the best place to park, and it will differ for each clinic. For example, an urban clinic might park in the same place on the same day each week, while a rural clinic might travel to a particular location every month. Evaluating visit data and utilization by site and combining that with feedback from the community informs

Photo

Mim Adkins

Community health worker Ghislaine Firmin drives The Family Van, a project of Harvard Medical School, which visits medically underserved communities in the Boston area.

the schedule.

A study of the demographic data collected by Mobile Health Map reported that clinics do indeed reach individuals not connected to the health care system. It found: “Many mobile clinics aim to reach populations with limited access to care. To understand which client populations the clinics were designed to serve, clinics are asked [by Mobile Health Map] to report the group or groups they target. Of the 291 clinics reporting, 56% targeted the uninsured, 55% low-income groups, 38% homeless persons and 36% rural communities.”2

MOBILE CLINICS IMPROVE HEALTH EQUITY

Mobile clinics do more than provide health care on wheels. They directly address access, trust and equity.

Access: Mobile clinics bring care directly into the community, often in familiar and accessible neighborhoods. Mobile clinics overcome barriers, such as transportation challenges, time constraints and cultural or language barriers. This does a lot to promote health equity. But for health care to be truly accessible, it must also be affordable and convenient. Many mobile clinics do not require appointments or insurance and offer care at low or no cost, welcoming all people regardless of their ability to pay.

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The Family Van. An elderly Portuguese-speaking woman visited the van. She hadn’t seen her primary care physician in a long time, so after she was greeted and services explained, she requested all the routine screenings (blood pressure, blood glucose, cholesterol). Her cholesterol screening came back quite elevated. The team of community health workers, speaking in her native Portuguese, educated her on what high cholesterol is and made a referral for her to see a doctor to discuss ways her cholesterol could be lowered, such as taking a statin. She said, “No, thank you, it doesn’t matter if I am prescribed medication because I do not have insurance to cover the cost.”

This medication access, which is a social determinant of health, created a barrier for her and prevented her from taking care of herself.

So, what did the van staff do? First, they contacted the Mayor’s Health Line — a free, confidential and multilingual information and referral service for Boston residents — and made an appointment for her on the spot to learn about what insurance is available to her and how to

People are more likely to seek health care services from a trusted provider and to follow recommendations when they understand them and are understood.

Trust: Mobile clinics are often communitydriven and staffed by members of the community they serve. Trust is earned by listening to the patient, providing care and education in a preferred language while considering cultural norms and preferences, and understanding the resources available in the community. People are more likely to seek health care services from a trusted provider and to follow recommendations when they understand them and are understood.

Equity: Mobile clinics welcome everyone, regardless of race, ethnicity, disability, gender identity, disability status, sexual orientation, socioeconomic status, people with limited English proficiency or other populations that experience health disparities.

An example of this type of health care that encompasses access, trust and equity is illustrated by a recent encounter in the Boston area on

obtain it. They explained what documents she would need to bring with her, letting her know the appointment was made with a Portuguesespeaking provider.

But the mobile clinic staff did even more. They called her preferred pharmacy, explained the situation and asked if there was a payment assistance program. The pharmacist confirmed that they did indeed have a financial assistance program where, if she qualified, she would be able to get the cost of a prescription statin down to $45 for a threemonth supply (compared to $450–$500). The pharmacist told her to come in so that he could assist her with the application process.

Finally, the mobile clinic staff educated her on the reasons why addressing cholesterol is so important, how the medication works in the body and why taking it on a regular schedule is vital. She went on her way with knowledge and a plan to take control of her health.

This is typical of what happens on mobile

health vans. This type of service goes a long way toward improving lives, building trust and increasing health equity.

Morgan Ellis, a current community engagement intern on The Family Van, observed, “To our clients, The Family Van serves as a gateway to holistic health care, emphasizing the individual as a whole. We recognize that behind every blood pressure and blood sugar reading, there are personal stories that shape each individual. By focusing on that, we create an environment that clients feel comfortable being in and that goes beyond numbers.”

OTHER BENEFITS OF MOBILE CLINICS

Mobile clinics’ other benefits support equitable health care delivery. They are responsive and nimble — able to move locations as community needs change and respond quickly in an emergency, like Project Vision Hawaii’s mobile clinic that was on the front lines of the 2023 Maui fires. Mobile clinics are also answering the call as rural hospitals close across the country, and they can travel to those areas to provide the care those communities so desperately need.

In addition, mobile clinics provide a training ground for future providers, which can contribute to systemic change in reducing health disparities. This benefit is best described by Ben Kovachy, a then-medical student who spent a month on The Family Van and has since graduated. “Having completed three years of medical school, I have spent many hours working in the health care system. … Over the years and across settings, I recall a number of patients who faced difficulty in getting access to health care due to issues of insurance, legal status and/or cost. Yet, it was striking that in a single day on The Family Van in East Boston, I heard about as many of these stories as I had heard in about six months at the hospital.”

“Over

LEARN MORE

Check out the Mobile Health Map to see if there’s a clinic near you. If your organization has a mobile clinic and you are not listed, please register your clinic. It is free and contributes to the body of research promoting mobile health.

If you are interested in learning about how to start a clinic, read “The Case for Mobile” report,1 and know those who work with Mobile Health Map are available to answer questions or link you to resources.

We also recommended joining the national association of mobile clinics, the Mobile Healthcare Association.2 The association holds an annual conference, has regional mobile clinic coalitions and provides resources and trainings.

NOTES

1. “The Case for Mobile: Mobile Healthcare is Good for Communities and Good for Business,” Mobile Health Map, 2021, https://www.mobilehealthmap.org/ wp-content/uploads/2022/11/The-CaseFor-Mobile-2022-Updated.pdf.

2. Mobile Healthcare Association, https://mobilehca.org.

These lessons and hands-on experiences will stay with future health care providers, shaping the way they will provide care to all people, improving access and creating systemic change.

DATA-GATHERING TOOLS FOR MOBILE CLINICS

The Mobile Health Map website has an impact tracker that shows the location of mobile clinics

the years and across settings, I recall a number of patients who faced difficulty in getting access to health care due to issues of insurance, legal status and/or cost. Yet, it was striking that in a single day on The Family Van in East Boston, I heard about as many of these stories as I had heard in about six months at the hospital.”

— BEN KOVACHY

BRIDGING DIVIDES

The Night Ministry, based in Chicago, provides human connection, housing support and health care to people who are unhoused or living in poverty. Here, a psychiatric nurse practitioner conducts a glucose blood test with a patient on the Health Outreach Bus.

around the country, including their names, the type of services they provide and the populations they serve.3 The map allows you to layer other social impact census data over the mobile clinic data to get a full picture of the landscape.

The website has free tools for clinics, allowing them to enter their data into a secure platform that provides both return on investment calculations and health quality ratings. Clinics that add data receive a custom dashboard that they can share with stakeholders, funders and decision-makers. Then the individual clinic data is aggregated to share the impact of the sector as a whole, which shows that mobile clinics have a very impressive aggregate return on investment of $21:$1. In addition, as this issue of Health Progress went to print, of the more than 1,200 clinics registered on the map, it showed that mobile clinics have nearly $924 million saved in health care costs, have avoided approximately 38,000 emergency room visits and have resulted in close to 12,700 life years saved over the past five years.

Mobile Health Map also publishes and shares research and papers on the sector and assists clinics in program evaluation and dissemination. It

also provides free training, webinars and information sharing.

Working together to promote health equity is accomplished throughout all facets of health care systems, and mobile clinics are a key component of this. Real change can happen, but it will take commitment and action to change culture, systems and expectations to improve the health of all people.

MARY KATHRYN FALLON works for Harvard Medical School as the assistant director of finance and operations for The Family Van and Mobile Health Map.

NOTES

1. “Our Mission,” Mobile Health Map, https://www.mobilehealthmap.org/what-we-do/ our-mission/.

2. Nelson C. Malone et al., “Mobile Health Clinics in the United States,” International Journal for Equity in Health 19, no. 1 (March 2020).

3. “Mobile Clinic Impact Tracker,” Mobile Health Map, https://www.mobilehealthmap.org/ tableau-public-data/.

Photo courtesy of The Night Ministry

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The Ripple Effect of ‘WASH’ in Catholic Health Care

SUSAN K. BARNETT Founder of Faiths for Safe Water

When the Daughters of Charity of St. Vincent de Paul first arrived in Ondo State in Nigeria in 1988, they found fertile agriculture as well as fertile ground for disease and severely limited health care. In 1995, they made a giant health care leap. They opened St. Catherine’s Hospital and Maternity. The initial site and building, which were donated, grew to accommodate the remote community’s needs. They do not charge patients.

Over nearly 30 years, they’ve treated countless patients. But without an influx of needed funds, St. Catherine’s health care story also became another story — a common one seldom told.

Tens of thousands of faith-based health care facilities around the world serve populations in impoverished areas where there might otherwise be no health care. But from maternal and newborn infections and deaths to dozens of illnesses and diseases, from malnutrition to the growing global crisis of antibiotic resistance, the root of health problems often returns to one thing, and it’s the absence of WASH: water, sanitation and hygiene.

With small budgets stretched to the breaking point, stocking drugs and meeting basic treatment protocols become the priorities. The necessity of WASH goes unmet. The irony, of course, is that access to WASH is the foundation for preventing many of the infections that make these drugs and treatments necessary, and contaminated water can make already vulnerable patients sicker.

The lack of priority and budgets for sourcing safe water and WASH infrastructure means pipes,

pumps, tanks and toilets don’t exist. Or they age, break and don’t get fixed. As an advocate for improved water, sanitation and hygiene measures throughout the world, I can’t count the number of broken faucets I’ve encountered, or sinks used as bookshelves and trash bins (or even collapsed off the wall entirely). Toilets are germ-ridden; medical waste is openly burned, leading to dangerous environments; labor and delivery ward conditions are shocking. Staff, including cleaners, are left to work and live in sometimes terrible conditions. Most do the best they can, but safe and dignified care is impossible.

This crisis is by no means specific to faithbased health care. Across the 46 least developed countries, 47% of all health care facilities lack basic water services, 79% lack sanitation services, 68% lack basic hygiene services, such as hand-washing, and 66% lack basic waste management. The consequences ripple outward into a cavalcade of problems — the lack of infection prevention and control leads to health care-associated infections and antimicrobial resistance, with a massive economic impact on gross domestic product.1

THE RIPPLE EFFECT

But there’s another ripple effect underway. A very good one.

I first wrote about a Vatican pilot initiative to improve WASH services in Catholic-run health care facilities for the Health Progress Fall 2021 issue.2 At that time, 150 Catholic health care facilities were wrapping up WASH assessments. In what now feels prescient, interest in this pilot project by the Vatican’s Dicastery for Promoting Integral Human Development began in 2019, before the COVID-19 pandemic.3

When the Dicastery officially reached out to bishops in 2020 to see if any might be interested in voluntarily participating, the invitation provoked an outpouring across 23 countries and 65 dioceses. WASH assessments got underway in the first 150 health care facilities that requested help, with a symbolic “151st” representing the WASH needs across the Catholic health care system, the “Ecclesia Universalis.”

Cardinal Michael F. Czerny, SJ, took over leadership of the Dicastery in 2022 and continues his strong support. “These facilities are invaluable, especially in deprived zones in which concerns for economic development and donor generosity go hand in hand. It is a matter of human dignity, solidarity and social justice,” says Cardinal Czerny. “I may add that providing effective health care is a way of avoiding other social and economic burdens to the society, and it is also a way of contributing to the equality of opportunities for all of which the Holy Father speaks about in Laudate Deum.”4

totaling 28 million people.

So far, more than $3 million has been raised in private donations and spread across about half the facilities. These funds are being used to train staff in WASH management and focus on the most critical WASH needs as funding allows. Of course, it’s not just about the money. For some projects, technical expertise and community labor contribute as much as 20% of the total project cost. And some WASH needs don’t need funding; they just need to be identified and then prioritized.

The core teams leading the way include Catholic Relief Services and Caritas Internationalis, along with Daughters of Charity and their technical partner Water Engineers for the Americas and Africa. Other participants include (but are not limited to) the Camillian Sisters, Brothers Hospitallers of Saint John of God, also known as Fatebenefratelli, and Doctors with Africa. The Catholic Health Association and several CHA members have contributed to global WASH work.

At St. Catherine’s Hospital and Maternity in Nigeria, the hospital no longer drains muchneeded funds on purchasing and transporting water. Sr. Mary Louise Stubbs, DC, who leads the Daughters of Charity International Project Services, raised funds to drill a new borehole for water and build new water tanks. They’ve also demolished unsafe infrastructure and built an incinerator to safely dispose of hazardous medical waste. There are new latrines accessible to those with disabilities and plenty of hand-washing stations.

“These facilities are invaluable … It is a matter of human dignity, solidarity and social justice.”

— CARDINAL MICHAEL F. CZERNY, SJ

Thanks to the 150 WASH assessments, nearly all the facilities have identified needs and estimated costs. The price tag to improve all aspects of WASH, including maintenance and operations for sustainability, averages $80,000 per facility; of course, that varies per needs. The total budget for these 150 health care facilities to get, repair or upgrade WASH — and ensure sustainability — is $12 million. If that sounds like a lot of money, it’s just $2.33 per person, considering these 150 facilities cover catchment areas

These WASH improvements have met a laundry list of needs. Not only do staff and patients have enough clean running water, but the community also has access to this safe water, which reduces exposure to waterborne diseases the health care center might otherwise need to treat. Improved facility conditions mean more people will be willing to seek out care at St. Catherine’s, especially prenatal, maternal and newborn care. Nigeria has the second highest maternal and newborn death rates in the world, with preventable infection among the leading causes.5, 6

Despite its many health benefits, getting WASH into health care facilities has, until recently, largely remained under the global radar. Then, in 2018, UN Secretary-General António Guterres issued the first global call to action. The World Health Assem-

BRIDGING DIVIDES

A Daughter of Charity, Sr. Augustina, is delighted with the new groundwater well at the health care facility she runs in Ondo State, Nigeria. With the well project inside their health care compound completed, the sisters now often have enough water to share with the public for community use, too.

bly followed with a resolution and WHO/UNICEF followed with eight practical steps as guidance.7-9

These initial UN actions were important in generating much-needed attention. That the Catholic Church — which operates a quarter of the world’s health care facilities and is the largest network of providers in the world — decided to take a look in its own backyard is admirable and influential.10

“Adequate WASH conditions in all health care facilities are a fundamental need and a priority. The assessment carried out through so many partners over the past years has revealed that there is much to be done in Catholic facilities in poor areas,” says Cardinal Czerny. “Moreover, the requests for assistance and training emanating even from health centers or congregations not involved in the initial assessment demonstrate a greater awareness of these issues.”

Indeed, this Dicastery-driven project has garnered attention at the highest levels in Rome, across dioceses, at the UN, WHO and UNICEF, and has attracted funders including CHA members, new partner organizations and local government engagement. While it is impossible to know how many more Catholic, public and other faithrun health care facilities are starting to look at their

own WASH needs, we know the ripple is widening.

Tony Castleman, director of agriculture, livelihoods, water and environment at Catholic Relief Services, sees the attention to this effort expanding. “The involvement of the Vatican’s Dicastery has been critical to inspiring dioceses, congregations and other local partners to prioritize improving WASH in health care facilities,” says Castleman, who also serves as director of monitoring, evaluation, accountability and learning for Catholic Relief Services. “The Dicastery’s voice has helped bring attention to this critical issue.” Sr. Stubbs agrees: “Being able to say we’re working with the Vatican on WASH projects increases our advocacy and reach.” She adds that the partnership has generated many more health facility water system projects for her organization, projects that also benefit communities.

It’s so important to note that faith-based health care facilities are not just embedded in a community; they are the community. Sometimes lip service is paid to community-led efforts, but organizations like Catholic Relief Services and Daughters of Charity live it. “The community impact of any one of these WASH projects,” says Sr. Stubbs, “is enormous.” A WASH project creates jobs.

Photo by

Daughters of Charity

The community gets access to the new water point. No longer having to spend time searching for water, girls get to go to school. The sisters actively engage community health workers, who spread health education — from hand-washing, to improving maternal and child health, starting with clean births, to emphasizing the importance of safe water for HIV/AIDS patients.

The Kenya Conference of Catholic Bishops has the largest number of health care facilities participating in this Vatican pilot. Kenya is also among the most water-scarce countries in the world, and the climate crisis only makes conditions worse. Assessments found most facilities had no access to safe drinking water because water came primarily from unprotected boreholes or vendors that transport water from rivers. Medical waste was burned in open pits, toilets were unhygienic and not accessible, and staff had limited WASH training. At one facility, when there was no water, the maternity ward would be shut down.

With 22 of 28 pilot facilities having received some private funding through this initiative, the Kenya Conference of Catholic Bishops and Catholic Relief Services began work on critical improvements, such as new water tanks with increased capacity for rainwater collection during dry seasons. In one facility, where the biggest challenge was replacing its borehole damaged by elephants, they’ve installed a solar pump and fenced the area in the hopes of keeping out animals. Data collection systems are also being set up to better measure impact, especially when it comes to reducing health care-associated infections.

But what isn’t typical is what happened next.

The Kenya Conference of Catholic Bishops is going to try to tackle the Achilles’ heel of WASH — sustainability — by hiring a point person whose sole purpose is to ensure it. WASH conditions inevitably deteriorate, and when there is no one with the focus, skills, tools and parts, and the funds to do preventive maintenance and fix problems, WASH falls apart. By hiring a dedicated person, the Kenyan conference will advance global understanding of how to systemically address this pervasive challenge. Starting with these 28 facilities, they hope to eventually cover all 497 of Kenya’s Catholic facilities.

Then came another ripple effect. WASH construction attracted the attention of regional and local government officials. Catholic-run facilities are becoming models and training sites for public facilities, which have many similar WASH needs.

In one diocese, the county government, in partnership with Catholic Relief Services and the diocese, is now mapping out water delivery options in a particularly arid area, sharing findings and connecting Catholic facilities to the public water utility system, where applicable.

The Vatican initiative is not limited to Africa. The Philippines has stronger government health care regulations, and medical staff are highly qualified. Still, facilities face structural problems and, not surprisingly, sustainability issues. WASH assessments found a lack of preventive maintenance, spare parts and funding for repairs. This systemic weakness led Catholic Relief Services to work with the Philippine pilot facilities to strengthen management to improve operations, maintenance and life cycle financing, and collect district-wide WASH data for better monitoring.

SMART INVESTMENT MADE SMARTER

These are some of the good tales to tell. Even so, Cardinal Czerny acknowledges broader support is needed. “A whole ecosystem is needed for the Church to effectively carry out this part of its diakonia ministry: the commitment of universities and other training centers, qualified experts, bishops, vigilant leaders in the health sector and well-trained staff. Procedures, maintenance routines and economic capacity are needed to support health care facilities.”

When it comes to increasing economic capacity with sustained funding, doubters out there — whether public or private funders — would be wise to take a look at a recent eye-popping report from WaterAid.11

Preventable infections acquired inside health care facilities, such as sepsis and pneumonia, are costing Sub-Saharan Africa a staggering $8.4 billion each year. Most health care-associated infections are caused by contaminated hands, surfaces or equipment. Infection prevention and control, like proper hand-washing, could prevent up to 70% of these infections. This $8.4 billion is also equivalent to the funds needed to provide universal, basic WASH services in all health care facilities across the 46 least developed countries where WASH remains desperately needed.12, 13

Using World Bank economic assessments generated with new methodology (available to countries to do their own assessments), WaterAid focused its report on seven countries where it has a presence: Nigeria, Ethiopia, Zambia, Uganda, Mali, Ghana and Malawi.14 Just to give a taste of

the extraordinary financial burden imposed by health care-associated infections, in Malawi, the impact on GDP is nearly 3% and consumes almost 11% of its annual health care budget. On average, health care-associated infections alone cost 4.5% of these health budgets every year. Investment in WASH more than pays for itself.

We talk about mass casualties in terms of war, but health care-associated infections are a war on the masses, causing mass death and suffering.

Of course, financial impact is not the only burden. One in 10 patients with a health care-associated infection will die.15 (I will never forget what a nurse sent from Scandinavia to install incubators in rural government health care facilities in East Africa once told me. Without reliable WASH, these incubators were, in his exact words, “killing machines.”)

We talk about mass casualties in terms of war, but health care-associated infections are a war on the masses, causing mass death and suffering.

To stop the rapid spread of health care-associated infections where WASH is lacking, health care providers overuse antibiotics. This, of course, contributes to antibiotic resistance, which kills at least 1.27 million people worldwide annually.16 But what choice do they have? The WHO makes this frightening prediction, “In all countries, some routine surgical operations and cancer chemotherapy will become less safe without effective antibiotics to protect against infections.” The World Bank estimates additional health care costs due to antibiotic resistance will top $1 trillion by 2050, and $1-$3.4 trillion in GDP losses per year by 2030.17, 18

NEW TOOL FOR ADVOCATES

In one way or another, we are all affected by the lack of WASH in health care facilities. While there are many competing global needs, this needs to be one of them. The UN General Assembly’s resolution to get water and sanitation, electricity, and a way to manage human and medical waste into every health care facility by 2030 is a new concrete tool for advocacy. 19 It was unanimously adopted and secured government commitments at the highest levels to increase coordination, collaboration, funding and technical support, as well as to identify bottlenecks.

BRIDGING DIVIDES

For advocates, it provides opportunities to remind leaders of this global commitment and its urgency. Advocates can invite policymakers to visit health care facilities to see conditions for themselves; engage health care facility staff to demand a safe and dignified working environment; highlight the value of WASH investments; hold leaders to account; and publicize progress to put good pressure on more decision-makers.

Since the worst days of COVID-19, when we faced a shortage of the health care many of us had come to expect, most of us better appreciate the tremendous pressures on health care facilities and staff. Among us is Pope Francis. “These past years of the pandemic have increased our sense of gratitude for those who work each day in the fields of health care and research,” he said on World Day of the Sick in 2023. “Yet it is not enough to emerge from such an immense collective tragedy simply by honoring heroes. COVID-19 … exposed the structural limits of existing public welfare systems. Gratitude, then, needs to be matched by actively seeking, in every country, strategies and resources in order to guarantee each person’s fundamental right to basic and decent health care.”20

There is ample opportunity to actively seek ways to offer support for WASH. As one nonCatholic funder of this initiative told me, “I’ve been inspired by how Catholic sisters working in hospitals and clinics in the most remote areas of the world are faithfully responding to the medical needs of the poorest of the poor, and how devastatingly difficult it is for them to do so if their health facility lacks water, adequate toilets or a place to wash hands.”

Catholic health systems will continue to catalyze growing global commitments to safer and more dignified health care for all. If you’re not yet part of these efforts, know that your help would be welcome.

SUSAN K. BARNETT is founder of Faiths for Safe Water and was part of the four-year Global Water 2020 initiative, which focused on underrepresented issues of global water health and security. A former journalist with the network newsmagazines PrimeTime Live, 20/20 (ABC News) and Dateline NBC, she now leads Cause Communications.

NOTES

1. “Half of Health Care Facilities Globally Lack Basic Hygiene Services – WHO, UNICEF,” World Health Organization, August 30, 2022, https://www.who.int/news/ item/30-08-2022-half-of-health-care-facilities-globallylack-basic-hygiene-services---who--unicef.

2. Susan K. Barnett, “Water, Sanitation and Hygiene: Vatican, Catholic Health Care Take Leadership Roles in ‘WASH’ Work,” Health Progress 102, no. 4 (Fall 2021): 38-44.

3. “WASH–Water Sanitation Hygiene,” Dicastery for Promoting Integral Human Development, January 17, 2024, https://www.humandevelopment.va/en/progetti/washwater-sanitation-hygiene.html.

4. Pope Francis, Laudate Deum, The Holy See, https://www.vatican.va/content/francesco/en/apost_ exhortations/documents/20231004-laudate-deum. html.

5. Nike Adebowale-Tambe, “Nigeria Is World’s Second Nation with High Maternal, Child Deaths — Report,” Premium Times, May 10, 2023, https:// www.premiumtimesng.com/news/top-news/ 597814-nigeria-is-worlds-second-nation-with-highmaternal-child-deaths-report.html?tztc=1.

6. Patricia Tonbra Osunu, Charles C. Ofili, and Ezekiel Uba Nwose, “Maternal Mortality in Nigeria: A Consideration of Infection Control Factor,” Preventive Medicine and Community Health 4 (2021): https://doi.org/10.15761/ PMCH.1000158.

7. “UN Secretary-General’s Call to Action on WASH in Healthcare Facilities,” Children’s Environmental Health Collaborative, March 2018, https://ceh. unicef.org/events-and-resources/knowledge-library/ un-secretary-generals-call-action-wash-healthcarefacilities.

8. “Water, Sanitation and Hygiene in Health Care Facilities,” WHO, January 30, 2019, https://apps.who.int/ gb/ebwha/pdf_files/EB144/B144_R5-en.pdf.

9. “Eight Practical Steps to Achieve Universal Access to Quality Care,” WASH in Health Care Facilities, https://www.washinhcf.org/practical-steps/.

10. “Catholic Health WASH Hub,” GoodLands, https://catholic-healthcare-facilities-wash-cgisc.hub.

FOR MORE INFORMATION:

arcgis.com/.

11. “Sub-Saharan Africa Left to Pick Up $8.4 Billion Cost of Healthcare Infections,” WaterAid, April 5, 2024, https://www.wateraid.org/uk/media/sub-saharanafrica-left-to-pick-up-84-billion-cost-of-healthcareinfections.

12. “WHO Launches First Ever Global Report on Infection Prevention and Control,” WHO, May 6, 2022, https://www.who.int/news/item/06-05-2022who-launches-first-ever-global-report-on-infectionprevention-and-control.

13. Michael Chaitkin et al., “Estimating the Cost of Achieving Basic Water, Sanitation, Hygiene, and Waste Management Services in Public Health-Care Facilities in the 46 UN Designated Least-Developed Countries: A Modelling Study,” The Lancet 10, no. 6 (April 2022): 840-849, https://doi.org/10.1016/ S2214-109X(22)00099-7.

14. “Costs of Health Care Associated Infections from Inadequate Water and Sanitation in Health Care Facilities in Eastern and Southern Africa (English),” World Bank Group, https://documents.world bank.org/en/publication/documents-reports/ documentdetail/099428002212438578.

15. “WHO Launches First Ever Global Report on Infection Prevention and Control.”

16. “Antimicrobial Resistance,” WHO, November 21, 2023, https://www.who.int/news-room/fact-sheets/ detail/antimicrobial-resistance.

17. “Global Action Plan on Antimicrobial Resistance,” WHO, 2015, https://www.amcra.be/swfiles/files/ WHO%20actieplan_90.pdf.

18. “Drug-Resistant Infections: A Threat to Our Economic Future,” World Bank Group, https://www.worldbank.org/ en/topic/health/publication/drug-resistantinfections-a-threat-to-our-economic-future; “Antimicrobial Resistance.”

19. “Global Action Plan on Antimicrobial Resistance.”

20. Pope Francis, “Message of His Holiness Pope Francis XXXI World Day of the Sick,” The Holy See, February 11, 2023, https://www.vatican.va/content/francesco/en/ messages/sick/documents/20230110-giornata-malato. html.

For Daughters of Charity, contact Sr. Mary Louis Stubbs, DC, executive director of Daughters of Charity International Project Services, at marylouise.stubbs@doc.org.

For Catholic Relief Services, contact Kevin Kostic, director of donor relations, at kevin.kostic@crs.org. For Dicastery for Promoting Integral Human Development, contact water@humandevelopment.va.

to one another, compassionate, oneforgivinganother

“Be kind ” as God has forgiven you in Christ.

EPHESIANS 4:32

Finding God in Daily Life

BRIDGING DIVIDES

Bridging Religious Identity in Health Care: The Time Is Now

EBOO PATEL, PhD Founder and President, Interfaith America

SUZANNE WATTS HENDERSON, PhD Senior Director of Faith & Health, Interfaith America

Anne Fadiman’s book, The Spirit Catches You and You Fall Down, tells the true story of a three-month-old girl, Lia Lee, in Merced, California, who began to shake uncontrollably.1 Her parents, immigrants from Laos, took her to a hospital where a team of highly committed doctors did everything you would expect: They stabilized the patient, drew blood and ran tests. They diagnosed little Lia with epilepsy and prescribed a complex cocktail of drugs for the parents to administer at set intervals.

Lia’s parents were part of the Hmong community and believed in a faith tradition that, in its simplest terms, would be described as shamanist. Based on their religious beliefs, they had a different understanding of her condition. Their view was that an evil spirit had captured her soul. They also had a cure: The right animals must be sacrificed, in the right ceremonies, with the right religious leaders present, and the souls of those animals traded to this evil spirit in return for Lia’s soul.

Most of the doctors at the hospital knew little about this Hmong belief and practice, but they were devoted to Lia’s health. What they knew was that her parents were not giving Lia her medicine, which concerned them deeply.

Her parents were frustrated, too. They believed that some of the hospital’s practices — waking babies up when they are sleeping to run tests, giving medicine that makes babies sluggish, and separating children from their parents — made Lia’s condition worse. They also disliked the hospital’s cultural practices. In Hmong culture, you speak to

the father first. You inquire about how the family is doing before launching into conversations on more serious topics.

A combination of Lia’s parents’ mistrust and lack of clear understanding meant they were inconsistent at best in administering her medication. Over the course of her early years, her condition got worse. The doctors called child protective services and had Lia removed from her parents’ home. It is a tragic story with a tragic ending. Lia fell into a vegetative state and lived that way for the next 26 years of her life until her death at the age of 30.

At the end of the book, the author looks at Lia Lee’s original intake file at the hospital and is taken aback to find that under the category “Religion” the box “none” had been checked. In a way, this one detail symbolizes the entire calamitous story: However good the doctors might have been, their inability to engage constructively with Lia’s family’s faith identity contributed to the terrible outcome.

Just as this story offers a cautionary tale about

the dangers of disconnecting health care from religion, it offers an invitation to bridge that divide in ways that strengthen health outcomes for all, especially the most vulnerable. While Lia was not at a Catholic hospital, faith-based health care systems may provide some practices that illuminate a path forward to better build on religious diversity to strengthen care. After all, on their best days, Catholic institutions operate from a core understanding of the religious dimension of the human journey. At a Catholic hospital, the intake process might well have brought to light the ways the family’s Hmong culture shaped their view of Lia’s condition and her path to healing.

MAKING THE CASE FOR INTERFAITH ENGAGEMENT

Several factors raise the stakes when it comes to taking faith traditions seriously in health care settings. For one thing, despite the rise in the religiously unaffiliated, it is still the case that more than 70% of Americans say religion is very or somewhat important in their lives. 2 Moreover,

tity more highly than other groups. That makes engaging our nation’s religious diversity a matter of health equity, as we see in the case of Lia’s immigrant family.

Despite this growing awareness about the vital importance of engaging faith in health settings, doctors and other clinicians still feel ill-equipped to cross what they perceive to be a “religion-science” divide in their patient interactions. 6 For some, it’s the pressure to shorten time spent with patients, which curbs meaningful interaction; for others, it’s an understandable discomfort about discussing a topic they’ve often been told, somewhat ironically, is “taboo.”

CATHOLIC HEALTH CAN LEAD THE WAY

Here’s the good news: There may be no group of health providers better positioned to bridge the faith and health divide than those rooted in the Catholic tradition. With its timeless commitment to uplifting human dignity in service to the common good, and its missional attentiveness to Pope Francis’ call to a “culture of encounter,” Catholic health leaders embrace their vocation as vessels of healing for all people, regardless of a patient’s faith tradition or worldview.

Despite this growing awareness about the vital importance of engaging faith in health settings, doctors and other clinicians still feel ill-equipped to cross what they perceive to be a “religion-science” divide in their patient interactions.

demographic shifts in the U.S. landscape lead researchers to predict both the decline of Christian identity and the steady increase of those identifying with minority traditions — such as Judaism, Islam and Buddhism — in coming decades.3

At the same time, a growing body of evidence suggests that attending to patients’ religious or spiritual identities in caregiving settings makes a difference in health outcomes.4 In fact, a recent article, titled “Spirituality as a Determinant of Health,” highlights the promise of engaging our nation’s religious diversity as a key strategy in person- and community-centered policies and practices.5 After all, groups that have historically faced more barriers to high-quality care — and thus harbor suspicion or mistrust when they seek it — tend to index their religious or spiritual iden-

As the Ethical and Religious Directives for Catholic Health Care Services makes clear, this isn’t “despite” Catholic identity — it’s “because” of it. Our organization, Interfaith America, is a relative newcomer to the health care landscape. But we’ve been working for decades to help campuses train the next generation of civic leaders to engage religious diversity well. Along the way, it’s been Catholic institutions, from universities like Georgetown to DePaul to Dominican, that have led the way, tapping into their distinctive Catholic roots as inspiration for fostering pluralism in the classroom and beyond.

Over the last four years, Interfaith America’s Faith & Health sector has applied a similar approach in health-related spaces. We’re partnering with leaders from health care, public health, higher education and other professional settings to embed interfaith learning across platforms — ranging from wellness to diversity, equity and inclusion (DEI) initiatives to curricula and grand

rounds — all to bridge religious and spiritual divides to strengthen health outcomes for all.

KEYS TO BRIDGING THE FAITH-HEALTH DIVIDE

Our growing partnerships have highlighted what it takes to bridge the faith and health divide. From Lia’s story, we know that “to bridge” can lead to outcomes that literally mean the difference between life and death.7 There are a variety of ways to build and strengthen these bridges in health care settings.

1. Leadership Matters

Health system leaders — from CEOs and their teams to floor- or practice-level leaders — can prioritize the training that equips their teams to engage religious diversity well by connecting that work to institutional mission. In the case of Catholic health, leaders can clearly articulate the religious values that undergird their commitment to the care of people, not just their diagnosis and treatment. They can ensure their team benefits from opportunities to build understanding and skills related to religious diversity and can invest in cross-team initiatives designed to bridge the faith and health divide. They also can take the lead in measuring the impact of such efforts on health outcomes and vital human flourishing by integrating such assessments into existing protocols. In other words, leaders can provide the visionary and strategic motivation, as well as the resources, that helps ground Catholic health to its origins.

2. Systems and Protocols

Part of bridging the faith and health divide successfully means integrating religious diversity as a factor across the systems and protocols that ensure quality care. For example, we’re all familiar with such intake questions as “How often do you wear your seat belt?” or “How many servings of alcohol do you consume?” But how much do clinicians know about what matters to their patients when it comes to how they approach questions of disease, healing, life and death? A growing number of health systems are adopting tools such as the FICA Spiritual History Assessment Tool8 to position practitioners as companions on patients’ health care journeys — not just as transactional experts prescribing medications and procedures.

Similarly, how do we account for religiously inspired dietary restrictions in the menu options

BRIDGING DIVIDES

provided to patients? For patients near the end of life, Catholic hospitals are well-equipped to ensure last rites for patients who seek them, but what about equally thoughtful attention to patients whose native sacred practices entail a smudging ceremony, an indigenous ritual that typically entails the burning of sage and prepares one for the end of life? Thoughtful attention to religious factors, wherever systems account for social determinants of health, can strengthen the integration of spiritual caregiving across health protocols.

3. Training and Education

Of course, getting serious about caring for patients’ diverse religious identities depends on a workforce with a baseline understanding of how to bridge the faith and health divide in constructive, not destructive, ways. That means ensuring that teams are equipped with what we call a “radar screen for religious diversity” and foundational skills to respect, relate and cooperate with one another across differences.

Imagine what might have happened if Lia’s care team had just attended a grand rounds highlighting the religious diversity of the immigrant community that was increasingly showing up in their emergency rooms. They might have taken an approach to her care that made room for Hmong practices and beliefs, even without compromising their commitment to Western scientific methods. They might have engaged Lia’s parents as partners in her care, and they might have established further trust throughout the community in doing so.

Better yet, imagine that the lead physician had attended a “spiritual generalist” training9 and, in the process, learned more about the value of compassionate presence. Even when the clinicians found themselves frustrated by the family’s tepid response to medical interventions, they might have had the wherewithal to reach out to a chaplain with the skills to navigate the faith-health divide.

4. Asset Mindset on Religious Diversity

Every hour, in hospitals across our nation, doctors and nurses treat patients threatened by traumatic injuries, health emergencies and diseases. They’re lifelong Catholics, avowed atheists, devout Muslims, contemplative Buddhists, liberal Jews and progressive Methodists. Surgical team

members are invariably inspired by their own religious or secular values, but they set aside differing views on end times or the value of prayer or Sabbath practices for the sake of their shared cause: saving a human life. When it comes to differences that might get in the way of healing, that’s a good approach.

Increasingly, though, health systems are recognizing that it’s not just their patients’ religious identities that affect health outcomes. Their religiously diverse workforce is also an underrecognized asset when it comes to delivering quality care. As employers, health systems ultimately

ishing. Health systems can forge connections to diverse faith leaders in their communities as partners in personal and public health.

During the pandemic, a health system in rural Pennsylvania reaped the benefits of connections they’d spent the previous decade forging with diverse faith community leaders. By listening to these leaders, they learned about community misinformation regarding COVID-19, its treatment and vaccination. They also learned about issues related to access on all fronts. Together, health system leaders, public health officials and community leaders from a range of traditions and ideologies charted a path toward safeguarding the public’s health.

By investing in relationships with community partners — faith-based and otherwise — that are aligned in purpose around human well-being, they can reap immense rewards that go beyond financial returns to foster vital conditions across their neighborhoods.

benefit from ensuring that health workers can perform their required tasks in ways that honor their religious identities. By offering employee resource groups, or other affinity groups, that provide structured support, or by creating opportunities for employees to interact with teammates around deeper questions related to purpose and meaning, leaders can foster a more profound sense of belonging and value, especially among employees whose cultural practices and religious beliefs are not in the majority of a workplace or region.

Perhaps it goes without saying, but hospital chaplaincy programs are a key asset too often disconnected from other facets of care. The COVID-19 pandemic initiated change in that, as chaplains are increasingly included in care teams, and their value in caring for staff has proven indispensable.

5. Community Connection

Increasingly, clinicians and health leaders recognize that the clinical encounter or hospital visit is but one brief point in their patients’ health stories. That means that life outside the clinical setting plays an even more critical role in their flour-

As nonprofit organizations, Catholic health systems take seriously their commitment to playing a constructive role in their communities. By investing in relationships with community partners — faithbased and otherwise — that are aligned in purpose around human well-being, they can reap immense rewards that go beyond financial returns to foster vital conditions across their neighborhoods.

6. Research

Finally, health systems can help bridge the faith and health divide by supporting research to inform and refine decisions related to engaging religious diversity in health settings. A growing body of evidence points toward the efficacy of engaging religious diversity when it comes to improved health outcomes, but more studies are needed. What is the return on investment in terms of compliance, repeat hospital visits and other metrics when patients’ religious identities are taken seriously during the course of their care? How does creating a workplace where religious diversity is an asset affect burnout and retention rates? How does engaging community partners in the continuum of care strengthen access and outcomes for all people?

These and other questions can spur us to greater understanding and, ultimately, a reinforced connection to the purpose for which Catholic health institutions were established: to promote human flourishing for all.

BRIDGING DIVIDES

EBOO PATEL is the founder and president of Interfaith America. Based in Chicago, he is an author, speaker, educator and interfaith leader who has worked to promote faith as a bridge of cooperation. SUZANNE WATTS HENDERSON is the senior director of Faith & Health at Interfaith America. Based in Charlotte, North Carolina, she is an author, New Testament scholar and ordained Disciples of Christ minister with extensive experience in higher education and religious pluralism.

NOTES

1. Anne Fadiman, The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors, and the Collision of Two Cultures (New York: Farrar, Straus and Giroux, 1997).

2. “How Religious Are Americans?,” Gallup, March 29, 2024, https://news.gallup.com/poll/358364/religiousamericans.aspx.

3. “Modeling the Future of Religion in America,” Pew Research Center, September 13, 2022, https://www.pewresearch.org/religion/2022/09/13/ modeling-the-future-of-religion-in-america/.

4. Dr. Tracy A. Balboni et al., “Spirituality in Serious Illness and Health,” JAMA 328, no. 2

QUESTIONS FOR DISCUSSION

(July 12, 2022): 184–97, https://doi.org/10.1001/ jama.2022.11086.

5. Katelyn N. G. Long et al., “Spirituality as a Determinant of Health: Emerging Policies, Practices, and Systems,” Health Affairs 43, no. 6 (June 2024): 783–90, https://doi.org/10.1377/hlthaff.2023.01643.

6. Ángela del Carmen López-Tarrida, Rocío de DiegoCordero, and Joaquin Salvador Lima-Rodríguez, “Spirituality in a Doctor’s Practice: What Are the Issues?,” Journal of Clinical Medicine 10, no. 23 (December 2021): 5612, https://doi.org/10.3390/jcm10235612.

7. Balboni et al., “Spirituality in Serious Illness and Health”; Nambi Ndugga, Drishti Pillai, and Samantha Artiga, “Disparities in Health and Health Care: 5 Key Questions and Answers,” KFF, August 14, 2024, https://www.kff.org/racial-equity-and-health-policy/ issue-brief/disparities-in-health-and-health-care-5-keyquestion-and-answers/.

8. Dr. Christina Puchalski, “Clinical FICA Tool,” The GW Institute for Spirituality and Health, https://gwish.smhs.gwu.edu/programs/ transforming-practice-health-settings/clinical-fica-tool.

9. “Spiritual Generalist Training for Healthcare Clinicians,” Chaplaincy Innovation Lab, https:// chaplaincyinnovation.org/current-opportunities/ spiritual-generalist.

Interfaith America works to unlock the potential of America’s religious diversity. When reflecting on this article by Interfaith America’s Eboo Patel, PhD, and Suzanne Watts Henderson, PhD, consider how their points and suggestions resonate with your own day-to-day health care responsibilities.

1. Does your intake process gather sufficient information to begin to respond to the spiritual needs of your patients? To what extent do you or others in your workplace tend to the spiritual needs of patients and their loved ones?

2. How do you approach the importance of religious or spiritual identity as a health equity matter? What more can or should be done to consider the importance of spiritual care in the provision of wholeperson care? How can an awareness of spiritual needs influence a patient’s health care decisions?

3. In what ways does your health care environment respect or support the faith traditions of health care workers? Are there changes that would be helpful to employees and care providers?

4. What educational opportunities do you currently offer staff so that they are better prepared to understand and appreciate the critical role that religious diversity plays in caring for patients and families?

Healthcare Ethics

Duquesne University offers an exciting graduate program in Healthcare Ethics to engage today’s complex issues.

Courses are taught face-to-face on campus or through online learning for busy professionals.

The curriculum provides expertise in clinical ethics, organizational ethics, public health ethics and research ethics, with clinical rotations in ethics consultation.

Doctoral students research pivotal topics in healthcare ethics and are mentored toward academic publishing and conference presentation.

MA in Healthcare Ethics (Tuition award of 25%)

This program requires 30 credits (10 courses). These credits may roll over into the Doctoral Degree that requires another 18 credits (6 courses) plus the dissertation.

Doctor of Philosophy (PhD) and Doctor of Healthcare Ethics (DHCE)

These research (PhD) and professional (DHCE) degrees prepare students for leadership roles in academia and clinical ethics.

MA Entrance – 12 courses

BA Entrance – 16 courses

Graduate Certificate in Healthcare Ethics

This flexible program requires 15 credits (5 courses). All courses may be taken from a distance. The credits may roll over into the MA or Doctoral Degree (PhD or DHCE).

BRIDGING DIVIDES

Mission Across the Miles: Mission Integration in Ambulatory Settings

NANCY JORDAN, EdD, and NAN ONEST, MA Chief Mission Integration Officers, Providence St. Joseph Health

Building community focused on the call and mission of Catholic health care requires thought and intention, and this feels particularly true when working with tens of thousands of care providers across seven states. How do you connect and inspire those often pressed for time, facing one another on a computer screen?

One example: What began as routine virtual “town halls” to update caregivers within the Northern California Providence Medical Group turned into a more spirited way to gather for staff appreciation and engagement across many miles and many clinics. After operational reports were shared at each virtual town hall meeting, the focus switched to Northern California Mission Integration Leader Montserrat Archila, decked out in a bedazzled blazer and surrounded by colorful balloons. She explained she had traveled to a surprise location to reveal “Values in Action” recipients — those who had demonstrated Providence’s core tenets through their work.

Archila was followed by a camera through doorways, past offices and toward blissfully unaware clinic teams who were gathered around computers and surprised by a live-streamed “prize parade.” Awardees were celebrated in real-time with flowers, certificates and items like mugs and lapel pins to mark their good work. The “parade” was viewed by approximately 1,000 colleagues throughout the nearly 3,000 square miles of Providence Medical Group.

The Providence Clinical Network includes more than 1,000 medical clinics, 30,000 caregivers, 10,000 providers, critical clinical service lines

and nonacute services, including graduate medical education, across seven states. The network includes a dedicated mission integration team that serves remote and hybrid workers by helping them to see their connection with the Providence system and by building bridges among clinic teams located across a vast geography. The opportunity to provide the full range of mission integration support without the benefit of a unified campus requires intentionality, inclusivity and creativity.

INTENTIONALITY AS STRATEGY

The clinical network mission team focuses on the realities of ambulatory services lines and operates with a sense of intentionality. Always aligned with system and Providence Clinical Network strategic plans and in partnership with local and system executive teams, we respond to workforce trends, engagement surveys, and other qualitative and quantitative data that identify the distinctive nature of ambulatory administration and operation. Outreach requires continued awareness that clinics are often far from acute ministries, the usual hubs for mission-centered activities. Even when clinics are within walking distance of Providence hospitals, limited break times often prevent

caregiver participation.

Members of this mission team design programs and support other leaders to develop in-house, customized versions of formation offerings. For example, the feast of Blessed Emile Gamelin is traditionally recognized in hospital cafeterias with a simple soup and bread meal to reflect the generosity of the foundress of the Sisters of Providence in serving those who were hungry in her family kitchen. Providence Clinical Network mission leaders help design variations of this beloved “Table of the King” that includes organizing soup potlucks in clinics or delivering dried soup packets to administrative offices. Approaches like this ensure those working within ambulatory spaces are not left out of critical formation and heritage experiences.

INCLUSIVITY AS PRACTICE

Inspired by Jesus’ ministry, the spirituality of our founding communities calls us into relationships that are active, inclusive and ever widening. We welcome new team members, build community and promote continued growth.

To translate numbers, the Providence Clinical Network comprises one-third of the entire Providence system, based on the number of people who work as part of the network; it is served by nine mission leaders who recognize their work as a ministry of presence. With the continued expansion of our services into new markets, the team is called to extend that presence by creatively building a circle of support that invites clinical and operational colleagues to partner with us to infuse mission into the daily experience of caregivers and providers.

Mission leaders for the clinical network turn to the commission to “go and do likewise” and develop the gifts and talents of caregivers who express a desire to participate in the work of formation and the preservation of identity. This work is done across departments, such as operations, patient experience and human resources.

with treating local clinics and departments as small communities within the larger defined ministry. Within this framework, local leaders (managers, supervisors and leads) are uniquely positioned to ensure that the mission, values, vision and promise of Providence are animated within their teams and that opportunities are created to build connections across multiple clinic teams.

While mission leaders are committed to providing presence whenever possible, there is also recognition of the importance of local leaders authentically living the spirit of mission and values. Within the Providence leadership model, this expectation thrives with intentional, inclusive and consistent formation.

With the critical support from executive leadership teams, the clinical network mission leaders have designed formation experiences that bring core leaders together to reground them in the mission and values, revisit patient experience tools and articulate how they support our mission. As one example, in Southern California, a daylong retreat called Cultivating Human Connection includes a discussion of how to create psychologically safe environments and explores communication skills.

Throughout formation, we focus on storytelling, especially heritage stories, as a leadership tool. Leaders are equipped to share best practices when it comes to building community and leading in crisis and chaos, as well as understanding

While mission leaders are committed to providing presence whenever possible, there is also recognition of the importance of local leaders authentically living the spirit of mission and values. Within the Providence leadership model, this expectation thrives with intentional, inclusive and consistent formation.

Taking a pastoral ministry approach, the clinical network mission leaders have experimented

servant leadership and the role of vulnerability in trust building. The goal is to empower leadership to be the primary model of mission for the people they serve, so we can ensure that the work and vision of our founding communities are hardwired throughout the ministry and stewarded

well into the future. As one mission team member often jokes, “If we are successful, we will work ourselves out of a job!”

Time and territory present challenges for mission leaders who serve outside the traditional framework of an acute setting, often decreasing the likelihood of a virtual live presence, let alone a physical presence, for most of the commitments on a given day. In addition to empowering leaders to provide that presence, the team has selectively trained mission-inspired caregivers to step into facilitator roles for mission-centered onboarding sessions and prayer breaks, as well as presider roles for small local blessings and heritage observations. The people in these roles go by various names, including Mission Guides, Dream Teams, Community Outreach and Advocacy Committees, or Ethics Navigators.

CREATIVITY IS CRITICAL

Serving large regions requires creativity. These mission leaders reach caregivers in ambulatory settings in varied ways. This sometimes requires meetings that are virtual (as in the case of committee meetings representing multiple clinics), in-person (as in the case of crisis) or hybrid (as in the case of town hall meetings).

Providence Clinical Network’s systemwide virtual reflection services include a speaking part for each of the network’s mission leaders, which allows caregivers to see their local, familiar mission leader. The systemwide reflections also encourage connectedness with teams across the network.

Beyond traditional methods, we embrace any opportunity to connect caregivers with mission, values and heritage, including social media, emails, instant chats, texts, calls, print cards and videos. For example, the team has been invited to produce content for the system’s TikTok account and contribute to system podcasts and internet radio programming. We offer our involvement and accept invitations for even the shortest opportunities to engage with caregivers: micro formation moments during daily huddles, management meetings, department meetings and more.

WE LOVE BECAUSE WE WERE FIRST LOVED

In a recent meeting, one of our care management

BRIDGING DIVIDES

coordinators shared a story about an elderly husband and wife who were establishing care at one of our clinics. As the coordinator reviewed the new patient binders with them, she noticed the wife beginning to get teary. So, she stopped and asked if everything was OK.

The woman wiped her eyes and said they were tears of happiness and relief. She expressed that she felt like a 100-pound weight was lifted off her shoulders, knowing that they were being heard and were not alone, recognizing that the care management coordinator was with them as they received care. Being present to another human being is a profound act of compassion and love of neighbor.

The care management coordinator was proud of the team for making a difference. For her, this went beyond patient satisfaction survey scores and good patient experience. It was about the human-to-human connection that she developed with this couple and so many other patients who had visited that clinic. We all know that human connection can improve patient outcomes, and at Providence, we call those moments sacred encounters.

The service industry accounts for three-quarters of the U.S. gross domestic product, and health care is part of that sector. In his book, Unreasonable Hospitality: The Remarkable Power of Giving People More Than They Expect, American restaurateur Will Guidara situates hospitality at the center of any service industry brand and reinforces the well-known Richard Branson quote, “If you take care of your employees, they will take care of the clients.”

Hospitality is central to who we are as a Catholic health care system, and it calls us to prioritize people; affirm their dignity, value and wholeness in all situations; and continually invite them into community.

Our Providence promise is “know me, care for me, ease my way,” and we frequently talk about how this promise applies to our caregivers as much as it applies to our patients. It is our commitment to hospitality for all.

NANCY JORDAN and NAN ONEST are chief mission integration officers for Providence St. Joseph Health.

How Do We Avoid the Misuse of Discernment in Decision-Making?

FR. MICHAEL ROZIER, SJ, PhD Associate Professor, Health Management and Policy at Saint Louis University

Even though most of us may not recognize it, much of our personal and professional lives are spent in regular discernment. Should I let my child have 10 more minutes of screen time? Should I have one of the cookies sitting in the break room? How should I respond to my colleague whose demands are routinely unreasonable? Our days are filled with decisions that are not overly consequential, but that, when taken together, shape how we live and who we become in consequential ways.

A discernment process is often used in Catholic ministries when matters of consequence are under consideration, and some may say that the above description unhelpfully conflates the idea of decision-making and discernment. They will rightly observe that we should not spiritualize the mundane decisions we all must make throughout our days. That is certainly true. Some questions are simply decisions: Should I wear a blue or a grey shirt? Can we afford to go to the movies this weekend? Such decisions are related to questions whose answers don’t fundamentally change who we are.

At the same time, we do not want to minimize the way that even routine decisions shape who we are and who we become. For some, the question about eating a cookie would be a decision, but for those who are consciously trying to be more disciplined in their eating habits, that same question may have an element of discernment.

Many others have helpfully described the core elements of discernment by placing it in the context of the Church’s history and different congregations’ spiritual traditions.1, 2 These elements include: identifying the core question; being transparent about one’s biases, hopes and fears; taking

time in prayer; and sharing honestly and openly. While Catholic health ministries have grown in the practice of discernment, we must also be aware of two critical errors that often accompany this practice. First, just as we speak of the conditions necessary for discernment, we must also be aware of its misuse. This is often uncomfortable to speak about because the desire for discernment comes from a good place. Nevertheless, like other good intentions, the use of discernment has the potential to be misplaced. Second, we should not allow the use of formal discernment to replace an even more fundamental expectation of having a discerning disposition.

Both of these issues are addressed in this article, and neither is meant to suggest that our collective investment in discernment processes is mistaken. Both concerns are raised out of a desire to refine the good work occurring throughout our ministries.

THE UNINTENTIONAL MISUSE OF DISCERNMENT

There are at least three categories of the misuse of discernment. The first is when people who are capable of undertaking discernment are not given the conditions to do so. This occurs when the

individual’s internal capacities for discernment are present, but something external to the individual compromises their ability to discern freely. For example, a participant in a discernment process may have the necessary freedom around a decision and may be aware of their personal hopes and fears related to the decision. At the same time, their supervisor may also be participating in the discernment. Even if the supervisor has freedom in the matter at hand, if those in the subordinate roles believe that the supervisor has a preferred outcome, a discernment is not possible. In this situation, every participant has the capability of undertaking a discernment, but there is something about the conditions themselves that have made such a task impossible.

The second misuse of discernment is when people who are incapable of or inadequately trained in discernment are asked to engage in it. This is probably the most common mistake made in ministerial discernment processes that take place within Catholic health care ministries. The truth is that genuine discernment is quite difficult, and many of the religious women from whom we draw this charism spent a lifetime cultivating the personal spiritual resources to do it well. Primarily, it requires having an active prayer life over a period of time. It also requires having a great deal of self-awareness, suspending judgment and delaying a decision for much longer and more often than we typically like to do. The challenge comes when rooms are filled with talented and accomplished people, and we pretend that being talented and accomplished in one area of life means that one is also prepared for the work of discernment. I wish that were true, but it isn’t.

structure to place greater emphasis on community health? That could be an appropriate question as well. Should we place radio ads for our new urgent care center? Although important, this is not a matter for discernment. Should we shift our investment policy toward higher-risk asset classes? Again, important, but likely not a matter for discernment.

Most matters are just not significant enough to be material for a formal discernment. In many situations, the question is a business decision that shouldn’t be falsely spiritualized by cloaking it in the language of discernment. Sometimes building a new wing of a hospital is a strategic business

The difference between a decision and a discernment is whether the outcome is likely to shape the character of the ministry.

decision that is perfectly fine to make through the lens of operations and finance. Of course, if the decision is to use financial resources to either build a new wing of an existing suburban hospital or build a clinic in an economically challenged city center, that may be a matter of discernment.

The difference between a decision and a discernment is whether the outcome is likely to shape the character of the ministry. This distinction parallels the different types of questions at the beginning of this article, which depend on whether the decision might shape how we live and, therefore, who we become.

The third common misuse of discernment is when the subject matter being considered is inappropriate for a formal discernment. This most often arises from good intentions being misapplied. A formal discernment process is a rather weighty activity and should be reserved for matters of greater moment.

In fact, I think a formal discernment process should be relatively rare within our ministries. Should we consider a major acquisition, alienation or merger?3 Those are questions for discernment. Should we reorganize our senior leadership

The unintentional misuse of discernment is a common type of spiritual trap. Most spiritual failings do not come from being overtly evil. Intentional evil, in my experience as a confessor, is rare. More frequently, spiritual failing comes from slightly twisting and misapplying an otherwise good desire. For example, one’s generosity and desire to help others can go from a virtue to a vice if that desire to help becomes too intense and instead becomes controlling behavior. Just so, we must be careful that the very good desire to engage in discernment doesn’t lead us to misuse the process when either the people are not ready, or the situation is not appropriate for formal discernment.

Acknowledging when discernments are poorly done is just as important as recognizing when dis-

cernments are done well. Both types of situations are great teachers and can only help us get better at discernment in the future. Sometimes discernments fail for one of the previously mentioned reasons. Sometimes discernments get it wrong despite doing everything in the way that we are supposed to. We are human, and that means we are imperfect. Having the freedom and awareness to retrospectively examine discernments and their results is key to becoming better at this important work.

A DISCERNING DISPOSITION

In the Catholic tradition, we distinguish between a Sacrament and sacramental or a sacramental worldview. The “big S” Sacrament is reserved for seven specific communal activities that are often described as an “outward and visible sign of an inward and invisible grace.”4 They are Baptism, Confirmation, Eucharist, Penance, Anointing of the Sick, Holy Orders and Matrimony.

These seven Sacraments have many similarities to sacramentals, which are a wide range of actions that offer a sanctification of people and the world. This includes the blessing of food, people or spaces, blessing with holy water, making the sign of the cross and lighting an Advent wreath. The list goes on. They are each a sign of God’s presence in our world and the blessing we are each called to be. Yet, as meaningful as they are, they do not have the same theological significance as Sacraments.

Moreover, we might also speak of someone having a “sacramental worldview.” This does not describe someone who regularly participates in the sacraments, but a person who moves through their day and is able to readily recognize God’s activity, or God’s grace, in the world around them. For example, this would include someone who is consistently and fully present to those around them because of their commitment to others’ inherent worth. Or it would be someone who regularly notices the good things in their life because they believe so deeply in the goodness of the created world. These are sacramental people who bring invisible grace into the visible world simply by how they live.

The distinction between Sacrament and sacramental worldview is the same distinction we should be making between Discernment and a discerning disposition. Sacraments (aside from Eucharist and Penance, perhaps) and Discern -

ment are relatively infrequent occurrences. On the other hand, a sacramental worldview and a discerning disposition are something we can all cultivate and display every moment of every day.

As a sponsor of a Catholic health ministry, I am far more interested in someone’s discerning disposition than I am in their ability to engage in Discernment. This is because a discerning disposition will affect every interaction with a patient or coworker, every contribution during a meeting and every decision.

FORMATION TO GROW A DISCERNING DISPOSITION

My primary ministry is Catholic higher education, and there is much that higher education and other Catholic ministries can learn from the formation programs present in Catholic health care. Nevertheless, we also know that Catholic health formation programs are not perfect.5

In the coming years, I hope we can take some of the energy we have devoted to discernment and place it toward being discerning. This is not to abandon discernment, but I suspect growing awareness of one’s discerning disposition would have a bigger influence on the culture of our ministries. For example, although our coworkers’ lives are impacted by whether or not we acquire another entity (the result of discernment), they are likely more affected by whether they feel involved in routine decisions in their unit (the result of a supervisor’s discerning disposition).

In addition to formal formation programs to help build discerning dispositions, there are many practices that can embed this into a ministry. For example, many meetings begin with prayer or reflection. The effect of this can be deepened by occasionally pausing during the meeting itself so that those present can take time to consider how they are reacting, in real time, to what is being discussed. This process is aided by activities to increase both self-awareness and comfort in speaking beyond the intellectual, particularly to one’s emotional state.

In addition, many teams are very good at taking time to consider an action before it is taken but are less disciplined in revisiting that action so that everyone can learn from it. Revisiting decisions is not just a good business practice, but is essential to the spiritual life. This is the key insight of a regular examination of conscience,6 which asks us to

retrospectively recognize patterns, both good and bad, so that in the future we might more regularly act on the good and avoid the bad. These practices and others are, of course, more possible if we consider one’s discerning disposition when recruiting and promoting within our ministries.

As a member of a religious order, and one that has a strong commitment to discernment at both individual and communal levels, my experience is that formal discernments are fairly uncommon. At the same time, we are expected to live our daily lives in a discerning way. I believe this is true for the congregations who founded our Catholic health ministries.

There are certainly some major decisions that define each of our ministerial histories and that will shape our future. Yet, for the most part, we speak to the character, or the disposition, of our religious foundresses. In fact, it is the daily attentiveness to one’s discerning disposition that cultivates the self-awareness and freedom that makes a larger discernment more possible. As it was for them, so may it also be for us.

FR. MICHAEL ROZIER, SJ, is a Jesuit priest and an associate professor of health management and policy at Saint Louis University College for Public Health and Social Justice.

NOTES

1. Ladislas Orsy, Discernment: Theology and Practice, Communal and Personal (Collegeville, Minnesota: Liturgical Press, 2020).

2. Scott Kelley and David Nantais, “Why a Habit of Discernment Is Crucial for Catholic Health Care,” Health Progress 103, no. 3 (Summer 2022): 4-11, https://www.chausa. org/publications/health-progress/archive/ article/summer-2022/why-a-habit-ofdiscernment-is-crucial-for-catholic-healthcare.

3. For more on alienation, see: Rev. Francis Morrisey, “Alienation and Administration,” Health Progress 79, no. 5 (September/ October 1998): 24-29, https://www. chausa.org/publications/health-progress/ archive/article/september-october-1998/ alienation-and-administration.

4. The Roman Catholic Church, Catechism of the Catholic Church: Revised in Accordance with the Official Latin Text Promulgated by Pope John Paul II (Huntington, Indiana: Our Sunday Visitor, 2000).

5. Diarmuid Rooney, “Ministry Formation Has Come a Long Way, but Is It Enough?,” Health Progress 104, no. 2 (Spring 2023): 55-57, https://www.chausa.org/ publications/health-progress/archive/ article/spring-2023/formation---ministryformation-has-come-a-long-way-but-is-itenough.

6. Timothy Gallagher, The Examen Prayer: Ignatian Wisdom for Our Lives Today (Spring Valley, New York: The Crossroad Publishing Company, 2006).

HEALTH PROGRESS

Navigating the complex ethical realities of health care can be a challenge.

WE’RE HERE TO HELP.

Access a variety of resources to help understand and apply the Ethical and Religious Directives. CHAUSA.ORG/ETHICS

Fine-Tuning a Regional Response to Aid Human Trafficking Survivors

HOLLY GIBBS

System Director, CommonSpirit Health Human Trafficking Response Program

There is much more to Angelíca Zuniga than what she has lived through, but she shares her story to be of service to others. Today, she is a community leader who advocates for vulnerable people.

As a survivor of child abuse, human trafficking and intimate partner violence, Zuniga recounts a significant encounter in 2013 that changed the trajectory of her life forever. While in a trafficking situation one night, law enforcement approached Zuniga after spotting her out in an area they were patrolling. They soon realized that she needed help.

“I remember telling them to just take me to jail,” Zuniga recalls. “I was so tired, so broken. I didn’t want to live that life anymore; I just wanted to get off the streets.”

Instead of taking her to jail, the officers took her to Dignity Health–Mercy Hospital Downtown in Bakersfield, California. Her health care needs were addressed, and she was later introduced to on-site advocates from a program now known as the Open Door Network.1 With her consent, advocates assisted in finding her a safe place to stay at the Women’s Center-High Desert, where she also attended counseling.2

Zuniga received ongoing support and services, including professional career development, from the Kern Coalition Against Human Trafficking and its member organizations in the following years, and credits the collaboration of community partners as a significant part of her healing. The

Angelíca Zuniga

Photo by Ally Swen

continuum of care in the region made a difference to her.

COMMONSPIRIT’S HUMAN TRAFFICKING RESPONSE PROGRAM

CommonSpirit Health’s systemwide Human Trafficking Response Program equips physicians, advanced practice providers and staff to identify and assist patients who may be experiencing any type of abuse, neglect or violence, including human trafficking.3

Efforts that began with Dignity Health and are bolstered through the expansion into the wider CommonSpirirt Health system include the hospital-based Human Trafficking Task Forces, led by senior nurse executives. They use a framework rooted in social support theory. The goal is for each multidisciplinary task force team to support colleagues and peers with informational, instrumental, appraisal and emotional support. Informational support includes providing guidance to staff about procedures, education and other resources. Instrumental support includes providing tangible resources, such as victim outreach posters, brochures and safety cards. Appraisal and emotional support include supporting staff with patient cases and case debriefings.

CREATING THE RIGHT SUPPORT NETWORKS

In 2018, the foundation now known as the CommonSpirit Health Foundation was awarded a federal grant of more than $940,000 from the Office for Victims of Crime, a part of the U.S. Department of Justice, to expand on and evaluate human trafficking response efforts in Kern County, California.4

This included efforts to strengthen partnerships with local organizations and advocates, including survivors of abuse and trafficking, and to strengthen the region’s collective community capacity to support the physical and emotional needs of people experiencing abuse, neglect and violence, with a special emphasis on both labor trafficking and sex trafficking.

Sandy Woo-Cater, the project lead for CommonSpirit’s Human Trafficking Response Program, restructured the education to include historical perspectives of trauma and human trafficking, including root causes of human trafficking vulnerabilities. She also included information about local resources for Kern County service providers. Examples of these providers include health care systems and supportive agencies for

Figure 1: Educating Service Providers

CommonSpirit’s Human Trafficking Response Program provides two sessions of training for those who may come in contact with people experiencing human trafficking.

Session I topics

History of national and international definitions of human trafficking

Foundational knowledge on labor trafficking and sex trafficking

Survivor perspectives on human trafficking

Historical evolution of the anti-trafficking field locally and nationally

Historical case studies of human trafficking

The role of community-based service organizations in anti-trafficking work

Session II topics

Identifying persons experiencing human trafficking

CommonSpirit Health’s PEARR Tool, which guides health professionals on how to offer victim assistance to patients in a traumasensitive manner1

Impact of complex trauma on the brain

Barriers to seeking safety

Critical language access issues

Safety considerations for professionals

Local human trafficking cases

NOTE

1. Dominique Roe-Sepowitz et al., “PEARR Tool Training and Implementation: Building Awareness of Violence and Human Trafficking in a Hospital System,” Frontiers in Medicine 11 (May 2024): https://doi.org/10.3389/fmed.2024.1311584.

those undergoing homelessness, family violence, sexual assault, etc., who come into contact with people who may be experiencing human trafficking. She then facilitated the training series with Zuniga. While the training series was originally designed as in-person education, they quickly pivoted to accommodate virtual sessions with the onset of the COVID-19 pandemic. Nine direct service organizations received two sessions of training, each from February to November 2020. (See Figure 1 above for training session descriptions.)

COMMUNITY PARTNERS PROVIDE INSIGHTS

To help measure the impact of these grantfunded efforts, CommonSpirit entered into a contract with Arizona State University’s Office of Sex Trafficking Intervention Research. In October 2019, representatives from this office interviewed leaders from six member organizations from the Kern Coalition Against Human Trafficking.

The participants provided recommendations regarding policies and procedures for hospital systems considering the creation of a human trafficking response program. Those involved in this process made multiple recommendations, and CHA members can learn more by downloading CommonSpirit’s Human Trafficking Response Program’s Shared Learnings Manual.5 (See Figure 2 on page 50 for recommendations.)

HELPING OTHERS

CommonSpirit’s human trafficking response efforts would not be possible without the commitment, strength and support of survivors like Zuniga sharing their insights, allowing us to also help others.

Zuniga has been a key part of projects against child abuse and human trafficking, among them serving as the chief executive officer for

CommonSpirit’s human trafficking response efforts would not be possible without the commitment, strength and support of survivors like Zuniga sharing their insights, allowing us to also help others.

Redeemed Home, a safe haven for women in Bakersfield. She also provides supportive services to high-risk and adjudicated youth in Kern County as a survivor leader with the Kern County Department of Human Services. She is a community leader, wife, mother and grandmother who loves to be surrounded by her family, including her dachshund pups.

Paving the way for other survivors to find their voices, Zuniga continues to highlight the

CommonSpirit Health System Project Lead of Human Trafficking and Health Equity Sandy Woo-Cater, above, and survivor advocate Angelíca Zuniga, lower speaker box, provide education at a 2020 virtual presentation.

Photo by Sandy Woo-Cater

Theme Examples

Partnerships and Be open to collaborating with other agencies. Collaboration Recognize HIPAA and confidentiality constraints. Develop mechanisms to share information to assist in serving the client. Make community agencies aware of the internal procedures/protocol (what it is, how it will be used) and how community agencies can partner. Have a care provider readily available that service providers can call for assistance with medication or medical assistance. Have a list available of contacts to call if care team suspects patient is a human trafficking victim so that service providers can come and work with the patient.

Trauma-informed

Develop a bedside manner approach for encountering patients Services suspected of being victims to open up the conversation and get them involved in services.

Avoid forcing a victim to get law enforcement involved. Speak with survivors about what helped them and what their experience with hospital systems was like.

Ensure confidentiality and build trust with the patient. Gain expertise to understand the issue.

Training

Make sure all staff (especially emergency room staff) are trained on the procedures/protocol, signs to look for and how to offer a traumainformed response to patients.

Train all hospital personnel on trauma-sensitive patient communication.

importance of human trafficking awareness education and trauma-sensitive approaches in health care, law enforcement and community-based organizations responding to human trafficking. “I was once a victim lost in the sex trade. I am now redeemed, restored and free.”

HOLLY GIBBS is system director of CommonSpirit Health’s Human Trafficking Response Program. In 2019, Gibbs received CHA’s Sr. Concilia Moran Award.

NOTES

1. The Open Door Network, https://theopendoor network.networkforgood.com. It was formerly known as the Alliance Against Family Violence & Sexual Assault.

2. Women’s Center High-Desert, https://www.wc-

hdinc.org.

3. “Human Trafficking Response Program,” CommonSpirit Health, https://www.commonspirit.org/ human-trafficking.

4. “Dignity Health Receives Grants from U.S. Department of Justice to Expand Human Trafficking Response Programs,” Dignity Health, November 29, 2018, https:// www.dignityhealth.org/about-us/press-center/pressreleases/2018-11-29-dignity-health-receives-grantsfrom-us-department-of-justice-to-expand-humantrafficking-response-programs.

5. “Human Trafficking Response Program Shared Learnings Manual,” CommonSpirit Health, August 2023, https://www.commonspirit.org/content/dam/shared/ en/pdfs/impact/human-trafficking-response/ CSH-HTRP-SharedLearningsManual-August-2023Protected.pdf.

Figure 2: Recommendations for a human trafficking response program

WE WILL EMPOWER BOLD CHANGE TO ELEVATE HUMAN FLOURISHING

MISSION

FINDING A PATH FORWARD THROUGH SYNODALITY

As I was preparing this column, I was still basking in the afterglow of CHA’s annual Assembly, which was held in San Diego in June. The Assembly is the largest in-person gathering of Catholic health care leaders, which is convened by CHA every other year. It was a wonderful opportunity to learn, reconnect with friends and colleagues, and celebrate the good work being done by all our ministries in extending the healing mission of Jesus Christ.

One of the highlights of our event was the keynote address offered by Cardinal Robert McElroy of San Diego, sharing his experience at the Synod on Synodality and what that might mean for us in Catholic health care. Cardinal McElroy reflected on four central questions for Catholic health care providers to ponder that have emerged from the Church’s synodal process. Those questions are:

How should Catholic health care build a culture of discernment?

How can the ministry contribute to Catholic theology and the renewal of moral theology?

How should the ministry bring a consistently Christ-like pastoral stance to Catholic health care institutions?

What is the countercultural mission of Catholic health care in the present moment?

I invite us all to reflect on these critical questions and consider how they might help guide our strategies and priorities as a ministry in the increasingly challenging years ahead. Specifically, how might we help to bridge the economic, political, geographic, workplace and religious divides that surround us in a way that builds unity for the betterment of our ministries, those we serve and the communities in which we live?

How should Catholic health care build a culture of discernment?

On the question of building a culture of discern-

ment, Cardinal McElroy said that it must be “rooted in perceiving the presence of God, listening, truly listening, with profound respect to the voices of others, and make all feel included and respected.”1 As leaders in Catholic health care, we can help build such a discerning culture. We must ensure that, beginning with the recruitment and onboarding of staff, all our strategies, policies, procedures and activities are aligned with our mission and core values. Are those we hire, especially in leadership roles, passionate and committed to the mission of the ministry? Are we inclusive and welcoming of all people, regardless of their background, as long as they are dedicated to furthering the mission of Catholic health care? Only then can we build a discerning culture, which is, after all, made up of people.

And when we do bring new people on board, are they oriented to the history, charism and values of the ministry? Are staff, at all levels, provided with ongoing formation that clearly connects the work to the organization’s mission? Only then will leaders and staff be informed, prepared and accustomed to approaching every question, issue, decision and strategy with a discerning mindset that reflects the ministry’s mission and values.

Though the mission leader should certainly be a model and catalyst, this task is not one to be assigned to the mission leader alone but rather to every leader in our ministries. As Cardinal McElroy indicated, in listening respectfully to the voices and experiences of others, including those with whom we might disagree, we can hear the voice of the Holy Spirit, who is always calling us back to the sacred foundation of our work.

DENNIS GONZALES

How can the ministry contribute to Catholic theology and the renewal of moral theology?

On contributing to Catholic theology, Cardinal McElroy said that those involved in the Catholic health care ministry must be involved because “at critical junctures, the Church’s mission to heal the sick raises key elements of emergent realities that must be addressed by the Church’s theology and teaching.”2 In response to this important need, CHA recently established the Center for Theology and Ethics in Catholic Health to support Catholic health care systems in addressing the many complex issues that arise as we pursue our mission.

The new center, headed by Daniel Daly, PhD, an associate professor of moral theology at Boston College, will foster dialogue, encourage faithful scholarship and provide consultation around pressing theological and ethical concerns. While the new center is in its early days of existence and much work is yet to be done, some goals include: convening health care practitioners and experts on broad health care challenges to facilitate thoughtful and theologically grounded solutions; publishing research on these challenges, inviting experts to lecture on them and, as appropriate, disseminating discussed results to those who can leverage change; and providing guidance to bishops and diocesan health care liaisons on Catholic health care and emerging issues.3

How should the ministry bring a consistently Christ-like pastoral stance to Catholic health care institutions?

On the question of how the ministry can bring Jesus’ love into the world, Cardinal McElroy noted, “Pope Francis has made this pastoral dimension of our faith the foundation of his pontificate.” He said that Catholic health care providers “must wrestle with how to make this inclusive, loving, compassionate, nonjudgmental healing presence resonate throughout its ministries and institutions in this hypercompetitive environment.”4 At the macro level, we must always strive to live the Gospel values, both personally and institutionally. This means welcoming all of God’s people into our ministries — staff, patients, families and communities — and attending to their spiritual health as we would their physical well-being, regardless of their religious or spiritual background.

This all-inclusive approach — which is not always easy — should set us apart and create a more Christ-like, pastoral workplace and care environ-

ment. I’m reminded of when a dear friend and Incarnate Word Sister was pressed by an emergency room nursing director at one of our formation sessions for leaders, “It is sometimes really hard to see Christ in others, be they patients, colleagues or family members.” To this, the sister replied, “If you can’t see Christ in the other, ‘be’ Christ to the other.” The flame of the Divine burns in each of us, and we must reflect that light into the world, both individually and organizationally.

What is the countercultural mission of Catholic health care in the present moment?

On being a countercultural force in society, Cardinal McElroy said that, in part, this means “serving most strenuously those in society whom our culture discards and ignores: the destitute, the undocumented, the unborn, the mentally ill.” One of the seven core competencies for mission leaders is, in fact, advocacy. We in Catholic health care are uniquely positioned to hear the voices of those in vulnerable populations and then passionately

Cardinal Robert W. McElroy of the Diocese of San Diego poses questions related to Catholic health care and synodality during his remarks at CHA’s Assembly this past June.

Photo by Jerry Naunheim Jr./@CHA

advocate on their behalf, with a preferential option for those who are marginalized and affected by poverty and a focus on ending systemic racism and injustice that lead to health disparities.

We must engage community and system leaders in dialogue to ensure strategy, decisions, policies and budgets demonstrate a tangible commitment to justice, solidarity and right relationship.

The flame of the Divine burns in each of us, and we must reflect that light into the world, both individually and organizationally.

We must be intricately involved in setting advocacy priorities and collaborating with stakeholders to meet the demonstrated needs of the community.

This advocacy encompasses the needs of patients, residents, families and co-workers, as well as the wider community. Catholic health care leaders must strive to encourage all associates and community leaders to follow the Gospel values demonstrated in the example of Jesus Christ. Like the synodal process itself, we must listen with profound respect to the voices of others and actively advocate on their behalf.

A UNITED VOICE FOR BOLD CHANGE

As noted in a recent article in America: The Jesuit Review, Fr. John English, SJ, and Fr. George Schemel, SJ, founder of multiple spirituality centers in the United States, co-founded a group in the late 1970s called Ignatian Spiritual Exercises for the Corporate Person, which included Fr. James Borbely, SJ, Marita Carew, RSHM, John Haley and Sr. Judith Roemer. They developed a method for organizational discernment, which they published in three volumes. The method guided groups through three questions: Who are you, as a group, before God? What do you do (or what are you called to do)? And how do you do it?5

Simply put, these are the questions we must ask ourselves as Catholic health care leaders. I’m betting that, although we all come from various and diverse backgrounds, geographies and cultures, our answers won’t deviate from our shared mission. As Cardinal McElroy commented in his Assembly speech, “One of the most striking realities reflected in our national dialogues was the commonality of the questions and perceptions of the people of God across dioceses, regions and cultures within our country. … the major joys, the hopes, the sorrows and the fears of God’s people were remarkably similar from place to place.” 6 Only by acting together, as the wider “we,” can we empower bold change to elevate human flourishing.

DENNIS GONZALES, PhD, is senior director, mission innovation and integration, for the Catholic Health Association, St. Louis.

NOTES

1. Lisa Eisenhauer, “Cardinal McElroy Poses Four Questions for Catholic Health Care from Synod,” Catholic Health World 40, no. 7 (July 2024): https://www.chausa. org/publications/catholic-health-world/archive/article/ june-2024/cardinal-mcelroy-poses-four-questions-forcatholic-health-care-from-synod.

2. Eisenhauer, “Cardinal McElroy Poses Four Questions for Catholic Health Care from Synod.”

3. Julie Minda, “CHA Debuts Theology & Ethics Center, Names Executive Director,” Catholic Health World 39, no. 20 (December 15, 2023): https://www.chausa.org/ publications/catholic-health-world/archive/article/ december-15-2023/cha-debuts-theology-ethics-centernames-centers-executive-director.

4. Eisenhauer, “Cardinal McElroy Poses Four Questions.”

5. Colleen Dulle, “The Jesuit Roots of the Synod’s ‘Conversations in the Spirit,’” America: The Jesuit Review, July 30, 2024, https://www.americamagazine.org/ faith/2024/07/30/conversation-spirit-synod-248471.

6. Eisenhauer, “Cardinal McElroy Poses Four Questions.”

KEEPING THE PERSON AT THE HEART OF DECISION-MAKING

Blank stares, a slight “hmm” and the inevitable “What is that?” are the usual responses I receive when I tell a stranger that I am an ethicist. More recently, people tend to have some sort of inkling that such a profession exists, as they might have read media articles during and since the COVID-19 pandemic highlighting some ethical dilemmas.

Now, I do not divulge this piece of information lightly. In fact, I often respond to the inquiry regarding my work with a vague answer of, “I work in health care.” Some of this reticence comes from my naturally introverted self; some comes from simply not wanting to get into a conversation about thorny subjects like abortion, euthanasia or vaccine requirements with my seatmate on an airplane. Yet, I am finding myself more self-aware of the responsibility I hold in responding truthfully.

BREAKING DOWN WALLS, GAINING UNDERSTANDING

Since the pandemic, the rise of ethical challenges facing health care has filtered into the public sphere. Prior to 2020, many ethical dilemmas could be classified as personal, such as, “Who will be my surrogate decision-maker?,” “Do I want to transition to hospice?” and “Is another round of chemo worth it?” The questions we face now are more social in nature; at least, they are more publicly known.

Health care decisions are being debated in the halls of government and the pages of newspapers. Ongoing debates and articles raise questions that must be addressed nationally, on topics such as maternal health, public health, health financing and end-oflife care. What were often private conversations with medical teams, patients and their family members have busted out into the wider discussion. Therefore, when I encounter a stranger and inform them of my profession, they tend to have some opinions about these issues.

Too often, issues in the political dialogue become divisive and seen as litmus tests for someone’s identity or even morality. When I read articles examining today’s questions, I am too often confronted with this same political discourse, one based on factions fighting against factions.

These authors, or “experts,” argue for their beliefs and their way. They make the point that their side has the moral high ground and that the other is twisted by devious goals. The debates tend to focus on procedures, treatments, costs, autonomy and the law — all certainly important aspects to consider. However, as I have opened my own personal walls to the strangers next to me, I have learned a great deal about the real concerns of others.

ALIGNING WITH OURSELVES AND EACH OTHER

One of the greatest lessons I have learned in my education and experience of ethics is the focus on the person. If you attended a lecture of mine, you would recognize this intention. Ethics is naturally a human endeavor. It regards the right relation

What were often private conversations with medical teams, patients and their family members have busted out into the wider discussion.

with ourselves, our communities, creation and our Creator. The Catholic Church recognizes this fundamental nature of ethics in its moral teaching. Human dignity is a core belief emphasizing the special nature of each and every person. Therefore, the person must be at the heart of decision-making. Now, reading the debates and listening to the pundits, the person seemingly has disappeared. Instead, we have the need to uphold

NATHANIEL BLANTON HIBNER

certain political or personal beliefs, such as individual freedom, consumer access and autonomy. Where has the person gone?

Many people have the impression that ethics, and in particular Catholic ethics, are about rules that restrict our behavior. In fact, Catholic moral teaching is an attempt to provide guidance that will lead us to human flourishing. As Jesus says in John 10:10, “I came so that they might have life and have it more abundantly.” The great Catholic thinkers have tried to understand this promise. At the heart of it is the belief that every human is worthy of joy, love and happiness. Catholic ethics is our attempt to provide guideposts toward this goal. If spiritual practices help us to align with our Creator, ethics is an attempt to align with ourselves and our fellow humans.

EVALUATING OUR INTENTIONS

How do we live this goal of human flourishing out in Catholic health care? First, we must remember that discussions of ethical practices start and end

with a person who has intrinsic dignity as created in God’s image and likeness. Second, debates about practices, procedures and techniques cannot be removed from their impact on patients, families and communities, especially those who have historically been marginalized. Third, when engaged in discussions regarding policy and laws, we must step back and discern whether we are coming from a point of love and concern for others or whether we are trying to achieve a less honorable goal. Finally, as I mentioned at the start, we must be brave advocates and share the loving care that the Catholic moral tradition attempts to live out every day in our ministry.

I know that I will try to be more engaged with strangers’ concerns and, in doing so, try to remember that I am called to love my neighbor and spread the good news of Jesus’ healing ministry.

NATHANIEL BLANTON HIBNER, PhD, is senior director, ethics, for the Catholic Health Association, St. Louis.

NEW ONLINE RESOURCE

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Health Progress articles for reflection, discussion and as a call to action.

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FORMATION LIGHTS, CAMERA AND SPIRIT IN ACTION

Once your eye catches the movement of the Spirit, it cannot be unseen. In recent months, my eyes spotted a peculiarity among leading characters in multiple films. At least three films this year featured a notable Catholic as the lead role. Cabrini opened in theaters in March. This independent film, about the first canonized U.S. citizen, traces Mother Frances Xavier Cabrini’s journey from Italy to New York City, where she tangles with the canny mayor and advocates for housing and health care for orphaned and immigrant children. Two months later, Wildcat, about the American Catholic writer Flannery O’Connor, opened in theaters.

Later in May, PBS released Teilhard: Visionary Scientist , streaming for free. This biographic documentary tells the story of French Jesuit scientist, paleontologist and theologian, Pierre Teilhard de Chardin, SJ. After years of exile in China, he eventually came to live in the U.S. and died in New York. In addition to these films in 2024, the final days of 2023 witnessed the release of Freud’s Last Session. This film imagines the encounter between the founder of psychoanalysis, Sigmund Freud, and C.S. Lewis, the British writer and theologian, as the two intellectuals debate the existence of God.

I am struck by the visibility of these stories in the so-called secular world. Conventional wisdom would say that it’s the Church’s role to tell the stories of such notable Catholics through preaching, evangelization or Catholic publishing. Yet the Spirit always finds a way through cracks and crevasses. Ordinary people — whose careers and vocations entail the arts, writing, acting, storytelling and the like — found something deeply compelling in the Catholic intellectual and spiritual lives of these individuals. So much so that they labored for years to tell the story. There is something worth pondering in the three biographic features

spotlighting individuals who were Americans or lived in the U.S. Coincidence is too simple of a dismissal.

I conjecture the Spirit is stirring hearts and great creativity among writers, filmmakers and actors alike, just as it has inspired other artists, sculptors, architects and literaries throughout the centuries. Within these films, I see three common threads that connect to our work and ministry in Catholic health care: tensions, love and hope.

TENSIONS

Every good storyline needs a twist. The devout characters in these films received no free pass from life’s difficulties, including challenges with their own faith lives. All three experienced tense encounters with superiors or ecclesial authorities. Founder of the Missionary Sisters of the Sacred Heart of Jesus, Mother Cabrini butted heads with

Within these films, I see three common threads that connect to our work and ministry in Catholic health care: tensions, love and hope.

Vatican curia and archbishops. O’Connor faced off with publishers and her parish priest. Teilhard endured the sting of rejection by the Jesuit Superior General and betrayal by an intellectual peer.

For Teilhard, his intellectual embrace of evolution could not be easily harmonized with

DARREN M. HENSON

centuries of Catholic teaching and the theology of the era. His writings remained suppressed his entire life. After returning to France following years of exile in China, solace still eluded him. He sought refuge in New York, and even there, the Jesuit community viewed him with suspicion. He spent his final years living alone in a small apartment with a single window facing a dark alley.1

Tensions saturate O’Connor’s work. A provocateur, O’Connor’s writings plunge headlong into Southern society and themes of illness and disability, crime, racism and socioeconomic disparities. At times, the most unsavory characters experience a moment of redemption, when more likable characters spiral as they confront their own transgressions and rejection of grace.

O’Connor so keenly sees the strangeness of the Christian story and the counterintuitive workings of divine grace alongside the awfully stubborn underpinnings of sin in human nature. All throughout, moviegoers get a taste of the exotic discovered in the spiritual life.

Conversations across Catholic health care scarcely escape the mention of the struggles and headwinds of being a Catholic ministry in the U.S. today. There is tension with policies that inhibit fuller expressions of human flourishing. Tensions abound with payers, private insurers, suppliers and vendors beholden to shareholders and private equity expecting profits on the backs of sick individuals, the chronically ill, senior populations and the dying.2 Tension arises in a society exhibiting declining trust in institutions, compounded by suspicion and misunderstanding of religious traditions.

The tensions we face today are additional verses of the song sung through these films. Mother Cabrini faced strikingly similar obstacles with politicians and businessmen. O’Connor’s prose reacts to a society at odds with the reign of God she glimpsed at daily Mass. Teilhard could not overcome the tension between faith and science and the institutional confines during his lifetime.

One of the many beauties of these films is how

For those of us in Catholic health care, these movies give us clues for letting some tensions remain while we continue with unabashed devotion to enlivening the healing ministry of Jesus in our aching world and society. Just as love impelled these characters, it does so for us as well today.

Cabrini highlights the work of St. Mother Frances Xavier Cabrini among the impoverished Italian immigrant population living in New York City at the turn of the 20th century. Cristiana Dell’Anna plays the title role.

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figures of faith channeled their interior lives. They responded to grace that opened paths and strengthened their vocational call amidst unresolved life tensions. For those of us in Catholic health care, these movies give us clues for letting some tensions remain while we continue with unabashed devotion to enlivening the healing ministry of Jesus in our aching world and society. Just as love impelled these characters, it does so for us as well today.

LOVE

Tensions loosen with love. If tensions drive the storylines of Cabrini, Wildcat and Teilhard, then love overflows all the more.

Mother Cabrini exhibited a genuine love of children, especially immigrant children. She saw in them her own story, one of struggle and searching for a way of life less confounded by prejudice and rejection. The community she founded embraced the children left parentless by illness, disease or the strain of migrating. Her desire to restore hope and a brighter future for these young people motivated her to build housing and hospitals, from New York City to Denver to Chicago, and places in between.

From the first minutes of Teilhard, the viewer sees his immense love of nature. It developed into a deep devotion to science, and especially to evolution, not merely to the physical world but to the spiritual life as well.3 Simultaneously, he had a genuine love for his priestly vocation. Days before his ordination, he writes about his sincere convic-

tion of the veracity of evolution despite the grave suspicion cast upon it by official Church teaching. This love for his priestly ministry endured years later when confronted with the proposition of leaving. Love alone could hold the strong contradictions Teilhard experienced.

O’Connor expressed a love of the Mass. She also loved birds and tended an aviary on her farm, including peacocks. Most of all, O’Connor loved to write.

Wildcat captures adaptations of some of O’Connor’s most exquisite lines. In one scene in the film, her character says, “Dear God … Let me be your typewriter.” The prayer expresses her love, and yet when asked about writing, she dryly replies in the movie, “It’s like giving birth to a piano, sideways.”4 Writers, artists and athletes know the struggle in practicing their art or sport. Discipline and practice that flow from a deeper well of love for the art or activity can temper tensions and lend to accomplishment.

Leaders and sponsors of Catholic health care exhibit great love and devotion to this healing ministry. Expressions of love mark our ministries and appear in our commitments to women, men and children in society’s throwaway culture — seniors, those unborn, persons with disabilities, individuals with serious and incurable illnesses, migrants and refugees, and those who experience a lifetime of disparity and disadvantage. The cogs and barbs of bureaucracy, however, snag even greater expressions of our ministry’s love.

When we feel exhausted by obstacles and

Courtesy of Oscilloscope

Flannery O’Connor was both an exceptional writer and a devout Roman Catholic. Maya Hawke stars as O’Connor in Wildcat

rejection, it can lead us to ponder avenues of abandonment to commitments and forego the difficult path of grace. The fervent love revealed in Mother Cabrini, Teilhard and O’Connor are contemporary witnesses to the scriptural reference that love endures all things (1 Corinthians 13:4-7). For me, these movies normalize the difficulties faced in today’s milieu. They temper a reaction to overexaggerate the difficulties of challenges, and they remind me that the work of ministry most often is tenuous, because it ultimately exists by grace. These grand narratives of O’Connor, Mother Cabrini and Teilhard are important for us in Catholic health care. Robert Ellsberg, editor-in-chief and publisher of Orbis Books, offers an apt explanation: “It makes a difference if we look at stories that elevate our spirits, empower our consciences, and open our hearts to new possibilities of human living. … In reflecting on the stories of saints, I was struck by how often a crucial turning point in their lives came through their encounter with another saint. Sometimes that was a personal encounter, but often it came through reading a story.”5

Formation knows the power of story. Perhaps some in Catholic health care might experience a turning point and inspiration through these great American Catholic stories. They have the power to inflame our own narrative and commitment, and good stories like these spark a renewed sense of hope.

HOPE

Mother Cabrini famously inspired her missionary sisters, as her character in the movie declares the need to build “an empire of hope.” Her love for immigrants, her community and vocation outweighed the strife she encountered and could not quench her great hope that came from faith in the resurrection of the dead.

CHA’s new strategic plan, building upon our vision “to embrace bold change,” echoes a similar message. Catholic health care’s bold plans to care for all, reimagine a just and sustainable health system, and stand united for change present a vision of hope.6 Many attendees of CHA’s Assembly in June departed with an unmistakable burst of hope. Similarly, ministry formation programs routinely conclude with hearts and vocations bolstered by great hope.

Such hope, however, cannot be taken for granted. Catholic health care leaders and sponsor members must be the conduits of hope so needed across our ministries. We are called to imitate the

enthusiasm of Mother Cabrini, O’Connor and Teilhard in our ministries amidst our communities today. As Pope Francis urges us to do for this Jubilee Year 2025, “[W]e are also called to discover hope in the signs of the times that the Lord gives us. … We need to recognize the immense goodness present in our world … .”7

LOVE PROPELS US FORWARD

The lead characters in Cabrini, Wildcat and Teilhard fostered love that soothed illness, overcame war-torn violence, endured marginalization and exile, healed broken relationships and ultimately imbued them with hope. These movies just might form us as leaders and sponsors of this healing ministry to boldly advance Catholic health care, propelled by great hope and love.

DARREN M. HENSON, PhD, STL, is senior director of ministry formation at the Catholic Health Association, St. Louis.

NOTES

1. Louis M. Savary and Patricia H Berne, Teilhard de Chardin—Seven Stages of Suffering: A Spiritual Path for Transformation (Mahwah, New Jersey: Paulist Press, 2015).

2. Healthcare Here, https://healthcarehere.org.

3. Ilia Delio, Making All Things New: Catholicity, Cosmology, Consciousness (Maryknoll, New York: Orbis Books, 2015).

4. Brad Miner, “Snippets: Ethan Hawke’s Biopic about Flannery O’Connor,” The Catholic Thing, June 12, 2024, https://www.thecatholicthing.org/2024/06/12/ snippets-ethan-hawkes-biopic-about-flannery-oconnor/.

5. Robert Ellsberg, “Walking the Path of Holiness: What I’ve Learned from a Lifetime of Studying Saintly Lives,” America: The Jesuit Review, June 29, 2023, https://www.americamagazine.org/faith/2023/06/29/ all-saints-robert-ellsberg-245549.

6. “The Catholic Health Association Strategic Plan: 2025-2027,” Catholic Health Association, https://www.chausa.org/docs/default-source/about/ cha-strategic-plan-2025-2027.pdf?sfvrsn=d31d9f2_3.

7. Gerard O’Connell, “Hope Is the Central Message of Pope Francis’ Decree for Jubilee Year 2025,” America: The Jesuit Review, May 9, 2024, https://www.americamagazine.org/faith/2024/05/09/pope-francis-jubilieeyear-2025-247898; Linda Bordoni, “Vatican Announces Motto of Jubilee Year 2025: ‘Pilgrims of Hope,’” Vatican News, January 13, 2022, https://www.vaticannews.va/ en/vatican-city/news/2022-01/jubilee-year-2025motto-archbishop-fisichella-new-evangelization.html.

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THINKING GLOBALLY

RETHINKING GLOBAL HEALTH PARTNERSHIPS: EMBRACING THE FOUR Es

You may have read about the three initial “Es” for building a framework for global health partnerships in my recent Thinking Globally column in the Health Progress Summer 2024 issue. It is a continuing journey, but I had an “aha!” moment at the culmination of several recent trips that led me to Uganda, Italy and Ukraine. All the trips focused on global health partnerships but from very different perspectives.

The deliberations, experiences and conversations in each place were unique, yet I walked away from each knowing that we had to rethink how we approach global health partnerships. As I reflected on the collective experience, some rethinking, reimagining and a framework for future collaborations emerged.

EXAMINING HEALTH THROUGH A GLOBAL LENS

Global health has its roots in the late 19th century, in the largely colonial, biomedical pursuit of “international health.” The 20th century saw a change in the field’s emphasis toward a much broader conceptualization of global health, encompassing broader social determinants of health and a truly global focus.1 The concept of global health partnerships emerged in the mid-20th century, when the world began recognizing the interconnectedness of health issues across regions, borders and continents. As a result, the creation of organizations, like the World Health Organization (WHO), fostered international collaboration on health matters.

The premise of navigating the intricacies of international health systems, legal frameworks and geopolitical dynamics is inherently complex and has proven to be complicated. Yet, the potential to achieve significant, lifesaving outcomes makes pursuing these partnerships essential to the future of global health.

COMPLEXITIES OF GLOBAL HEALTH COLLABORATIONS

The endeavor to forge global health partnerships

and collaborations is fraught with challenges. These initiatives, aimed at addressing pressing health issues, require coordination among diverse stakeholders with varying agendas, resources and cultural backgrounds. Threats to ethical, equitable and effective partnerships include funding and co-funding disparities between partners from high-income and low-income countries, inequalities, lack of shared vision and priorities, skewed decision-making levels, and limited flexibility to minimize inequalities and make changes.

Further, imbalances in power, privilege, position, income levels and institutional resources create opportunities for the exploitation of partners, particularly those in low-income countries, which widens the disparities and limits the success and sustainability of partnerships.2 Finally, the energy created by participating in a global project or partnership can often be misplaced. Too often, due to such factors as systemic issues, misaligned priorities, and a lack of understanding of local context and culture, the energy that motivates global health partnerships is created by the act of giving and not the resulting outcomes.

INTRODUCING THE FOUR Es FRAMEWORK

To navigate the complexities and enhance the efficacy of global health partnerships, I have begun to consider a guiding framework based on four critical Es: ethical, equitable, effective and energizing collaborations. This approach seeks to align stakeholders around shared values and goals, fostering partnerships that are not only productive but also sustainable.

1. Ethical collaborations prioritize transparency, accountability and respect for all participants.

BRUCE COMPTON

They also ensure that all actions and decisions are just and fair, acknowledging the dignity and rights of the collaborating organizations, individuals, communities and those affected by the collaboration.

2. Equitable collaboration and equity in outcomes are essential to address the imbalances in resources, access and power that often characterize global health initiatives. Equitable partnerships strive to distribute benefits and responsibilities fairly, recognizing each partner’s unique contributions and needs.

3. Effective collaborations are measured by the tangible impact on health outcomes. This necessitates a commitment to evidence-based practices, continuous learning and adaptability. Effective collaborations focus on achieving specific, agreed-upon goals that address the needs of the populations served.

4. Energizing sustainable collaborations will require ongoing motivation and commitment to inspire and mobilize all participants and stakeholders, thus fostering a shared vision and enthusiasm for the work and, most importantly, its outcomes. This involves recognizing and valuing the contributions of all stakeholders, facilitating professional growth, addressing barriers, monitoring progress and celebrating successes.

BEYOND PERSONAL PERSPECTIVES

Achieving the Four Es in global health partnerships requires transcending personal biases and experiences. It demands a willingness to engage in open, honest dialogue that bridges diverse perspectives and expertise. This involves actively seeking to understand the challenges and opportunities from the standpoint of different stakeholders, including local communities, health care workers, policymakers and international partners.

The essence of global health collaborations lies in recognizing that no single entity holds all the answers. Instead, it is through collective effort, mutual respect and shared vision that impactful and sustainable health improvements can be realized. This approach challenges us to look beyond our assumptions and work together in new and innovative ways.

REEVALUATING EMPOWERMENT

A pervasive term in the discourse on global health partnerships has been “empowerment.” However, this concept requires reexamination. Empower-

ment is frequently advocated as a positive approach to addressing individual and communitylevel health needs. Despite its popularity, relatively little has been said about the unintended consequences of empowerment, which may give rise to some troubling ethical issues or result in outcomes that may not be considered health-promoting.3

To say that one party will empower another presupposes a power dynamic antithetical to equity and partnership principles and suggests a transaction where power is transferred. In 2021, Flor Avelino, a professor and researcher with Utrecht University, reviewed several theories of power and social change and found that multiple authors highlighted mistaken assumptions on which various failing empowerment programs were based. They instead emphasized that power cannot be shared or delegated but only attained and exercised from within: “We can confer authority; but power or capacity, no man can give or take.”4

By moving beyond the notion of sharing or delegating power to a collaborative environment where all parties can exercise their agency and contribute meaningfully, we can foster a more genuine collaboration that acknowledges and leverages the strengths and capacities of all involved.

DIVING DEEPER INTO THE FOUR Es

Engaging in the Four Es of ethical, equitable, effective and energizing collaborations fosters productive and sustainable partnerships that align stakeholders around shared values and goals. Below are a few considerations critical in ensuring the success and sustainability of partnerships and safeguarding the dignity and rights of the communities they aim to serve.

Ethics lie at the heart of any successful collaboration. When building a global health workforce, we must adhere to principles prioritizing the wellbeing of individuals, communities and societies. Here are some key ethical considerations.

Informed consent: Ensure all stakeholders understand their roles, responsibilities and potential impact. Informed consent fosters trust and transparency.

Cultural sensitivity: Acknowledge diverse cultural norms, values and practices. Respectful engagement is crucial for ethical collaborations.

Beneficence and nonmaleficence: Strive to do good while minimizing harm. Prioritize actions that benefit the workforce and the populations they serve.

Equity in global health workforce collaborations is challenging to achieve. Here’s how we can work toward it:

Resource distribution: Equitably allocate training, funding and infrastructure resources. Address disparities between high-income and low-income collaborators.

Capacity building: Invest in development across all regions. Reinforce the importance of local talent through education, mentorship and skill-building.

Representation: Ensure diverse representation in decision-making processes. Amplify voices from underrepresented communities.

Effectiveness should be the litmus test for any collaboration. To enhance global health collaborations, consider the following:

Shared goals: Align efforts toward common objectives. Whether it’s disease prevention, research or health care delivery, a shared purpose drives effectiveness.

Data-driven decision-making: Leverage data to assess impact, identify gaps and refine strategies. Evidence-based approaches lead to better outcomes.

Ongoing learning: Develop a culture of learning and adaptation. Effective collaborations evolve based on lessons learned.

Energizing collaborations infuse vitality into global health partnerships. Here are some ways we can work toward energizing these relationships.

Motivation and passion: Cultivate enthusiasm for the mission. Individuals who are connected to a larger purpose tend to contribute more intentionally.

Recognition and appreciation: Acknowl -

edge achievements and celebrate milestones. Recognition fuels motivation.

Collaborative learning: Create spaces for knowledge exchange. Energize the workforce by fostering curiosity and intellectual growth.

SHIFT TO PROPEL CHANGE

Rethinking global health partnerships through the lens of the Four Es — Ethical, Equitable, Effective and Energizing — offers a pathway to more meaningful and productive collaborations. By refocusing our energy, moving beyond the concept of empowerment, and embracing a more collaborative model, there is the potential to address the immediate and long-term global health challenges. This shift requires a commitment to continuous dialogue, learning and adaptation, grounded in the understanding that the strength of global health initiatives lies in our collective endeavor to foster a more resilient, responsive and impactful global health system.

BRUCE COMPTON is senior director, global health, for the Catholic Health Association, St. Louis.

NOTES

1. Mike Rowson et al., “Conceptualising Global Health: Theoretical Issues and Their Relevance for Teaching,” Globalization and Health 8, no. 1 (November 2012): https://doi.org/10.1186/1744-8603-8-36.

2. Damalie Nakanjako et al., “Building and Sustaining Effective Partnerships for Training the Next Generation of Global Health Leaders,” Annals of Global Health 87, no. 1 (July 2021): https://doi.org/10.5334/aogh.3214.

3. Verena Biehl, Thomas Gerlinger, and Frank Wieber, “Professional Characteristics of Health Promotion: A Scoping Review of the German and International Literature,” International Journal of Public Health 66 (July 2021): https://doi.org/10.3389/ijph.2021.1603993.

4. Flor Avelino, “Theories of Power and Social Change. Power Contestations and Their Implications for Research on Social Change and Innovation,” Journal of Political Power 14, no. 3 (March 2021): 425-448, https://doi.org/10.1080/2158379X.2021.1875307.

ENSURING INTEGRATED PALLIATIVE CARE FOR AN AGING AMERICA

MARK KANTROW, MD, FAAHPM

Spectacular advances in medical care have resulted in improved overall health and longevity. Combined with a surge of baby boomers, our population is now aging at an unprecedented rate. This demographic shift is anticipated to strain an already taxed post-pandemic health care system.

By 2030, all 73 million baby boomers will be 65 or older. By 2050, an anticipated 47% increase in the number of individuals over the age of 65 will result in a large fraction of this population of 82 million people having debilitating chronic illnesses like dementia, stroke, cardiac and respiratory diseases.1

Compared to younger adults, aging individuals often live with several complex medical diagnoses and can anticipate predictable functional decline, increased frailty and, too often, significant cognitive impairment. The supportive care associated with the increased medical complexity of older adults due to declines in functional and neurologic status is anticipated to overwhelm long-term care and family caregiver resources. The sheer number of aging persons will also make providing basic health care services, both in and outside of hospitals, increasingly difficult.

A multifaceted approach that supports older patients and their families is essential to providing the highest quality of care to this aging population. In addition to investments in infrastructure, workforce development and technological solutions, palliative care is central to achieving the goal of high-quality medical care for every seriously ill person.2

ALIGNING CARE WITH PATIENT, FAMILY PRIORITIES

Palliative care, affirmed in the U.S. as a distinct medical specialty nearly 20 years ago, provides an additional layer of person-focused care delivered by an interdisciplinary team alongside the treatments provided by other medical teams. It is appropriate at any age and stage of serious illness, aiming to improve the quality of life of patients

and families while reducing avoidable suffering. The relief of distress associated with diseases and treatments, while supporting patients as individuals with personal goals and values, is a hallmark of palliative care.

Palliative care aligns medical treatments with patient and family priorities, providing the critical service of educating patients and families to improve understanding and manage expectations. This is particularly important as individuals near the natural end of life or deal with chronic, debilitating illnesses associated with aging that can threaten the quality of life and one’s personhood. Supporting patients and families with palliative care to navigate our complex, high-technology medical landscape achieves desired, but often otherwise unobtainable, outcomes, increasing the overall quality of care while reducing the associated cost.3

Despite the natural assumption that personcentered and coordinated care happens spontaneously, decades of experience show that medical care provided often misaligns with patient values and goals. The momentum of critical care begins as soon as a patient reaches the emergency department, often leading to burdensome treatments without a pause to ensure the care provided is appropriate, desired or capable of achieving the hoped-for outcomes. Expectations of what outcomes are possible or most likely to occur are often more influenced by pop culture than medical science. Involvement of palliative care teams can lead to better-informed decisions that honor patient autonomy in these high-stakes situations.

The need for palliative care extends beyond hospitals to community programs, skilled nursing

units and long-term acute care facilities. Proper care planning, including identifying a surrogate who can speak for the patient if they lose decision-making ability, is essential but often neglected. Studies show that while nearly 80% of patients want to discuss their wishes for future end-of-life care with their providers, only 7% are asked.4 This silence between patients, families and care teams can be alleviated by improving the capacity of everyone involved with patient care to provide an appropriate degree of palliative care.

A COMMITMENT TO IMPROVE PALLIATIVE CARE

The Catholic health ministry has long viewed palliative care as an expression of its mission to serve the seriously ill and dying. In 1994, three Catholic health systems came together to establish the Supportive Care Coalition,5 an organization committed to advancing excellence in palliative care in the Catholic health ministry through advocacy, education, and the integration of Catholic teachings and ethical principles into palliative care practice.

Membership in the coalition grew over the years and, in 2021, CHA, an early coalition member, integrated the Supportive Care Coalition into its operations to support the continued growth and development of palliative care across Catholic health care. As CHA CEO and President Sr. Mary Haddad, RSM, said in 2021, “The integration of SCC into CHA will enhance palliative care programs and services to our members and will create a strong and unified voice for enhanced funding and support for outstanding palliative care at the state and national levels.”6 To provide quality medical care to our aging American population, this unified voice has never been more important.

As demographic, financial and policy drivers push health care to do more with less, CHA is working with its members to strengthen their commitment to palliative care. These efforts will focus on continued education about the inextricable link between mission, quality, and palliative care and support for member efforts to improve the quality of their palliative care programs.7

High-quality palliative care is foundational to the mission of Catholic health care by serving those most in need, addressing suffering for seriously ill patients, and ensuring a sacred and peaceful transition at the end of life. Catholic health care must stay focused on our obligation to provide this care for our sickest patients despite

waxing and waning financial challenges. During these difficult times, financial decisions informed by formal discernment are essential, and we must avoid the temptation to simply check a box marked “Yes, we have palliative care” without providing the actual staffing required to deliver quality, holistic, multidimensional support for the sickest patients and families. CHA’s discernment model, “Listening and Cooperating with the Spirit,” notes, “Decisions that could significantly impact local communities, persons’ lives and affect an organization’s Catholic identity and character should be made against the background of the organization’s core commitments and be approached with discipline and discernment.”8

BUILDING A CULTURE OF PALLIATIVE CARE

Staying true to our Catholic mission is especially important given a recent study that found that prior to the COVID-19 pandemic, for every four hospital-based palliative care programs that started, one existing program closed.9 Continuing our mission is also especially important given that post-pandemic palliative care programs struggle to get needed resources to keep up with increased demand that resulted from services becoming highly visible and valued by seriously ill patients and families during the pandemic.10

Consciously pushing against this trend, in 2020, at the beginning of the pandemic, leaders at Franciscan Missionaries of Our Lady Health System (FMOLHS) observed the inconsistencies in how palliative care was provided in the health system’s hospitals. Recognizing the need to provide the highest quality of medical care consistently in all ministries, processes were put in place to ensure consistent growth of palliative care in all FMOLHS hospitals and communities. This has allowed equal access to full-team palliative care throughout the health system, resulting in dependable, high-quality palliative care in every hospital and higher levels of mission-aligned care across the ministry.

Prior to this initiative, every hospital grappled with providing palliative care as it saw fit, dependent on the variable understanding of the need for palliative care realized in each C-suite and greatly influenced by financial considerations. In individual hospitals, if financial resources were strained, developing palliative care programs was considered optional. Not understanding the vital link between palliative care and quality, this led

to highly divergent levels of palliative care, with some hospitals unable to meet the need within their hospital or community.

Having fully staffed teams in larger hospitals has improved the ability of FMOLHS to address patient and family needs in innovative ways. As an example, the palliative care team at Our Lady of The Lake Regional Medical Center in Baton Rouge, the largest hospital in Louisiana, can provide support to Our Lady of the Angels, a small rural hospital, through telemedicine, in concert with an on-the-ground palliative care team led by a chaplain and with the participation of family medicine residents. This has been surprisingly effective in providing palliative care to rural patients and families while supporting resident training.

Having more robust palliative care support has also allowed the development of a hospice and palliative medicine fellowship at the medical center, sponsored by the Accreditation Council for Graduate Medical Education. The program provides education to not only those involved in the fellowship program, but also supports the ongoing training of all FMOLHS palliative care teams twice a week through video connection to transmit training lectures and encourage ongoing collaboration between palliative care teams throughout the health system. Currently, every hospital with more than 300 beds has a full palliative care team, which includes physicians, nurse practitioners, nurses, a social worker and, importantly, a chaplain to support the multidimensional needs of our sickest patients.

As we welcome the groundswell of aging patients, FMOLHS is well-positioned to continue growing palliative care in the hospital and community with clinics and home-based programs, expanding support for the most seriously ill patients. Unquestionably, the key driver of success has been system-level leadership.

Dependable access to high-quality palliative care programs fosters something unexpected: a far-reaching culture of palliative care. In the same way a visit to a perfume factory will leave the pleasant scent on anyone’s clothes who passes through, a robust palliative care program benefits not only the patients seen by the palliative care team, but also extends to the care of many others by enhancing the generalist palliative care skills of all health care providers. This requires intentional administrative effort to ensure palliative care programs are adequately supported and

funded throughout Catholic health care communities. The highest quality medical care for our patients cannot be achieved without proactive palliative care support.

A LEADING VOICE TO EXPAND ACCESS

Catholic health care is sometimes critiqued on what we cannot do because of our faith. I am heartened by the growing recognition of what we can and should do as Catholics in health care. We must provide the highest quality medical care, which includes palliative care support to all seriously ill and suffering patients and those important to them, including caregivers. This care often begins in the hospital but ideally should continue to expand into community programs, long-term care facilities and in every location where there is serious illness and suffering.

Every pope since John Paul II has commented on the need for Catholics to provide effective palliative care. As Pope Benedict XVI rightly said, “This is a right belonging to every human being, one which we all must be committed to defend.”11

Respect for life, a tenant so central to our Catholic faith, must extend to the preservation of dignity, autonomy and compassionate treatment at life’s inevitable end. Ensuring excellent palliative care everywhere requires a clear leading voice.

As a member of the Supportive Care Coalition, and since taking over the reins of it in 2021, CHA has been committed to expanding access to palliative care. The Catholic health ministry can support this goal by ensuring that palliative care is well-represented in the future strategic plans of all Catholic health systems.

As we navigate into these next decades and our aging population swells dramatically, robust and high-quality palliative care across the continuum of care will be a defining feature of future successful health systems.

DR. MARK KANTROW is system medical director of palliative care at Franciscan Missionaries of Our Lady Health System.

NOTES

1. “Get the Facts on Healthy Aging,” National Council on Aging, August 16, 2024, https://www.ncoa.org/ article/get-the-facts-on-healthy-aging; Mark Mather and Paola Scommegna, “Fact Sheet: Aging in the United States,” Population Reference Bureau, January 9, 2024, https://www.prb.org/resources/

fact-sheet-aging-in-the-united-states/.

2. Terry Fulmer et al., “Actualizing Better Health and Health Care for Older Adults,” Health Affairs 40, no. 2 (January 21, 2021): https://www.healthaffairs.org/doi/10.1377/ hlthaff.2020.01470.

3. “The Value of Palliative Care,” Center to Advance Palliative Care, https://www. capc.org/the-case-for-palliative-care/.

4. “Final Chapter: Californians’ Attitudes and Experiences With Death and Dying,” California HealthCare Foundation, February 2012, https://www.chcf.org/publication/ final-chapter-californians-attitudes-andexperiences-with-death-and-dying/.

5. “Our Beginnings,” Supportive Care Coalition, https://supportivecarecoalition.org/ about-us-blog/2017/10/31/beginnings-1.

6. Catholic Health Association, “Supportive Care Coalition Joins the Catholic Health Association of the United States,” news release, November 18, 2020, https://www.chausa.org/newsroom/ news-releases/2020/11/18/supportivecare-coalition-joins-the-catholic-healthassociation-of-the-united-states.

7. Valerie Schremp Hahn, “Palliative Care Webinar Focuses on Giving Quality Care to the Whole Person,” Catholic Health World, August 15, 2023, https://www.chausa.org/ publications/catholic-health-world/archive/ article/august-15-2023/palliative-carewebinar-focuses-on-giving-quality-care-tothe-whole-person.

8. Listening and Cooperating with the Spirit: CHA Discernment Model & Facilitator Guide (St. Louis: Catholic Health Association), https://www.chausa.org/store/products/ product?id=4650.

9. Maggie M. Rogers et al., “Factors Associated with the Adoption and Closure of Hospital Palliative Care Programs in the United States,” Journal of Palliative Medicine 24, no. 5 (May 2021): 712-718, http://doi.org/10.1089/jpm.2020.0282.

10. “Fast Facts on U.S. Hospitals, 2024,” American Hospital Association, https://www.aha.org/statistics/fast-factsus-hospitals.

11. “Palliative Care,” Diocese of Manchester, https://www.catholicnh.org/community/ public-policy/issues/palliative/.

U.S. Postal Service

STATEMENT OF OWNERSHIP, MANAGEMENT AND CIRCULATION

(Required by 39 U.S.C. 3685)

1. Title of publication: Health Progress

2. Publication number: 0882-1577

3. Date of filing: August 21, 2024

4. Issue frequency: Quarterly

5. No. of issues published annually: 4

6. Annual subscription price: free to members, $29 for nonmembers

7. Location of known office of publication: 4455 Woodson Rd., St. Louis, MO 63134-3797

8. Location of headquarters of general business offices of the publisher: 4455 Woodson Rd., St. Louis, MO 63134-3797

9. Names and complete addresses of publisher, editor and managing editor: Catholic Health Association, Publisher; Betsy Taylor, Editor; Charlotte Kelley, Managing Editor; 4455 Woodson Rd., St. Louis, MO 63134-3797

10. Owner: Catholic Health Association of the United States, 4455 Woodson Rd., St. Louis, MO 63134-3797

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13. Publication name: Health Progress

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I certify that the statements made by me above are correct and complete. Betsy Taylor, Editor

DEMONSTRATING COMMUNITY BENEFIT IN ACTION THROUGH THE POWER OF STORYTELLING

MEGAN McANINCH-JONES, MSC, MBA, and ADRIENNE WEBB

Beyond the walls of hospitals and clinics exists an extensive network of organizations and collaborative efforts to create healthy communities and promote health equity. Often, behind the scenes, community health professionals and their partners work diligently to identify and address the root causes of illness and partner to create solutions that put the most vulnerable on a path toward health and wellness.

Community health work has been at the heart of Catholic health care for more than a century, working in collaboration with clinical programming, guiding community resource design and influencing legislation. Yet, this foundational work is often misunderstood and goes unrecognized publicly because it operates within the traditional and broader health care apparatus, where the focus tends to be on the provision of preventive and lifesaving care. Community health work also comes from a place of humility, where the focus is on lifting others up versus shining a light on the efforts themselves. For these reasons, it isn’t well-known for its significant role and the value it provides within our communities.

At Providence St. Joseph Health, a national, nonprofit Catholic health system serving seven Western U.S. states, we view community health programs as an extension of our mission to care for all. Providence’s legacy began with founding sisters determined to address the most pressing community needs, from providing health care to offering shelter to those experiencing homelessness. Our steadfast commitment to respond to community needs is one of the many ways Providence ministries, affiliates and caregivers live out our shared mission and serve as a vital safety net. Providence’s community benefit programs and its Annual Report to Our Communities reflect this commitment. 1 Every year, we publish and promote the community health improvement work

of Providence ministries and affiliates, telling the stories of the inspiring individuals we have the privilege to serve, as well as the caregivers and community partners who help bring our mission to life.

Providence takes a comprehensive approach to community benefit and its reporting to further connect our stakeholders to the mission and to support a more thorough understanding of the many ways Catholic health care provides for its communities.

A COMPREHENSIVE APPROACH TO COMMUNITY BENEFIT

Providence’s more than 165-year legacy of investing in communities is rooted in a tradition of caring for those in need, with compassion and in partnership with the people we serve. We work to ensure basic health needs are met and strive to remove barriers to care, build community resilience and innovate for the future through proactive community health improvement programs; free and discounted, low-cost care; and subsidized services. In 2023, Providence ministries and affiliates provided nearly $2.1 billion in community benefit programs and services.

Our approach to community benefit programming allows us to scale best practices across urban, rural and suburban markets throughout our ministry. Resources include tools and facilitation to support robust community

engagement; feedback on needs identification and prioritization; our Inclusive & Caring Language Guide; learning collaboratives on such topics as data analysis/interpretation and food insecurity; and data hubs that organizations can access to support grant writing and gain insights into their populations’ needs.

This work is complex and requires the involvement of many collaborators. While community health may lead these efforts, there are deep partnerships with public affairs colleagues, our boards and service area executives, teams of caregivers and like-minded partners in the community.

We recognize that the challenges facing our communities go beyond direct patient care, and the solutions must go upstream as well. Communication is instrumental in extending the benefits of our programs. By elevating the work of our partners and amplifying the voices and experiences of those who benefit from these programs, we’re drawing attention to critical needs and influencing and advancing social change.

STORYTELLING TO UNDERSTAND THE ‘WHY’ AND ‘HOW’

A recent national consumer survey found that there’s a significant lack of public awareness around community benefit.2 However, when participants were presented with examples of community benefit, a majority agreed that the areas of focus — for example, financial assistance and housing — were valuable and aligned with how they would prioritize investment.

Storytelling is critical to helping people understand the “why” and involving them in the “how.” To bring the mission to life for stakeholders, Providence uses its annual report and multimedia storytelling to highlight our community work and partnerships and to demonstrate our impact. Through the experiences of those who receive support from our community benefit programs, we can better articulate the challenges facing our families, friends, neighbors and co-workers and the solutions for a healthier community. Effective storytelling serves as a powerful call to action and change agent.

Teams across Providence come together to identify and share powerful examples of patients, caregivers and community partners collaborating to make communities healthier through strategic programming and focused investments. We showcase written and visual stories on our annual re-

port website with community benefit data from each service area and region we serve, helping to drive conversation and awareness across geographies, media outlets, communication platforms and stakeholders.

Local ministries and regions use content from the report website to build unique communication plans that reflect their programs, partnerships and audiences. For example, in Alaska, local data and stories of community benefit featured in the report are printed and distributed at local events; shared with caregivers in internal newsletters; made available to patients in clinics and hospitals; and provided to partners, donors, legislators and media.

Additionally, in Centralia and Olympia, Washington, local Providence teams recently launched community dialogue sessions to help identify and develop solutions around community health issues, including homelessness. Communication leaders use information and resources from the annual report to frame conversations with community members about shared health priorities and community health programs and their impact. Insights from these conversations go on to inform the hospitals’ community health needs assessment process.

A large part of Providence’s communication efforts is dedicated to the organization’s 120,000 caregivers. It’s important that those who support the mission see the impact their efforts and the community benefit programs have in the communities where they live and work. It also provides us with an opportunity to recognize the many people who have a hand in designing and supporting community benefit programs that touch thousands of lives. We leverage internal newsletters and our intranet to cascade stories and content, share materials across social media channels that caregivers follow, and use stories in meeting reflections and presentations.

Providence’s annual report goes beyond reporting requirements for community benefit. Providence ministries and affiliates use it to inform and engage stakeholders in conversations about a wide range of programs and initiatives that represent our legacy of charitable, nonprofit Catholic health care, such as awarding grants, philanthropy, health equity, sustainability and advocacy. Community benefit is just one way we address challenging health care issues and give

back, and we make a point to put it all into context through the annual report.

CORE TENETS FOR AN INTEGRATED PROMOTION STRATEGY

Over the last several years, Providence’s community health investment and communication teams have developed a collaborative process for sharing our good works through the annual report. Several lessons learned have helped us create an inclusive, integrated and successful approach.

Cross-functional Engagement and Alignment

Community benefit programs intersect with many departments and teams. Identifying and bringing together key internal stakeholders to codevelop the annual report creates an inclusive, collaborative environment and ensures the content is representative of the various communities featured throughout.

Flexibility for Local Adaptation

Community benefit is designed to respond to the unique needs of a particular area. Similarly, communication must be tailored, relevant and meaningful to resonate with our audiences. Creating evergreen, universal content allows for easy adaptation and localization, while maintaining key themes and cohesion.

Surveying and Measurement

Community benefit investments are intentionally structured to be dynamic so they can best meet current and projected needs. The ways we communicate and disseminate the annual report are

equally flexible. Each year, we survey teams across Providence to understand what information and format would be most helpful in reaching target audiences. Additionally, we use data to further refine our plans and develop best practices, including determining which social media channels are most effective in driving traffic to the report website and how stakeholders prefer to receive report content.

A COMMITMENT TO PRESERVE OUR STORIES

Showcasing Providence’s community benefit investments through the annual report has become a hallmark of our communication with stakeholders and a tool to preserve our history. As the media and technology landscapes continue to evolve and our audiences’ preferences for receiving and interacting with storytelling and data change, our community health and communication teams will seek new, innovative ways to serve up content that resonates and meets people where they are, mirroring how we approach and invest in community benefit programs.

MEGAN McANINCH-JONES is the former executive director of community health at Providence and is based in Portland, Oregon. ADRIENNE WEBB is the executive director of national communication at Providence and is based in Seattle.

NOTES

1. “2023 Annual Report,” Providence, 2023, https://www.providence.org/about/annual-report.

2. “2024 National Consumer Survey: Issues & Advocacy,” Jarrard, 2024, https://jarrardinc.com/ resources/national-consumer-survey-2024-request/.

PRAYER SERVICE

Holiness & Sainthood: A Universal Call

KARLA KEPPEL, MA, MISSION PROJECT COORDINATOR, CHA

PAULO G. PONTEMAYOR, MPH, SENIOR DIRECTOR OF GOVERNMENT RELATIONS, CHA

INTRODUCTION

In our daily lives, we are often faced with challenging conversations with co-workers, family and friends. In these moments, we can become defensive, losing sight of shared values, goals and ideas. Have these discussions caused friction? Are there relationships strained by differing viewpoints? Have you grown frustrated with leaders?

Now is the time to consider mending these bonds. Drawing inspiration from the saints and Mary, who exemplify forgiveness and reconciliation, we can find guidance in their lives. Let their examples help us navigate divisive times, fostering unity and understanding.

PAUSE AND REFLECT

As you prepare to pray, pause to check in with your mind, heart and body. Our physical bodies can house emotional turmoil in places where we least expect. Take a few breaths to focus your attention. As you exhale, release any tension, and as you inhale, embrace peace.

In his discussion of sainthood, author and hagiographer Robert Ellsburg explains: “The object [of sainthood] is to be a whole, integrated and happy person … someone whose life is aligned with the deepest purpose for their existence.”1 Put this way, our personal call to sainthood becomes more clearly apparent. Ellsburg continues that recognizing and honoring these qualities in others opens our own path to a more deeply integrated life.

Choose one of the following saints

“Prayer

to sit with in prayer, perhaps taking notes on how it might inform the pursuit of aligning your life with the “deepest purpose of your existence.”

“The clearness of my conscience has made my heart hop for joy.”

— St. Thomas More

St. Thomas More, known as the patron saint of politicians, is a paragon for acting according to one’s conscience. Even in death, More balanced the demands of love with integrity and grace. Whether we realize it or not, we are always navigating internal and external politics. How can you be attentive to the values that inform your own conscience, and remain true to the call to love your neighbor?

“Nothing is far from God.”

— St. Monica

St. Monica is known for her patience.

She suffered greatly when her son, St. Augustine of Hippo, did not share her faith. However, she remained patient, not because she knew he would eventually come around, but for the sake of love for him. How can you embody a patience that is rooted in love, especially with those who hold different values than you?

CLOSING PRAYER

The image of Mary as an Untier of Knots, illustrated in the classic Baroque painting of the same name, depicts the mother of Jesus untying a rope with many knots in it. While the devotion has been popular in many parts of Latin America for some time, in his tenure, Pope Francis has made it known worldwide.

Consider where in your heart there are knots to be untied as we invite Mother Mary to intercede for us in prayer:

Mother of God, untie the knots of our hearts. Grant that we can embrace peace inwardly to exude your peace with others. Guide us in our own paths to sainthood, to a more deeply integrated life that is more closely aligned to your love, care and forgiveness. May we know our place in creating a safe space for all to be well; and may we serve God earnestly with our hands, our eyes, our thoughts and our hearts. Amen.

NOTE

1. Robert Ellsburg, “Walking the Path of Holiness: What I’ve Learned from a Lifetime of Studying Saintly Lives,” America: The Jesuit Review, June 29, 2023, https://www.americamagazine.org/faith/ 2023/06/29/all-saints-robert-ellsberg245549.

Community Benefit 101

The Nuts and Bolts of Planning and Reporting Community Benefit

OCTOBER 15, 16 & 17, 2024

Each day from 2 to 5 p.m. ET

CHA’s highly regarded Community Benefit 101 provides new community benefit professionals, and others who want to learn more, with the foundational knowledge and tools of community benefit programming.

LEARN MORE AND REGISTER NOW AT WWW.CHAUSA.ORG/CB101

This virtual program is taught by experienced community benefit leaders. Topics covered include the importance of the organization’s community benefit mission, public policy, what counts as community benefit, community health needs assessment and implementation strategies, program planning and evaluation, accounting principles and communicating the organization’s community benefit story.

Thank you to our sponsor, the American Hospital Association.

ATTENDEES WILL RECEIVE A COPY OF CHA’S A GUIDE FOR PLANNING AND REPORTING COMMUNITY BENEFIT. We Will Empower Bold Change to Elevate Human Flourishing.