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Transforming health care in the USA

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Image: Transforming health care in the USATransforming health care in the USA will require leaders and associates (all employees and caregivers) to tap deeply into their discretional energy. Improving access and quality, while reducing costs and delivering health care that is more preventative and holistic presents health care systems with a revolutionary challenge.

How can caregivers be engaged in responding to this obvious need for transformation? How can faith tradition inform today's health care applications? Ascension Health, the largest Catholic not-for-profit health care system in the USA is addressing these challenges through several mechanisms. Two such mechanisms are:

  • an innovative application of a model for workplace spirituality, and
  • a system for measuring commitment to its “Catholic identity”.

Ascension Health operates 76 hospitals and provides health care services at more than 500 locations in 19 states and the District of Columbia. Its faith-based mission, vision, values and Catholic identity emphasize giving special attention to those who are poor and vulnerable, respect for life in all its stages, the provision of holistic care, and a commitment to a just and compassionate society.

A model for workplace spirituality

Ascension Health's integral model for mission integration and spirituality was initiated in 2003, when the system began to develop a framework for “a spirituality of work”. The model begins with describing a framework for understanding workplace spirituality – one that is marked by several characteristics: diverse, inclusive, relational, life-giving, rooted in reality, discoverable in awareness, and effective in service. The model maps how these characteristics flow through the various components of an associate's work-life, from how associates are selected and oriented, to what developmental opportunities are made available to them. Infusing these components of organizational and community life with the defined characteristics of spirituality will empower associates in their response to Ascension Health's “call to action,” thereby leading to the transformation of health care.

After developing the integral model, it was made a system priority by placing its implementation on the organizational scorecard. For five years spirituality joined measures like budget, mortality rates and supply chain compliance as a key indicator of success for the system.

Spiritually centred decision making

In a diverse and pluralistic work-life, new ways of being a community must be discovered; one that can help shape and guide the decisions needed to achieve meaningful, lasting transformation. One of the key components of the formation programmes and business practices in Ascension Health is the organizational ethics discernment process.

There are seven successful corporate practices which are integrated into this discernment process. These include:

  • Networking with stakeholders to reconcile their competing claims.
  • Seeking out participation so associates will be a part of the solution.
  • Clarifying objectives and expected results.
  • Adopting innovation and search, resisting quick-fix solutions.
  • Exploring the potential risks and benefits of each option to eliminate biases.
  • Examining all proposals in light of organizational values and any other salient ethical concerns.
  • Creating win-win scenarios for all stakeholders and tolerating mistakes.

The discernment process helps to ensure that decisions are thoughtful and reflective, that they engage the whole person at every level. This means that decisions will be participative, innovative, life-giving, transformative and enduring for the organization. In so doing, communities of caring and trust and communities where practical wisdom can take hold are being created.

Leadership formation

Ascension Health's formation programmes began as a direct result of its Sponsors' vision of an ever increasing role for the laity in system leadership. Not long after Ascension Health was established, it began planning a formation programme for high potential leaders who would help the system achieve a stronger commitment to its mission, vision, values, Catholic identity and “call to action”. The fruit of this planning is Formation for Catholic Health care Ministry Leadership, an intensive two-year programme, conducted in collaboration with the Vocare Center at the Aquinas Institute of Theology in Saint Louis. The programme includes six online theology courses, eight spiritual retreats, spiritual direction, a leadership-style assessment and an integration project.

"Some felt that it was inappropriate to try to measure spirituality; others felt that spirituality, though perhaps not directly measurable, would nevertheless be enhanced if leaders were held accountable to some measurable outcome."

To help make the church's social teaching more concrete in their professional roles, formation participants complete their studies with an integration project. The intent of these projects is to demonstrate that participants can integrate the spiritual practices and theological reflection they have experienced in the programme into their own work and into the work-life of their health care ministry. In one example of how this has worked well, a Vice President for Compensation, while working in the Catholic Social Teaching course, reflected on attributes of Ascension Health’s compensation structure which could be more closely aligned to the church's social teachings. He and another participant developed a proposal to revamp the compensation structure. Key elements of the proposal were accepted by the Ascension Health Board of Trustees. Projects by other participants have included: the development of a Formation Programme for Managers; a series of spiritual reflections for use by charge nurses; and a guide for respectfully transitioning associates.

All formation participants progress differently, but there seems to be a general pattern of growth. At the beginning of the programme participants come together and experience a variety of inclusive activities designed to strengthen them as a learning community. Throughout the first retreat they are asked to share their own story at gradually deeper levels. The group then passes into an engagement with the course materials. Participants are typically very active on-line and excited to be learning a new vocabulary and new thought structures. This often lasts into the beginning of the second year. During the latter half of the programme, participants typically meet a challenging period during which they become increasingly aware of the difference between their lived experience in their local health ministry and the ideals of the social teaching as presented in the programme.

Creating a system for measuring impact

Measuring the transformative impact of workplace spirituality, discernment and formation is perhaps the greatest challenge to the application of practical wisdom. For example, deciding whether to put spirituality on the organizational scorecard was hotly debated. Some felt that it was inappropriate to try to measure spirituality; others felt that spirituality, though perhaps not directly measurable, would nevertheless be enhanced if leaders were held accountable to some measurable outcome. The latter argument was persuasive.

During its five years on the scorecard, many proven practices in spirituality were documented and shared throughout the system. These proven practices include: the introduction of potential hires to the Ascension Health values in order to determine a good fit; celebrating a 400 year heritage of the healing ministry on special feast days; and the integration of spirituality into operations through the study and use of the discernment process.

In addition to its high-level organizational scorecard and in response to a request by its religious sponsors, Ascension Health initiated the design of another values-based measurement tool, to assess its effectiveness in achieving its “call to action”. This tool is known as the Catholic Identity Matrix (CIM). The CIM is used to assess how six principles, such as participatory community of work and mutual respect, are expressed throughout the organization, and is an effective tool in assessing the impact of workplace spirituality, discernment and formation.

Ascension Health's Integral Model for Mission Integration and Workplace Spirituality and the Catholic Identity Matrix are examples of how the assessment of values and principles can be integrated into an organization's metrics to support transformative efforts.

September 2011.


This is a shortened version of “Transforming healthcare: a study in practical wisdom”, which originally appeared in Journal of Management Development, Volume 29 Number 7/8, 2010.

The authors are Bill Brinkmann and Dan O'Brien.