HSHS preserves rural health care through hospital acquisitions

March 1, 2020

Catholic system invests in services, spiritual care, leader formation


SHELBYVILLE, Ill. — About six years ago the board of the 18-bed, nonprofit Shelby Memorial Hospital here reached the difficult determination that to secure its future, the stand-alone hospital needed to join a larger health system.

HSHS preserves rural  health care
Dan Elbert, maintenance supervisor at HSHS Good Shepherd Hospital in Shelbyville, Illinois, hangs a crucifix in the hospital.

Although the hospital had maintained its independence for almost a century and was in fairly good shape financially, rising operating costs — especially those associated with complying with Medicaid and Medicare regulations — were a growing concern. The hospital board came to the conclusion that its overarching priority had to be keeping the doors open and retaining health services in the rural community.

Hospital Sisters Health System emerged as the board's clear preference among the six systems that expressed initial interest in acquiring the hospital. Headquartered in Springfield, Illinois, about 50 miles away, HSHS was a known entity. It had service-line level partnerships with Shelby Memorial. It had opened specialty and primary care medical practices in Shelbyville.

Employees of HSHS tour a cemetery
Employees of HSHS tour a cemetery on the grounds of the motherhouse of the Hospital Sisters of St. Francis in Springfield, Illinois, as they learn about the heritage of the women religious who founded the Hospital Sisters Health System. The visit was part of a formation program at the retreat house on the property.

Rural connection
HSHS has four hospitals within a 60-mile radius of Shelbyville, including its flagship, HSHS St. John's Hospital, a tertiary care teaching hospital in Springfield. And HSHS was making investments in rural communities at a time when rural hospitals and health services are facing growing challenges to their viability.

Kristy Gorden, a marketing specialist for the Shelbyville hospital, says its leadership was confident that HSHS had a good understanding of the hospital, its community and their needs, since HSHS and its founding congregation — the Hospital Sisters of St. Francis — "have been rural minded from day one. They understand rural health care."


Jean Hudson, executive assistant to the hospital's chief executive, says HSHS stood out among suitors because it "wanted to partner to help maintain health care in Shelbyville. They truly wanted to serve the community and keep quality care here in the community, and that impressed the board so much."

The unknowns
But while HSHS's January 2017 acquisition held the promise of providing long-term stability for Shelby Memorial, beyond the crosses that went up on the walls in every patient room, employees and members of this predominantly Protestant area were unclear about how the rechristened HSHS Good Shepherd Hospital would live out its identity as a Catholic ministry and a community anchor.

Good Shepherd is a major employer in Shelbyville — population nearly 5,000 — and surrounding communities. Would the acquisition lead to job loses? What would change when the secular facility became a Catholic hospital?


"With any change comes angst and anxiety," says E.J. Kuiper, president and chief executive of HSHS's Illinois Division.

About three years in, staff, board members and the community have their answers. HSHS has maintained staff count and invested in the hospital and the community, winning over any skeptics. "Shelbyville has really embraced this hospital being part of HSHS," says Kuiper.

System playbook
Kuiper attributes this success to the "playbook" that HSHS developed as it acquired rural secular hospitals in Oconto Falls, Wisconsin, and Greenville, Illinois, converting them to Catholic ministries. The tactics are transparent and simple: HSHS is very intentional about developing and nurturing good relationships with stakeholders, getting their input and providing for their meaningful participation. For example, mission leaders from HSHS reached out to the local ministerial association to explain that Good Shepherd would be a welcoming place for patients of all faith traditions.


Aaron Puchbauer, president and chief executive of Good Shepherd, says the ministerial association appreciates HSHS's faith-based mission.

The system and hospital also conducted a program for employees on the history and mission of HSHS and on what to expect with the transition to a Catholic facility. Hospital executives participated in the system's leadership and formation training and all staff are invited to take part in formation activities including at the sisters' Chiara Center, a spirituality center in Springfield.


Fr. Nick Husain is employed as a chaplain at Good Shepherd and at an HSHS hospital in Decatur, Illinois, about 35 miles away. He celebrates Mass each week in Good Shepherd's new chapel and provides spiritual care to patients. He has been mentoring staff who want to pray with patients.

Staff volunteer to read a prayer over the intercom each morning and they've grown accustomed to starting meetings with prayerful reflection.

Rapid progress
Puchbauer has led the facility through rapid improvements. Working with HSHS, the facility has been recruiting more clinicians to the hospital and community, and has added or expanded service lines, including orthopedics, general surgery and primary care. The hospital recently completed a $2.3 million renovation and expansion of its emergency room. Next year Good Shepherd is going live with HSHS's medical records system.


Puchbauer says the hospital also has greatly expanded community benefit work, including through outreach and partnership with local schools, to improve students' health care access and knowledge.

Lorrie Hayden, a manager of the facility's health information and patient registration departments who shares the mission leader role with a colleague, says HSHS welcomes open spiritual expressions, volunteerism and outreach. "Everyone can get involved," she says.


She is particularly fond of the "Mission Possible" program, which invites each hospital department to come up with outreach activities in line with the HSHS mission. Projects have included collecting school supplies for kids and food for local pantries; volunteering for bell ringing for the Salvation Army; and donating board games to nursing homes.

Dave Cruitt, a Good Shepherd board member, says: "You can hardly open up the local newspaper or get out on Facebook without seeing something about a community garden, a food truck or a holiday event that the hospital is involved in."

Former board member Randy Biehler says HSHS has delivered on its promises. "Everyone sees the improvements and that we're offering more services and keeping treatments here locally. The community feeling overall is very positive."

Relationship-building essential when bringing secular hospitals into ministry systems

HSHS earned stakeholder buy-in for acquisitions


When a secular hospital prepares to join a large Catholic system, the prospect of an ownership change can bring uncertainty for the hospital's staff and the community.

Trepidation can be heightened in rural communities where residents may have deep personal and philanthropic ties to a hospital, and where people who are not Catholic may have little knowledge of the tenets of Catholic health care.

Recognizing this, before Hospital Sisters Health System of Springfield, Illinois, acquired rural hospitals in Oconto Falls, Wisconsin; Greenville, Illinois; and Shelbyville, Illinois, it courted the communities, building confidence and solid relationships with all key stakeholders.

Sr. Laws

It engaged in transparent and forthcoming communication with hospital board members, administrators, admitting physicians, staff, patients, community clergy of all denominations, business and civic leaders and residents, says Sr. Monica Laws, OSF. As vice president of mission integration for HSHS at the time of the acquisitions, she helped to orchestrate the mission integration work connected with the acquisitions. (Sr. Laws retired Nov. 8.)


Peter Mannix, HSHS vice president of strategy development and implementation, says, "We wanted to ensure the communities would welcome us. We engaged with them to get their buy-in. We wanted to have them feel they were part of the process. We didn't want to overwhelm them." (Mannix retired Sept. 1.)

Getting to know you
Mary Starmann-Harrison is president and chief executive of HSHS, which has 15 hospitals and a network of non-acute facilities in Illinois and Wisconsin. She says in seeking out potential acquisition prospects, HSHS looks at facilities within a 90-mile radius of its hospitals, evaluating which ones have unmet health needs in their communities that HSHS could help shore up.


Mannix says HSHS determines how it can add value to the hospitals, including through the introduction of the system's electronic health record, standardization of care processes and group buying opportunities.

HSHS leaders keep local ordinaries, or bishops, in the information loop from the outset of acquisition talks. Sr. Laws says, "You never want a bishop to be surprised and read about something in the morning paper" that he has not been briefed on. Starmann-Harrison says bishops have been enthusiastic about adding a Catholic hospital ministry in their diocese.

When HSHS and the hospital are ready to move forward with a letter of intent and to make their plans public, HSHS reaches out to more stakeholders. This can include hosting retreats with the community hospital's board and administrators, making presentations to staff and to business leaders, convening community town hall meetings, and establishing a social media feed as well as outreach to traditional media outlets.

Listen and learn
Sr. Laws says HSHS and the hospitals had preexisting affiliations in place with the Oconto Falls and Shelbyville hospitals and that foundation reduced qualms. But HSHS was an unknown in Greenville when it moved to acquire the community's only hospital.


Jeannie Korte, an HSHS mission leader in Southern Illinois, says that in Greenville — which has a large Protestant population, but not a large Catholic presence — people didn't understand Catholic health care's ethic, and they "feared we'd try to proselytize or convert people. … So, our task in part was to introduce what it means to be a Catholic facility."

The system built relationships with local clergy of all denominations, welcoming them to provide pastoral care for their respective hospitalized church members and has involved them in celebrations and rituals at the hospitals.

HSHS' recent acquisitions of stand-alone community hospitals:

Sr. Laws says in all of the meetings in and out of the hospital, HSHS representatives were there to listen as much as to talk, and they invited questions and ongoing follow-up communication.


Mary Salm, director of spiritual care and mission integration for HSHS in Wisconsin, says system representatives also ensured "our messages were clear and consistent. We were intentional about presenting our mission" and being clear about the meaning and purpose of HSHS's work.

Korte says of the staff and communities, "We respected them, listened to them, we identified barriers to the acquisition, and we reassured them."

Intro to Catholic health care
Sr. Laws, Salm and Korte were on mission integration subcommittees that made numerous presentations, especially for staff of acquired hospitals, on the history, legacy, mission and ministry of the Hospital Sisters of St. Francis, the health system they founded and what it means to be Catholic.

The subcommittee members helped staff understand the meaning of — and reasons for — practices and protocols that would be put in place under HSHS's ownership, including the placing of crucifixes in all patient rooms, the addition of religious art in common spaces, the hiring of mission personnel, the use of prayers to begin meetings, the celebration of certain feast days of saints and the addition of chapels.

Korte says, "The more we shared, the more it resonated."


What's in a name? For HSHS, connections to communities

What's in a hospital name? Heritage. Connection to place. Brand promise.

Unveiling HSHS Hospita sign
Mary Starmann-Harrison, Hospital Sisters Health System president and chief executive, and Brian Nall, then the hospital's chief operating officer, unveil the HSHS Holy Family Hospital entrance sign. In the background is Bob Spencer, the facility's supply chain facilitator.

Aware that names carry great weight, Hospital Sisters Health System wanted to use the process of renaming the secular hospitals it acquired to create goodwill in its new host communities. The process it followed recognized that successful relationships between hospitals and communities require respect, a willingness to listen and mutuality of interests. The names had to identify the hospitals as Catholic while acknowledging the community's culture.

As acquisition talks progressed in each community, HSHS leadership listened in meetings with the hospitals' boards, other stakeholders and community groups for clues to names that would resonate with the communities. Two HSHS executives, one in charge of mission integration and the other over the system's communications and marketing department, did additional research and came up with a list of suggested hospital names for the leadership of the Hospital Sisters of St. Francis to vet and winnow down.

Unveiling HSHS Hospita sign
Fr. David J. Hoefler, vicar general of the Diocese of Springfield, Illinois, blesses an entrance sign for HSHS Holy Family Hospital in Greenville after the hospital's conversion to a Catholic facility. Vicki Kloeckner, the hospital's human resources manager, is beside him during the May 2016 ceremony.

The sisters then signed off on three possibilities for each community, leaving it up to the respective community hospital boards to make the final name selection.

Community members in Oconto Falls, Wisconsin, wanted to retain the "Memorial" in the Community Memorial Hospital name. They saw it as a tribute to people who have served in the military.

In introducing the community to the history of HSHS, system representatives described the special devotion the Hospital Sisters congregation that founded HSHS have for St. Clare, an aristocrat who turned her back on wealth to live a monastic life of prayer and service to the poor.

When it came time to choose the hospital's name, Oconto Falls residents and board coalesced around HSHS St. Clare Memorial Hospital.

The residents of Greenville, Illinois, resonated with renaming Greenville Regional Hospital as HSHS Holy Family Hospital.

HSHS Good Shepherd Hospital was the standout favorite in Shelbyville, a farming community where animal husbandry and agriculture are economic mainstays.


HSHS has 'playbook' for building Catholic identity

Since 2014, Hospital Sisters Health System has completed three acquisitions of secular rural facilities. As it learned from experience, the system set out a guide for making these conversions in a way that gained community buy-in.

The HSHS "Catholic Identity Work Plan" includes details around:

  • Delivering presentations and disseminating materials to stakeholders — especially employees — about the Hospital Sisters of St. Francis and HSHS. The sisters' and system's mission, heritage, principles and values are covered.
  • Building relationships with the local diocese.
  • Developing a spiritual care program at an acquired hospital.
  • Establishing an ethics committee.
  • Ensuring the charity care policy is in line with HSHS protocols.
  • Putting in place rituals and celebrations connected with the Catholic faith and the sisters' heritage.
  • Building a chapel if there isn't one.
  • Installing religious symbols and art throughout the facility.
  • Ensuring physician practices and patient care processes conform to the Ethical and Religious Directives for Catholic Health Care Services.
  • Putting in place education, development and formation programs for leadership and staff.


Copyright © 2020 by the Catholic Health Association of the United States

For reprint permission, contact Betty Crosby or call (314) 253-3490.