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BY: CELESTE M. DeSCHRYVER MUELLER, D.Min.

Dr. Mueller is assistant professor, practical theology, and director, Vocare Center, Aquinas Institute of Theology, St. Louis.

Applying Theological Reflection to the Business of the Day

Catholic health care systems have developed a variety of formation programs that enable leaders to serve the mission more effectively by inviting them to discover the richness of Catholic heritage and tradition as resources for their lives and work. Despite the profound commitment to mission that these processes represent, leaders and associates continue to wrestle with tensions inherent in operating a business that is also a ministry.

In most organizations, specific decision-making tools¹ are utilized to ensure that critical issues are resolved with prayerful attention to mission, to Catholic values and tradition, and to voices and experience of significant stakeholders. However, reflection on ordinary or routine practices, which make up an organization's daily life, is less common. This is unfortunate because unexamined practices can communicate messages that undermine mission and identity.

This article proposes Strategic Theological Reflection as a valuable tool, one that bridges the ministry-business dichotomy through a method that explores and articulates the links between the myriad policies and daily practices of an organization and the values embedded in the organization's mission. Consider, for example, just one common practice — that of pulling a curtain around a patient's bed. The curtain communicates a conviction that humans have a right to privacy. Within the context of Catholic health care, we can also see embedded in that practice a belief, derived from our understanding of God, that we value the dignity of each human person. In reality, it is the ordinary policies and practices as much as the weighty ethical questions that communicate a message about mission. And the collective impact of those policies and practices can be significant.

Strategic Theological Reflection is a process that ensures widespread vigilance and guards against compartmentalizing mission-related concerns. It explores the vision being communicated by practices so that leaders can be sure it is the vision the organization wants to communicate.

Specifically, Strategic Theological Reflection allows strategic thinking to be informed by deeper insights into how an organization's practices affect mission in two important ways: It analyzes complex business practices to determine what vision and values they are communicating and it fosters dialogue with Catholic tradition and values.

Knowing the Foundations
Strategic Theological Reflection rests on four foundational understandings:

1. As noted previously, the identity of any organization is constituted by the collective impact of the vision communicated through the daily and routine practices of the institution, which, whether practitioners are conscious of it or not, communicate a message about mission much more loudly than any mission statement.
2. Every practice is the product of a complex array of circumstances, influences, intents, motives and actions. Without careful attention, the number of "voices" that may be influencing a practice can make it challenging to objectively hear the dominant message being communicated by the practice itself.
3. Each of our practices communicates some embedded theology.² That is, ideas about the world, creation, and the nature and purpose of human life, about how humans ought to relate to one another and creation, and even ideas about God, are embedded in the practices themselves.
4. Strategic Theological Reflection is oriented to strategic action. In contrast to most methods of theological reflection in ministerial literature, which seek personal spiritual insight or pastoral responses as outcomes, Strategic Theological Reflection is intended for group reflection on an organization's practices and seeks practical wisdom for the sake of strategic action as an outcome.

Once we have explored the complexity of a business practice and discerned the embedded or operative theology in it, Strategic Theological Reflection facilitates dialogue with the Catholic theological tradition as a resource for our efforts to strategically align our practices with what we hold most deeply and want to communicate to the world.

Putting Strategic Theological Reflection to Work
A variety of organizations have used Strategic Theological Reflection successfully to explore decisions as diverse as: an anticipated business merger; dismissal protocols used in layoff policies; awarding "at-risk" or performance-based compensation; a decision about who should open and sort mail. Virtually any practice or policy in an institution is suitable matter for reflection. The most fruitful use of the process occurs when a group is genuinely curious about what vision is embedded in an existing or anticipated practice.

The basic framework for Strategic Theological Reflection is a three-stage process of inquiry:

1. Exploring a routine or practice in all dimensions of its context. Questions to be asked include: "What is going on here?" "What vision or claim is being communicated through this practice?" "Who does this practice say we are?"
2. Discerning the "heart of the matter" in light of the situation's complexity; that is, asking, "What does this signify for us, in this place, at this time?"
3. Engaging the riches of the Catholic Christian tradition in dialogue with what is determined to be "the heart of the matter" in order to consider strategic options for maximum alignment with the mission and identity to which an organization is called. This means asking, "How can we most effectively align our practice with who we most want to be as an institution?"

Step 1: ECHO Analysis
A series of guiding questions, to which I have applied the acronym ECHO (Environment, Commitments, Human needs or tendencies, and Obligations) help to sound out the various and complex dynamics that shape a practice.³ The ECHO analysis attempts to get at the fullness of a practice, but the categories are neither discrete — the dynamics they highlight will overlap — nor are they necessarily the only possible categories to use. They are simply a set of keys to unlock the dynamics, to explore what is going on. There is no preferred order in which these categories should be explored. (See box.)

The ECHO analysis should be reflective, deliberate and as boldly honest as possible. Conducting Strategic Theological Reflection with a group of key stakeholders who represent different perspectives maximizes its effectiveness. As the analysis unfolds, it is important to keep asking the question, "What is really going on in this practice?" and to understand that the process is necessarily messy. Beware of temptations, such as the temptation to smooth over conflicting views; i.e., to name only what reflects well on those engaged in the practice, or on the organization, and thereby discuss only what the group hopes the practice implies. The point is to assemble as much data as possible so that the group can scrutinize the practice in its complexity.

Once the group has worked through the four categories of the ECHO analysis, the culminating question should be asked: "What operative vision reverberates through the dynamics of the practice?" (See box.)

This question should lead the group to discern and name the theological views that are being explicitly or implicitly communicated. The challenge is to base an articulation of the vision on the data at hand, and not to project an ideal or espoused vision into the situation.

Leaders at one health care group examining policies related to "at-risk compensation" recognized that their practice reinforced a notion that "status entitles some to rewards earned by the work of others who are not able to reap rewards for themselves from their own efforts." They observed that a vision operative in their practice was: "Human worth is determined by one's status in a stratified community." The operative theology of human community they uncovered was in stark contrast to the theology of "communion" and "inalienable worth" articulated in Catholic tradition and in their organization's values. It was not easy for the group to say this out loud — even though it was only part of the story. However, by recognizing and engaging the gaps between their operative vision and their espoused vision, they were able to consider the relationship between that particular practice and the effective communication of Catholic identity and values.

Step 2: Articulating the Heart of the Matter
Surveying the whole of what they have uncovered in Step 1, a group works to capture the heart of the matter — what is at stake for the institution — in a simple but "thick" statement or question, to borrow a term common to the field of cultural anthropology. The heart of the matter is "thick" because it has been informed by the fullness of the ECHO analysis, which has allowed the group to see more in the situation than might first meet the eye. As one health care leader using this process put it, "[We need] to reflect on what might be the appropriate question to ask ourselves. If we do not think carefully about the question, then we as problem solvers will likely come up with an answer, but [it] may not address the true issue."

Step 1, attending to the complexity of a practice, is a process of careful and dogged observation and examination; Step 2, articulating the "heart of the matter," requires intuition and imagination. When groups engage Strategic Theological Reflection, it is common for several, and often differing, articulations of the heart of the matter to be proposed. The point is not to determine who is right or wrong. Several articulations may be "right." The point is to determine which articulation resonates most deeply with the group, the life of the organization, and what is at stake in this time and place. The key question guiding Step 2 can be variously phrased:

• What pattern or theme is apparent in the various dimensions of this practice?
• Considering all that has been identified in our analysis of the practice, what for us, right now, is the "heart of the matter?"
• What critical question is emerging for us from our analysis?
• What is really at issue for us in this practice?

The final determination of the "heart of the matter" may be quite different than what was imagined at the start of the process.

For example, a group of school faculty and administrators engaged Strategic Theological Reflection as a tool in exploring their institution's financial aid policies. Their initial question was "How should we revise our financial aid policies to meet scholarship needs and to protect our endowment funds?" When they articulated the "heart of the matter" — what was at stake for the institution — they stated the question this way: "How can we work together as teachers and administrators to hold parents accountable for their fair share in the costs of this education?" Two key observations made in their ECHO analysis contributed to the shift in their perception. First, they had an operative vision of "ministry" which precluded actions that, in their view, might make others angry — "Because we are a ministry, we have to be nice" — and secondly, they became aware that they had regarded "tuition collection" as an administrative task, not a task for faculty. As a result of that perception, teachers had been barred from assisting with collection even though they had the most direct contact with students and parents, and therefore more opportunity to ask about payments. They brought their new, "thicker" question — informed by the ECHO analysis — into Step 3, seeking resources from the Christian tradition to inform their response to the question.

Step 3: Engaging Catholic Tradition
The Catholic Christian tradition continuously calls Catholic institutions to be sacramental signs to the world of God's power to create, to heal and to save. Catholic institutions are called to proclaim, through every dimension of their organization, a hope and a vision that can draw the many audiences who meet them into the profound mystery of God. That same Catholic tradition offers a wealth of resources for those institutions striving to live into the fullness of that call. Engaging the dialogue between the heart of the matter as discerned in the Strategic Theological Reflection, and the faith tradition, allows both the call and the resources to be activated at the level of the particular decisions that constitute the ordinary life of the institution.

For most leaders of Catholic institutions, the challenge in Step 3 of Strategic Theological Reflection is learning how to access and navigate the layers of the tradition. Appointed for their competence in business, medicine, education, law or another professional arena, leaders may be at a loss to know how to engage the tradition in meaningful ways. If the call of Catholic institutions was merely to apply and to follow a set of dictums and rules, the task of leaders would be simpler, but the call is to embody in time and space a vision that transcends time and space. It is here that the benefits of a substantive theological and spiritual formation for leaders are most clearly realized: The more broadly and deeply one is able to access the tradition, the more effectively and responsibly one can engage one's own context and practices in dialogue with it. No matter their formational background, groups should follow the process as far as they can, noting questions or areas in which they might need more knowledge or understanding of the tradition to proceed further. As it enhances one's capacity for reflection, the practice of Strategic Theological Reflection may also stimulate curiosity and further deeper engagement with the Catholic tradition.

The Catholic tradition is not, as some would caricature it, a monolithic body of "propositions" or teachings. Bringing our questions into dialogue with the tradition means drawing from a deep and wide pool of resources that includes Scripture, doctrine, history, liturgy and worship, ministry, lived faith and more. Consequently, the Step 3 dialogue between the tradition and the "heart of the matter" may proceed in a variety of directions. Time for reflection and communal conversation are needed to elicit the streams of the tradition that can speak to the matter at hand. Guiding questions that may stimulate the dialogue can include:

• What does the tradition have to say about the matter or issue we have identified through analysis of this practice?
• What questions about our tradition does our experience of this matter generate?
• Are their practices within the tradition that can shed new light on the practice in question?
• Do dominant streams within the tradition affirm our practice⁴ or suggest ways that we might reform our practice for better alignment with the mission?
• In light of what we know from the tradition, how might we proceed strategically within the circumstances in which we are working?

The final step of Strategic Theological Reflection is complete when a group takes strategic action based on the practical wisdom they have received from the process. Evolving circumstances, challenges and sensibilities will prompt a new round of reflection, and every new strategic decision may become the source and matter for a later reflection.

The time required to complete a Strategic Theological Reflection process is variable, depending on the complexity of the practice under review. The first time a group works with the process, two hours together can yield a good result. Beginning with a fairly simple practice builds confidence that allows a group to take on more difficult situations. When the process is used on a regular basis, it becomes easier. The formalities can quickly be internalized, so that the process becomes a lens through which individuals and groups habitually see their work.

Practice Evokes Change
A Catholic health care organization is compelled to reflect theologically on the business of the day. The organization will communicate its Catholic identity and its commitment to the healing mission of Jesus to the degree that its faith perspective, its theology, is embedded in its practices.

Not only do practices communicate to internal and external audiences; practices also shape individual practitioners. The messages proclaimed by a practice are part of its "goods" which, in turn, shape those who experience and witness it.⁵ Baseball, as a practice, offers a good example. The complex of activities that we engage as we play baseball shape us into baseball players, though other goods internal to the practice — sportsmanship, love of the game — may also be realized. Like muscle memory for a baseball pitcher, practices become ingrained and formational. Similarly, business practices — with their embedded theology and vision — that are lived out by the thousands of leaders and associates in organizations are shaping not only institutional identity, but also their personal lives, dispositions and hearts.

The practice of Strategic Theological Reflection invites practitioners to become people who habitually see deeply into situations, who explore practices honestly, who are attentive to the values their actions proclaim, who can suspend judgment and engage dialogue, who can use imagination and intuition creatively and strategically, and who are open to ongoing transformation. Leaders who deliberately incorporate Strategic Theological Reflection into normal institutional life as a business practice create opportunities for both institutional and personal transformation. To what end? So that through ordinary work, through the business of the day, individuals and institutions can become the agents of transformation needed to actualize the mission and vision to which Catholic institutions are called.

As Trinity Health declares in the system's core values, this call has global implications: "The scriptures look to the day when there will be a new heaven and a new earth, when creation will be made perfect. Our vision is no less. In all we do, we reach for more — greater respect, fuller justice, deeper compassion, better care, less poverty. We are impatient to do better and hold ourselves accountable for continuous improvement in the services we offer. (Mt 25:14-23; 2 Cor 9:6; Rv 21:1)"⁶

Strategic Theological Reflection: A Case Study
Two directors of Nazareth Living Center, a Catholic long-term care facility in St. Louis, presented the following case involving Strategic Theological Reflection in a practical theology class. With the permission of the facility's executive director, the case was subsequently explored by other groups. The case concerns the practices surrounding the occasion of a resident's death at Nazareth Living Center.

1. The Practice
Previously, when a resident died, the practice at the center was to call family members who were available and allow them a time of private goodbyes in the resident's room. When the family had departed, the staff wrapped the body and took the deceased out through the rear of the building — the employees' entrance — to meet the car from the mortuary, which would have pulled up behind the building. The other residents and staff were not notified of the death. The practice, though it had already been changed, was offered for theological reflection so that participants could explore and understand more fully the vision embedded in the practice from a faith and mission perspective.

2. ECHO Analysis (See box.)

3. Operative Vision
By teasing out the diverse and intersecting dynamics, the ECHO analysis enabled the group to become more aware of the complexity of the practice, and allowed a clearer picture of what vision of human persons, relationships, creation and God the practice may be intentionally or unintentionally communicating or proclaiming to its multiple audiences. Continuing their reflection, the group discussed the operative vision emerging from the various facets and dynamics they observed in the practice:

• In every category there seems to be an overwhelmingly negative view of death."
• When I think about the vision of God in this, I see a God who likes things tidy."
• Yes, almost as if we have a God of the living rather than a God of both the living and the dead."
• It's a very dualistic vision."
• I didn't realize how much we were trying to protect the residents from death, which seems kind of silly now, I mean, they know they are going to die. Are we sending a message that says that we don't expect them to grieve over the loss of people with whom they have been living?"
• I don't know, I still think if we take people who have died out the front door, it's going to be bad for business."
• Why are we trying to keep death hidden?; what does that say about our belief in the resurrection?"

The vision the group identified as communicated by their practice is expressed in the box here:

• God is God of the living, not the dead.
• God doesn't like messy situations.
• Humans ought to be efficient, expedient and protected from strong emotions.
• Reality is dualistic — life is good; death is bad.

If this characterization had been a judgment imposed from outside the situation, it could be argued that it is too stark and too harsh, but the group who had been living with the practice identified the operative vision for themselves as they weighed all of the various facets of the context that were at play.

4. The "Heart of the Matter"
In silence and reflection the group was asked to identify the "heart of the matter." The result was a question informed by the previous analysis and discussion: "Can we honor people's dignity, their sensibilities about death, and our Christian belief that death does not end life?" This question was then brought into conversation with the wider tradition, beginning with claims about God and human existence already implicated in the earlier discussion. For Christians, death is not the end of life, and as the Scriptures affirm, ". . . to this end Christ died and lived again, so that he might be Lord of both the dead and the living" (Rom 14:9).

The question was addressed to the pastoral care tradition of the church, particularly the experience of hospice care and care for families of the dead, which affirm the value of acknowledging the reality of death and sharing in the process of saying farewell. In the end, the element of the tradition that spoke most clearly to the question was the liturgical tradition of the Catholic faith that affirms the power of symbol, ritual, and prayer to celebrate mystery, to hold paradoxical feelings and experiences, and to comfort and sustain.

5. Strategic Action
Today, when a resident dies at Nazareth, the family is given private time to view the body of the deceased, and then invited to join in a ceremony named "Prepare the Way." The receptionist announces over the intercom system, "(Resident's name) on Hall (#) has been embraced by the love of God." With that announcement, residents and staff line the hall and the vestibule of the center. A beautifully decorated cloth is placed over the body. The chaplain, one of the sisters, or a staff member leads a ceremony of blessing, prayers and song. (The pastoral care staff has provided sheets of prayer and song so that all can participate.) The ceremony concludes with singing, and those who are able join a procession with the body out the front door.

As one staff member described put it, "It is a rich tradition that we have started at Nazareth, and our families, residents and staff really do feel comforted by the fact that their loved ones go out the front door the way that they have come into Nazareth instead of going out the back door quietly where no one gets to say goodbye." Another staff member offered an even broader view of what the new practice proclaims: "It really is quite beautiful and moving. It never fails to bring tears to my eyes. For me this is truly about faith and hope and a rich expression of love."

The leaders at Nazareth Living Center made a decision to reform their practice surrounding the death of a resident, and drawing from the wisdom of the tradition, they were able to recognize the powerful message of care and resurrected life that their new practice proclaimed. Through Strategic Theological Reflection, they not only affirmed their revised practice, but also came to see how dramatically this simple shift of a practice, which previously had been unquestioned for many years, offered the opportunity to embody their mission "to participate in the healing mission of Jesus" and their core value of "life at all stages."⁷   

NOTES

1. For example, Ascension Health employs its Organizational Ethics Discernment Process; Trinity Health uses its Mission Discernment Process.
2. The praxis-theory-praxis model of theology, upon which Strategic Theological Reflection is based, is explored in depth by Don Browning in Fundamental Practical Theology: Descriptive and Strategic Proposals. (Minneapolis: Fortress Press, 1991).
3. Browning.
4. John Shea, speaking to sponsors of Catholic institutions, notes that "thickening the connections between the present policies of the institution and the tradition" and using those deep connections to answer the "why questions" provides motivation for those responsible for implementing policies, sustaining them in their tasks and helping them to persevere when times are tough. (Collaborative Sponsor Formation Program Meeting, Oct. 30, 2008, Chicago)
5. Alasdair McIntyre defines a practice as "any coherent and complex form of socially established co-operative human activity through which goods internal to that form of activity are realized." See After Virtue (Notre Dame, Ind.: Notre Dame Press, 1981), 175.
6. See www.trinity-health.org/AboutUs/MissionValuesVision/index.htm.
7. See www.nazarethlivingcenter.com/missioncorevalues.

ECHO ANALYSIS

Environment (Sociological perspectives)

• In what sort of environment is the practice taking place?
• What are factors related to demographics, ethnicity, gender or power structures that are influencing or evident in this practice?
• What social, economic and political dynamics and constraints are present?
• What cultural influences and dynamics are present?

Commitments (Perspective of concrete frameworks)

• What are the established roles in this situation?
• What are the written and/or unwritten rules that govern or influence this practice?

Human needs/tendencies (Psychological perspectives)

• What are the human needs of those engaged in the practice or of those served by the practice?
• What are the psychological/emotional needs, habits or patterns at play in this situation?
• What tendencies (positive or negative) of humans are operative or influencing this practice?

Obligations (Moral perspectives)

• How would those engaged in the process name the obligations for which they feel responsible?
• To what obligations might those involved be responding?

OPERATIVE VISION

Operative Vision (Theological perspectives)

• What view of the nature and activity of God is operative here?
• What do the complex dynamics of our practice suggest about what humans are and what they ought to do?
• What does this practice suggest about the nature and order of creation?
• What are we hearing in our analysis about relationships between God and humans, God and creation, humans with one another, and humans with creation?

ECHO ANALYSIS FOR NAZARETH LIVING CENTER

Environment (Sociological perspectives)

• Nazareth Living Center is in a fairly affluent suburban location.
• The residents are predominantly white/European Americans; many are sisters from the sponsoring congregation.
• The staff includes African-Americans and recent immigrants, many from Bosnia and Eastern Europe.
• "Seeing dead people carried out the front of the building could discourage visitors and those considering Nazareth for their loved ones."
• Questions were raised about cultural sensibilities of staff — especially immigrants — to death.
• Questions were raised about the symbolic significance of the "employee entrance" being the exit for the deceased.

Commitments (Perspective of concrete frameworks)

• Staff commitment to care for the physical, emotional and spiritual needs of the residents (and families)
• Leadership commitment to maintain public relations and viability of institution
• Facility commitment to abide by all health regulations relating to death

Human needs /tendencies (Psychological perspectives)

• Fear of death — personal
• Cultural aversion to death
• Tendency to avoid difficult emotions
• Need to mourn and grieve; need for closure. Were these needs being met for residents and staff as well as the family of the deceased?
• Need for respect and dignity
• Need for privacy

Obligations (Moral perspectives)

• To protect residents from "seeing death"
• To protect the privacy of the families
• To treat the body of the deceased resident, and the living residents, with respect and dignity
• To maintain efficiency and order in the facility
• To maintain both the mission and the margin of the facility

Copyright © 2009 by the Catholic Health Association of the United States
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