BY: ANDREW H. SCHAUER, PhD
Dr. Schauer is a psychologist at St. Francis Health Center,
A Topeka Hospital Works to Continue the Catholic Health Ministry in Northeast
The current challenge for the Catholic health care ministry in the United
States arises from its need to maintain a 275-year-old tradition of providing
social justice and care for the poor while simultaneously addressing all the
practical demands facing contemporary medicine.
We who constitute that ministry find ourselves in transition. As we develop
new ways to think about our work and struggle to integrate the emerging medical
science necessary to deliver care to the ill or the vulnerable, we must also
somehow remain grounded in our church's spiritual traditions and the traditions
of our congregational sponsors.
As we work toward that end, we can take heart from one writer's reminder that
although "institutions shape us . . . we also shape institutions through our
own conception of and belief in the common good."1 With that thought in mind,
St. Francis Health Center, Topeka, KS,* recently responded to the demand for
innovative solutions in the evolving world of medicine by returning to the "tried
and true"—that is, by striving to rediscover the scriptural ideal of stewardship.
This ideal we found illustrated in Jesus' Parable of the Talents (Mt 25:14);
stewardship we saw embodied in the "three t's": time, talent, and treasure.
However, making this real in practice required much exploration. We who work
at St. Francis had to rebalance our cultural beliefs as they related to these
* St. Francis Health Center is sponsored by the Sisters
of Charity of Leavenworth, Leavenworth, KS.
Our call to the struggle commenced in February 2000, when the facility's
president and CEO, Sr. Loretto Marie Colwell, SCL, reminded its leaders—its
vice presidents, department directors, and psychologist—that long-term survival
requires less preoccupation with "treasure" (i.e., the bottom line) and more
focus on the "talent" and "time" elements within our culture. Her challenge
initially caused consternation among the leaders, some of whom thought she failed
to understand business practices in the "real" world. Even those who agreed
with her message found the idea of making the called-for "cultural realignment"
clearly uncertain and thoroughly daunting. Did Sr. Colwell really know what
she was asking?
The leaders took up her challenge hesitantly. In early conversations about
stewardship, the concept was sometimes decried for its "squishiness." Some vice
presidents worried that contemplative forays into what they saw as an old
notion like stewardship would divert "expensive resources" from the leaders'
labors to find practical ways to operationalize time, talent, and treasure.
A few department directors argued that everyday business demands called for
their full attention and required the implementation of "current business models."
Others felt perplexed, wondering: "Wasn't it Sr. Colwell's role to handle the
'spiritual side' of things while others handled the 'business side'?" Or perhaps
the vice president for mission integration should handle the "spiritual side"?
Sr. Colwell responded to such questions succinctly. "Welcome to the realities
of lay leadership in Catholic health care ministry," she said. She underscored
the priorities for St. Francis and its leaders. And she went on to add that
it is "now, at this very juncture," that we—the lay members of the hospital's
leadership—must find a way "to foster a culture in which God may be found."
We wondered how to address stewardship principles while, at the same time,
running the business end of a health care facility. This was exactly the issue.
In effect, we were the message. We would need to generate and demonstrate this
nurturing culture in the way we—and the rest of St. Francis's staff—interacted
with everyone coming into our facility.
Sr. Colwell stayed her course, tenaciously maintaining her conviction that
we could rediscover new ways to express the scriptural concepts of stewardship
and, in the process, find new ways to enhance our ability to navigate these
"white-water" times in health care. Still, the process of integrating the spiritual
elements embodied in the "three t's" began with considerable tension and great
uncertainty. Often, during the past three years, we have wandered down blind
alleys. The process demanded far greater investment of time than anyone initially
imagined. In a world in which positive results are expected to be demonstrated
on a spreadsheet each quarter, our initial progress would have been judged a
failure and a waste of time and resources.
Going from There to Here
We decided that our long-term goal was ensuring that the Catholic health
care ministry in northeast Kansas continued well into the 21st century. To accomplish
that, we began to realize, we must first make stewardship a "business practice."
We divided this project into five phases.
Phase One Our initial steps toward understanding stewardship as a business
practice started with general leadership discussions in which we looked at ways
of thinking and behaving that needed strengthening in our culture. We began
this work by reminding ourselves that God holds dominion over all and that we
act as caretakers for creation, including health care ministry, now and for
the future. Above all else, stewardship obligates us to exercise the wisdom
that maintains human dignity grounded in our understanding of God. These Phase
One conversations led us to identify four stewardship principles, each of which
represents at least one of the three scriptural elements (see Box).
Phase Two Once the leaders had formulated behaviors they wanted to
enhance within the context of the scriptural elements of stewardship, a third
of them spun off into a "working group" of 10 people, whose efforts revolved
around finding ways to consciously integrate these values into the organization.
Working group meetings, held weekly, involved 30 minutes of discussion (i.e.,
reflection) and 30 minutes of committee work concerning the assimilation of
the four stewardship principles into the culture. The group discussed possible
outcome measures for the initiative. Among other measures, we decided to identify
at least two questions from the most recent employee survey as illustrating
each of the stewardship principles; we planned to compare those responses to
the answers on a new survey to see if progress toward the new culture was being
In time, the working group developed a meeting format involving expanded spiritual
reflection and accompanying discussion. We group members began to trust each
other, to experience each other in new, positive ways. Early feedback from leaders
not yet directly participating in the process confirmed both the changes in
our behavior as well as the effectiveness of the process itself. For example,
a senior leader noted easier social interactions in meetings with at least two
working group members.
Phase Three The working group's interpersonal experiences led its members
to the next level. Building on the same successful process, we extended the
opportunity to increase informal interaction among the hospital's leaders by
dividing them among three small groups. In effect, the working group sought
to have other leaders rediscover, as we had, the time-honored truth that when
God's people come together for a common purpose, wonderful (and sometimes strange)
changes occur. Working group members reported, for instance, that their increased
encounters with each other led to quicker interdepartmental problem solving
and fewer instances of personalizing moments of tension with other members.
We working group members found ourselves taking time for spiritual reflection,
consciously discussing the ways stewardship principles related to our work,
experiencing the joy of pursuing a common task (i.e., organizational cultural
change), and choosing specific behaviors reflecting one of the four stewardship
Meanwhile, our format underwent further development. The working group broke
up, its members now becoming the facilitators of a series of small groups comprising
all of St. Francis's leaders. Like the working group, these small groups
began their sessions with a period of reflection and then moved on to discussion
of a particular topic—usually a specific "problem area" of the organization
identified in a recent employee survey. Problem areas were selected for discussion
according to how they seemed to connect to at least one of the stewardship principles.
Leaders of the small groups then took the problem to their work areas, seeking
input from staff. This input each leader brought back to his or her small group
and, with the help of group members, developed a simple plan for dealing with
the problem. The group measured its success in solving the problem by the responses
to the questions in a new employee survey.
Change in the organization seemed to reflect discussions in the small groups.
For instance, some of those St. Francis leaders who had perceived the stewardship
ideas as ambiguously "squishy" resigned from their jobs, thereby self-selecting
out of both the organization and its emerging culture. At the same time, the
remaining leaders' increased clarity about stewardship values helped attract
new colleagues who held similar ideals. In turn, this collaborative synergy
reinforced our efforts to find God in our work. Discussion of spiritual issues
occurred more spontaneously than they had before as the initial awkwardness
associated with the process diminished. Departmental and other daily facility
meetings started less often with obligatory prayers and more often with spiritually
focused questions that, in turn, engendered richer conversations among staff.
New employees voiced appreciation for the chance to practice openly their values
in the work setting. Other, perhaps less spiritually obvious, changes occurred
as well, including a general sense that, as one staff member put it, "laughter
had reentered the building."
As their final task of this phase, the small groups crafted principle-based
questions concerning each of the four principles of stewardship for use in interviewing
job applicants (see Box). The aim of these questions
is to help recruit people who already hold values similar to St. Francis's and
who, by joining our staff, enhance our changing culture. The principle-based
interview questions served as another outcome measure for this phase of the
Phase Four The interview questions helped the facility's leaders clarify,
solidify, and enhance new ways of thinking and acting based on the stewardship
principles. We had broken the working group down into several small groups as
a way of building relationships among St. Francis's leaders. Now, in Phase Four,
the leaders gathered again in small groups, this time focusing on ways to enhance
the meaning of one's work. Our aim was improving the recruitment and retention
of health care workers.
These discussions involved using a "career timeline" in which each of the
groups' members plotted the points in his or her life at which the importance
of each of the four stewardship principles became obvious to him or her. The
group members also explored three words with different but subtly related meanings:
job, career, and calling. Next, we talked about a recent book
whose authors discuss the key aspects of work.2 We asked the groups' members
to examine again the reasons why they entered health care. We asked them to
think about how—if they had known, at the start of their careers, what they
knew now—they would model the stewardship principles and how they might develop
an immediate feedback model to demonstrate enhanced ways of thinking and feeling
about the stewardship principles. In this last exercise, we used "appreciative
inquiry," a process that makes use of staff members' own imaginations to produce
Phase Five The last step in integrating the stewardship principles
into our culture involved all of St. Francis's 1,700 employees. As it happened,
a group of St. Francis nurses had, at the same time the stewardship initiative
was getting under way, begun reviewing clinical practice. Their discussion led
them to seek ways they might reignite a spirit of caring among both nursing
and non-nursing staff throughout the facility. Outside consultants helped the
nurses incorporate the stewardship principles into their practice with a simple,
research-proven behavioral model that made the principles operational. In time,
this discussion—concerning the links between stewardship principles and staff
behavior—was transformed last spring into an organization-wide initiative called
"Kindness Connects" (see Box).
Participants in the small groups also talked about ways we might make the
presence of God concretely operational at St. Francis. It occurred to us that
one thing we could do was encourage spiritual reflection. Today, we do this
in several ways. For example, we urge departments to open their meetings with
a spiritual moment, led preferably by a line staff member rather than the department's
director. We also emphasize the importance of reflection through modeling leadership
behavior in a less reactive and more thoughtful way, especially when dealing
with the crises that inevitably occur in a health care setting.
In addition, facility leaders, by making a conscious effort to greet staff
members and visitors whom they chance to meet in the hallways, demonstrate the
way that people associated with St. Francis should value each other. Leaders
also report paying attention to their nonverbal behaviors, thereby demonstrating
their realization that subtle reactions can make a situation either better or
worse—and taking responsibility for those reactions. Indeed, one leader reported
that his effort to greet those he meets in the hallway has improved his interactions
with people whom he perceived previously as distant. Finally, St. Francis has
established new ways to honor those staff members who "go beyond self" (as we
put it) in being of service to another; and these new honors have taken root.
Our rehabilitation department, for instance, created a quarterly "Stretch Your
Neck" award. The most recent recipient of the award picks the next recipient,
a process that enables one person to extend himself or herself toward another
while positively acknowledging altruistic actions in service to the facility.
People report taking much pleasure in this award process because it adds a bit
of warmth to the department and validates its members' efforts to share that
warmth with each other.
Carrying the Mission Forward
When all this started three years ago, we who were involved in it thought we
were going to create a new business model for carrying on St. Francis's necessary
tasks. In effect, we allowed our perception of the institutional realities of
the modern world to shape us. By contrast, our CEO (who also happens to be a
woman religious) suggested we find a way to foster a culture in which God may
be found. She encouraged us to shape the institution through our own belief
in the common good. This process revealed something remarkable. Without at first
fully appreciating its implications, we initiated a process of listening to
ourselves and to each other in a context grounded in the scriptural concept
of stewardship. From that concept we made operational four principles:
- Honoring reflection
- Valuing others
- Extending ourselves beyond self-interest
- Embracing ownership of and responsibility for addressing the problems each
of us could see
In doing that, we have created a work culture devoted to carrying forward
the spiritual values that informed our founders' mission.
The author would like to thank Chuck Jones, PhD, and Leigh Hagan, PhD,
for their helpful comments.
- J. P. Dolan, "The Church and America," Health Progress,
July- August 2002, p. 41.
- H. Gardner, M. Csikszentmihalyi, and W. Damon, Good
Work: When Excellence and Ethics Meet, Basic Books, New York City, 2001.
- J. M. Watkins and B. J. Mohr, Appreciative Inquiry:
Change at the Speed of Imagination, Jossey-Bass/Pfeiffer, San Francisco,
Scriptural Elements of Stewardship
||Honoring reflection by encouraging a culture in which one
takes time to set a spiritual context for business discussions and decisions
Valuing others by promoting a culture that recognizes the multiple
talents of everyone working in our health care facility
Going beyond self-interest through advancing a culture in which everyone
involved in patient care uses his or her abilities for the good of the
organization rather than solely for his or her own self-interest
||Embracing responsibility through fostering a culture in
which people stewad resources by recognizing problems, "owning them"
them, implementing solutions to them, and solving them
Applying a Stewardship Principle
Applicants for positions at St. Francis Health Center are routinely asked:
What distinguishes a good employee from a great one? The question is intended
to elicit an applicant's grasp of the third stewardship principle (going
beyond self-interest). Answers are scored as follows:
||(for a response such as: "When I see someone having a
tough time at work, I try to find out what I can do to help")
||(for a response such as: "One time I stayed late at work
because my friend asked me to")
||(for a response such as: "Someone who shows up and does
a good job")
Stewardship Principles and the "Kindness
- Going beyond self-inerest
- Honoring reflection
- Building on the excellence we already have
- Embracing responsibility for our decisions
- Becoming the areas employer of choice
- Becoming the area's health care center of choice
Copyright © 2003 by the Catholic Health Association of the United States
For reprint permission, contact Betty Crosby or call (314) 253-3477.