BY: JOHN GLASER, STD, and KEVIN BUCK
Dr. Glaser is senior vice president, theology and ethics, and Mr. Buck is
director, ministry leadership, St. Joseph Health System, Orange, CA.
The diminishing presence of "the sisters" is a phenomenon that no
one in Catholic health care could miss. But something else is vanishing along
with the sisters, and it is something we could easily miss — community ministry.
It is not just that our ministry will have fewer sisters in the future; there
will be less and less community in our ministry unless we carefully and consciously
do something about it.
We, the authors of this article, intend to examine some aspects of the importance
of, and endangerment to, community in Catholic health care. Our thesis is briefly
this: Whereas U.S. culture is fundamentally individualistic, Catholic health
ministry is essentially communitarian; the powerful presence of community inherited
from religious congregations can only be sustained with clear focus and hard
work.
Individualism and Health Care
U.S. health care is a mirror of American culture, and American culture is a
culture of individuals. Our deepest affections, our spontaneous assumptions,
our philosophical and political building blocks, all find their magnetic north
in the ideal of the individual.
The roots of this fixation reach back to the beginning of our nation, whose
founders were steeped in philosophers such as John Locke. The best-known early
chronicler of our individualism is probably Alexis de Tocqueville, who described
the American spirit trenchantly as one tending to a self-understanding that
owes "nothing to any man; [Americans] expect nothing from any man; they
acquire the habit of always considering themselves as standing alone and they
are apt to imagine that their whole destiny is in their own hands. Thus, not
only does commercial democracy make every man forget his ancestors, but it hides
his descendants and separates his contemporaries from him; it throws him back
forever on himself alone and threatens in the end to confine him entirely within
the solitude of his own heart."1
This individualism can be seen in the subculture of medicine. Even when medicine
focuses on ethics, it tends to do so in a way that focuses narrowly on issues
affecting the welfare of the individual, rather than that of the community.
Bioethics, for example, has spent three decades emphasizing and advocating individual
patient autonomy. George Annas, a pioneer in U.S. bioethics, put it succinctly:
"The core legal and ethical principle that underlies all human interaction
in medicine is autonomy."2 As two medical sociologists have noted, this
cultural myopia is "a widespread characteristic of the field of bioethics,
one that generally manifests itself in the form of systematic inattention to
the social and cultural sources and implications of its own thought."3
The culture of the individual is present in psychotherapy as well. The founding
theory of modern therapy, psychoanalysis, was focused on the individual. Even
after the advent of family systems theory in the 1960s, the majority of therapists
continued to work primarily with individuals. One of the authors of this article,
a clinician and graduate professor who has been associated for more than 12
years with the Marriage and Family Therapists program at Pepperdine University,
Malibu, CA, has often heard other clinicians and students say that working with
individuals is more attractive to them than working with groups, because it
is less complex and therefore easier to manage. The fact that assessment and
testing instruments are developed for individuals, and not for groups, also
reveals psychology's bias for the individual.
Because organizational psychology had its origins in the larger conceptual
world of individual psychology, it tends to focus on the individual, too. The
authors know of many excellent instruments for the assessment and measurement
of the strength and growth of individuals, but we have been challenged in our
search for corresponding instruments for defining and measuring the strengths
of teams. We are familiar with no instrument that specifically addresses the
assessment of communities of leadership.
Catholic Ministry: Essentially Community Ministry
Catholic tradition paints a picture of striking contrast. A pointed expression
of Catholic communitarianism appears in the U.S. bishops' pastoral statement
on the economy: "Human dignity can be realized and protected only in community.
. . . The Christian vision of economic life . . . asks, 'Does economic
life enhance or threaten our life together as a community?'"4
The ultimate source of the Catholic Church's view of community life is,
of course, the mystery of the Trinity. We, in our being and doing, are the likeness
of God — not persons in isolated individuality, but being-in-relationships.
Community is thus not what happens when individuals come together; it is the
very condition for the possibility of individuals. Community is the easily forgotten — even
in Catholic theology — essential element of human dignity: individual-in-community.
As with the Trinity, we are distinct but not separate.
Secular philosophers, too, have noted how even our individual, physical being
reflects our community nature: In our navels, we manifest our relationship to
past generations; in our genitals, we manifest our bondedness to future generations.
^ne of the scriptural images that best captures the communal nature of reality
is, of course,
1 Corinthians: "Just as a human body, though it is made up of many parts,
is a single unit because all of these parts, though many, make one body, so
it is with Christ. In the one Spirit we were all baptized, Jews as well as Greeks,
slaves as well as citizens, and one Spirit was given to us all to drink. . .
. Now you together are Christ's body; but each of you is a different part
of it" (1 Cor 12:12-13, 27).
Religious congregations made this being-in-community come alive as did no other
part of the church. The religious community was the soil in which individual
members had their roots and from which the life and nurturance of specific ministries
came. Enormous amounts of thought and effort went into nurturing these communities.
The vast majority of U.S. Catholic ministries would not exist today were it
not for all the spiritual and material investment that has gone into building
and nurturing religious communities.
But just as, when visiting a forest, one often overlooks the forest floor that
feeds the trees, so do we who prize Catholic health care tend to overlook this
community-beneath-the-ministry — even as we admire the sisters and their
work. Put another way, seven-eighths of the ministry is like the seven-eighths
of an iceberg that floats beneath the surface of the ocean and is therefore
beyond one's view.
This puts those who value the ministry in a potentially calamitous situation.
The community source of the present ministry is diminishing — just as, though
perhaps less visibly, the number of women religious is diminishing — and
the ministry's leadership is being transferred to people who have achieved
their success in an individualistic culture and industry. This situation is
especially fraught with danger because the two cultural dimensions shaping the
situation — the community dimension of the sisters, on one hand, and the
individualism prized by Americans and their health care culture, on the other
hand — are subtle but also enormously powerful.
These are the elements that give us, the authors, a sense of urgency concerning
the community dimension of health care ministry. We want to call attention to
the inadequately noticed disappearance of the nurturing soil of Catholic ministry — the
community of ministry. We want to focus attention on the task of building a
robust theology of community ministry among new leadership.
Practical Consequences
If the analytic sketch above is accurate, it raises some practical issues. The
authors would like to offer some suggestions that outline the larger arc of
the subject and some details of specific elements in this arc.
A Focus on Core Values The overall challenge may be described as follows:
How do you take a dominant culture of individualism and modify and expand it
to include a complement of community? The following thoughts are suggestive,
not prescriptive. They are meant as "triggers" and "teasers"
leading to further dialogue, not a detailed road map.
In our pursuit of a culture of communities, we can learn something from our
ongoing, decades-long evolution of "core values." Over the last 25
years, we have come to recognize what a foundational role core values play in
an organization. Every institution has developed its version of such values.
Catholic health care organizations have defined them in detail and made them
part of their aesthetic and ethic. Core values have become the starting point
of most major efforts — from individual evaluations, to workplace philosophy,
to five-year strategic plans.
We who work in the ministry have developed detailed standards for the values;
we have defined layered competencies that flow from the values; we have created
metrics to measure performance against these values and attempt to tie them
fairly and effectively to compensation; we construct continuous improvement
programs to enhance our realization of these values. We have given them star
treatment by identifying "heroes" and "champions" of these
core values and celebrating them with maximum corporate kudos.
Community Is More Important than Values Integration Over the last three
decades, Catholic health care has worked hard to identify and integrate core
values into the key systems and structures of its institutional life. The results
have been admirable and effective.
However, the authors believe that attending to the community nature of ministry
is an even more fundamental component of ministry than values identification
and integration, because it is the larger, more encompassing reality within
which the values have their importance and meaning. But we also believe that
the weight and centrality of the community nature of ministry have not been
recognized and elaborated adequately. Indeed, our awareness of and sense of
urgency concerning the community nature of the ministry is similar to our awareness
of and sense of urgency about "the values" some 25 years ago.
Much of the values work actually can be seen as having community as an indirect
and secondary theme. Perhaps our efforts are now best understood as making this
implicit and secondary dimension — community of ministry — the broader
and deeper context for understanding health care ministry.
Recognition of Community as Framework A first step in building a culture
of community consists in recognizing that what was formerly implicit and marginal
needs to be made explicit and central — the fact that the theological concept
of community is the framework within which mission, values, v5sion, and goals
have their coherence and integrity.
At the St. Joseph Health System's Center for Ministry Leadership, Orange,
CA, we have experienced how difficult it is to go beyond the language of community — which
we have incorporated into our thinking and discussion — to the consistent
detailed understanding and application of the reality. We have engaged in lengthy
dialogues about the concept, but these have produced more questions than answers.
Those of us who work at the center are aware of the problem. Sometimes, even
when we intend to discuss leadership development in a communitarian context,
we find ourselves relapsing into a "default setting" — focused,
that is, on individual leadership development. The individualistic model is
dominant even in the center's organizational culture. Balancing individual
leaders with communities of leadership is difficult. Even when we know the destination,
the journey of extricating ourselves from patterns of individualism involves
traveling a long, dusty road.
Elaboration of Essentials of Community The next step, of course, is
clarifying the essential components of a new community of ministry. For the
sake of further discussion and development, the authors venture to offer the
following rough definition:
A community of ministry is one that so lives, loves, sacrifices, serves,
and celebrates that other people, when encountering the community in a sustained
and significant way (regardless of their religious belief), experience harmony
with the deepest truths of their hearts: truths concerning human dignity,
community, success, power, growth, sacrifice, love, suffering, debility, and
death. Having experienced harmony between their heart's deepest resonances
and this community's character, those people go from this encounter more
healed; more whole; and more able to live, to love, to hope, and to die.
To flourish as a community of ministry, the community we have in mind would
have qualities identified by the psychologist Carl Rogers as essential to personal
spiritual growth: unconditional positive regard, empathic understanding, and
congruence.5 What do these terms mean?
- Unconditional positive regard This unconditional affirmation of the
other person results from the experience of our individual and unique, but
common, shared humanity. It is such a strong recognition that it becomes the
frame for all other issues and exchanges. It is this deep affirmation that
provides the unshakeable ground from which even powerfully divergent opinions
and judgments can be directly and strongly expressed, explored, and brought
to closure.
- Empathic understanding This is the ability to "walk a mile in
another's shoes." It involves the suspension — not the abandonment — of
one's own perspective long and deeply enough to enter into the experience
and world of the other person.
- Congruence This occurs on two levels. First, it is the capacity
to be increasingly aware of and intentional about one's own inner world
of body/mind/spirit. The content and intensity of one's mental, visceral,
and emotional movements are available to one's awareness with minimal
delay or masking. Secondly, it is the ability to know when and to what extent
these should be explicitly expressed in one's exchange with another person.
The authors' point in spelling out this Rogerian construct is not to suggest
that these are the only or the essential relational qualities needed by a community
of ministry (though a case could be made for including them in such a context),
but, rather, that a culture of community will be guided by an explicit and detailed
understanding of the qualities it strives to deepen.
Creating the Environment in Which These Elements Flourish Next, each
defined community characteristic would be further translated into processes,
experiences, and tools that deepen them. Instruments would be developed that
measure the elements' presence or absence; and such profiles would lead
to continuous improvement programs.
An example can help. If we identify unconditional positive regard as an essential
characteristic of the community, it follows, as night follows day, that we must
value spending time together in order to encounter one another on that level
of shared humanity that is the foundation of such regard. If a group is unwilling
to spend adequate time together, it cannot develop the quality of unconditional
positive regard and sense of community it needs to become a true community.
The opportunity for co-creating relationships thrives within the sacred space
of time. There is really no substitute for this.
Kevin Buck, one of the authors, has worked extensively with physicians in this
regard. As an initial exercise, he invites each physician to tell his or her
story to another in the room, explaining why he or she decided to dedicate life
and energy to the healing ministry of medicine. While one physician speaks,
the other tries to discern the deeper, universal themes under the individual
story. After both partners have told their stories, they share with the group
the themes and "veins of meaning" they have heard. Their hospitality
toward each other in the present moment has allowed a powerful new story to
emerge. The transformation of their community has begun.
In assessing this essential element, one looks at the frequency with which
the group meets and the length of time it is willing to invest in being together.
A group that recognizes and values growth in this regard will be willing to
schedule such time; indeed, the group will make such sessions one of its "non-negotiables."
Processes and tools such as these can provide leaders with an explicit picture
of the larger community of ministry — including executive teams, boards,
middle managers, groups of employees, and medical staffs — revealing areas
in which the community is robust and areas in which it needs attention. Such
models and tools would provide the means for setting priorities and making continuous
improvement.
The Public Juridic Person as Community
It may be helpful to apply some of this reflection about community to a current
and emerging issue: the formation of public juridic persons (PJPs), the lay
entities that have begun to succeed congregations of women and men religious
as sponsors of the church's health care organizations. It would be easy
to approach the new church-community issue of the PJP with individualistic categories:
What criteria, for example, should we have for inviting someone to be a member?
What kind of education should individual members have? What kind of formation,
beyond education, is necessary? These are all individually oriented queries.
They are important.
But the deeper, more difficult questions concern the PJP as a community. Do
we have a taxonomy of community with which we could examine the PJP?
If we think of a continuum of community — with what might be called "communities
of convenience" at one end and genuine communities at the other — where
would PJPs fall? Clearly, they are not "mini" or "lite"
versions of religious communities of old. But they are just as clearly not boards
of trustees equipped with more power and a more thorough theological/canonical
education than current boards. The authors do not see these as academic or rhetorical
questions, but, rather, as essential entry points to future forms of ministry.
How do we define, create, and nurture such communities? We believe that these
are more fundamental questions about the PJP, in whose context questions about
individuals can best be asked and answered.
If we were to summarize the PJP as a community question, we would ask: How
shall we define and nurture communities of vision, commitment, and sacrifice
that lie on the community continuum somewhere between boards of trustees and
religious congregations and for which we currently have neither experience,
language, nor — an especially important element — a juridic model?
Balance of Individual and Community
Our concern with community should not obscure the need for balance between
individual and community. Part of the wisdom of religious communities is that
they both encouraged individual spiritual direction, on one hand, and practiced
ongoing community formation, on the other. It will be essential for the ministry
to create processes that hold us accountable for the interplay of both the community
and the individual as we move forward during this time of transition.
The authors believe that the ministry's best efforts are still in front
of it, and not in the past. Nostalgia of who we have been is vital in recounting
our legacy. It is an integral part of telling our story. And, because of what
we are called to do as communities of ministry, we must not rest on the accomplishments
of the past. We are called as a community to be tireless in our efforts until
all are one, as God is one. We are at a tipping point, where the choices to
be made will be of critical importance.
In a culture fixated on the individual, an emphasis on community deserves to
be the imperative of the moment. There is so much about community to be recognized,
created, and realized. Perhaps, for the foreseeable future, the ministry should
adapt a much-used slogan: "No community — no mission."
NOTES
- Alexis de Tocqueville, Democracy in America, Henry Steele Commager,
ed., Oxford University Press, New York City, 1947, p. 312.
- George Annas, "Life, Liberty, and Death," Health Management
Quarterly, vol. 12, no. 1, 1990, p. 5.
- R. Fox and J. Swazey, "Medical Morality Is Not Bioethics — Medical
Ethics in China and the United States," in R. Fox, ed., Essays in
Medical Sociology, Transaction Books, New Brunswick, NJ, 1998, p. 647.
- National Conference of Catholic Bishops, Economic Justice for All,
U.S. Catholic Conference, Washington, DC, 1987, p. 2.
- Carl R. Rogers, On Becoming a Person: A Therapist's View of Psychotherapy,
Houghton Mifflin, Boston, 1961.
Copyright © 2004 by the Catholic Health Association of the United States
For reprint permission, contact Betty Crosby or call (314) 253-3477.