BY: FR. MICHAEL D. PLACE, STD
Fr. Place is president and chief executive officer, Catholic Health Association, St. Louis.
Over the last year, the Catholic health ministry has experienced leadership
transitions, or the announcement of impending leadership transitions, in several
key executive positions. While transition in key positions is not in itself
unusual, the number of changes involving highly visible positions has become
a source of conversation and discussion both within and outside the ministry.
Some of that discussion has centered on the difficulties and challenges facing
any health care executive today, let alone one who has the added responsibilities
of stewarding an ecclesial ministry. Other discussion has focused, in one way
or another, on questions the ministry has been engaging ever since the movement
to lay leadership began: How do we understand and describe what is needed in
an effective ministry leader? And how do we ensure that there will be a "critical
mass" of such leaders available for the future?
Such an environment makes it opportune that this issue of Health Progress
has as its theme ministry leadership. In what follows, I will share some
reflections on that topic. They will build on previous columns in Health
Let me begin by reflecting briefly on what we have accomplished in recent years.
Clearly, we have come a long way. For example, we have identified core competencies
associated with effective leadership, competencies that are recognized across
the ministry as having relevancy, in a variety of ways, to local recruitment,
hiring, ongoing development, and retention. We have developed resources based
on that work, such as the "360-degree" assessment tool, that can be
utilized or adapted. We also have paid a great deal of attention to agreeing
on what the "foundational" elements of the Catholic tradition — elements
important in being successful as a ministry leader — are. These elements
can be experienced through the program, "Foundations of Catholic Health
Care Leadership," presented annually by CHA staff and others or through
local adaptations such as those conducted in some systems.
In mentioning the above, I realize that they are but the visible, national
tips of what is, fortunately, an ever-growing iceberg of leadership activities
in the ministry. Clearly, across the ministry, there is heightened concern,
energy, and intentionality about leadership, all of which are reflected in the
articles in this issue's special section. In addition, there are expanding
efforts, where appropriate, not only to share "leading practices"
but also to jointly develop mutually beneficial programs (e.g., the "Collaborative
Formation Program for Public Juridic Persons" created by Trinity Health,
Covenant Health System, Catholic Health East, and Catholic Health Initiatives;
and the Ministry Leadership Formation Center, developed by five systems with
facilities on the West Coast*). Clearly, at the national, system, and local
levels much has been done and much is being accomplished.
* See William J. Cox, "Nurturing the Ministry's Soul"
Reasons for Concern
That being the case, why does the recent spate of senior transitions elicit
so much discussion and, I dare say, concern? As in most things, it could be
that there are multiple reasons for this concern.
First of all, there is within the ministry a passion for a vision that comes
from the Lord and that has been conveyed to us by generations of religious women
and men; and, flowing from that passion, there is also a profound sense of responsibility — whether
one is religious, lay, or cleric — for the future. In the context of that
passion and responsibility, it is clear to many that one of the most critical
issues is effective leadership for the future at three levels: executive, governance,
and sponsorship. Attending to any one of the three would be a daunting task.
Addressing all three simultaneously raises understandable anxiety.
Secondly, there is a clear recognition that the business, as well as the practice,
of health care is increasingly complex. In other words, the "howness"
of the ministry, as distinguished from its "whyness," has changed
and will continue to change dramatically.
On "Howness" and "Whyness"
Lest I leave all my readers lost in this flight into philosophical rhetoric,
I will make a brief digression to explain my categories.
We know that Jesus left to his community of disciples the charge to proclaim
the good news that the Reign of God is at hand, and that, as an expression of
that presence, he urged them to heal the sick. Bringing healing to the world
is our mission, our purpose, our "why." The church's response
to this mission is both individual and collective. (We used to be more focused
on the collective, but the Second Vatican Council called us to attend to the
personal responsibility of all the baptized as well.) The collective or organized
response is what today we speak of as "ecclesial ministry." As we
know, the root meaning of "ministry" is associated with the concept
of service. Consequently, we can say that across the centuries the community
of disciples, the church, serves the mission of proclaiming the Reign of God
by being about healing. The healing ministry is, in a sense, a constitutive
element of ecclesial life.
By turning to the Gospel stories of Jesus' healing, we can get a general
sense of some of the essential elements of being in service, in ministry to
the mission of Jesus Christ. They include witnessing to God's active presence,
demonstrating a sense of inclusiveness, providing both care and cure, and restoring
As helpful as these core elements are in providing depth to an appreciation
of our purposefulness, the question remains: "How do we bring this purposefulness
into existence?" Over the centuries, our collective or ecclesial response
has taken on different forms of "howness." Today, around the world,
the "how" of the healing ministry varies from one place to another.
The hospices of Mother Teresa, the dispensaries of Asia, the clinics of Latin
America, and the tertiary and quaternary acute care centers in the United States
all represent various "hows" of today's ecclesial healing ministry.
This same variety is also present in our own country. As we have grown in our
appreciation of the fact that Jesus' healing is of body, mind, and spirit,
the "how" of the healing ministry has evolved. This evolution was
reflected in the 1979 decision to change our name from the Catholic Hospital
Association to the Catholic Health Association. Utilizing the word "health"
provided a framework for the evolving complexity of the ecclesial healing ministry.
Our "howness" includes large and small acute care centers of varying
forms and shapes in urban, semi-urban, and rural communities; clinics and community-based
health services; and elder and senior services of various modalities; as well
as emerging efforts related to community wellness, such as affordable housing
and environmental advocacy. Individually and collectively, these institutions
constitute the "howness" of the ecclesial healing ministry. Whereas
the ministry's purpose, its "why," is noted by a sense of transcendence,
the "how" is quite incarnational.
A Dualistic Approach Will Not Work
Having established the distinction between why and how, let me return to my
reflections on leadership. We were speaking of the recognition that the "howness"
of the ecclesial healing ministry is increasingly complex and, consequently,
the demands on leadership are more challenging, too. It is understandable that
some might wonder whether there is, at various levels in the ministry, the "bench
strength" needed to manage, govern, and sponsor its current and future
"howness." (While admitting that this is a reasonable concern, I must
also offer the editorial observation that our predecessors did not let their
own concerns stop them from building today's remarkable ministry.)
I would propose, however, that there is another reason for our concern — namely,
the recognition that, in fact, the very complexity of which we speak makes the
distinction between the "why" and "how" of the ministry
more intellectual than real. In other words, we cannot run the "why"
and "how" of the ministry as if they exist in isolation. There is
no "why" without a "how"; and a "how" of acute
care, senior care, or community service that lacked the essential "why"
would not really be an incarnation of the healing mission. Perhaps it is this
growing recognition that fuels anxiety in the ministry as to whether we have
leaders who can effectively serve the "how" of contemporary health
care in a way that makes it an apt vehicle of the "why" of an ecclesial
healing ministry that advances Jesus' and the church's healing mission
of service and transformation.
Recently, I was privileged to participate in a discussion with some of those
in the ministry who share the responsibility in various ways of serving Catholic
health care leadership efforts. It was that discussion that catalyzed what I
have just written. As I listened, the meeting's participants asked themselves
whether the ministry might not need more explicit efforts to assist all who
share responsibility for its leadership to be effective leaders of both the
"why" and the "how," the transcendent and the incarnational,
the mission and the margin. In posing this question, the participants recognized
that, although not everyone needs to know everything, a dualistic approach that
simplistically gives the sponsor responsibility for the "why" and
administrators responsibility for the "how" will not work. It will
not work because, in fact, "how" and "why" cannot be easily
separated. Obviously, the hard part is in figuring out how much of each is needed
at each level.
A New Pilgrimage
Let me turn now to ministerial leadership at the executive level. What is needed,
at this level, to be effective at integrated leadership of both the "why"
and the "how"? Clearly, if this line of reasoning is found to have
merit, we might need to explore new opportunities or be more intentional with
existing efforts. As I reflect on these issues, it seems to me that we will
have to engage a tension that could exist between the ethos of the "why"
and that of the "how."
Allow me to explain. If we approach the "why" (or purposefulness)
that is mission, we immediately are drawn into the world of depth and meaning
as experienced in the Roman Catholic faith tradition. To use a secular phrase,
we enter into a distinctive culture. And, as we know, culture is passed on not
so much by words as by experience. To get somewhat technical, in cultural transmission
the rational cannot exist apart from the imaginative, the affective.
I would suggest this recognition is not something new to the ministry. All
one needs to do is talk to an executive who has participated in a system- or
institution-sponsored retreat to Assisi or Montreal. Participants come back
with a new energy (with, dare we say, an experience of purposefulness?) and
often say something like, "I get it now" or "The parts came together."
(Dare we say an experience of "whyness"?) In many cases, those on
these pilgrimages are veterans in the ministry. They have read about and understand
the charism of the sponsoring community. However, experiences such as these
pilgrimages — which often are described as "transforming" events — provide
something more. Perhaps it is that "more" to which we must pay more
I have been thinking about what I have heard from those who have participated
in these pilgrimages and from those who have been on our annual program of Ecclesiology
and Spiritual Renewal for System Leaders. I have heard some common themes, themes
that might provide some insight into what facilitates an encounter with purposefulness,
an entry into the nonrational dimensions of the Roman Catholic culture.
- First, there is the opportunity to be "apart" from the regular,
- Second, there is a sense of permission not to be about the "how."
- Third, there is the new place to which the participants go, a place that
is rich with history, symbols, and mystery.
- Fourth, there is an opportunity to experience a sense of community that
is bigger than self.
- Fifth, there is an explicit prayerfulness that oftentimes is nurtured by
the ritual and Liturgy of the Roman Catholic Church, even while its honors
the distinctive faith experience of those participating.
- Sixth, there is an opportunity — provided through reading, input, and
discussion — to "connect the dots" both intellectually and emotionally.
- Seventh, there is an invitation, extended through various venues, to the
participant to begin a "so what?" journey — to ask himself or
herself, "What does all of this mean for the manner in which I live as
a leader in the world of the "how"?
- Finally, there is the possibility of experiencing a sense of celebration
that makes God's unlimited gracefulness tangible and invites a prayer
of thankfulness for the gift of being able to share in this ministry.
Beyond the Tyranny of Doing
As I reflect on the above, I see that to experience purposefulness one must
move beyond the tyranny of doing and producing in order to experience
meaning. Individualism needs to embrace community, and control needs to give
way to call. There is, then, as noted earlier, a certain countercultural dimension
to the world of purposefulness. Within the Catholic imagination, however, that
countercultural dimension does not require us to leave the world; rather, it
calls us to embrace the world within the tension that is created by these countercultural
realities. In other words, in the Catholic experience we go on pilgrimage not
to escape the home we leave but in order that we can return to a better home.
So, too, when, as ministry leaders, we address the purposefulness of the "how"
of Catholic health care, we embark on pilgrimages that will allow us to more
faithfully lead the "how," whatever form that might take.
In drawing these reflections to a close, I will propose some tentative conclusions:
- Ensuring a critical mass of effective ministry leaders for the future ought
to be one of our highest priorities.
- Although the "how" of the ministry has and will change, the "why"
- Though the "how" and "why" can be separated intellectually,
in experience they are essentially intertwined.
- Ministry leadership development efforts must address both the "why"
and "how" dimensions of leadership in an integrated manner.
- In addressing development in the arena of the "why," we must experience
the imaginative and rational dimensions of the Roman Catholic culture.
- The metaphor of pilgrimage might be helpful in understanding how to approach
this aspect of development of ministerial leaders.
Each year, during CHA's program in Italy for system leaders, we visit
sacred sites in Rome and Assisi, including the humble — yet profoundly beautiful —
Portiuncola, the tiny medieval chapel of St. Francis, which is now contained
within the great basilica of St. Mary of the Angels. It was here, in this intimate
chapel, that Francis responded "yes" to God's call to rebuild
the church. If today's ministry leader is to integrate the "why"
and the "how," he or she, in that same spirit, should be able to move
beyond producing to experience meaning. The leader should be able to embrace
a sense of community and say "yes" to a call that will profoundly
affect the way he or she approaches the "how" of Catholic health care.
Copyright © 2004 by the Catholic Health Association of the United States
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