BY: MARY KATHRYN GRANT, PhD
Dr. Grant, CHA's former executive director
of ministry leadership development, is a consultant for Ministry
Development Resources, Michigan City, IN.
To emphasize the importance of leadership
development to the Catholic health ministry, the Catholic Health
Association (CHA) has named it as one of four "focus areas"
in the next phase of the association's planning. To further
advance the cause of ministry leadership development, highlight
current successes, and generate a sense of urgency, CHA's Ministry
Leadership Development Advisory Committee commissioned the writing
of the following white paper. The paper is intended to:
- Trace the history of Catholic health ministry leadership
development in general and, in particular, to highlight some
of the successes resulting from the joint efforts of Catholic
health systems and CHA
- Identify emerging major issues, challenges, directions
- Stimulate discussion of these major issues
- Facilitate networking
- Facilitate benchmarking of success factors
"No time, no money, no option." This phrase
aptly describes the current situation in Catholic health ministry
regarding leadership development. Fiscal constraints, time limitations,
critical shortages in certain clinical and professional areas — these,
when combined with a passionate desire to secure a strong and
vital future for the ministry, add up to the imperative that
sponsors, trustees, and executives focus their attention, channel
their resources, establish their preferred outcomes, and commit
themselves to ministry leadership development.
Leadership development has been a clarion call
in Catholic health care for several decades, and solid progress
has been made in several critical areas. These efforts — and the
notable successes, which will be highlighted later in this paper — constitute
the first stage or foundational platform for ministry leadership
development. Many Catholic health care organizations are now
focusing energy on second-stage activities. This paper will
reflect on the lessons of the first initiatives in an effort
to address, and perhaps eliminate, barriers to success for the
current effort.
Very early in the evolution of Catholic health
care leadership development, a continuum depicting the movement
"from compliance to congruence to commitment and conversion"
was proposed as a conceptual framework for the process. It might
be helpful, as these efforts continue to evolve and mature,
to keep this conceptual model in mind.
Theology of Ministry
All theologies of ministry stress that a Christian
is commissioned for ministry with baptism and that ministry
is the prerogative not of the ordained alone but also of the
baptized. Additionally, most would assert that the Christian
faith is communal and that the Christian community is ministerial.
These two realities, community and ministry, undergird all leadership
development efforts in Catholic health care. Community impels
people to seek the common good, however inadequately understood;
ministry gives meaning and purpose to all the actions and activities
in health care services.
The relationship of this calling to service is
an essential grounding for any leadership program. This is not
in any way to suggest that all leaders must be either Christian
or Catholic. But all leaders in the Catholic health ministry
must recognize that the core impetus to serve, to minister,
comes from the Christian's commission at baptism. Given this
foundation, leadership development initiatives must be rooted
in and reflective of the mission and values of Catholic health
care as incarnated in their organizational mission and values.
The 1980s
In 1985 CHA convened a Blue Ribbon Leadership
Development Task Force composed of representatives of Catholic
health care systems and sponsors, all of which shared a common
concern about leadership development. The task force brought
together people specializing in mission, on one hand, and people
specializing in human resources (HR), on the other, and facilitated
networking between them. The task force also published Healthcare
Leadership: Shaping a Tomorrow (1988), a catalogue of resources
for a leadership "curriculum."
During this same period, several other efforts
were initiated.
Academy of Catholic Healthcare Leadership
Begun in the mid-1980s, this institution was modeled on
the American College of Healthcare Executives. The academy,
originally a stand-alone organization, was absorbed by CHA's
Center for Leadership Excellence in the early 1990s and has
subsequently been dissolved.
Catholic Healthcare Administrative Personnel
This program, sponsored by St. John's University, Jamaica,
NY, and the Catholic Medical Center of Brooklyn and Queens,
continues to sponsor two annual week-long programs in which
well-known leaders address topics of current interest to Catholic
health care leaders.
Consolidated Catholic Health Care (CCHC) CCHC
was formed in 1979 to address the needs of Catholic health care
systems. At one time CCHC had 24 system members and sponsored
several annual events, most notably the Governance Forum, which
brought together sponsors, trustees, and executive leaders to
examine current critical issues facing Catholic systems. Meetings
of the CCHC board, made up of system CEOs, provided a valuable
opportunity for networking. CCHC has undergone several reorganizations
in recent years. In 1999 the Governance Forum was transferred
to CHA.
Mercy Leadership Development Program This
program, created by members of the Mercy Health Conference (1980-1984),
inspired several systems to launch their own leadership programs.
In the 1990s, the Mercy effort also provided the initial vision
for CHA's Foundations of Catholic Healthcare Leadership program.
In the late 1980s, the Commission on Catholic
Health Care Ministry issued a report, A New Vision for a
New Century, that called upon all those engaged in Catholic
health ministry to address the critical issue of leadership
development. (The report ultimately led to the New Covenant
initiative of 1995.) Catholic health care conferences at the
state level, which usually focused on legislative and regulatory
issues, began to offer leadership development programs at their
meetings.
Meanwhile, some Catholic health care systems,
seeking to create a common culture and sense of community among
their members, formed their own internal education and development
programs for executives, managers, trustees, and physicians.
The 1990s
Several new leadership development initiatives
were launched in the 1990s.
CHA's Center for Leadership Excellence (CLE)
This initiative grew out of the work of the 1985 Blue Ribbon
Task Force. In 1993 CLE commissioned Hay McBer, a Boston consulting
firm, and the Center for Applied Social Research at DePaul University,
Chicago, to conduct research into the behavioral competencies
shown by outstanding leaders of Catholic health care organizations.
The next year, at CHA's annual Catholic Health Assembly, the
researchers presented their findings in a report entitled "Transformational
Leadership for the Healing Ministry: Competencies for the Future."1
That study, as a CLE staff member noted, gave the ministry its
first opportunity "to quantify with empirical evidence the competencies
that distinguish the outstanding leaders in Catholic healthcare."2
The researchers found such leaders to possess
18 observable and measurable competencies. CLE incorporated
this concept in several products and programs:
- Dossier, a multirater (360-degree) tool for measuring
leadership competencies.
- Leadership Enrichment through Assessment and Development
(LEAD), a five-day program that assessed leaders' management
styles, motivations, and competencies, and the organizational
climates they had created.
- The Advanced Institute, a competency-based forum
for the development of leaders. Institute participants first
underwent the LEAD program and then attended three annual
leadership retreats.
- Behavioral Event Interview (BEI), a tool for gathering
the information used in the competency-measuring process.
CLE ceased to exist in 1999, but its competency
model became the prototype for several systems' leadership initiatives.
Sponsorship School A twice-yearly program
for religious sponsors, the school was offered by the Loyola
University School of Law, Chicago, and McDermott, Will, &
Emery, a Chicago firm specializing in health care law. The school
ended in 1999.
Partnership for Catholic Health Care Leadership
Sponsored by CHA and 18 Catholic systems, the partnership
was created to identify common leadership needs and address
them in a unified fashion. The partnership dissolved in 1999,
but its work has been continued by CHA. Among the products created
by the partnership are:
- A revised version of Dossier called the Mission-Centered
Leadership Model*
- A revised curriculum for CHA's Foundations of Catholic
Health Care Leadership program
- A BEI workshop with Hay McBer
Medicine in Search of Meaning The Catholic
Health Association of Wisconsin developed this leadership program
primarily for physicians. It is currently available on a contractual
basis.
In addition, several Catholic systems have used
the Mission-Centered Leadership Model to develop competency
models. Others — most notably, the Sisters of Charity Health System,
Cincinnati; the Sisters of St. Joseph of Orange Health System,
Orange, CA; Holy Cross Health System, South Bend, IN; and Ascension
Health, St. Louis — launched their own leadership development
efforts, each of which included orientation to the history,
mission, culture, and heritage of the sponsoring congregation.
Both kinds of programs — those based on the Mission-Centered Leadership
Model and those not — continue to be adapted by various Catholic
systems.
Moreover, several colleges and universities have
begun to develop postgraduate training (including courses in
theology, mission, and ethics) for mission leaders and other
executives.
Leadership Development Survey
In early 2001, CHA conducted a survey of national
and large regional systems concerning leadership development.
Twenty-two such systems responded. The following are the highlights
of the survey's results.
New Role Thirteen systems had leadership
development specialists who had been in their positions a year
or less, usually because the system had recently undergone consolidation.
Some specialists had had experience in leadership development
in other organizations.
Mission Base Thirteen systems launched
leadership development in their mission services function. Six
incorporated it in organization development. Three made it part
of HR. (In some cases, leadership development was part of more
than one function.)
Competency Model Fourteen systems used
a competency model; three others were in the process of developing
such a model. As for the models themselves, 12 systems had designed
(or were designing) their own, six used the CHA model, three
used the Lominger Limited model, and three used the Personnel
Decisions International model. Some used the CHA model in combination
with an outside vendor.
360-Degree Instrument Nine systems were
using a 360-degree multirater instrument; three others were
developing one. The frequency with which the nine systems used
the instrument varied from six months to two years. Seven systems
used it for annual evaluation, five used it for development
planning, and four used it for recruitment and selection. (Some
systems used it for more than one purpose.)
One of the challenges in developing any competency
model is the relationship between what are perceived to be mission-related
competencies and business-outcome or performance-outcome competencies.
Thirteen respondents indicated that "mission" and "performance"
were one and the same; therefore, they said, all competencies
related to mission fulfillment. Nine other respondents indicated
separate mission competencies.
Thirteen systems integrated their competency
model and the 360-degree instrument directly with their mission.
Nine used other competency models. Five systems used neither
a competency model nor a 360-degree instrument.
Succession Planning Although only five
systems had included leadership development as part of their
succession planning, 11 others said they intended to do so.
Indeed, succession planning was the most frequently mentioned
need for leadership development.
Outcome Measures All responding systems
agreed that leadership development programs need a way to measure
outcomes, but most had not yet created one.
Mission and Values Integration Most responding
systems agreed that the first priority for a leadership development
program was the integration of mission and values. (Some said
that this integration could be made part of a program component
such as continuous quality improvement.) Other high priorities
were sponsorship education, retention planning, executive management
support, and mentoring.
Four Challenges
The Catholic health ministry faces four major
challenges, each of which underscores the need for leadership
development.
Sponsorship Evolution The sponsorship
of Catholic health care organizations, originally undertaken
by the religious congregations that founded them, continues
to evolve. Laypeople are increasingly assuming the sponsorship
role. What do they need most? Immersion in the theology of ministry?
Studies in canon law? Training in mission reflection or discernment?
When should they receive such preparation? Should they be required
to demonstrate that they possess certain competencies, skills,
and knowledge before being considered for the role? Or is on-the-job
development sufficient? Should such people be practicing Catholics?
And isn't consideration of these questions increasingly vital
as current sponsors prepare to pass the torch to their successors?
Sponsorship development is essential because
sponsors shape the ministry and hold it accountable for mission
and values. Without strong sponsorship, the whole fabric of
the ministry is weakened.
Executive Leadership Catholic health care's
executive workforce is both aging and growing more ethnically
and religiously diverse. When the scarcity of professional mission
executives is highlighted, the situation is even more critical.
The ministry must therefore put greater emphasis on the selection,
orientation, and development of new executives, preferably before
they assume their posts.
At present, ministry organizations too often
hurry to fill leadership vacancies, allowing the need for expeditiousness
to override serious consideration of candidates' preparation,
competence, and general fitness for the job. Selection of new
leaders may at times be driven more by business imperatives
than by careful screening of ministry leadership competencies.
In choosing new leaders, some systems have reported that they
emphasized management and business competencies over ministry
leadership competencies.
Because ministry executives (such as sponsors)
are aging, they should be carefully planning succession strategies.
However, although most acknowledge this need, few felt they
have addressed it adequately. Recognizing its importance, executives
nevertheless often feel compelled to deal with what they see
as more urgent business needs. And sometimes their tendency
to delay succession planning is reinforced by board members,
who — although certainly persons of goodwill, dedication, and
generation — often lack experience in ministry development themselves.
Systemic Mission Integration A third challenge
is linked intrinsically to succession planning. Even after 20
years of effort and considerable successes, systemic mission
integration still has a way to go. The question is, why? Several
explanations have been advanced.
Some people say that full integration is difficult
to achieve because systems' business concerns tend to override
nonbusiness ones. Others say that sponsors and system boards
fail to hold their organizations' leaders equally accountable
for both mission and business outcomes. Still others trace the
problem to mission leaders, many of whom came to the ministry
with neither business nor health care experience and therefore
lack credibility among leaders who did. And some say that systems'
plans for mission integration are often poorly planned or poorly
implemented.
No doubt, some or all of these factors have contributed
to mission integration's limited success. Whatever the cause,
the problem is serious. A failure to fully integrate, coupled
with a lack of understanding of or commitment to the notion
of the common good, can significantly impact the ministry's
future.
The Common Good The New Covenant initiative,
which, starting in 1995, brought systems, independent hospitals,
dioceses, Catholic Charities, and others into discussions of
mission integration, was catalyzed by the successful incursion
of for-profit organizations in health care. Urgency marked the
moment. Systems and sponsors pored over maps, risk-benefit analyses,
antitrust restrictions, and business case scenarios, exploring
ways to strengthen and unify both Catholic health care and Catholic
social services in various markets. Organizational independence
and self-preservation were weighed against the threat of for-profit
takeover.
Adversity brought competing providers to explore
consolidation, collaboration, and affiliation. Unfortunately,
the participants of that discussion seem, in retrospect, to
have inadequately internalized the common-good concept that
undergirded their efforts. Granted, the concept is ambiguous.
Pride can strongly motivate an organization to defend its sense
of identity. Insisting that it submerge itself in a generic
or communal identity is to go against the grain.
The same tendency can be seen in the leadership
arena. Systems have historically competed with one another in
their efforts to recruit and retain leaders. No executive likes
to see a competent, successful manager leave the organization
for a "competitor." Unfortunately, no organization has more
than a limited number of leadership roles. Can Catholic health
care embrace the notion of the common good in a way that allows
it to retain scarce and valued human resources in the ministry,
if not in particular systems or organizations?
The ministry needs all the talented human resources
it can get. It also needs a model of leadership development
that truly integrates mission, ministry principles, and ministry
values with clinical, professional, executive competencies.
Initial recruitment and selection, incorporation and development,
reward and retention must embody a minimum set of ministry competencies
and be applied to governance, clinical, managerial, financial,
and sponsor selection. No arena is exempt from the need for
careful attention to this central and critical area.
Clearly no magic formula for success in this
area exists. All sectors of health care — religious, secular,
not-for-profit, and for-profit — have grappled with one or more
of the dimensions of the leadership issue, whether it be shortages
of trained professionals; attracting and retaining committed
individuals; or identifying the competencies needed by physician
leaders, sponsors, trustees, and executives.
Because the Catholic health ministry is so integrally
connected to the communities it serves, its future — its vitality
as well as its very viability — is contingent on its ability to
create and nurture communities of people committed to a common
mission. What binds us together and gives us hope, in this pursuit
of ministry leadership development, is that we share a common
desire — to bring God's healing presence to our needy world.
NOTES
- See John Larrere and David McClelland, PhD, "Leadership
for the Catholic Healing Ministry," Health Progress,
June 1994, pp. 28-33, 50.
- Judy Cassidy, "Briefing," Health Progress, June
1994, p. 4.
Leaders on Leadership Development
"Leadership Development Is Integral"
If you're really serious about having an organization
that is on the cutting edge — a forward-looking, exciting organization — you
need to attract, retain, and develop the right leadership. If
you want to build on "something special," you have to have a
high-quality leadership group.
We started our leadership development program — "Leadership
That Shapes the Future," a five-day, competency-based program
with strong team-building and spirituality components — in August
1999 with our corporate office senior staff. Soon after we began,
we learned our "financials" for that fiscal year were devastating.
But we continued with the program anyway. We might have said,
"We'll get back to leadership development later," but decided
that doing so might be dangerous. Leadership development needs
to be seen as integral to the organization, not ancillary. If
you let it drop off the agenda because of other pressures, it
becomes ancillary.
In January 2000, as we were focusing on problems
in our local facilities, one of our senior operations people
called me. He was scheduled to attend that month's leadership
development session, but he really wanted to get out of it.
"We're drowning out here!" he told me. "We can't afford
to take a week off." But I said, "Yes, you can take a
week off." In the end, I think, he and the others went back
to their jobs refreshed. The message was: "Good times or bad
times, leadership development is going to continue."
About 200 of CHI's leaders have gone through
the program, including half of our CEOs. Now entire leadership
teams are attending the programs together. Through the program,
they bond as teams in a way that's hard to do when you're struggling
with day-to-day problems in the facility. So many people have
said to me, "Thank you for spending the money on me for that
leadership development program." They appreciate the interest
the organization takes in them.
Our program has been a significant part of our
really coming together as one unified organization. A national
leadership development program such as ours welds these leaders
to you as an employer. Of course they have a natural affinity
for their local organization — it's where they work. But our program
has been excellent for "wiring" them to the national organization.
They feel, "I'm part of CHI, not just this hospital." That's
another payoff.
Patricia A. Cahill, JD
President and CEO
Catholic Health Initiatives
Denver
"We Discuss Ministry Issues Together"
We have a lot of conversation around here about
succession planning. I think it's hard to do good succession
planning in organizations that are as lean as ours. The models
from other corporate sectors don't translate very well to not-for-profit
environments such as ours. Our board will have the responsibility
for picking my successor. The best I can do is make sure there
is a group of people here that can manage until the board selects
a leader.
The best way to do so is to get the group really
addressing ministry issues together. If we do it right, then
the strategy person can be as comfortable talking about social
justice as the mission person; and the CFO, when asked about
juridic status, can be comfortable answering the question.
At present, the seven officers here at the corporate
office get together for a half-day every other month to study
and discuss issues important to Catholic health care. We take
turns planning these sessions, selecting the materials to be
read beforehand, facilitating the conversations, and so on.
We've looked at the recent changes in the Ethical and Religious
Directives for Catholic Health Care Services and at Catholic
social teaching on labor issues and other justice issues. As
a group, we learn together. We have conversations about what
we know and don't know.
For us, the next step is to replicate this kind
of development experience for Covenant's senior management group — the
CEOs and COOs in the system's hospitals. We have a responsibility
as a juridic person, just as religious congregations do, to
ensure continuity of the ministry. The only way we're going
to do that is to find the best people who share our values and
allow them to grow in their understanding of and commitment
to the ministry. We have to take on the responsibility for sharing
our learning with those who come after us.
David R. Lincoln
President and CEO
Covenant Health Systems
Lexington, MA
"Lay Leaders in a Ministry of the Church"
From my vantage point, leadership development
is critical because we need people who know what it means to
carry on the ministry of Jesus and also to operate a successful
business. Historically, we selected people based on their business
expertise and relied on the sisters to carry on the ministry.
But all the activities of a health care system are the mission
and the ministry, requiring that every leader understand and
be committed to what it means to minister.
We need people who have an understanding of their
own call and how they are living out that call publicly as lay
leaders in this ministry of the church.
As a sponsor, we have become very intentional
about the key things we want lay leaders to know, understand,
and act upon. We are taking a more formal approach in the education
and development of our leaders. For example, all senior leaders
and those who are on a path to become senior leaders are required
to attend a Foundations of Catholic Health Care Leadership program
that is offered several times during the year. Leaders have
been very positive, if not enlivened, by their participation
in the Foundations program.
Chris Carney, our president and CEO, and I visit
each of our local systems and their board of directors every
year. During our visits last year, I offered a reflection on
the shared statement of Catholic identity as a prayer for the
opening of the board meetings. After the reflection, we spent
some time discussing "What does this mean for us?" We also discussed
the Mission-Centered Leadership Competency Model to explore
how leadership must be values-based and founded in our Catholic
identity. The organization can only remain true to its mission
when each leader understands and lives this competency model,
choosing to be part of a ministry, not just a business.
Sr. Patricia A. Eck, CBS
Chairperson, Board of Directors
Bon Secours Health System
Marriottsville, MD
"We Will Identify 'High-Potential' People"
Last week, I was at a Healthcare Research and
Development Institute meeting, for CEOs of both for-profit and
not-for-profit health care organizations, at which this very
topic — leadership development — was discussed. When you look at
the ages of leaders in Catholic and other health care organizations,
you see that the average age is "up there." We need to be proactive,
to identify our upcoming leaders, and make sure these people
are ready.
Earlier in my career, I worked in a large pharmaceutical
company, in sales and marketing first, then later in operations
as an executive vice president. Once the leaders of that company
have identified a person with leadership potential by assessing
the person's strengths and opportunities for growth, they put
a plan together and track the person throughout his or her career
with the company. "High-potential" people are given opportunities
to learn through both internal training programs and external,
formal programs, such as those offered at the Kellogg School
of Management at Northwestern University. Potential leaders
are also given projects that stretch them, opportunities to
work and learn with other more seasoned executives on new ventures.
This company also assigns the high-potential
person a mentor, someone in a position above you who can answer
your questions, ensure that you get exposure to senior executives,
provide you with entrée into learning opportunities that you
wouldn't otherwise be invited to.
We're going to try to duplicate that sort of
development program at CHW. We're just in the early stages of
building it, but we are going to start identifying our high-potential
executives and do a "mini" version of what I experienced at
the pharmaceutical company. It's critical that we take the initiative
and begin to work with such people to develop the skill sets
they'll need in this environment and in the future. I believe
it's a leader's responsibility to find and form the leaders
of the future. I believe very strongly that leadership development
is imperative for the ministry.
Lloyd H. Dean
President and CEO
Catholic Healthcare West
San Francisco
"'Servant Leadership' Is Our Model"
At Providence, many of our leadership development
activities have been aimed at the organizational and operational
model we are applying — we call it a "relational model." Fundamentally,
I'm a decentralist; I believe that authority and accountability
belong at the local level. In our relational model, everything
we do is for individual and community health, and it starts
and stays where the action is, locally, close to the person
served. Responsibility and accountability ought to be as close
as possible to those we serve.
So what is leadership in a relational model?
"Servant leadership" is the phrase that best describes it. The
best leaders in our system are facilitators, teachers, and coaches.
They spend most of their time helping individuals and teams
achieve their potential.
We've built a competency model that includes
the vocation and values competencies from CHA's Mission-Centered
Leadership Model. That's a cornerstone of our work. It's used
as part of a 360-degree evaluation process and as part of our
talent stewardship process, which includes a focus on succession
planning. We are making good use of the "360," we have a good
cycle of evaluation working at the individual and team levels,
and people quickly come to understand what's expected of them.
But there are lots of "next steps." We have miles
to go. The process is ultimately about selection — getting people
into the right roles, mentoring them, and building on their
strengths. We are pretty good, but our potential is far more
untapped than tapped. It's a great opportunity.
I think we have something really unique in Catholic
health care in that we have both permission to bring our spirituality
to work and the expectation that we will do so. This is true
for everyone carrying out the ministry. They really are living
it. For a person like me, who spent most of his life outside
Catholic health care, it's wonderful to be able to live my own
spiritual side in my work. I want all our 35,000 employees to
have that opportunity.
I've worked very hard at understanding what it
means to make this work ministry, to integrate it so
that it's not just words. That's a constant journey. I've studied
Catholic social teaching, and I do some spiritual reading. I've
also been especially blessed in having Sr. Karin Dufault* and
other Sisters of Providence provide for my formation. Not everybody
gets the opportunity that I've had. One of the things I'm committed
to is extending that opportunity to others.
Henry G. Walker
President and CEO
Providence Health System
Seattle
Copyright © 2002 by the Catholic Health Association of the United States
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