BY: DAVID J. NYGREN, CM, MA, MDiv, PhD
Fr. Nygren is corporate board effectiveness leader, principal, Mercer Delta, LLC.
With Sponsorship at a Crossroads, Navigating Change Becomes Vital
Sponsorship
of church ministry refers to the unique relationship of oversight, endorsement,
or support by a group that commits itself to advancing the ministry of Jesus.
Sponsorship is a call and a response to advance the love of God manifest in
Jesus and in a ministry of the church. The response, born in profound trust
and confidence in providence, implies that the person or group entrusted with
the ministry can attest to its worthiness. The sponsor is responsible for interpreting
institutional fidelity to its founding intent and for suggesting modification
to its form or configuration to ensure its continued vitality, relevance to
those served, and worthiness of public trust.
When we say that religious congregations
sponsor health care ministries, we assume a common understanding of the term.
Catholic health care has used the term "sponsorship" to define the unique relationship
between the founding congregation and its works. Hospitals, systems, and other
corporations founded and endorsed by the congregation often carry the name of
the congregation. The congregation sponsors the ministry. The evolution of sponsorship,
however, has not kept up with reality and has led to considerable heartache
within the health care ministry.
Not so long ago, sponsorship of an institution
implied a direct relationship between the congregation and the ministry. Often
the name carried the brand, so to speak. Mercy Health System, the Daughters
of Charity National Health System, and Alexian Brothers Hospital triggered a
firm image in any church member's mind. At the very least, the name implied
the organization's founder or religious character, even to people who were total
strangers to Catholicism. To those involved in the work of health care, moral
connotations such as respectability, legal control, and values may have been
evident. Employees often understood the importance of the congregation's tradition
on the type and quality of service provided, special care given to spiritual
needs, or care for the poor. Insiders referred to that special gift of the order's
tradition to the institution as the charism.
In recent years, systems aggregated hospitals
by markets, incorporated Catholic and community hospitals, and rapidly created
large faith-based enterprises that looked as much like big business as ministry.
Obligated groups convened, assets were commingled, and system names were changed.
Congregations quickly determined that alternatives to this rapid evolution were
limited. Ironically, however, many Catholic sponsors continued to compete or
isolate their ministries rather than combine charisms and "lose their identity."
Some did so at their own peril. Others survived this wave of consolidation and
have generally held on to a sole sponsorship model.
Sponsorship describes reasonably well the
unique relationship between a congregation and its ministry. Does it continue
to hold when describing the relationship of a congregation in either multisponsored
ministries or within the public juridic person construct of ministerial oversight?
Less so, I believe. But even in these configurations the local ministry retains
much of the character, identification, and values of the founding congregation.
Multisponsored Hospital Systems
For all their great intent and actual
success in delivering on their promise, cosponsorship of ministry takes time,
trust, and constant renewal of conviction. Congregations making a commitment
to one another to share in the sponsorship of ministry think in evolutionary
terms. They generally believe that their charism will be sustained through the
transition into the new organizational form. Even when individual group dynamics
have already been formed, new group dynamics emerge while the ink is drying
on the contract. The old structure is disrupted, and theological assumptions
get challenged. Each congregation has its own rituals, celebrated heroes, and
special places that embody the congregation's spirit that they expect to continue.
The friendly interchange that may have accompanied the courting phase may devolve
into unpleasant conflict and misunderstanding. The experience for congregation
members can be bewildering.
Why does this degeneration seem to happen
so repeatedly and rapidly? Each congregation experiences God in highly nuanced
ways. Employees and staff assume that sisters coming together share the same
mission of healing, and in many ways this is true. Too often, however, the core
of congregational identity is presumed to be clear. In fact, charisms are intricate
experiences of faith, group consciousness, and mission. If convictions and differences
are not explored thoroughly before entering a cosponsorship of ministry, chances
are high for post-merger frustration and, often enough, failure. Consider a
congregation whose primary identity is service of the poor. It desires to merge
ministries with a congregation whose primary emphasis is the corporal works
of mercy. Assumptions about the core combined mission may vary despite the seeming
similarity of intent. Congregations may differ on populations served, how resources
are allocated, which ministry will close, how governance is exercised, and who
should lead the organization. What began as an evolutionary journey is experienced
as disruptive, if not totally revolutionary. When the inevitable downsizing,
closures, or clinical consolidations occur, each sponsoring group has a natural
bias to protect its own and cosponsorship becomes further challenged.
Deciding to cosponsor is the beginning of
the process, not the end. Although incredible energy is required to begin the
transaction, even greater energy is required to sustain consolidation. The building
of a new, shared culture requires a new theological anthropology. Expanding
congregational awareness and behavior that demonstrates a broader intent by
a congregation to embrace the duty of care, the duty of loyalty, and the duty
of oversight over hospitals that have heretofore been, at best, only a name
is an immense challenge.
Public Juridic Persons
The decision by a congregation to incorporate
ministerial assets into a new public juridic person (PJP) alters the nature
of sponsorship of that ministry. The PJP is, by definition, a change in control
and sponsorship from one group to another body legally recognized by the church
and society. For various reasons, even with full knowledge of the shift, founding
sponsors continue to feel some abiding obligation to the work and its employees
(rightly so) even though their fiduciary control has been shifted to a new entity.
Catholic Health Initiatives, Trinity Health, and others systems sponsored by
PJPs face unique dynamics with former sponsors (see below for a description of the four existing PJPs of pontifical right). Sponsors face similar
upheaval in their role definition.
Merger of assets and the accompanying shifts
in canonical and civil control require relationships to realign. Although a
member construct may continue in the new enterprise, the reserved powers are
usually limited to appointment of congregational members to serve as members
of the board of the new PJP. Some have slightly more power, but these powers
are restricted.
Although sponsors understand the rudiments
of the shift, the emotional costs of alienation are high and the resistance
or hesitation to implement the terms agreed upon can be intense. Congregational
leadership transitions may compound the challenges. The leadership that combined
a few sponsored hospitals into a system will differ from the leadership that
merged the singular sponsored system into a cosponsored ministry. In addition,
the decision to move from a cosponsored construct into a new PJP model i™ often
made by yet another leadership team. Congregational members may not understand
or agree with the rapid evolution often born of market necessity.
Congregational leaders themselves may not
support, appreciate, or communicate the restructuring clearly, often because
the choices are limiting and resistance within the congregation may be emerging.
Conversely, leaders who once embraced the new PJP model may not be entirely
satisfied with the direction set by the leadership of the new PJP once they
have ceded their assets into the new construct. This dissatisfaction may result
in an attempt to influence the direction of the PJP.
Once the myriad challenges are understood,
what can we do to make an effective transition and advance Catholic health care?
Whatever the decision by the congregation relative to sole sponsorship, cosponsorship,
or migration to a new PJP model, several actions are worthy of consideration.
Recalling that any organizational form is a social construction is helpful.
Organizational forms merely provide the architecture for a set of relationships.
The term "sponsorship" cannot carry the full range of relationships embedded
in either cosponsorship or the new PJP models of ministry. Using the term continues
to set expectations between a congregation and its institution — expectations
that the new structure needs to redefine.
Remembering Our Purpose
Charisms are gifts graciously given by
God for the building of the church. Their proclamation is ultimately about the
love of God, not about the charism itself. The founding inspirations of each
congregation are in very mysterious and beautiful ways about the kingdom, the
eternal, and incarnate love of God. Charisms also evolve in unexpected ways,
including diminishment or transformation to a new life and membership form.
Furthermore, believers — lay, religious, and clergy — embrace the healing ministry
of Jesus. The proclamation of the love of God in Jesus is the center of personal
and collective religious identities. Although religious life is clearly a strong
mediator of God's grace and love, it is a channel of healing instrumentality,
a conduit of hope, and a framework of continuity and stability. The healing
ministry is rooted in the love of God manifest in Jesus.
The PJP structure of ministry should find
its purpose and identity in this unmediated love of God. Many of us have believed
that health systems are about the preservation of sponsorship. Although this
may have been a secret hope, preservation of a charism alone is not sufficiently
compelling. What matters to those who must govern these ministries is not that
they were or are Dominican, Daughter of Charity, Franciscan, or Alexian. The
health system must be focused on the immediate love of God manifest in these
works. The board and congregational leadership must discuss this point. The
issue is not preservation of a charism or congregational identity, but living
the sacrament of the immediate love of God.
Who holds the trust of the traditions? All
the traditions, while uniquely important in a local context of ministry, publicly
and collectively express the healing ministry of Jesus. A board commits itself
to advancing the healing mission of Jesus, advancing the faith of the church,
and building healing environments and services. A board must develop the heart
of a sponsor if it is to:
- Attest to the worthiness of a ministry in the eyes
of the church and the community
- Interpret the fidelity of the ministry to its purpose
and for its constituents
- Be the public face of the church, for the church, and
to the church in collaboration with the president
Directors or trustees are not called to a
vocation in any congregation, but they do experience the call to service in
the church by promoting the healing ministry of Jesus through a church ministry.
Therefore, they oversee and support the development of a culture and environment
that is faithful to the Gospel life of Jesus. The charisms of the religious
congregations indeed have significance and importance historically and in an
ongoing fashion, but only the congregation is capable of interpreting the specific
charism.
By entering into a covenant with a new PJP,
congregations entrust their unique gift as lived through their healing ministries
to people of faith in the corporation. Theologically their charism remains with
the congregation. A health system composed of many traditions cannot be a blend
of charisms; neither can it describe itself as a charism in the church. It may
have a culture, an operating environment, and be in the lineage of charismatic
traditions. A PJP is fundamentally a ministry of the church. Its end and inspiration
is Jesus, not the founders of congregations, however important they may be to
the spiritual history.
The more we continue to debate internally
among ourselves how we will advance multiple charisms in complex health systems,
the more time, focus, and commitment to the real task of spreading the love
of God manifest in Jesus and the healing ministry will be lost.
The Differences between Governance
and Sponsorship
There is little that the term "sponsorship"
adds to the full notion of governance if governance is properly understood.
Governance of a church organization has all the aspects of sponsorship embedded
in its self-definition. If we accept that governance is the process of establishing
the mission, philosophy, direction, and strategy of the organization to ensure
its long-term viability, all responsibilities of sponsorship are included in
the obligations of governance.
What more does the term sponsorship imply
that is not also covered in the word governance, particularly for a PJP? By
dichotomizing sponsorship and governance, we assume that the full moral, fiduciary,
and spiritual authority does not reside with the board, but with sponsors.Yet,
if we consider that governance, properly understood, incorporates potentially
all that sponsorship implies, might shifting the burden of obligation to those
governing be worth considering? If we were to do this, what would become of
sponsor influence? Would the relationship between the congregation and the institution
or system end?
What Can We Do?
Congregations entering into cosponsorship,
a new PJP construct, or even expanding their own sponsored ministries will benefit
by clarifying their intentions and hopes early in the process. Never assume
that sponsorship means the same thing to all sponsors.
The first challenge is to open the conversation.
Test assumptions about the charism and perspectives about faith, the church,
and the healing ministry. As noted before, inferences about such key principles
will not necessarily hold. Second, understand the deep structure of belief beyond
the operating style of the organization with whom you intend to partner. Determine
how, if at all, the members of the congregation hope to remain involved and
how they expect that the congregation's charism will influence the cosponsored
works or the PJP. Expect to write a new theological anthropology that specifies
the new entity's theological framework, the social and culture norms and behavior
that will characterize it, the inductive ecclesiology that it embodies, and
how the new enterprise operates in its environment as a healing ministry. Be
explicit about congregational views of the church and what collectively advancing
the healing ministry of Jesus means in a practical sense. Finally, adopt new
patterns and rituals to celebrate conversion and conviction for the new organization.
These seemingly obvious steps are, in my experience, the most overlooked aspects
of the due diligence process.
Lay leaders within these health ministries
are often perplexed by the lack of precision in the rationale for a merger among
sponsors. When the core identity and values evolve into a new identity, everyone
is curious about the practical and personal consequences. Congregations must
conduct a dialogue with each other about the fundamentals of their culture,
value system, operating environments, and views of the church in order to partner
effectively in a structure that is inherently complicated. In addition, engaging
lay partners in the dialogue at the outset will help support the change process
and codify the congregation's intent over time.
Moving the Agenda
With or without the term "sponsorship"
in our vocabulary, the traditional duties of oversight, care, and loyalty for
ministries of the church will be ongoing. The emphasis here has been to suggest
that sponsorship does still apply in some form to the unique relationship a
religious congregation has with its works. Sponsorship can be changed into something
as rich and enduring as charisms, but to do so requires sticking to the conversation
and being open to new models.
Pope John XXIII spoke in the Dogmatic
Constitution on the Church in the Modern World of initiating a new order
of human relationships in which all people are called to holiness of life and
discipleship. Catholic health care is rapidly adopting new disciples to the
healing ministries of the church. Believers embrace the healing ministry of
Jesus, and the proclamation of the love of God in Jesus is the center of identity.
Sponsored ministries, cosponsored ministries, and new PJPs are moving toward
a new ecclesiology that has yet to be claimed. The charismatic lineage from
whence these systems emerged historically will influence those responsible for
governing and leading these new systems by pointing the way to Jesus. Although
folding their charism into a broader ecclesial identity to advance the healing
ministry of Jesus is difficult for religious congregations, they understand
at some level that this is the future. Religious sponsors need to be ready and
willing to trust and invest in the new ecclesiology. Former sponsors must continue
to endorse the work given over to the new entity without their trademark being
obvious.
Most congregations understand at some profound
level the action of God shifting the sands of history beneath them. The challenge
is to trust that lay and other leaders within the church can and will steward
the patrimony. Yes, the new leaders and governing bodies will never be formed
with the same intensity that initially created the congregation's ministry.
Similarly, the formation process for health leadership and governance will have
to be rapid and systematic if this transition is to occur. The church has myriad
resources that it can and will put to the task once the common work is acknowledged
and we collectively understand where we are headed.
Health care systems of the size and scale
constructed over the last five years make sponsorship influence difficult to
achieve. In cosponsored ministries and in the new PJP structures, leadership
must be concerned about the evolution of Catholic culture and values. Sponsors
at the local level still serve a powerful role in a practical and symbolic sense.
In many ways they are the church to the local community. In many contexts,
what is known of Catholicism is known by virtue of the deep and abiding presence
of the individual religious women. The danger exists of negating the roots of
inspiration in individual religious in favor of only a programmatic approach
to mission and ministry at the system level. Systematic approaches are required
in our complex health systems, but some things can be learned from the living
incarnations before us. For instance, we see that public trust is earned over
decades; our employees still tend to go to the trusted sister advisor despite
the fact she may have no formal role, and if the sisters are not aligned with
leadership, the leader will likely fail before the sisters do. The deeper issue
is about forming and sustaining a culture without eradicating its foundation.
The adage "driving by the rear view mirror
is a hazard" comes to mind when thinking about the way in which we anticipate
the future of Catholic health care. We keep looking to the road behind us to
explain how things will be. Yet we simultaneously recognize that the old ways
will no longer prepare us for the future ministry of health care.
In summary, a few action steps are worth
considering:
- Reduce the bifurcation of sponsorship and governance.
Fold the historic duties of sponsorship into the duty of Catholic governance
and expect alignment of governance systems so that the religious and theological
questions are at the heart of a board's work. Let the spirit soar and loosen
the proprietary hold on God's grace; it is not known only by a chosen few.
The deep structure of the Catholic imagination is more resilient than all
the charisms combined. This is the historic wellspring of grace and new foundations
in the church.
- Structure educational opportunities, partner with Catholic
universities, and outsource training for health care governance to those who
can deliver value to adult instruction that is both theological and industry
specific. In other words, deliver a market to an educational institution that
has demonstrated the drive to support Catholic ministry. Catholic health care
education has become fragmented and is ready for some focused consolidation.
- Write a theological anthropology that moves beyond
the bifurcation of formation as either a religious or lay spirituality. Focus
our theological reflection and discourse on the ministry of Jesus. Preparing
leaders and governing bodies to carry on the sponsor's tradition is of limited
impact. If we believe, as most individuals do, that the sisters are irreplaceable,
we create that reality. However, as believers and healers, we understand that
Jesus heals through many channels of grace. We must trust those we think of
as partners in ministry and journey with them into a new ecclesiology, particularly
physician healers.
- Prepare boards for their emerging canonical and civil
legal work so they can assume stewardship of the public trust of these ministries.
- Redefine and understand the moral agency of congregations.
For instance, some congregations are moving out of institutional ministry
to direct service, but their intent may not be explicit.
- Set the standard for effective leadership in Catholic
health care by using CHA's Mission Centered Leadership Model and let the respective
boards implement the standards through systematic evaluation.
- Adopt new patterns and rituals to celebrate conversion
and conviction to a loving and healing God that is not simply an interpretation
of a saint's calling hundreds of years back. In other words, reveal the call
to all believers to participate in building the kingdom now.
- Ask ourselves why we are still aggregating by congregations
rather than by sustainable natural markets. We have much work to do to strengthen
our presence as church ministries. In some cities we are letting church ministries
die rather than partner with those with whom we have competed for years. In
other circumstances, we are partnering with other faith and community traditions
to remain viable. Essentially, Catholic health care continues to fragment
when congregations cannot see the greater good of the community being served
by natural market combinations.
- Congregational leaders have a choice and opportunity
to be heroically generative and to transition their legacy to new forms. The
time to rethink national systems in this market-driven industry is now. Imagine
new organizational forms to achieve even greater ends.
- CHA should encourage ministry and civic leaders to
gather with the intent of interpreting next-stage market evolution for health
care in our communities and congregations and help to design the way forward.
- Align ministries within markets, reduce redundancies
quickly, and partner with other ministries of the church, such as education
and social service, to build healthy communities more effectively. Ready the
church and our communities for the work ahead. One helpful activity would
be to write the theological anthropology of building community, defining the
role of faith-based health care in the equation.
- Start this hard work easily; open the conversation
by talking about the role of Jesus in the work of healing.
Copyright © 2001 by the Catholic Health Association of the United States
For reprint permission, contact Betty Crosby or call (314) 253-3477.