BY: REV. CHARLES E. BOUCHARD, OP, STD
Fr. Bouchard is president, Aquinas Institute of Theology, St. Louis. This article is adapted from chapter 13, "Morality, Business and the Meaning of Work," in his book Whatever Happened to Sin: The Truth about Catholic Morality, © 1996 Liguori Publications, Liguori, MO. Reprinted with permission of the publisher.
Renewing the Experience of Work
In healthcare, as in any other field, work can become dehumanizing, meaningless drudgery. But good managers can transform their organizations and renew the experience of work.
Good management demands not only good business skills, but character, rooted in truthfulness and vision. Three virtues are particularly important: prudence, justice, and fortitude. The moral skill of prudence enables healthcare managers to know what is to be done; justice creates honest relationships; and fortitude enables managers to seek a good that is difficult to achieve—to do the right thing.
Businesses must also explore their potential for sacramentality and find ways in which employees—and employers—can become better, holier people through their work. Organizations should strive to achieve subsidiarity and keep employees well-informed of their missions. Establishing a sense of connectedness is important, as is open and honest communication. Finally, managers—and healthcare organizations—must always work for the common good.
The movie adaptation of David Mamet's play Glengarry Glen Ross
—the story of a branch real-estate firm trying to bolster its sales—portrays business gone bad. The centerpiece of the film is a lengthy monologue by a handsome, soulless downtown executive, played by Alec Baldwin, who gives the agents a pep talk about the importance of building sales, no matter what. He pushes the overworked and demoralized salesmen into a crude sales competition: The first prize is a new Cadillac, the second prize is a set of steak knives, and the third price is "you're fired."
As the film unfolds, all the salesmen descend into a moral and emotional pit as they try to meet their family obligations, keep their jobs, or just "play the game." A staccato fire of four-letter words reflects the desperation and poverty of spirit that characterize their lives. Far from humanizing them, their work has turned them into competing animals who lose respect for their managers, their clients, and themselves.
Glengarry Glen Ross is a brilliant work, but it is also frightening because it paints in bold strokes the all-too-common characteristics of work at its worst: drudgery, low pay, tyrannical bosses, impossible working conditions, and lack of job security.
Even in healthcare, which is often distinguished from other kinds of work because of its orientation to service and the good of people, jobs can lose their meaning and become boring and dehumanizing. Good managers can make the difference by helping their employees see work, and especially patient care, as occasions of grace, moments in which Christ himself is made present. Good management thus demands not only good business skills, but character. Managers must strive to be holy persons, so deeply rooted in truthfulness, justice, and vision that they cannot easily be compromised. These qualities enable them to transform their organizations and renew the experience of work.
Three virtues are particularly important to healthcare management: prudence, justice, and fortitude. Prudence is the moral skill of knowing what is to be done. Far from a prudish restraint, the virtue of prudence gives us the bold and confident ability to know what the goal is and how to achieve it. Healthcare managers must work to achieve financial stability for their organizations, but also must make a creative contribution to patient care, to employee satisfaction, and to the community at large. They must be able to draw on experience and to foresee consequences; they must know when to consult and when to make a decision; they must know when to go "by the book" and when to try something different. The prudent manager is not just cautious, but effective—someone who can see the whole picture and make the right move at the right time.
Justice means creating honest relationships with suppliers, customers, professionals, patients, and employees, and seeing that each of these groups receives its due. Justice involves truthfulness and equality, as well as compensation for goods and services proportionate to their real worth. In healthcare, justice requires finding a balance between obligations and rights so that we contribute to good health according to our means—even if that means only keeping ourselves healthy—and receive from society the healthcare we need.
Fortitude, which enables us to seek a good that is difficult to achieve, is also important. Businesspeople are under great pressure to make a profit, and healthcare leaders to meet the bottom line. This may cause them to consider doing unjust or unethical things. Fortitude can help them do the right thing: implement more humane but less profitable downsizing, treat competitors fairly, and strike a good balance between quality of care and efficiency.
Peter Senge says that corporations must become "learning organizations" that are "committed to the development of all people's ability to create the life they want."1 Healthcare leaders must help their organizations learn that they are not only in the business of healthcare delivery. They are promoters of social change and proclaimers of the Gospel, which promises a new age of justice and compassion.
Sacramentality in the Workplace
Thomas More, author of Care of the Soul, says that "work is liturgy," and that we can help workers bridge the gap between "the sacred and the secular by occasionally ritualizing the everyday things we do. We might buy tools of satisfying quality, well made, pleasing to look at, fitted to the hand, or an office desk of special design or select woods."2 Our work should be creative. This does not mean it must be exceptional, but it should always "make something for the soul." The virtuous manager will help each and every employee do that, even if only by improving the manner of doing a task that does not have great intrinsic meaning.
Each business, whether a not-for-profit healthcare service or an investor-owned enterprise, has to explore its own potential for sacramentality and find ways in which employees (and employers) can become better, holier people through their work. A few general principles apply to all.
Subsidiarity The principle of subsidiarity, one of the bedrocks of Catholic social teaching, says that decisions should always be made at the lowest possible level of organization. In business, subsidiarity gives people as much freedom as possible and removes their decision-making authority only when it is in the best interest of the whole.
One way of achieving subsidiarity is through broad consultation, but in large corporations this is often not feasible. Some corporations have adopted "demassification"3 and broken down into smaller organizational units, sometimes creating discrete companies that function independently but remain within the sphere of the larger organization. The theory is that demassification gives people increased access to and control over data, production, and working conditions, resulting in greater employee satisfaction and a better product. However accomplished, any method of subsidiarity that empowers more people and keeps all decisions from rising to the top will make the workplace more satisfying.
Mission and Ownership
All of us find it difficult to work for an organization we do not understand. If I am responsible for moving part X from location A to location B but have no idea what happens to it before or after my action, my participation in the organization's overall mission is very limited and my potential for frustration is high. On the other hand, if I know why the organization exists, what its final product is, what it takes to make the product, and the market forces that affect production, my involvement will be much better informed and more enthusiastic.
As the president of a school, I have found that I can never reiterate or discuss our mission too much. The more I do so, the more the faculty and staff are able to appreciate it as their mission also and help shape it for the future. If the mission of my organization were my possession alone, it would receive only the limited nurturance I am able to give it.
Connectedness In his book The Great Game of Business,4 Jack Stack notes the importance of setting specific goals for employees, almost creating a game in which the finish line is clear to everyone so that people can work together to reach it. He suggests setting big overall goals and breaking them down into smaller goals for each unit. This gives employees a stake in the outcome and enables them to see exactly what their effort contributes to the overall result, helping them feel connected and making their work more meaningful.
Communication Nothing is more frustrating to employees than being kept in the dark. When managers fail to keep employees and staff aware of the mission, reasons for changes, or impending problems, they risk losing confidence and cooperation. Sometimes poor communication is deliberate, but at other times it is a matter of bad timing. Many memos and talks are forgotten because the information is not given at the pertinent moment. Good communication involves not only knowing what need to be said, but when.
The Common Good "A manager is a person who is responsible for the common good," says Rev. Raymond Baumhart, former president of Chicago's Loyola University. "In decision-making the manager must habitually weigh the interest of all parties and try to arrive at a solution that promotes the common good."5 This is clearly true within the healthcare organization, as managers try to make all the parts work toward the mission. But it is true in a larger, social sense as well. Healthcare organizations, now being compelled by market forces to establish collaborative arrangements for the sake of greater efficiency, quality, affordability, and accessibility, must be aware of their power to influence society around them.
Tom Chappel, founder of Tom's of Maine, has noted: "The ultimate goal of business is not profit. Profit is merely a means toward the ultimate aim of affirming the health and dignity of human beings and their families, affirming aspirations of the community and affirming the health of the environment—the common good. What business leaders need to recognize is the awesome power we have to turn our ingenuity and cash flow toward helping others. American companies have to think not only of their own private good but the common good."6
Healthcare organizations have a special obligation in this regard because they hold in trust the vast resources of medicine: skilled professions, personnel, research, scientific knowledge, patient cooperation, and financial capital.
The Heart of an Ethical Business
The heart of an ethical business is a virtuous manager. The virtuous manager cultivates truthfulness, clear communication, appreciation for the dignity of each worker, engagement with society, and respect for the covenant his or her organization has with society. He or she always aims to promote the common good of the company, society, and even the globe. A far cry from Alec Baldwin's character in Glengarry Glen Ross, virtuous managers keep workers "connected" so that they do not just work for a company, but participate in it. Virtuous business makes work sacramental so that it becomes a gift of cocreation with God.
- Peter Senge, The Fifth Discipline: The Art and Practice of the Learning Organization, Doubleday, New York City, 1990.
- Thomas More, Care of the Soul: A Guide for Cultivating Depth and Sacredness in Everyday Life, HarperCollins, New York City, 1992, p. 182.
- Michael Finley, "Smaller Is Beautiful," Business Ethics, January-February 1993, p. 30.
- Jack Stack, The Great Game of Business, Doubleday, New York City, 1990.
- Raymond Baumhart, "It's Not Easy Being a Manager and a Christian," America, May 4, 1991, pp. 486-489.
- Tom Chappel, The Soul of a Business: Managing for Profit and the Common Good, Bantam Books, New York City, 1993, p. 202.
Copyright © 1997 by the Catholic Health Association of the United States
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