FaithHealth

A Shared Mission of Healing

Q & A: Gary Gunderson and Jerry Winslow on Faith and Healthcare

Aug 18, 2016 | FaithHealth Community

 

 

Here’s a conversation with two people deeply rooted in connections between faith and health. Both serve as leaders in Stakeholder Health where this first appeared. 

Dr. Gerald Winslow, a.k.a. Jerry, is Vice President for Mission and Culture for Loma Linda University Health. He is the founding Director of the Institute for Health Policy and Leadership. He is also Professor of Ethics at Loma Linda University, specializing in biomedical ethics and the relationship of social ethics to health policy. He is also the chair of the Stakeholder Health Advisory Council.

Dr. Gary Gunderson serves as Vice President for FaithHealth at Wake Forest Baptist Medical Center. He is known for more than two decades of creative work in the field of faith and public health initially at The Carter Center and Emory School of Public Health. In Memphis his ideas found ground through more than 500 congregational partners showing hard evidence of significant improved health outcomes. He is a frequent speaker and author of five books. He is co-founder of and serves as Secretary of Stakeholder Health.

Interview by Tom Peterson

Stakeholder: How do you see the faith and spiritual trajectory of hospitals that were started, usually long-ago, out of a faith tradition? For example, Jerry, with the Adventists.

Winslow: I don’t think it’s ever been entirely lost. We went into the business to keep people healthy and not just patch them up after they got injured or sick. But we have to admit that for many decades we got reimbursed for rescue medicine. We didn’t get any help to speak of if we tried to keep people healthy. Far from it. If we did a great job of keeping people healthy, as more than one executive or physician mentioned to me, we were just ruining our business because we were cutting back on volume and we got paid for volume. So the simple truth is that we went further into those areas for which we got paid.

Gunderson: What do you mean by rescue medicine?

Winslow-G-2016Winslow (at right): Well, to tell another unpleasant truth, ever since the 1980s, with the passage of something called the Emergency Medical Treatment and Labor Act, known in the business at EMTALA, we hospitals have an obligation to care for everyone who shows up in our emergency department. In fact, according to case law, we’re obligated if they get within 200 yards of our emergency department to go out and bring them in and make sure they’re cared for regardless of ability to pay. That’s been our national health plan, one version of it. That’s a vivid example of rescue medicine. We may wait until somebody’s desperately ill or injured, they show-up in our emergency department, and then we’re obligated to care for them whether or not they can pay.

What we intended to do when as a faith community Adventists went into the health work was to try to help people stay healthy and out of hospitals. But showing up in an emergency department after you’re already seriously ill or injured is what I would call rescue medicine. It’s not just that. That’s the tip of the iceberg, but it illustrates what I’m talking about.

Back in the mid-19th century when Adventist went into the business of restoring people’s health and trying to keep them healthy things like third-party payments, government involvement in reimbursement, large insurance companies and the huge amounts of money involved in today’s health care didn’t exist.

When I was a kid less than half of the population had coverage for health care. Every year my dad would compare what would cost for him to buy Blue Cross insurance to what we had paid out-of-pocket for health care and see whether we won or lost. But he never bought the insurance. So I grew up in a household that didn’t have health insurance and I was not alone in that.

So what was created in my lifetime is huge amounts of money, a very different reimbursement scheme with bureaucracy to go with it. Gone is the notion of running health care as a charitable enterprise where people in the community give of their resources knowing that if they don’t there won’t be a charitable hospital for them or the community to use.

The other things gradually faded away, not entirely. It became very big business with billions and, finally, trillions of dollars at stake and the huge cost of drugs, surgeries and all different types of interventions being paid for by third-party payers. This makes it hard to continue thinking of it as a small, charitable operation.

Gary GundersonGunderson (at right): Also, there are different religious histories behind the different religious hospitals. Most of the Jewish hospitals, for instance, were created because, at one point, Jewish physicians were not allowed to practice in Protestant or Catholic hospitals. Most Catholic hospitals like Bon Secours were established by the women’s orders that had an explicitly charitable mission. The hospital part of the mission often came after other parts of the social mission had been expressed.

Baptists, Methodists and Presbyterians tended to create their hospitals in the early 1900s as part of the social gospel movement, in which the more progressive side of Protestant experience was caught-up in the movement to express the social implications of the gospel. But the science of the time made it possible for many hospitals to be established for what now would be regarded as just a little bit of money. It was literally within the range of congregational offerings that started what’s now Wake Forest Medical Center. The Baptists in North Carolina started it with the explicit recognition of the role of social factors that created medical problems at the time. They recognized that medicine was not just responding to microbiology, it was responding to poverty and broken families.

Jerry, can you talk about the importance of language in mission and, in particular, the way most religious hospitals today have adopted a quasi-military language to describe their work?

faith hospitalWinslow: Language can either support or corrode a commitment to mission. Early on Adventists, and we were not the only ones, referred to a ministry of healing by which we meant that the work that we do in health care is sacred work. But in the 19th century we started adopting military language. Doctors give orders, nurses work at stations and give shots. Physicians are armaments in the battle against disease, which threatens to overwhelm the body’s defenses. And when you leave a hospital you get discharged, something that only happens in a couple places in society.

Military language became pervasive, but the most successful language to come into hospitals in the last few decades is the language of business, the health care industry. Hospitals have products and product lines, the bottom line, we have market shares and marketing departments. I’m just asking people who once could speak the language of the ministry of healing to see if they can become multilingual.

Stakeholder: How does language about health frame our approach to health?

Gunderson: For religious communities, stripping away the religious language from the ministry dramatically diminishes its power, even in a medical sense. When you take spirituality out of it, it’s like just describing music in terms of its vibrations on your eardrums but not listening to it, and the words, and the history, and the deep resonance that comes with the meaning of the music. When strip away all of the spirituality, the rich humanity and social meaning of the ministry, from a medical intervention all you’re left with is biochemistry and it’s just not as effective.

Stakeholder: Many people in health care systems chose their careers as a way to express caring and healing for others, motivated from their own faith or spiritual journeys. Some will say that these things that motivated them to start with aren’t there as much as they’d anticipated.

Winslow: Well, lots can be done about that. We have, for example, an entire department of employee spiritual care. It’s not the chaplains for the patients, it’s attending to the spiritual needs of our colleagues. We teach all of our health care professionals about meaningful spiritual relationships with patients, where we tune into that important core of meaning in their lives. Thousands of people where I work get up every day and see their work as a sacred calling. They show up here through thick and thin, through the risks of exposing themselves to disease and so forth, in part not just because they get paid a salary but because they believe that it is a spiritual calling and they want to fit into that aspect of the patient’s life.

Now, JCAHO can require us, and they do, to attend to patients’ spirituality. But that’s a crude, bureaucratic instrument for ensuring that we ask patients about that aspect of their lives. It’s worthwhile to remind ourselves that a significant portion of people who choose to work in faith-inspired health care do so because they think it is a spiritual calling.

faith hospital 2Gunderson: There is no more religiously diverse social group in the nation than the group of people who are practicing medicine today in any modern hospital. Whether it’s Baptist Hospital in Winston-Salem or Adventist in Loma Linda, inside our walls you have an extraordinary diversity of people expressing their own spiritual calling in the work of healing. I don’t know if it’s a common soup or a salad, but we find ourselves expressing our own spirituality alongside someone else of a very different spiritual tradition, who is also expressing their spirituality in the same work of healing. With such polarization and distance in the public spaces today, in the medical spaces there’s an extraordinary commonality of purpose and expression of spirituality in the most beautiful way of work of healing.

Stakeholder: How are hospitals engaging with faith groups in their communities?

Winslow: The religious diversity is pretty amazing in our part of the country where you’re as likely to find a Hindu or Sikh or Greek Orthodox person. Our clergy appreciation breakfasts are attended by imams and rabbis and priests and so forth. But of 4.2 million people in this area, 1.7 million are members of the Catholic diocese. And we have built a strong relationship of trust with their ministry. If we miss the opportunity to collaborate with the diocese, we would miss the biggest opportunity we would have to connect faith and health. So it has to be tailored to the different realities in the communities where we work.

Gunderson: In my setting in North Carolina half of the clergy who visit our patients are Baptist. There are 3,600 congregations in the North Carolina Baptist Convention. We have a governance relationship with them, but they’re also, by far, the largest part of the social fabric of the expression of faith in the state. So we are continually renewing and putting a new energy into the founding governance relationship with the religious people who invented the hospital. We spend a lot of time in the formal structure, not just at the state level, but at the association and congregational level.

At the same time, we look for similar opportunities to engage the structures of faith, whether it’s a Presbyterian congregation or the Presbytery. We work with the United Methodist annual conferences, the districts and the individual congregations. We look for the collaborative relationships that are so common in many communities where people from different religious denominations and backgrounds create collaborative structures, often at neighborhood level, sometimes in the form of a shared ministry like a food bank or a health ministry.

faith hospital 3So, you have to use a bit of the sociology of religion to look for where religion exists, with all it’s different forms of connectional apparatus, and engage that. That’s part of the work of chaplaincy, and spiritual care, and faith health in hospitals. When it turns outside its walls it tends to look for the structures and the networks of faith and not just for the individual personal expressions of faith.

Winslow: Health systems now dwarf the church in some ways. We have just over 1 million members who are Adventist in North America and we have over 125,000 employees in the Adventist health service. How a little church runs a health system like that is an interesting challenge but we’re making progress in renewing the covenant.

Stakeholder: How is heart or faith relevant in an increasingly secular industry?

Gunderson: Where there is less participation in traditional religious structures I don’t think there’s any less heart or spirit in human experience. It’s incumbent on those of us running health care systems—where you’re meeting people at often the most traumatic turning points of their life—to meet them with a full apparatus of what a human being has to bring to another human being. That includes the bio, psycho, social and the spiritual components of the healing encounter. You have to create human systems that can deal with the full humanity, both in their own employees and in those who come for healing.

Winslow: Those of us who work in faith-based, I prefer faith-inspired, systems sometimes may overlook the things that are closest to us in that regard. We’re unafraid in such systems to address the ultimate questions of meaning that people are going to bring-up when they’re desperately ill, as they often are in our settings.

Also, it’s the role of faith to vivify the imagination so we see new opportunities for creating ministry of healing that might be overlooked if it were just viewed as a business exchange. All kinds of creativity come forward.

Gunderson: The relationship between science and faith in a science-inspired, faith-inspired institution is that the faith and the science not just play off each other and complement each other. They actually inspire each other. The radical advances in prevention science and the extraordinary number of conditions that are now able to be managed over a long period of time have inspired those of us with faith to see how much of suffering is preventable, how much is manageable, and how much of an opportunity we have to create a different kind of a world.

faith healthWithout the advancing science, the imagination of faith would be limited to what was known in the 1900s. But science also desperately needs faith to see the possibilities for healing at social scale and creating opportunities for new relationships that science alone can’t begin to fathom. So there are extraordinary opportunities for faith and science to continue to inspire each other.

Stakeholder: We hear so much these days about how much of a person’s well-being and health are impacted by where they live and other social drivers of health. What role do faith institutions have? And what would be the first steps if a hospital was wanting to more intentionally engage with the faith community?

Gunderson: The first step to open our own eyes and the eyes of a hospital is often to look at our data, interpreted through the lens of science, to see what’s going on in the medical lives of our patients and our neighborhoods. The eyes of faith open up those science eyes a bit wider to see if there are more dynamics going on in the lives of patients than just those medically understood phenomena. It helps us to add dimensions and patterns to what we see. The first step is to continue to open our eyes to what’s actually happening one patient at a time, one neighborhood at a time, one community at a time.

Winslow: One of the early steps is to become clear gain about the founding convictions that gave rise to the health industry. What did we believe then? What do we believe now? What are the best of those beliefs that we intend to bring forward so that, as one of my theologian friends says, when we go back to the fires of the past we get the coals and not the ashes? If we mine our own traditions for the best of their convictions, there are some coals that still burn. Any kind of health ministry that isn’t rooted in a strong set of convictions about the community and about faith is probably not sustainable.

Gunderson: Jerry just outlined the three questions that are always the starting point: Where am I? Why am I here? And what can I do? Whether we’re a nurse or an executive we can begin there every day when we walk in, realizing that we are at a starting point and not assume that what was there yesterday is adequate today.

Winslow: Albert Einstein said “Science without religion is lame, religion without science is blind.” Einstein was no fundamentalist. There’s no comfort in there for people who want the bumper sticker version of “God says it, I believe it, that’s good enough for me,” But I think he’s onto something. He says science can tell us how to do things, make progress and increase knowledge, but can’t tell us why and can’t give us any sense of purpose. Life turns out to be one damn thing after another.

hospital faithStakeholder: What are some of the most hopeful trends that you see in the area of these faith communities collaborating and coming together with health care systems to improve public health?

Gunderson: I think the Stakeholder Health movement is a powerful and optimistic engagement that’s happening across the country, and that’s not just inside those institutions with some political reason to pay attention to their religious legacy, the faith-based organizations. We’re finding that many organizations which do not even have a faith base are now becoming inspired by faith, so they actually are faith-inspired. When they look around their communities and they ask who are those that care about the most vulnerable people, about the most vulnerable neighborhoods? Where are the social assets that are actually on the ground? Who really cares?

Frequently they find themselves inspired by the faith networks’ interactions. So some secular hospitals, academic medical centers are now being inspired to levels of community engagement that probably had not happened before. I like the idea that the faith-health movement is much broader than health institutions that have a governance legacy rooted in religious structure.

Winslow: I see things popping up all over the culture so fast that, I suppose for those of us who have cared about this longer, it almost feels like a freight train moving on its own track, at its own speed, and out of control but it’s a good thing. There are just so many convergences.

Stakeholder: What else should we be paying attention to over the next year or two?

Gunderson: Realistically, we’re in a public environment in which the language of faith is being used like a hammer and a knife, often on the most vulnerable, often on our enemies. So those of us who speak a language of faith optimistically—charitably, a language of mercy and justice—have to be more demonstrative than we’ve ever been about why it is even safe to talk about faith in public. We’re under a heavy burden to model that faith not just matters, but that it matters for good. We cannot assume that the language of faith in our political culture today, our organizational culture, will be permitted or recognized as a genuine asset.

hospital faith 2Winslow: I think that one of the reasons the faith-health movement has gotten the traction that we’re seeing now is related, in part, to the passage and now the implementation of the Affordable Care Act. It’s a very imperfect world and a very critiqued act, but it has healthcare leaders thinking more about community and population health, even if they don’t know what that means. It opens some doors and presents opportunities to make more strategic investments for these systems to use the kind of language that the cost accountants understand. But at the same time it comes with certain dangers. It’s easy to have people who want to look good rather than, maybe, to be good, to use those opportunities essentially for marketing strategy, which is a big part of where the so-called community benefit was located in the past.

So one of the challenges, but also a wonderful opportunity, is to try to shape the future that we really want—one in which we mean what we say when we talk about faith-inspired, whole-person care and not just a sea of marketing strategies to help business. That will require a certain prophetic courage, at times, because one wishes to do that in a way that’s not obnoxious or self-righteous.

Gunderson: Another piece of work is to bring the prophetic imagination of faith to bear on where the tools of prevention and chronic care have actually been moving so far. Hospitals are struggling to understand how to extend to the entire community the extraordinary benefits of modern science at the point of prevention and chronic care. It’s hard for hospitals because they are like battleships. What we need to do now is take the land and move into healing relationships at a neighborhood scale, and it’s excruciatingly hard for hospitals to understand how to do that. I believe that those of us in religious organizations are responsible for burning the prophetic fire so we cannot be limited by what hospitals have done in the past and really find our way. Even against the financial self-interest of our own institutions to really achieve the promise of what the medical field calls population medicine, what public health has always stood for. The religious communities are the ones with the moral energy to hold us accountable to what is possible.

Winslow: If we are open to the adventure of the faith-health movement, I think that we’ll be surprised at some of the great things that can happen in the next short period as we have many conversations about how to take this to the next level. I hope to be a part of that adventure.

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