Wednesday, December 21, 2011
Sunday, December 18, 2011
Sunday, December 11, 2011
Thursday, November 24, 2011
The paper arrived this morning with some news and three pounds of marketing to warning of the spending frenzy anticipated to start at midnight. A brief pause of thankfulness and then a mud wallow of desire. Yikes!
Gratefulness is the way, not just an emotional response to what happens along the way. Gratitude precedes, enables, nurtures and finally, completes, life. Thanks is not just a spirit that follows the harvest. It is also the critical insight on which all creative and useful work rests. This is the intelligence underneath the work of "religious health assets" and its hopeful labor of systematically accounting for what we have to work with to build community and nurture health (www.arhap.uct.ac.za). Steve DeGruchy liked to say that "you can't build a community out of what you don't have." So the very first act of leadership is to notice what we do have, what already is, and what it might be good for. The work of noticing is what I've come to call the "discipline of abundance."
We literally have to pay ... attention; invest our attentiveness on what we have. This suggests we don't get gratitude automatically like a burp after a big meal. This is especially true when we wake up to pounds of marketing honing the edge of unfulfilled desire for things we didn't know we didn't have. We have to take some of our attention span and consciously direct it away from what is missing toward what is not missing, toward what we are thankful for; toward what we are not afraid of, toward what we are confident of.
The plane was landing in Memphis about 25 hours after I left Tel Aviv last Friday. More than a bit dazed from all the miles, I glanced west out of the window and ... noticed. The sky was painted as if God was trying to imitate a Larry Pray watercolor (www.larrypray.com). I fumbled for my iPhone and snapped the picture, which is below unedited. I don't know how long God worked on that sky, but I'm glad I attended to it.
We have a lot, once you pause even a tiny bit of time to notice. The vast majority of what we have, we did not and could not pay for: the miracles of breathable air, living soil, light, color, food, consciousness, intimacy, clear-eyed friends and work worth doing. A riot of abundance. Plenty.
Monday, November 14, 2011
Nobody who does not live in Eastern Jerusalem should tell anyone who does anything at all. I have no idea what it would be like to try to raise children or care for a mother here. I am pretty sure that access to healthcare would be among my least worries; falling way behind worrying about my kids or mom getting shot, insulted or run over by a tourist bus on the way to get milk. But if you did need healthcare, you'd have to worry fast and deep, leaving plenty of time to negotiate the check-points and aforementioned tourist busses (and hope your physician did, too).
This is the home of every pathological and transcendent impulse that ever crossed the mind and spirit of a human being. Our hotel, on the Mount of Olives, is surrounded by graves for a half mile in every direction, interspersed with a monument or church marking something or another that happened one, two or three millennia ago that causes people to think of genocide today.
Of course, any disease condition linked to stress, poverty, inadequate housing, food, preventive screening is epidemic. More people surely die from unmanaged diabetes than gunfire; way more from undiagnosed cancer, too. But the problem is not the science and not even presence of clinical facilities and skilled, committed providers. It is hard enough to run a health care organization in troubled Memphis so I pause in wonder watching nurses, doctors and administrators showing up at work here and doing their best to care for those who need them. Showing up for work and giving one's competence to others is a mundane miracle that is far more wondrous to me than all the monuments put together (and here that is really saying something).
Jesus was killed for showing little respect for the extrinsic formalities of his religious traditions and the self perpetuating trappings of power that tradition had prostituted itself to defend. He attacked with sarcasm, disrespect, simple stories that cut through the deadly pomp like razors. He was deeply, transcendently maladjusted to the world we want to merely tweak and improve. He flipped over the tables of those that make money selling religious distractions amid injustice that mocks God's generous, creative shalom. He'd be dead again today for the same reasons.
Find somebody you disagree with today and ask them something about their life. Anything, really; but best to ask about their kids and what they hope for them. Ask what they are proud of; what they hope their children see in them; why they show up at work and give themselves to their labor. But, really, just ask anything at all. Don't explain anything about yourself at all, unless they ask. Your head is not the point. Ask.
You'll be laying down one thin thread of hope that God might weave with.
Saturday, November 12, 2011
Prayers begin early in this part of the world, long before the sun makes it over the horizon. In the early light you can see it all, hillsides of ancient graves next to walls built over millennia to protect this or that ruling clique from another aspiring one, both indistinguishable in the dust of time. And in the background construction cranes ready for another day. And, of course, religious symbols vast and tiny mark every corner the eye could find.
One stream of Jewish tradition says that every year God has to choose to continue to create the world again. It is amazing that God continues to do so given how quarrelsome and unappreciative we humans are on most days. But God does keep on choosing to create and by doing so invites us to create, too.
The group of hospitals gathering today tend to think of ourselves as old institutions. We have lots of pictures on our walls of old medical technology and nurses dressed up in garb we now think of as quaint. We feel modern and wonder that we have endured 120 years or so. That's longer than most of the tools of public health, although one could quibble that prevention preceded healing by millennia. It is a quibble among us moderns. Meanwhile, the dusty stones of these hills testifies that medicine, hospitals and most of our religious forms are very young. Most of the graves between the hotel and the Mosque and Temple across the history drenched ravine were filled without any medical professionals including executives making any difference at all.
For the vast portion of the journey of our religious tribes, the story has not had--or needed--us. Faith-based hospitals are a very recent fruit of God's imagination at work in the world. This should give us a bit of humility, but perhaps even more usefully, a certain lightness in our deliberations. We are young and perhaps the world and God are just figuring out what we might be good for. Maybe the future does not depend on our laborious efforts at innovation at all. Maybe we are at more basic level where we need raw imagination, focusing on opening ourselves to be vessels, conduits, receivers and amplifiers--social media through which God's imagination can work now and work next.
Perhaps we can hold ourselves, and especially our brief pasts, more lightly, with less anxiety and grasping. We can be, dare we say, somewhat playful, look at ourselves and our work with a beginners mind, a child like sense of wonder that we are here at all.
Process Theology (with capitals!) says that God stand with us at the boundary between now and the not yet, continually choosing the world from among many possibilities. We humans participate partly by choosing to giving privilege to some of those possibilities by our language, presence, attentiveness and of course where we put our money and time. And we also give privilege by what we hope and fear, what company we keep, who we listen to and what we count. The future is wild and ragged and uncertain; but it doesn't just happen to us. We participate in choosing it.
Bill Foege, who has taught me so much by reversing so many obvious sayings called the question on one of the most common to scientists: where the simple mind says "I'll believe it when I see it", the creative mind of both science or faith notices that you can's see something until you believe it is possible to be seen. Tentative believe opens eyes to possibility which can guide creaitive research, risk-taking initiative--innovation.
I was pondering all the stones and wondering how many layers of other civilizations' stones lay beneath the ones I could see. I noticed a few feet away a young Muslim couple trying to balance their camera on one of the stones, setting the timer so they could both be in the picture. I dropped my weighty deliberations and offered to help, which they accepted with the same snapshot smiles I've shown in front of hundreds of tourist sites. I clicked and then we all stared into the little LCD on the back of the camera and declared it good.
Maybe that's the point; to look around and notice who else is looking at the same past, present and future and help each other get it in focus.
Friday, November 11, 2011
I am writing this in the Atlanta airport, moving toward Jerusalem to gather with others from faith based healthcare organizations (http://www.faithbasedhealthcare.net/ejc2011/).
This makes me think of our work in Memphis in a global lens, which brings different things into focus. When we think locally, we're feeling pretty good these days, breaking ground on new hospital, coming into partnership with the premier cancer group (The West Clinic), going to the White House and being named by US News as the #1 system in the region. Cool.
But when we see ourselves in global context, it is clear that we’ve been decent, with the low but still respectable expectations of the #2 system in a small, poor city. Now we are #1 in a small poor city and have begun to move to good to very good, where we can see (on our best days) how we might be great. And not just great inside the walls, but great for the city and region that is defined by terrible health. "Great" in Memphis demands that we understand and implement intelligence about the drivers of population health, not just clinical treatment. We have begun to show faith—that we can get there. But we are also intently aware of the treacherous, fluid, uncertain political, policy, economic and competitive environment.
How do you continue to move boldly toward great in such a time. Shouldn’t we be okay with decent, print brochures about "great" and wait for better weather?
In this context I read Jim Collins new book, Great By Choice, which examines companies that far exceed their peers even when operating in radically turbulent settings—like ours. It is, I think, his best book filled with surprises, mainly that the lessons of his earlier books that have been so key to informing how this management team thinks, still hold: you still need hedgehogs and level 5 leaders, BHAGs, flywheels and such. But you also need, surprisingly SMaC: systematic, methodical and consistent: durable operating methods.
Now I’ll tell you that is not good news to me personally. I love the new, bold, innovative, frame-breaking, game changing---and so on. But greatness, Collins counsels, lies as much in knowing what not to change, as in changing—especially in radically uncertain times. Of course values and mission persist, but the greatest (Southwest), also hold steady in their SMAC, changing them slowly over time compared to their more nimble, but less great, peers.
The point of all this, is that we can choose our greatness, but have to choose it every day down in the little things that only matter when they are done pretty much every time over years. All this comes at a time when the Congregational Health Network is getting a lot of attention as if it was already great. It is something of a prodigy, growing to nearly 400 congregations in under 4 years, winning enormous trust from pastors and, even more remarkable, women of the church who have a pretty cold-blooded eye for whether something actually matters or not to people they love. Well over 1,200 people have completed at least one seven week class so far, mostly women.
So I'm wondering what our SMac is; what we will look back on in 20 years and claim greatness. It will probably be in things that I am personally not great at, even a little bit: making sure that every single CHN members who has been discharged from the hospital gets a phone call every day until they are well enough to call somebody else. We'll probably have been fanatic about ignoring the lines between physical, mental, social and spiritual health, relentlessly checking on all four facets of those who show vulnerability in any of them. These are the mundane revolutions going on in the lives of people blending what the hospital knows about disease and congregational caregivers know about life. We have begun to blend those intelligences, but not yet made the disciplines explicit enough that we make sure we do them over and over and over.
As I move to Jerusalem I'm going to be looking for those little things done well in India, Kenya, Germany, Taiwan and Norway. Do you know anything great like that in your neighborhood?
Monday, November 7, 2011
A week from now a group of hospital and faith people will gather on the Mount of Olives in East Jerusalem to begin an intense dialogue about the future of faith based healthcare organizations. This is a conversation that has been going on since the end of World War Two when church groups in Europe and the US had to figure out what to do with the mission hospitals they had accumulated during the time in which evangelism and colonial expansion were the same thing. The best guess is that we actually have more faith-linked hospitals today than 60 years ago and many of them have grown to extraordinary scale, complexity and technical sophistication. I'm thinking of the Christian Medical College in Vellore, but I work in a pretty obvious one in Memphis, too. In a world of extraordinary demands for compassion and justice, should faith groups keep such huge resources committed to hospitals? If we should keep them, in what way are they distinctive--faithful--enough to claim them as leaven in the social loaf?
For the next couple weeks I'll be blogging regularly about this event for two reasons. First, it is pretty historic (THAT Mount of Olives!). And, more personally, I need your help because I am giving the closing keynote....on innovation. Giving a speech on innovation on a hill marinated in history is a curious task all by itself. There is so much past in the present that there would hardly seem to be any room for the future. However, there is no lack of novelty and change today at any scale in any town in any country. The whole world and all its certainties seems fluid and turbulent. Many of those changes happen to us, not because they are chosen by us. How do we choose our innovations, focus our creativity on relationships that matter most; that are most distinctively reflective of our faith?
So I need some help from you thinking with me about how we choose the world--that's what we do when participate in creative work. I'll be posting fragments of the speech I'm thinking about and will hope you will help it become better, more useful, more innovative. In effect, you'll be helping give it (and if you do, I'll acknowledge you on the "credits" slide in what will inevitably be a powerpoint).
This reflects my first and most basic hunch, which is that innovation emerges from within relationships. The more unlikely, diverse and scattered the relationships, the more likely the innovation. This has certainly been my personal experience, notably with the religious health assets work and the wildly generative stew of Memphis. The social media that links us at this moment in which your eyes are playing over my words brings our minds within range of each other. We can create. Or not. We can tease novelty out of the present. Nathan Wolfe is a virologist who has risen to such fame as to have gotten on the Colbert Report this week (which is nothing compared to being my daughter's fiancé, but still a big deal) says that we humans can learn from viruses about how they create novelty that allows them to adapt, change and thrive. Viruses are generous with their very essence; where two or more gather, there will soon be a new virus blended from the essence of the the others. They are social innovators.
So, too, are religious movements, especially those that consciously open themselves to the essence of others' pain, suffering, hope and highest aspiration--such as institutions of health and healing that live in troubled parts of the the world like East Jerusalem and Memphis.
So, will you help us as we begin to move toward Jerusalem? I'd love a story about how you found a new way forward through an unlikely relationship with a colleague, friend or patient. How did this novelty turn into an innovation that changed your work in some way? (If you've got a picture to help the story, extra points!).
Thanks, in advance, for a bit of your essence.
Monday, October 31, 2011
Sunday, October 16, 2011
Since meeting him at Wake Forest two weeks ago, Fred Bahnson and I have been exploring different ways of thinking about how things spread, or get big enough to matter to communities. The question is critical to our work in Memphis because Methodist LeBonheur Healthcare is big: it is the regional referral hospital for a couple hours around, especially for children (LeBonheur is the only level 1 trauma hospital for hundreds of miles).
We want our congregational networks to be of the same scale as the clinical systems. We are not far from our initial goal of 400 congregations and now think the network will rise toward and perhaps past 500. A referral network is held together by guilds, protocols, legal obligations and vast amounts of money. Our young network of congregations is held together by trust, respect and shared compassion for people we think of as "patients" and the congregations think of as "members" or "neighbors."
Should we think of our web of congregations sort of like gardens? Here's where Fred has some insight:
"Scaling a community garden should be horizontal (connecting to other gardens) rather than vertical (getting bigger). I think too often when people look at a community garden or other highly-localized effort at agricultural shalom they say, 'that's great, but will it scale'? In other words, the garden is a quaint thing for a neighborhood, but you can't really feed people with it. Sometimes when people ask if it will scale, they are really asking "can we make it really huge"....which leads to the Wal-martization of life that people like you and I abhor.
"I am intrigued by how your emphasis on how your whole system in Memphis seems to hang on face-to-face relationships. Until learning about your project I didn't know that was possible on a city-wide scale. So my sense of scale has been expanded. But my hunch is that you're near your limit. Once you've included every willing congregation within the area of Memphis, you've hit the walls of scale and to go further would not only compromise the fragility of the network you've built, it would change its very nature.
"When we talk about how to scale community gardens, I think we need to recognize that the scale must have that human face-to-face connection you've demonstrated so well in Memphis, and get no bigger than the connectional ability of its members. But it also needs to take in the very real ecological limitations of scale which modern agriculture simply ignores. E.F. Schumaker's book comes to mind here. Small is beautiful, and ecologically it can also be much more productive than Big.
"A diverse garden is far more productive than a monocrop, and I've had the opportunity to see these all over (Cuba, Quintana Roo, Bolivia, California, Anathoth, my front yard...). Until recently, we Americans have had so much land that we haven't really had to think very hard about how to make a small piece of land highly productive. That's the new agricultural frontier. Currently, using conventional farming methods, it takes 1.2 acres to feed one person on a U.S. diet per year. That same acre can feed a) one cow for a year, b) fill up your gas tank exactly twice, or, c) with biointensive organic practices that same acre can feed 10 people for a year.
"So I guess what I'm getting at here is that we need to change what we mean when we talk about scale. Rather than think about scale as an expansion in size and space, we need to think about scale in terms of stacking and layering and creating densities of interaction. Which seems to be very much what you're doing in Memphis (at the big end of the Small is Beautiful spectrum) and what we did at Anathoth (at the small end)."
I'm a city boy and never seen anyone actually feed themselves with a garden plot, but smart people like Heather Wood Ion assure me it did and still does happen. It is hard for others who have never experienced the care of a congregation to take that seriously, too. But it did and does happen. We don't know exactly how to scale either gardens or congregations, but we are learning. With congregations there are two issues: connecting enough of them to make a difference (400, or 20% of them) AND build their capacity and competence (train, train, train, train) so they are truly useful and not just symbols. We want the bio and spiritually intensive type of generative relationships, sort of like one of Fred's intensive gardens.
(For more of Fred's intelligence find him at www.fredbahnson.com)
- Posted on the journey
Monday, October 3, 2011
Commissioner Henri Brook and Rev. Dr. Chris Bounds are standing in a garden on nine acres of former cotton fields about a half mile from my house. I'd ridden within a hundred feet of it on my bike dozens of times and never noticed. I have no idea what kind of corn grows that high, but it is probably laughing at me along with Henri and Chris as they remind me how dumb I thought community gardens were only a few months ago. The Commissioner knew that Shelby County has more than 3,000 vacant lots; why not turn them into gardens? This one had already taken root in the the swarm of hopeful things happening in Binghamton. This garden was started by Peter Schutt (publisher of the Memphis Daily News) and Jim Townsend (former heating and air-conditioning executive) which is how they tend to happen. Each one is highly particular and even unlikely, but that is the pattern: unlikely people doing what seems (in retrospect) obvious: turn vacant land into a garden. And the pattern is that it never quite stops with the tomatoes: Peter and Jim started a farmers' market, too.
This is happening all over the place. I was speaking at Wake Forest friday and there it was again. Fred Bahnson (foodandcommunityfellows.org) writes like a well-tended garden and argues that food and gardens matter so much that the salvation of the planet may depend on them. Go back and find his rich piece in the July 2007 issue of Orion magazine. You'll come into the world of Jeremiah's Anathoth gardens reborn 2,600 years later just down the road from a killing outside Raleigh, North Carolina. Five acres given by a black mother to a white church provoked an outpouring of saving grace (and okra, potatoes, squash and, curiously, garlic scapes). Something like this is probably happening near you. Look around.
Are gardens a symbol of hope, or the first fruits of a renewed food system? The same question pertains to the many small scale faith-health initiatives such as parish nursing or volunteer caregiving. The Congregational Health Network is, as far as I know, the largest scale connectional strategy in the world, with 376 covenanted congregations (so far). But this year we will only see 3,000 of the the 65,000 inpatients at our hospitals. That is like a hundred community gardens compared to Kroger. So are we sending a message to the System or actually changing it? As for me, I find even the most clever symbols bitter fruit unless they give me hope for scale. To talk of change, we must have ideas that can function at the scale of the current system and a logic for getting from now to then. Mennonites have chosen radical integrity for centuries, refusing to take part in the war industry even though they know they will probably always be a minority voice. Is that what gardens--and health ministries--are?
The language of the Wake Forest event is like most other similar events, that assumes that building the new system to scale requires force of will, borrowed money and enormous efforts. Even the scale achieved in Memphis seems unlikely given that logic. When pushed to explain what efforts it took to align our hundreds of congregations I explained, "it wanted to happen; we aren't driving, but accommodating to the new system emerging through and around us." Shalom wants to happen; but it needs humans to work with it.
Forests find their way to scale when people stop chopping. They want to happen, so they once covered the continent and probably will again. I understand that the percentage of New England under forest is about what it was when the Pilgrims landed. Thousands of small farms turned into forests when everyone was busy doing something else. I'm sure we'd have 3,000 micro-forests in Shelby County if we stopped mowing, too.
Gardens are different than forests because of their complex organic dance between humans, soil, water and seeds. But that dance wants to happen, too. It is hard to hear the music and get everything out of the way, but things that want to happen tend to happen eventually. Scale in human systems--food or health--happen when the desire for life flows into and through systems that are built for life. People are born to plant, tend, harvest and savor. And people are born to care and be cared for. Make it possible and it will scale.
The picture looks like one of John Shorb's silhouettes he is becoming famous for. This particular willow had dropped all its leaves but the one down in the far left hand corner. Is it hanging there as the last leaf of the season or maybe the first to get a jump on Spring? I do know it is not sending a symbol; it is busy turning sun and water into life as long as it can.
I'm never sure which season I am working in either. How do we know such a thing? We are on the side of what is still growing, still wanting to happen. That is quite enough for me.
- Posted on the journey
Saturday, September 24, 2011
Dr. Jeffery Brenner, of "hotspotters" fame lights up the room at The White House meeting Tuesday with laser-sharp data about the illogical waste in the health system of Camden New Jersey (and pretty much everywhere). Katherine Gottlieb of the South Central Foundation (Nuka) in Alaska had just finished laying out that stunning model. Bobby Baker and Teresa Cutts opened the hopeful trifecta explaining the "Methodist Memphis Model of hundreds of community partners."
At least 100 people--more than 20 of which were CEO's of major health systems--crowded the room. I'll post links to the extraordinary power points and summaries of the meeting when they are ready.
I had the privilege of giving opening comments in place of Gary Shorb, Methodist Healthcare CEO, whose mother had emergency surgery. Here are my comments:
We come to this White House aware of our many roles: we are citizens, believers, administrators, healers, sons of mothers, sisters, neighbors and, yes, even policy wonks. We will speak out of that complexity in different ways as together we try to catch a vision of what is practically possible and how we can help each other make the possible come quickly.
Why are we here? This is a mean and bitter time in public places; the poor and the sick resented by the powerful for making inconvenient claims of mercy. So it is curious that this Tuesday morning this small group of faith and community based hospitals meet with government partners at the White House to do some opportunity solving. The focus is on how to weave the extraordinary 21st century technologies with the tenacious capacities of the love-based, justice-seeking institutions still accountable to faith or community.
This is no time for happy talk, as health organizations and government face uncertainties too numerous to list. We usually forget that the most disruptive uncertainties are good news, not bad, including the most obvious; successful policies and partnerships have resulted in most of us living inconveniently long.
Technologies today let physicians see blockages in arteries in real time 3-D allowing robotic surgeries quite recently unimaginable. Every specialty rides a wave of technical innovation that propels it almost faster than can be described. The disruption comes because the technologies that change the possibilities also change the relationships between specialized roles rooted in the previous technologies, back when nothing was digital, everything on film or paper. This kind of positive disruption dominates the attention of Washington because it changes who gets paid by whom.
Let's be clear what we are not doing: we are not pleading for our burden to be less; we want to be accountable for the effectiveness of our close working partnership with government so that together we bear the fruit we are intended to bear in health (Rev Dr Don Stiger of Brooklyn Lutheran not pleading...).
In Memphis, Methodist LeBonheur Healthcare reports $156 million dollars of "community benefit" including $104 million of the actual cost of charity care and another $21 million of cost for patients only partly covered by government. A similar amount goes to pay for training health professionals in partnership with publicly funded Universities in Memphis. We do not wish the amount to be less; we want it to be more effective.
All of the hospitals here today far exceed the level required by government. We are not trying to get around the system, we want to know how to form more powerful alignment between public, private and faith driven partners to generate more health.
Most of us are committed to do this in very tough communities, each of which we think is tougher than anyone else's. Memphis is a vortex of snarly, intractable challenges of race, class and ill health. But it is not any tougher than Jacksonville, Alaska, East LA or Brooklyn. And, truth be told, we love Memphis; we are here on purpose; and we want it healthier. Just as you do your community. So we are not here to complain; we want to learn with other partners who can help us be the institutions our communities need.
The most profoundly positive disruption of all may be the new relationship possible between hospitals and neighborhoods, especially illuminated by the bright light of 21st century science. Most diagnoses are no longer death sentences; not even AIDS, cancer or CHF. We live with conditions that would have killed us only recently, but we live in greater dependence on a web of partners. We obviously still need healthcare: insurance, pharmaceuticals, physician, other providers and, from time to time, hospitals. But now the journey of life includes family, congregation, social services and a host of wellness-enhancing helpers including community health workers. These are brains on the ground, not just boots on the ground. Our communities are filled with answers and assets, which we can work with, if we become teachable by those we previously only saw as liabilities and needs.
In a time filled with swagger and spit, venom and vanity you will find this room filled with the cool breeze of humility and the refreshing tone of adults trying to act like adults (two of them, Joshua Dubois of the White House and Fred Smith of Wesley Seminary pictured). The result is not predesigned to be revealed at the end of the meeting. Nothing will happen today that we ourselves do not create. It will come out of our conversation with each other about how we could be together to help us do the right thing in our own community, informed transparently by others trying to do similar work. That would help us in Memphis, so we hope for some ongoing relationship, especially in the practical spirit embodied in the Partnership office's work.
The quality of teachableness is what links three innovative health models held up like a lens: the way that Nuka in Alaska has built a highly efficient, broadly comprehensive system by listening with unfeigned respect to their native American members receiving their services; the radically useful intelligence Dr. Jeff Brenner discovered by following his most expensive patients home to the apartment buildings where they taught him the reality of their lives; the 376 covenant congregations of Memphis who are shifting outcomes data the hospital previously found inscrutable and intractable. These are disruptive models that decenter the hospital and drag the accountants outside the lines of their spreadsheets.
In a cynical time of diminished expectations from nearly everybody, hope simmers and bubbles as we ask, "How do we bring these disruptions to full bloom?" Innovation. Community scale. Faithful. Bold. Today.
- Posted on the journey
Monday, September 19, 2011
Most weeks going to the White House for an all day meeting would be pretty much the biggest part of the week. This week it is at least arguable that being part of a plenary panel for 1,500 wonks 10 miles North of 1600 Pennsylvania Avenue may be more significant. The panel kicks off the annual meeting of the Agency for Healthcare Research and Quality, a federal unit which sets much of the agenda about what and how the government measures what matters in health organizations. This year the focus is on how innovation and collaboration in healthcare can change disparities, access and quality of care.(ahrq.capconcorp/ahrq)
Not very long ago Memphis would be the negative case study because we get all three of those wrong so often. In recent years our quality inside the walls has gotten pretty respectable. But our patients don't live inside our walls; they live outside most of the time. And when they step one foot onto the sidewalk they can be back, not ten or fifteen, but 150 years, when race and class created vast differences in life expectancy and unnecessary suffering. Unraveling the mystery of why could take the full-time career of all 1,500 of my fellow-wonks.
Hospitals were rarely equitable in their healing effect on the community, since they were largely created out of the power and largess of the dominant political and philanthropic culture, which in Memphis was largely white. Employment, privileges to practice and basic access where unequal, even among the faith-based hospitals like Methodist Healthcare. We have worked very, very hard to reverse that history, but it does not help to deny it. (The picture is of Nelson Mandela's sleeping mat in his cell on Roben Island.)
The hope of healthcare is to for the powerful instituions to become teachable, not just by battalions of wonks and researchers, but by the mothers, brothers and neighbors who know the other part of what we need to understand about life in our tough city. They may not know the detailed etiology of diabetes, but they know about the lives in which that disease must be lived. The most powerful gain from our covenant with 376 congregations is to bring the hospital into an appropriate relationship where we can be taught and guided by them. Not all are "minority" (should be called majority in Memphis). But the blend of cultures and class is rich in wisdom and practical tactical insight. We all become teachable so that the blend of intelligence comes alive.
Not many data wonks will thrill at the previous paragraph. What measures and metrics? Gathered with what assurance of objective credibility? Translated exactly how across the different cultures? With what clinical processes administered by what credentialed individuals taught by who? Albert Einstein said that " if we knew what we were doing, we wouldn't call it research." I'm with Albert on this. But all the research questions must be pursued and answered and tested. That is how these organizations move, change and, eventually, change the bitter history into something that looks more like what God had in mind.
- Posted on the journey
Sunday, September 18, 2011
The US News and World Report recognized our little hospital system in Memphis as the best in the region for the second year in a row, a fact which makes us very proud. The list of specialties in which we excel runs down the side of our largest hospital for four stories, as you can see. But if you look closely, "improving the health of the community" is not on the list. And it would not be on the list of any of the other hospitals the magazine honors. It is simply not something that anyone expects a hospital to be good at, much less excellent. But back a hundred years ago when our (and most every other) faith-based hospital was founded it was assumed that a great hospital would in fact, inevitably lead to a healthier community. It turns out to be harder than that.
The idea was that government would take care of public health prevention and surveillance (watch the movie Contagion, if you are wondering whether you need that....). And faith and non-profit agencies would get tax breaks to provide charity care. Nobody imagined it was possible to make a profit running a hospital and even it it was possible, it was a bad idea to try. Until this past year it was childishly easy to pretty much make up numbers proving that the tax waiver was justified, so gradually there emerged a whole category of hospitals that should be called Not-Not-For-Profits but Senator Grassly largely closed that loophole. Last month the State of Illinois, not known for its virtuous government, took away the tax break for a number of hospitals that were simply beyond the pale.
But nobody quite knows what to ask of the hospitals in terms of their role in generating the health of the community. The hospitals don't really know what to ask of themselves beyond taking care of a lot of people who can't pay. Should they also be expected to be a creative partner in advancing community health? How exactly would they do that and how would anyone know if they were good at it?
On Tuesday The White House and Department of Health and Human Services will convene a small group of health organizations to explore how communities are crafting partnership and programs that work for the good of the whole. The meeting is organized by Mara Vanderslice, Director of the federal Center for Faith Based and Community Initiatives (hhs.gov/partnerships/). The Center has a long bipartisan history, officially created by President W Bush and tweaked under President Obama. But the faith-government partnership has been gathering steam since Carter, Bush 1.0 and Clinton. Once could argue it has been in and out of fashion for 250 years, an acknowledged part of how America works since de Tocqueville wrote in 1835 (pictured).
The current meeting has blended DNA, part of which traces to the Interfaith Health Program at Emory (ihpnet.org) and its long work with the Centers for Disease Control and Prevention. They jointly hosted a meeting at The Carter Center on the role of the "strong partners" years ago. It was curious about the role that faith-based hospitals (and the foundations that were sometimes created when they were sold) could more systematically contribute to the health of the public--not just their patients. That was the first time the phrase "religious health assets" was coined. And the meeting noted that "If you follow good science to the root causes of disease and injury, you will find more than a long list of individuals awaiting admission: you will find yourself struggling in a community with social incoherence." ("Playing to Our Strengths," Carter Center 1995)
The idea of religious health assets was later elaborated and deepened by the scholars of southern Africa, especially the late Steve DeGruchy (pictured) and Jim Cochrane, then the World Health Organization, especially Canon Ted Karpf and then hundreds of others, even in Memphis.
The other streams of DNA of the current discussions trace through the many particular histories of the hospital systems and the different way that science, faith and human communities combine and morph along their journey. Neither personal or organizational DNA is destiny, however. Genes are triggered by environment and in this case leadership, community and family. Sometimes a gene can be recessive for generations and then find its time has come. I think that's what happening Tuesday. The small set of hospitals coming to the White House Tuesday have in common the fact that are not afraid of the flux and tumult of our time, they are expressing their deep DNA. They are strong and while challenged, led by people who want their systems to fulfill the promise their founders--and their governmental partners--intended.
To do that the hospitals will need to learn from each other and government experts, as both also learn from the communities about what works and what is possible. That won't all happen in six hours, even at the White House. But in this mean and bitter time in Washington, it signals that it is a bit too early to give up hope that we can be the people our communities need us to be.
- Posted on the journey
Saturday, September 17, 2011
On Tuesday morning about 20 health organizations, mostly large hospitals like Methodist Healthcare, will meet at The White House for a day of opportunity solving. We will not be coming to complain that we are facing harder challenges than any generation since humans figured out how to walk on two feet. It is a group of grown-ups trying to do what grown-ups are supposed to do--work together in the interest of those that depend on us to do the right thing.
These are tough times in more ways than can be listed in a blog. Government and health organizations facing radical changes driven by technology and global interconnectedness that has bound us together in ways we don't even know how to manage. We are swimming--almost drowning--in more information that we we can make any sense of. That's the new normal. But this is not entirely new, which is why I began with the picture of one of the bronze carvings on the front door of Grace Cathedral in San Francisco.
It is also still normal that adults try to make decisions to work with what we have to give hope a chance. When you fill up a room of 15 or 20 faith and community-based healthcare organizations and federal experts, you have a LOT to work with. Even one of the more modest systems--our own in Memphis--has 10,000 employees providing care to 64,000 inpatients and another quarter million outpatients every year. About 8% of our total revenue covers those who pay nothing, with another 2% only partly covered by the government and we still give another 2% to our University partners to train medical professionals. We absorb that $156 million and still have an A+ bond rating. It is quite a feat of skilled--faithful--management, but we and others like us do that. It is not a small point to note that these faith-based institutions accomplish this in very tight relationship to the federal, state, county and local governments beginning with the very large portion of our payments that come from Medicare or Medicaid, not mention the grace in not having to pay taxes. That's what we were designed by an earlier generation of grown ups to do and it works pretty well.
We are meeting at the White House because we think it could work even better.
Warren Buffet knows you make you most profitable investments when the market is paralyzed by fear. The most significant social investments are also made in times when things seem to be falling apart. You can make different connections and alignments precisely because the pieces are apart. When the ground shifts, new things are possible.
The picture is of the rock bent into gorgeous new shapes just north of San Francisco, which sits above the fault line. The earthquake shaking health organizations these days is the fundamental shift in science that has shaken our wall to the point they are almost irrelevant. The wall has collapsed between the old idea of public health (prevention, surveillance) and healthCARE (treatment, disease management). We all tend to live inconveniently and expensively long, precisely because of earlier success in both public health and the treatment organizations (hospitals).
Our common challenges are conditions we can live with over time, sometimes shockingly long periods of time even with AIDS, diabetes and many cancers that only recently were death sentences only demanding lament (hence the picture of the poignant AIDS Interfaith Chapel inside Grace Cathedral).
These high-capacity organizations built in one paradigm now have to re-organize ourselves around these new opportunities to extend the promise of 21st century science to our communities. That's really what is happening on Tuesday; not pleading, but planning how to be together in a new way so that all the assets are aligned to serve what is now possible.
That sounds so naive, doesn't it? But it is the cold truth that many billions of dollars of health assets will be in the room that are owned by and accountable to faith or community. Their adult leaders are paid pretty well to make sure those assets provide a maximum return on the investment measure in the health of the communities that have trusted them with such extraordinary possibilities.
From time to time it is still normal for adults to do the right thing. The United Nations was formed in the aftermath of the catastrophic events of World War Two, partly as a result of fervent prayers offered up and still remembered in Grace Cathedral (marked by this wall just inside the front door). Adults to that kind of thing. And they still can.
Tuesday's work is far less ambitious for we already have all the institutions we need. We just have see new ways to learn from each other and work with each other. We don't have to invent water, just rearrange the plumbing so that health--and maybe a bit of justice--can flow down as it is intended to do.
- Posted on the journey
Thursday, September 8, 2011
Beneath hot blue sky,
baked green canvas,
shimmering air and
on polished copper
held above the open grave
by dull grey metal and webbing
they knelt by mounded dirt.
Jeff, then Sally,
then John, Lauren
let the grey dust of Melinda
through their fingers
into the light
under the tent
(as it sometimes does
through clouds after
a Delta storm).
Melinda drifted in
the last emptiness
between Jean and
The grave breathed in.
And then, as gentle as a
memory of a smile
Free as steam rising
from coffee on a cold day
lifted as dry promise
into the beam
a last and only time
over and around the family
before the preacher said a word.
- Posted on the journey
Saturday, August 27, 2011
Two gatherings in two days, both shaped by prayer. The top 500 or so leaders of Methodist LeBonheur Healthcare meet every quarter to look at mission-critical information. On Wednesday our time was built around Jim Conway, the remarkable long term leader of Dana Farber Cancer Institute in Boston (which I'll blog about another day). We always open with a invocation sometimes by me and more frequently by one of the chaplains in our division. Many think of the invocation sort of like the flashing lights telling you the real meeting is about to happen. This time the prayer flashed and illuminated the whole place as Rev. Steve Miller seized the full authority of his ordination which is multiplied by many years of integrity and prayed:
O Lord our God, how majestic is your name in all the earth!
As we gather this morning, we do so asking You to remind us of the calling and purpose You have placed upon our lives.
So remind us once again that there is no “Good to Great”, without a moral foundation, that we have no future direction, without a current guiding principle. Remind us that the “Power Of One” lives and resonates within each of us.
Remind us that our work is not only the care for the broken and diseased body, but to soothe the chaotic and fearful soul, and quiet the disrupted spirit anticipating a surgery or procedure.
Help us to genuinely care for Your people. Grant us the empathy to walk with them, hand in hand, and navigate this institution we call Methodist LeBonheur Healthcare.
Remind us that with all of our advances in medical technology, pharmacology, surgical procedures, state of the art equipment, our bedside nursing and even our status as a teaching hospital, that we will never achieve our fullest potential to heal, our greatest medical outcomes, or outstanding patient satisfaction, without compassionate care to our patients, families, and onto each other.
Lest we forget, remind us that when the patient is sick, the whole family is sick, remind us that we are the visitors in their lives, that’s why we wear the name badges, they already know one another. We are strangers giving them diagnosis they don’t understand, prescriptions, they can’t pronounce, and sometimes prognosis they can’t comprehend. We are the visitors, not them.
So change us Lord. Change our perceptions, and remind us that one day disease can overtake our bodies, that we will age and be in need of care, that we will be the patients, the one waiting with baited breath for a word from our physician, we will be the one waiting for a nurse to bring medicationfor our pain, we will be the one waiting for results from our x-ray and labs, We will be the one praying for transparency and honesty from staff, so that we can make difficult decisions for ourselves and members of our family.
Change us because we might find ourselves in an institution where our status as a healthcare worker won’t provide us any special professional privilege, our knowledge of medicine and the human body won’t entitle us to any special treatment, our hospital ID won’t grant us any special access. Change us we pray.
Now help us Lord to always do the right thing, no matter what the cost. Live out our lives individually and collectively without regret, having treated every patient, every family member, every visitor, and every co-worker the way we want to be treated with dignity and respect, with neighborly compassion and care, for we are but the servants of the Most High God. Amen.
When he finished the room had been reduced to stunned silence knowing that something holy had happened to us all.
Later the next evening, a couple dozen gathered in the Innovation Studio of the Center of Excellence to talk, pray and break the Ramadan fast at the invitation of me and Dr. Alim Khandekar, one of our long time surgeons. He and the other Muslim physicians has last eaten about 5am, worked all day, broken for prayers, then joined us to talk about how spirituality guides their healing work. One of them did the call to prayer about 8pm and we ate. And we did talk intensely about our various pathways that have brought us into healing work, how it shaped our presence with those who are ill and dying. We talked about how the Muslim physician from Pakistan has learned how to pray with the Memphis protestant at the most sacred moment in their journey. And we talked about how we can come alongside each other on the next steps of our walk of faith and healing.
Prayer. What a mystery it is that we are made to imagine that short-lived, shorter tempered humans can find our way to the boundary of the holy and speak appropriately, even, dare I say it, usefully? It is as unlikely as finding a planet made of diamond. That also happened on Thursday, the third most astonishing thing of the two days. (http://www.washingtonpost.com/blogs/blogpost/post/diamond-planet-discovered-by-astronomers/2011/08/26/gIQAAXIRgJ_blog.html)
Apparently God can make pretty much anything God choses to imagine. So
what if all of us prayed for all of us? We would never know which prayers worked. And perhaps they all would.
- Posted on the journey
Sunday, August 14, 2011
(Methodist Healthcare celebrated our "Living Awards" this past Thursday evening with quite a big show at the Peabody Hotel with nearly 500 important people attending, all in the name of faith and health. The highlight of the evening was the honors given to the Church Health Center and Dr. Bob Waller. Here are the comments I gave earlier in the evening.)
Faith and Health at Methodist healthcare embeds an ambitious strategy of aligning a strong faith-based hospital with equally strong community assets--historically, the Church Health Center and more recently, Christ Community Health Services--all surrounded by and connected to a cloud of hundreds of congregations (362 as of this morning) all focused on justice and mercy at community scale. That’s quite a sentence, but it is exactly what is happening. The only way these powerful assets come into alignment is through the shared vision and blended intelligence of those in leadership roles within all those organizations, many of whom are laypeople serious about their faith and deeply committed to the vitality of the city they love. This room if full of people like that which is why you sense such deep power moving in and through us.
Methodist Hospital is a pretty good hospital hungry to be great. While US News says we are the best in Memphis, we are tantalized and on many days humbled by what remains before us. The region we serve continues to face profound –some less hopeful than us even say intractable—health challenges driven by long patterns of gross inequity and poverty. And, as Faulkner said, the problem with history is that it is not in the past. You can see the past in our emergency rooms every day if you understand anything about the health problems of the people we serve. This is to say that our eyes are wide open to the reality of our challenges.We do not blink and will not turn away. We believe we are called to be the hospital—and health partner—that our region needs. We think we can indeed be great not just in the eyes of some national magazine, but in the hearts and minds of those who need us most.
It is easy to be confused about what is happening at the Living Awards, especially if we think we are here to honor these remarkable people for what they have done in the past. They have all received plenty of awards for that and do not need ours to add to the bookshelf. Tonight is about the future and the possibilities these lives inspire us to envision. We are looking not at, but through these lives, “as through a glass darkly” in the words of the Apostle Paul. What we are looking for is inspiration. What if? What if? What if, these exemplary physicians were the norm? What could they lead us to be? What if Dr. Waller was not such a solitary model of statesmanlike vision? What if there were a thousand of him, too many to pick out which one to honor? What if the extraordinary creative engine of compassion, the Church Health Center, was typical of faith-based programs, instead of unique?
In time of great fear and uncertainty, the world wonders where the grown-ups have gone. The credit rating agencies are really downgrading the maturity of the leaders we have chosen and thus, quite directly, us. The rating agencies, like everybody, aren’t looking for geniuses, but grown-ups. In this time, nothing is more important than to look at real lives who inspire us with the confidence that maybe we, too, could be the people and organizations our city needs.
Tonight, look not to the past. Join me in looking toward the future. Perhaps we can move from “what if” to why not: why not us, why not now.
- Posted on the journey
Sunday, July 24, 2011
I have a Norwegian name and maybe 1/16th of my blood comes from the fierce, noble people who carved a distinctive culture of rock tough land and a cold ocean. I treasure my Norwegian friends that share in the hopes of building a global network of faith-based health institutions.
So I am also proud of a King who can cry for his people as did Harald V this weekend. Every single one of the 4 million Norwegians know at least one of the 92 young and civil servants who will be buried in the next couple days. The people are so tightly bound that most are an extended part of the many extended families who will weep for a long time.
In recent decades Norway has come to be thought of as a gentle wealthy country, so fair-minded as to be confused for neutral, sort of like Switzerland. But their oil wealth is quite recent and like the smart farmers and fisherman they have been for millennia, most of that wealth is in the bank or invested in education and health so that it will bear dividends needed when the oil runs out. And they are not gentle, but fiercely tenacious to what they have always been willing to fight for--their independence and free voice. Their "boys in the woods" tied down hundreds of thousands of Nazi troops in World War Two, keeping Britain from invasion until the Americans decided to show up and join the fight. They were among the first to lend their young men to fight in the frozen mountains of Afghanistan against Bin Laden.
Now they will weep a waterfall of tears for every single one of them and all of us who have come to love and respect them. But Norwegian sorrow will not spill like acid on the sacred documents of their democracy. They will remain recognizably Norwegian. They will love their free and open society and thus protect it against anyone whether it be a crazed evangelical from among themselves, a distant muslim or meddling American (like the Bush era puff who accused them of not being tough on terrorism). They will teach us what it looks like to defend democracy even when the attack comes from within.
Because of who they are, the lament for family and friends will be deep and slow. But so, too, will be their proud refusal to give in to fear, to turn away from the world and into themselves. Our Norwegian friends at Diakonhjemmet Hospital are convening a meeting of global and interfaith healthcare leaders on the Mount of Olives in East Jerusalem in November (Methodist Healthcare is proud to co-sponsor, with Augusta Victoria Hospital as the host)(http://www.faithbasedhealthcare.net/ejc2011/). This is the 120th anniversary of the founding of Diakonhjemmet Hospital, but they thought it would be better to focus elsewhere because it might support a global movement to do so, which is about as typically Norwegian as it gets.
The Norwegian church remains the soul of the people in a way that is hard for Americans to understand, since on most Sundays most Norwegians are off walking or skiing in nature. But the Oslo Cathedral filled to lament and strengthen resolve almost before the dust settled on the rubble a couple hundred yards away. And some of those prayers were instantly and instinctively to preserve the powerful humanistic values Norway represents, including openness to cultures and faiths from around the world. God so loved the (whole) world, pray the Norwegians, and they mean the whole thing. May we pray with them.
- Posted on the journey