Thursday, November 24, 2011

Gratitude is the way

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 ( 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 ( 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

Jerusalem: History kills

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

Jerusalem: Choosing the World

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

Jerusalem Two: SMAC

I am writing this in the Atlanta airport, moving toward Jerusalem to gather with others from faith based healthcare organizations (

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

Jerusalem 1

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.