Monday, February 20, 2012


Not all the religious nut cases are  running for office. Some of them park their vans across the street from government buildings in Washington. This particular brother (maybe cousin) parked across from the offices of the Health and Human Services where 28 faith-based and community-oriented health systems were meeting to talk about how our faith could drive a deeper and more effective partnership with a government that shares our mission for improving the health and wellbeing of our communities. We were convened by the White House and HHS offices for Faith-Based and Community Initiatives, led by Mara Vanderslice and Alexia Kelly.

What does faith have to do with life? At least four varieties of answers were on view in Washington in the past week. The one getting the most attention was that offered up by the Catholic Bishops whose lawyers would probably want them talking about almost anything other than sex. But they understand their role as laying down their understanding of what religion has to do with condoms and other means of interupting pregnancy, which is to say, life. Life is a non-negotiable good and that's that, no matter that nearly all Catholic women agree with that principle, but do not extend it to cover contraception. Life is simple, say the Bishops. Not quite, say the Catholic women.

Another answer was offered up through the research findings of Gallup, which had a big meeting of academics just down the street. They were exploring the surveys of 676,000 Americans which indicated that Americans who are most religious have the highest levels of well-being. (I'm guessing the guy in the van was not in the survey pool.) The study "does not allow for a precise determination of why this might be the case" and promised to keep working at the mystery. Dr. Ellen of Ilder, now of Emory explored this some years ago making the link between participation in congregational life -- not spirituality--so this is sort of old news. But don't quibble: even with all its obvious ambiguities, religious people have more well-being. (Except for clergy, which have terrible health status. Apparently something like an overdose is possible.)

I returned home to Memphis where today a room full of United Methodist District Superintendents and a Bishop were meeting in the Innovation Studio, working on the future of the Church. The United Methodist Church has lost about 1,000 members a week  for 43 years in a row, so this is daunting labor. You can tell what a person has faith in by what committees they attend, said my Methodist father.  Religious life is about structure, connection, organization and strategy. (Where does Gallup think all those congregations come from?) So they were plugging away with maps, to-do lists and mounds of paper.

A fourth answer was offered up inside the HHS building in the room full of healthcare people. About 80 billion dollars worth of faith and community health assets were learning from each other about how to allow the best 21st century science to liberate their funding from an almost total focus on hospital-based medical care so that we can get at least  tiny portion of those funds onto the streets and into the lives of people who actually need something much cheaper than an emergency room. Over the next few days I'll be posting links to the stunningly smart presentations offered up so faithfully by friends at Loma Linda University Medical Center, Henry Ford Health System in Detroit, Camden Coalition, South Central Foundation in Alaska.

More insights came from the Public Health Institute in Berkley, the Centers for Disease Control (advising the IRS on determining legal rules for community needs assessment) and HHS leaders working to drive innovation, liberate data and, more or less, "do the right thing." For this group, faith is the hopeful energy that embraces uncertainty with curiosity, not fear.

Religion may be the thing that draws lines, points the finger and stirs the anger. Faith is the thing that asks, "why not?" Ethics based on religion tends to be about not doing something. Ethics based on faith tend to be about trying to do something, especially a right thing that has never been done, that lives in the "not yet."

The faithful health systems were sharing how they might do something never done before--achieve a merciful and just community marked by health and wholeness. The dude in the van across the street could only scowl. But amid the data, and amazing tools of GIS mapping, financial analysis, creative clinical management and public scale policy you could feel the spirit of possibility breaking through.

Felt like faith to me.

(Powerpoints should be available online later this week.)

Sunday, February 12, 2012

Mercy -- and a hint of justice

The Tennessee Healthcare Campaign alerted that on the 21st of the month for just a few hours there will be a crack in the wall allowing a few more thousand people in the state to get covered under TennCare. From 6pm till 8:30 pm the phone lines will open for the lucky poor who get their call through. Reminds me of the Buffet song about how the whole world lies waiting behind door number three. But this is truly life and death.
This is our version of Medicaid, the government program for the poor, but you have something similar--and similarly restricted-- where you live. The brutality of the vulnerability is simply medieval. 
Wealthy politicians swagger and blather about how we should quite worrying about the the poor. So it is helpful to look at how vulnerable you have to be to get covered: You must be either 65 or officially disabled AND have medical bills about the same size as you monthly income AND have no more than 2,000 savings (3,000 if married).  The phone lines are expected to jam within an hour as thousands of people fitting that profile in just one state compete with each other to get through the eye of a needle.
It is not surprising that someone with an account at Tiffany's or the Cayman Islands may be a bit out of touch with the fact that there are so many people like that. But you'd think they'd at be curious about it.
This is the human reality behind the accountable care act that President Obama has brought to life in the face of rabid opposition. Granted this is not artful legislation. It was a highly compromised before it was even submitted and getting more compromised as it is written into rules and then into real programs on the streets. It is not beautiful, but don't imagine it is not necessary.
The political dwarves are too easy to criticize; they can't help themselves. The fact is that I can't relate much better than Newt to this desperate vulnerability. If you are reading this on your home computer, you are probably out of range of understanding their reality, too. But the poor are not from another planet; their lives are knowable by anyone who cares to know.
This is much on my mind as 28 health systems with a high level of care for the poor will be gathering under the auspices of the White House and HHS offices for Faith Based and Community Initiatives later this week. Every one of us carries tens of millions of dollars of cost for providing care to people who have no money and no coverage for their care. This is for people who don't even qualify for TennCare--another whole notch more vulnerable.
Systems like Methodist Healthcare provide mercy and are proud to do so. But often the request for mercy is so delayed that the care is too late to be effective or very useful. We know that what we give is rarely given at the time that 21st century medical science would want it available. And the poor tend to get their mercy, such as it is, at the Emergency Room, which is the opposite of a sustained relationship with a medical provider trained to manage care over a lifespan.
 Most of the "emergencies" we treat are entirely predictable, if not preventable; they are usually conditions that have a long trajectory easily managed with modern science--but through regular access to a medical provider and access to pills and supporting services. In our weird economy those things are quite simply out of reach of millions of people unless they are covered under a decent insurance program (such as TennCare). 

It is amazing to me that two-thirds of those asking us for mercy last year only needed it one time. The poor are tough and proud.The Tennessee Healthcare Campaign wages a daily, grinding struggle to help our democracy do the right thing for people who need mercy even if they cannot really hope for justice. Your state almost certainly has a similar band of prophetic mercy-makers and justice-seekers. If politics permits and the accountable care act survives somewhat intact, in a bout a year a half there will be millions--not just thousands--of people able to get covered under some level of insurance. That process will be ragged and difficult, too. But don't imagine that it will not be live-saving.It is not even close to justice, but it is a start toward decency.

Monday, February 6, 2012

Flashlights and hammers

 What counts matters, but not everything that matters gets counted. Just ask any United Methodist pastor these days. That denomination is under storm warnings after losing roughly 1,000 members a week for 43 years (I am not making that up). Even though there are still 7 or 8 million United Methodists on the rolls, that steady decline matters. But what exactly would you count if you wanted to map the opposite of decline? What would you measure if you were interested, not in pathology, but  vitality? What is the arithmetic of life?

Counting can feel like a flashlight or a hammer depending on who is counting and whether they are trusted. If you are a pastor and the your are asked by a  Bishop, Board or big deal committee, the counting can feel like a hammer, with you being a nail. This is exactly what is happening today in the denomination. The the ones wanting the numbers are not trusted by the pastors because the clergy don't think the people on the committee understand the parish reality enough to understand the numbers. The numbers are more likely to hide reality, than disclose it. They like to say that a parish is not like a corporation, so one can't count in the same way. But a parish is not the only organized entity where complex intimacy is the norm. Hospitals are, too.

We count many many things in hospitals every day, with greater and lesser usefulness. Mostly we count process markers so we can good quality from bad quality. And we count money pretty carefully. And we know that the things that matter most occur in the intimate human spaces where metrics are crude by comparison to the complex wonders that take place. Healing actions and saving behaviors cannot be compelled with anything like a hammer. But it is possible to hold a flashlight to help see whether the good intentions actually do result in good work. That's what matters. 

Pastors, nurses, physicians, teachers all tends to be suspicious of data, trusting the high bandwidth of stories instead. The human mind is tuned that way. One of my senior colleagues' mom is in the hospital right now and he has noticed that even with the vastly detailed electronic medical record the staff still seem to lose track of what is actually going on with her--her real story.

Until a leader sees a pattern, they are powerless to do anything but react out of fantasy or fear. Their action is arbitrary or random. Even success is dangerous because it will result from action that is disconnected from reality.  They can kill the ducks and grind the gears.

Good data helps sensitive leaders find the true patterns in the stories. Good stories help sensitive leaders find the true story in the data.

I used to work as a carpenter and had a toolbox filled with all sorts of tools. Sometimes in a hurry I'd grab anything I could reach and use it to pound something into place. Even a flashlight can be a hammer, if you hit hard enough. Bishops and executives do that, too.

Don't make the metaphor do all the work here. Member and patients are far more complicated, confounding and nuanced than a gaggle of french ducks. And any denomination or hospital is a far more intricate mesh of moving parts than any mechanical gear. Grab a flashlight, turn it on and pay attention.