Veritas Institute

CIM Client Showcase

A Chat with Mark Taylor, President/CEO, Columbia St. Mary's

What are some of the most profound implications of health care reform for Catholic health care institutions?

Where do you start? Here's the way I describe the impact of health reform to the board, employees, associates, and the community: almost every part of health care we have known is going through a change. How we get paid, how people come to us, their expectations when they come to us, when and how funding comes, the level of scrutiny, our relationship with other providers. Literally, the perception of ourselves is in a state of change, also. We have tended to think of 'us' as the big buildings, the hospitals, but that perspective is gone. Everything you look at is gone. And yet, during this time of tumultuous change, Catholic health care has something unique. We have a powerful thing that will take care of us: our values. In times of chaos, what stays steady are your values, not your strategic plan, contracts, your pay plan. Time and time again in history and in management theory, we see that in tumultuous times, our values see us through. While they [values] may be framed, they are truly palpable in our organizations. We are in an enviable position in this shifting time in our industry as our values serve as our true North. Our founders - who started our Milwaukee health system in 1846 - have gone through multiple wars, the Depression, the Spanish flu and other epidemics, but what held us together was our values.

How has Columbia St. Mary's committed itself to the integration of mission in all its activities, decisions and strategies?

First, I think we need to ask why are we integrating. In organizational theory, if you optimize any one component, it minimizes the functionality of the system altogether. Historically, health care has maximized the components. If you have the best docs, best nurses, best building, with the best technology, we are maximizing the individual components and then we wonder why it doesn't work as a system. When you move to integrating a wholeness, it's more of a focus on the complimentary parts. So the principle becomes how well we are achieving the outcome, rather than the individual parts. We like to say at Columbia St. Mary's, "IT'S ABOUT ONENESS."  Making things one.

How does the Catholic Identity Matrix (CIM) play into this integration?

Well, if our values are the most important assets we have and we believe our only success comes from an integrated delivery system, we have to integrate our values.  The CIM gives us a mechanism, not only to measure how well we are doing in deploying our values, but how well are we integrating our values in our system.  Edward Deming has famously stated that which is measured is treasured. I would transversely say that which is treasured SHOULD be measured.  We can start integration by measuring the very things that we most treasure.

How do you relate your Malcolm Baldrige journey to the experience you had with the CIM?

The hard part is being able to really differentiate one from the other as they are so intertwined. If you are familiar with Baldrige, it focuses primarily on leadership - establishing the direction and values of the organization. Where are you going and why is it worthwhile? In essence, how do you apply your values in the business or school environment? How do you measure the deployment and impact of your espoused values? We use the CIM as part of our Baldrige evaluation process, asking how well we are doing and then where do you go next to improve. I like to say that it is not just a thermometer, it is a thermostat. They are predictive processes that are leading inevitably to improvement. With the CIM, it is focused on the Catholic values but Baldrige asks directly about the values of the organization.

How have the CIM assessments served as a conversation starter with the bishops?

I will share our personal journey as we had already elected to do the CIM when, at the same time, the American Council of Bishops expressed an interest in how Catholic health care organizations might be audited - how well they lived their Catholic identity. In Wisconsin, different bishops had different perspectives. Our Milwaukee Archbishop was interested in learning about our CIM journey, so we embarked on a running conversation for six months or more as we shared in detail what we were finding. The Archbishop was truly interested in how the CIM was a tool for improvement and sharing across ministries. In fact, I would say that he was captivated by it, as he had watched our journey from its birthing and shared our ownership. For others, it can come to serve as the basis of true improvement initiatives and honest conversations. One of the things that our Archbishop appreciated was the value of a critical method of assessment that was taking place with the CIM. Being able to see that we didn't score 5s on everything - he was glad to see the rigor and see there were 2s. He knew that this assessment was valid if you are truly identifying some honest improvement areas.

How does an organization truly breathe life into its guiding principles? How does assessment play a role in this process?

That's an interesting question, and consequently those are always the hardest questions. If you were to ask me:  how does the Taylor family work? That is hard to answer, because it's a wholeness, and it loses the richness by trying to describe the individual parts. Much the same is true with a "Catholic health system." Our guiding principles are so inherently what we do. The CIM lets us break down that whole system into meaningful conversations and honestly see how we are making the world a better place. We can describe things in ways that are easier for people to decipher, rather than esoteric, theological things and concepts. We are called to social justice and, for us that means we are involved in improving access. For instance, the Affordable Care Act means thousands of people that didn't have coverage have health care insurance today, but to be successful in our new reality we must have integrity about what we say AND what we do. 

A chat with Daniel Dwyer, senior vice president of mission integration, Trinity Health

What are some of the most profound implications of health care reform for Catholic health care institutions?

Well, first the good news, and there is a lot to be positive about. A number of people who have not been covered and did not have the best form of access to care will have it and have better care than in the past. We always took care of them, but they would show up in the ER with congestive heart failure or another chronic illness that should have been treated much earlier. Now, a good 20 million people will have access to primary health care. Women will have opportunities to avail themselves to more prenatal care and other preventive measures that have been sorely lacking. 

There are going to be some real challenges in handling the demand, though, because there is such a shortage of primary care providers in many communities. As an industry, we’re just not prepared to do preventive care. We’re really good at acute care. Now, we need to better grab hold of how to keep them well instead of just caring from them when they are sick. In many ways, this gets to the root, the notion, of holistic care. Trinity has been working on this for a number of years. 

In fact, a stimulus for engaging in the relationship with the Veritas Institute evolved from  a thoughtful assessment of the implications of health care reform for Catholic health. Before the law passed, we had six work groups that were analyzing and anticipating the implications of the law. One of those work groups was the Catholic Identity workgroup – we looked at the legislation and wanted to expand what we meant by the principles of Catholic health care, and determine how to maturely work and communicate with our bishops. We also took a look at financial implications and clinically integrated systems as a whole - all of the nuts and bolts issues that would become a reality. We identified what those implications were, and we adjusted our strategic plan for the organization with new priorities, with an eye toward how to go deeper into the world with non-Catholic providers and partners. We asked ourselves:  how do you engage and truly make an impact?

How has Trinity Health committed itself to the integration of mission in all its activities, decisions and strategies?

We are conscious about doing mission discernments about all significant decisions  and changes in strategic direction, on a local level and across the system. Through mission discernments and ethics due diligence, we are constantly asking what are the implications to our identity as a Catholic ministry, and how are those implications impacting our key stakeholders? We use the mission statement as the ground from which 25 or so questions are asked about the different components of the matter at hand and how it reflects our mission. That process has been in place for a great while. All mission leaders are part of a senior leadership team, and at the point where decisions are considered, we have a seat at the table and are part of the discussion. Do we need to do a discernment? I would say that is a part of the fabric – really the gold thread - of the Trinity culture.

How does the Catholic Identity Matrix (CIM) play into this integration?

What we’ve learned from our first five engagements is that there are numerous opportunities to broaden and deepen our identity as Catholics. In each assessment at every ministry location, we can see opportunities for improvement (OFIs). We have established follow-up activities that are substantive initiatives – that will have a material impact and truly change how we see ourselves. It’s been very enlightening. The different ministries are getting to pick up on some patterns across the ministries. For instance, our metrics are very weak in many of the key elements, so there is a general sense of needing to determine how we can measure across the ministries. While we have a lot of qualitative impressions about impact, we see that we need a much greater impact in a quantitative way as we go forward in the process. 

How have the CIM assessments served as a conversation starter with the bishops?

The bishops that are in the places where we have done this are delighted that we are doing these types of assessments and having these conversations. When we were talking with the Davenport bishop (our first engagement was in Clinton, IA), the editor of the Diocesan newspaper came in to learn more about the CIM and our process in the ministries. Likewise, the bishop in Columbus, OH, was pleased on a number of different levels – from his confidence about an organization that he is very impressed with [University of St. Thomas] and has experience with [as he served as a rector at UST]. Across the board - Boise, Idaho and eastern Oregon - they are all very happy to hear about an effort that we are really serious about: being Catholic and living out what that means. What will be interesting is this year we will be working hard to distinguish metrics for "act in communication with the church," and I’m looking forward to sharing with the bishops and seeing what they think about our effort.

There is a unique relationship between the areas of corporate ethics and Catholic identity.  What is your distinctive take on corporate responsibility within a corporation such as Trinity Health?

We put the sign on the wall, the ‘shingle out’ so to speak, and we say that we are serving together in the spirit of the Gospel. When you say we are the healing ministry of Jesus you have declared that you must attain that aspiration to the extent that you are serving all people. Pretty high standard. So Catholic social thought is really taking the Gospels and operationalizing them. The principle of “participatory workplace” – you can draw a direct line to the Sermon on the Mount, Beatitudes, and what that means about being a leader, manifestable teachers. How do you justify yourself? How do you provide evidence that shows you are living your mission? When you are depending completely on external funding and that funding source declines, you have to deal with expenses in a new way. People’s jobs have to be eliminated and decisions are made with a different lens, all of which can look like we are just a business making money. So that principle of stewardship becomes paramount. How do we balance stewardship issues with a perception that we aren’t ever going to lose our Catholic identity? 

Business vs. mission – I don’t think there is an equation per se. Our business practices have to reflect the mission and when they don’t, people have a right to ask what is going on. As a $9 B business, you can’t sustain without pretty solid business principles, so how do you conduct business in a spiritually grounded way? The CIM is a wonderful way to give experience and grounding, practically eliminating the dichotomy between mission and business. Sr. Mary Roch Rocklage (former CEO Of Sisters of Mercy) used to say if Catherine McCauley of the Sisters of Mercy had a nickel, she’d rub the buffalo off of it. Some of the most hard-nosed business people I have met have been the Sisters. Before Medicare and Medicaid, the Sisters would say they did whatever needed to be done. They didn’t walk away from obstacles. It was a manifestation of their call, their vocation. They would close hospitals if needed and start them in places where they were needed. 

How does an organization truly breathe life into its guiding principles?  How does assessment play a role in this process?

We need to do formation. We need to have our leaders participate in formation that is deep and extensive enough to understand what it means to be a leader of a Catholic ministry and a non-profit health care organization. Leaders need to be invited to explore their own spirituality and harness the core source of purpose and meaning that is within all of us. The CIM gives us a way to evaluate our formation program. How good is it? We can use the CIM to serve as a baseline assessment of early formation. In many of our institutions, only a very few have had formation.  Years from now, if a CIM is done and it shows significant opportunities for improvement, then you may have identified a flaw in the formation program. This type of formation evaluation is pivotal. All organizations have an identity - whether it’s Catholic or not. We will see whether formation makes a difference. Enron had an identity. What the CIM does is to put a mirror in front of us and see who we are and where we need to grow.