Author: garygunderson

On Monday and Tuesday we experienced a most remarkable flow of blessing as the Center of Excellence in Faith and Health was blessed, celebrated and consecrated. Bishop William Young leading in prayer, Dr. Ralph and Barbara Hamilton lending their support, Rev. Steve Miller blessing the hands of clergy (even me!).

Here are my comments; others to follow:

I must give a personal word of thanks to the many present who have made this space sacred by their creative gifts of every possible kind. And to the most remarkable staff of our division who do the daily work of caring, teaching, prayer and research–wrestling with ideas and data until they turn into smart program. I am an ordained guy from Atlanta who writes books. I would be easily ignored in a busy hospital, if were not for the sparkling quality of their work. That is the true credibility on which this Center rests.

When we started this journey several years ago, I imagined someone asking me “so, where’s the excellence?” I wanted to be able to say, “go look to the family and ask them. It should be present in their lives.” The families helped us get the design right along the way. The family care center is testimony to their guidance, especially the learning spaces so crucial to helping the families with knowledge when they need it. It is important to say that the space makes possible the participation of volunteers who come from our 329 covenant congregations. And the volunteers learn as they serve, enhancing the capacity of those congregations to be places of caring and healing far beyond our walls.

This is the virtuous circle which carries us: more partners, more aligning of strengths and more blending of intelligences. This enables us to do things together that no other hospital or community can aspire to do.

This special room is all about innovation, so let me say a word about that. A lot of what passes for innovation in healthcare is expensive bangles and beads. Innovation is about doing different things, not trying harder at old things.

Nothing could be more obviously needed or difficult to do than changing the relationship between the hospital and the community. This is social innovation, cheaper, but harder than plugging — or unplugging — another medical device. Any innovation, technical or social, rests on a blend of imagination, intelligence and evidence. The blender for the Memphis Model is the Innovation Studio at the heart of the Center of Excellence in Faith and Health right near the front door of Methodist University Hospital. This is where the 329 congregations are trained in the arts of connection and caring; here the real-time analysis of many forms of data, here technology connects us with experts working the same challenges in Cape Town, Tubingen, Oslo, or Vellore. This kind of innovation isn’t free, but infinitely cheaper than doing the wrong thing or missing big opportunities to do the right thing.

And where is the faith? The whole story is faith: blending our faith-based hospital, with faith-based primary ministries like Church Health Center and Christ Community Health Services. But the true health system is the hundreds of congregations that surround our medical sites with caring, comfort and healing. These are the primary partners led by clergy who have already been generous with their intelligence and lending us their most precious gift, their trust.

Joycelyn Elders once said this kind of work is like dancing with a bear: you don’t sit down when you get tired, but when the bear gets tired. The bear is not tired. But together, we dare believe that we can bend the curve of brutal health data that maps the patterns of death in Memphis today.

So we today consecrate not just a space, but the hope the space serves. Every bit of carpet, fabric and art sings out the word of life, as does the light that washes the space. This is God’s imagination at work, I believe, imagining a community beloved and whole and healthy.

May God protect and empower us as we move.

– Posted on the journey

Rev. Bobby Baker works for me. But I am just smart enough follow him. He has evoked the Congregational Health Network, now 314 strong, that is the most unusual part of what is coming to be known nationally as “the Memphis Model.” This week we inaugurated the “innovation studio” in The Center of Excellence in Faith and Health by hosting a working delegation of leaders from federal health and human service agencies, including Mara Vanderslice, the acting director of the office on Faith Based and Neighborhood Initiatives. They wanted to understand how this very novel model of collaboration emerged where you would least expect it. So we played Memphis Minnie as the sound track: “use what you got, baby,” she counseled.

It is, as Mara noted, a victory all by itself to see a covenantal relationship among hundreds of congregations working to advance the health of the community. But the Memphis model includes many other partners, especially Church Health Center, Christ Community Health Services, the county health system and other collaboratives (notably Healthy Memphis Common Table). We all have different (sometimes opposite!) ways of doing business and staying alive. We work in an environment of conflicting, even perverse, disincentives and weirdness. But in Memphis we do find a way to help each other express our best selves on most days.

We are known for mapping our assets as taught by the South Africans. They also taught us to focus on what we’ve got. As Steve DeGruchy said, “you can’t build a community out of what it doesn’t have.” Still a work in progress held together by leaders trying to do the right thing, this work of aligning our assets is bending the curve. Or, maybe even more; perhaps the arc of history is bending toward justice, as Dr. King prophesied.

This is a time when the country needs models built for the real world of mud and muddle like Memphis. All of gathered this week with a deep sense of urgency as we work in a mean spirited political atmosphere where health reform is frayed and undermined even before it is barely under way. We need to move fast and bold.

Just days before I was in Miami at the annual governance meeting of Premier network of non-profit hospitals. The theme was all about “leading transformation through the power of collaboration.” Premier is essentially a buying club for hospitals so that they can achieve bulk savings. But it has grown into a learning network of real significance. I attended an early morning briefing by Kirk Hanson about the ethics challenges of reform. Notably, it took Kirk nearly all his time to list the many wild drivers of change in hospital-land these days that are spinning off ethical issues like feathers flying from a truck load of chickens. But he barely got to the big ones, such as what hospitals really should be accountable in terms of creating healthy communities. And he didn’t quite get to the fundamental uncertainties such as global economics. Oh, and climate change.

The name of this blog is “leading causes of life.” It is about a simple ethic: if it looks like life, go that way; and if it looks like death, go the other way. And make sure you grab the hands of whoever is heading toward life, too.

I thought of Bill McKibben, in his stark book “Eaarth,” about catastrophic climate change, but counseling us to not despair in the face of destabilizing realities. How to live? Come together acting in hope, intelligence and sacrifice beginning in your own neighborhood, city and region. Act like grown-ups, in other words, working with other grown-ups to create social levees adequate to the floods we face. The waters rise, drive and fly in the winds of change. So we turn to each other and do the right thing, whatever that means with whatever you have influence over or leadership for a huge hospital, a health clinic, a congregation or just your own home.

That’s the Memphis Model. You can see it happening….live.

– Posted on the journey

This is the covenant that guides the wildly vital life of Oakhurst Baptist Church in Decatur, Georgia. (You can read it at http://www.oakhurstbaptist.org) Written in 1977 by a number of mostly laypeople some of whom are still finding their life on the corner where the “covenant stone” now rests. Karen and I joined only a year after it was written and born and raised both daughters in its light. The covenant continues to be living body of thought for sons, daughters, rising and setting stars, recovering and revolutionizing people ever since. It was amended in 1997 to broaden Galatians 3:28 to exclude distinctions in sexual orientation and mental ability. God only knows what other distinctions will be excluded next, but I would note that my golden retriever, Jessie, once walked the aisle on a snowy day to join and was accepted. ( I believe that even the Apostle Paul would have recognized Jessie’s faithful heart.)

The covenant invites, not contains, reminding me of the the way the banks of a delta river guide, more than hold, the vital flow. And like a river, you can never visit the same Oakhurst twice.

John Shippee offered up the prayers of the world this day (those prayers being pretty much the only constant in the order of service for the past 30 years). John’s language is usually the superabundant eruption of Old Faithful. But today–on his 67th birthday– all of us could hear that the cancer is back. He asked for our grace as he read his prayer. I can’t remember a single syllable, but I am sure God took good notes and got to work on them. But you could feel the depth, ache and reach as he prayed, not for himself, but for the green and glorious, bloody and lonely world.

Curt Armstrong, the leader of the local l’arche community, spoke to the last line we pledged, “with God’s help and the help of my sisters and brothers in this fellowship, I make this covenant.” Echoing Jean Vanier, he distinguished between productive and fruitful fellowships and the way that our blended vulnerabilities lead us to healing as they pull us toward relationships. Incompleteness is a grace, when experienced in fellowship. So is the ache of never-to-be-completedness.

I thought of other days when we stood by the stone and read the covenant.
One sunday I even preached and said that the test of a covenant is that it would not be fulfilled in ones life, but would be found valuable enough to be picked up when we laid our lives down. I had no idea what I was talking about, of course, assuming I would always have time. Now I see that my very best thoughts and visions call me far beyond my little self for I will not see them complete.

The Congregational Health Network also has a “covenant” that calls us beyond ourselves to the beloved dream of a Memphis that looks more like what God had in mind when he made the river flow just beneath the bluffs and across the rich delta. This is a baby covenant, alive only three years and living among only the first 311 congregations. What will it be in 2045 when it will be 34 years old like Oakhurst’s is this day? Will it still stir the heart of young and old and call out prayers by the sick on behalf of the well? Will it still feel young, wild and possible only with God’s help and the help of the sisters and brothers in the fellowship?

May it be, Lord, please may it be.

– Posted on the journey

So, I was planning all this week to post a very cool and thoughtful reflection about presenting a seminar at the World Bank about Memphis’ experience as developing community and, of course, how our mapping, aligning and animation of religious health assets is showing such promise. Would that not have been very impressive? Well, it turns out that Washington DC needs a bit of development. About 15 minutes from landing in the heavy snow our plane headed back up above the clouds because the ground radar was broken. Flying cowboy that he was, he insisted that he didn’t mind landing into that twisty little runway by the Potomac in the driving snow, but they wouldn’t let him try it without ground radar. Kudos to whoever decided that!

So instead of a picture of me at the World Bank, I give you a picture of the little train that shuttles back and forth in the Detroit airport, which is where they send you, apparently, when you have tried and failed to land in DC.

Delta handled the deluge of frustrated passengers with calm competence. And the hundreds of frustrated passengers were pretty calm themselves, actually. I did think some of those in the ‘privileged” line would pop a gut when two people in wheelchairs turned out to be even more privileged than they.

I found my way back to Memphis on an early morning flight in time reflecting on how it was that there are people in Detroit standing by, prepared and ready for such a deluge in the middle of the night. Where do they keep all the stuff that turns out to be needed on sudden notice? What would all those people have done with their time, if we had not dropped from the sky?

And I thought about the fact that even in our tightened times, there is slack in the system when needed. And there is actually slack in other systems, too. About 10% of our patients at Methodist pay nothing these days and yet we find a way to cover it and keep going, still making money ourselves. There is enough to go around.

The last picture is another one from the soon-to-emerge Center of Excellence. This one is soon to be where Ruthie will sit in the reception area welcoming families, clergy, and zillions of volunteer care-givers to be trained. And a lot of other kinds of smart people ready to blend their intelligences to create the social innovations we need in Memphis. There is enough for us to work with. Way more than enough.

– Posted on the journey

Things are emerging in Memphis wrapped in new sheetrock, glass and even HTML. I do love things under construction!

What? Aren’t I supposed to be reflecting on Dr. King and rampaging violence? Well, we do that pretty much every day in Memphis. I can see the Lorraine Motel from my desk. So I find myself thinking about the idea of an “implicate order” emerging through the complex dance across the years. David Bohm wrote a great book about the idea that order unfolded through the mystery and wonder at the edge of “the unlimited.” I like all that and am known for being dangerously comfortable with ambiguity. Sometimes I am accused of mistaking plane ‘ol disorder for emergent order. Fair.

Bohm was the last thing from naive, but his language implies something less than the brutal turbulence I have come to appreciate in Memphis. Here disorder fights back, actively, and does not play fair. Blood flows.

It is dangerous to think the intractable phenomenon of even the most obvious evil–race-linked health differences–will simply unfold. We must wage health with all the focus and intelligence and energy that others wage war. Our tools are not those of violence, but need to be sharp as any sword.

That is what the Center of Excellence in Faith and Health is for, especially its “innovation studio” which will be open within a few weeks. And just in time. The CDC released one more stunning report about disparities yesterday. Another 116 pages of footnotes to the most obvious intractable story. (http://www.cdc.gov/mmwr/pdf/other/su6001.pdf )

We saw some of this in our own our North Hospital in a study focusing on heart attack and heart disease survival rates. Those findings find an echo in the study of disparate outcomes in the LeBonheur ER for hispanic children almost as dramatic at the Black elders at North. This has brought to view information we can’t look away from–and need not.

We have the intellectual capacity to burrow through piles of unreflected assumptions sorting out the things we can do now from those we must drill deeper into. We have leadership capable of applying moral capital guided by good judgement to change the reality of gross disparities toward equity. We didn’t create disparities in health and we can’t eliminate them by ourselves. But we can think and lead, building trust and momentum in the process through transparent, non anxious systematic work, acting where the course is clear enough to do so and systematically researching where it is not. That’s what grown ups are for, especially those with the faith the size of a kudzu seed.

The pursuit of equity is not confined to religious partners. Indeed, it is the most obvious intersection between public and faith at every level in any democratic country. And the imagination of faith is not confined to health disparities, partly because all scriptures are pretty realistic about how hard it is to bend the arc of human history toward what God hopes for. But. We can do better.

The Center of Excellence will open in tough times dedicated to going right at the heart of darkness. It is only one unit in a very large organization with many partners. But for the first time we will have a place designed and committed to the work of innovation that dares hope for transformation.

This signals a long term sustained creative effort that reflects our most fundamental confidence that our institution and our community is part of God’s ever-constant action to create the Beloved Community. The space is nice, but our commitment and confidence rests not on our competence alone, flawed and fragmented as it is. We do not act alone, for we are moved by a God who is not done with us or our community.

Oh, and check out our new website, which we breathed fresh air yesterday– http://www.methodisthealth.org/faithandhealth. I hope Dr. king would like it.

– Posted on the journey

Scott Morris is a physician. And he is a minister. And he is a classic social entrepreneur, creating and sustaining a unique ministry for a quarter century, The Church Health Center. And he is a one great story teller.

All of these come together in his new book, “Healthcare You Can Live With.” The book is built around Scott’s rich reservoir of stories and the simple, but profound framework of Christian virtues and “model for healthy living.” The Church Health Center builds around the same two frameworks, so it is possible to read the book as a lens through which to focus on health ministry, and just as well, to focus on one’s own health.

The virtues come straight out of the third chapter of Colossians, which I think Scott understands better than Paul. At the very least, Paul would have been surprised to find how smart his simple list actually turned out to be once Scott built a large ministry on them. Clothing oneself with “compassion, kindness, humility, gentleness and patience” is, well, healthy, especially when they are bound together in “perfect unity” in love. Forgiveness and release of grievances is the hub of them all, of course, which Scott unpacks in many richly persuasive narratives. Very healthy.

Scott lays out a nice “model for healthy living” designed to help people develop “smart goals” in the various aspects of health including medical, movement, work, emotional, family and friends, nutrition and faith life. The focus is on what one can do themselves, not on scolding or simply accepting somebody else’s prescription.

Policy makers will be disappointed with all the easy shots at government (You’d never guess Scott voted for a Democrat in his life by reading the book, but I have reason to believe that he has.) Academics would like more footnotes, of course. Some clergy might be hoping for someone to write them a prescription for a healthy congregation. Scott tells stories and, in effect, says to come and look at The Church Health Center. It is a very good idea to do just that (churchhealthcenter.org).

In the meantime, read the book: http://www.amazon.com/Health-Care-You-Can-Live/dp/1616262478

And choose life.

– Posted on the journey

There is nothing new in the world when it comes to suffering, not even in Tucson. Over the horizon of our attention span yesterday dozens, perhaps hundreds, maybe thousands of equally innocent people where cut down with as little reason. Perhaps they were also caught in a rising tide of violent and cynically divisive rhetoric. Perhaps, another man armed like a warrior but fighting only internal daemons, went off like a grenade in their lives, too.

It is certain that another 25,000 children died of things like diarrhea, hunger and quiet desperation because they do not look like the people where they live who have money or guns or education. The same day the bullets flew in Tucson, our local paper published an exhaustive article about the grossly disparate rates of premature death linked to race in Memphis. No bullets, but lots of death.

There is nothing new in the world when it comes to suffering.

Or healing.

Says Larry Pray: “I do not live in Tuscon. But I know what the churches, synagogues, mosques and temples there are doing. They are gathering together. They are praying, they are reaching out, they are consoling, they are looking for ways to stem violence. They are embodying Tikun olam. That’s what they do.” (http://www.larrypray.com/?p=2077)

What are we for, if not to heal? Or, as Larry spins out the vocabulary of hope: “Mend. Repair. Forgive. Strengthen. Find hope over despair. Find a way to stem the tides of violence. Heal. Tikun olam.” That’s what we are for.

I am old enough to have known people doing this kind of most basic healing for some decades. They serve in the soup kitchens, come alongside the bruised and battered women and children, sit with the abandoned ones suffering mental torment and those caught in chemical tangles. They tenderly, quietly stand with those damaged by violence. Tikun olam.

This kind of healing isn’t done on the internet or through the windshield. While you can send an unmanned drone to kill, you can’t heal that way. “No drive-by compassion,” I heard many years ago.

Healers, most astonishingly, keep doing it decade after decade. How can this be?

We are find our lives in the healing of others’. It is not a paradox; it is straight up truth of how it works on this odd and wonderful planet.

Healing is mystical, but not magical. We can show up on purpose. Prepare ourselves on purpose. Train our congregations to do healing work on purpose. We can choose words that heal on purpose. We can give our children eyes to see others kindly on purpose.

That will all happen in the morning in Minneapolis, Memphis and Mombasa. And it will happen in Tuscon even amid the tears.

– Posted on the journey

Back in Memphis after a brush with global weirding. That’s a more useful phrase than global warming, as the local affects of climate instability show up as extremes of cold, heat, drought and drenching. In our case, we just caught a glancing blow of a storm that rearranged many lives this past week. Just 10 inches of snow and temperature in the teens locked us in our cabin for three days longer than these city people planned.

And amid the weirdness, great beauty for our eyes are tuned to regard as beautiful the most mundane aspects of nature. Freezing and thawing of water, snow on the trees, fire on wood. What could be less notable? But I am drawn in wonder to the play of sunset’s light in the ice.

We are so comfortable in natures womb that we are surprised to learn how wondrously balanced it all is, and what a narrow range of conditions permits our living. Just a wobble this way or that, and we find ourselves near edges we had no idea were there.

About a month ago I found myself with many hours of driving alone, so I downloaded Bill McKibben’s, Eaarth which riveted me in extremes of sadness and hope. Sadness as he persuaded me that the planet I grew up loving no longer exists. We have literally changed the chemistry of the air with countless effects, some of which we can actually see in all their weirdness. The hope (less convincing) is found in the human ways of coming together with what we have and can do. Bill sees hope in localism and regionalism and, via our long term connectedness, globalism. He and some Vermont students created one of the most remarkable signs of viral hope that you should visit: 350.org.

The number is the whole story–the level of carbon in the air above which our Eaarth can stabilize somewhere near our current level of warming. Above that and the chemistry of the air guarantees that we will continue to warm — and not in the long future of our grandchildren. But visibly, quickly, in a few dozen years. I love a lot of people who are vulnerable to that.

McKibben sees hope in how we connect to each other where we actually live. I saw that this week up in our micro-neighborhood of a couple dozen cabins scattered around the steep and winding gravel roads. Eddie Geller is about 6 foot two inches of practical human decency, who made it around on his ATV to check on every last stranded family. Getting baby formula for the Brazilians up the hill, getting another woman to her chemo appointment. And then he guided us all down the icy roads to safety when it was possible to move at all.

I was worried for the safety of my family amid the ice. I was glad Eddie was in my life to help. And I am worried for my larger family amid the growing warmth. But also filled with the wonder of how we are wired to find our way, first toward each other, and then to do what wisdom makes visible.

Go to 350.org and help out.

– Posted on the journey

I’m hoping this post does not circulate to certain foundations making major healthcare grants for consumer engagement such as one we recently applied for. So don’t go forwarding this willy nilly; keep this among us humans. I think I’ll even hide it beneath some nature pictures for safety.

Maybe its just being snowbound in a cabin, but I’ve had it with calling human beings “consumers” as if that is a promotion of some sort. The curious habit has even infected healthcare organizations who started describing the people in their care as….consumers. This is more common among those receiving stigmatized outpatient treatment, such as mental health services. The idea is that we should remember patients are active decision-makers and purchases of services, just as honorable in their own way as somebody choosing Target over Walmart.

Treating people with as much decency as Walmart seems like a low goal to aim at. Human beings in a relationship of caring and treatment are in a more complex dance of intimate exchange than Walmart understands.

Somewhere between 17-19% of economic activity in the United States currently involves health services, so there is a lot of consuming going on. But even when the activities do involve people paid to be present, the relationship is poorly understood as consumption. Larry Pray, who may be my very smartest friend, posted about his visit this week with his mother who is suffering from dementia and is in the daily care of people who are not his family. “It is the last day of my visit to the nursing home in Madison. The Memory Care unit to be exact. I am touched, once again, by the kindness of the staff who have learned how to lovingly live with confusion, how to turn caught thoughts to another topic, how to comfort, and how to laugh. Doctors are great, but here where folks actually live it is the staff-on-duty who speak of life.” (http://www.larrypray.com/?p=2024)

It not just impolite or impolitic to describe such relationships as consumption; it makes everyone involved stupid and less able of playing their role. Those closest to the work of healing, the family, are reduced to functional bargains because they work for free. Physicians and nurses are similarly diminished, but paid. Hospital leaders are no more than marketers and distributors of services. Leaders of caring congregations are reduced to gullible partners, lending their skills to doing others’ work without pay. I can assure you that the Le Bonheur staff in the picture care way, way beyond what money can explain.

Thinking of people only as consumers blinds us to the extent that the “health system” is constrained to only institutions and people who do things for money. All professionals, whether medical or those in “public health” are diminished to mere employees and providers of monetized exchanges.

No wonder we have trouble understanding the complex journey to and through our institutional space that is governed by many moments of discernment, trust, judgement, expectation, hope and fear. No wonder we are surprised when, for reasons of race or religion, people fail to act like we think rational consumers would do.

Health is not consumed or provided, it is the name of how we live together. We do not engage consumers, we listen to each other.

So why not call ourselves members? Why not citizens? Why not extended family, brothers and sisters?

Our electronic medical record at Methodist is the hard wiring that connects every member of the our treatment system with those in our care. It keeps track of every pill and procedure for every person involved, including many things nobody pays for, such as spiritual care. Our system is distinctive in that it also has a page allowing physicians to recommend actions to be offered up by a patients’ congregation, as a natural part of the healing system. We have the capacity to help all involved in the caring process to be informed and guided by the others. Sort of like humans might do.

Even those of us most highly paid “providers” will experience our time of dependency. We hope that when we do, we will be engaged not as a consumer, but listened to even as a mother, father, sister, brother, friend.

– Posted on the journey

Ever since moving to Memphis five years ago an odd family tradition involving the Waffle House in Jasper, Georgia has developed. (Hence the picture.) For fifteen years we had hosted an increasingly large Christmas Eve party after church at Oakhurst Baptist. Many folks there have, let us say, complicated families, and we opened our house to those who needed a family place to land on the Eve, eat, drink and be merry. Now we try to catch the service on the way from Rock Hill to our cabin in north Georgia, but instead of having hundreds at own home, we throw our lot in with whoever happens to be in the Waffle House.

The “A-Team” is usually not covering Christmas Eve, so unusual–and always interesting– things happen. Once we were waited on by–I swear to God–Mary. The teen-age waitress was pregnant, unmarried and obviously ready to have the Prince of Peace right there in the corner booth at any moment. Last year, we ordered (eggs, eggs, eggs and, for me, a waffle). After a bit, the eggs and hash browns showed up. Waffle?

“Oh, I’ll be right back.”

The coffee was refilled twice as each time I commented how good a waffle would be.

The third time she noticed all by herself that I was waffle-less. I heard her exclaim (as she shuffled out of sight)…. “waffle, waffle waffle.”

You would not think one would need memory tricks to remember waffles in this restaurant, but some do.

And you wouldn’t think you’d need to remember what Jesus was about, either, but most of find it heard to keep track. And not just amid the ridiculous clutter of brain dead buying and selling that marks the month.

I write in the aftermath of the Waffle House, but also anointed by 10 inches of astonishing snow that has frozen us in place and riveted my attention.

Robert Farrar Capon wrote “The Astonished Heart”, the title inspired by Ecclesiasticus 43:17-18 (KJV): “As birds flying he scattereth the snow, and the falling down thereof is as the lighting of grasshoppers. The eye marvelleth at the beauty of the whitness thereof, and the heart is astonished at the raining of it.” (p.118)

Capon continues: “The Lover who restores the world in Christ is not the God of the philosophers or even the theologians (unless they are very astonishing theologians indeed). And that God is certainly not the god of the inner-harmony-through self-help gurus…. He runs the world from beginning to end by the radically astonishing device of romancing it into being out of nothing….. And when every last particle of creation–including you, me, the lamppost, and the church–ends up dead, gone, and at absolute zero, its heart will still leap up at the voice of the Beloved.” (p122)

“Waffle, waffle, waffle,” she muttered.

“Life, life, life,” I try to remember.

Astonishing.

– Posted on the journey