Beloved Community – Page 2 – garygunderson Blog

Warren, Kenny and Barney

Warren G is a 43-year old rapper looking for a new song. He should not be confused with Kenny G.

Fred Smith is a Harvard-SMU-Emory PhD and United Methodist preacher. He grew up tough in Oakland playing football. When he and I were walking around Jack London Square Thursday night after a nerve-fraying couple of days, we went looking for some music at the jazz venue just a hundred yards from the water. Up we walked, me in REI garb and blue jean uniform and Fred dressed as Fred. We glanced at the ticket booth and saw Warren G, who we thought, without really thinking very hard, was….Kenny G. In we went, found ourselves seated way in the back looking like two poorly constumed narcs in a room of about 400 …. self-medicating socially complex consumers.

Warren and Kenny did not come from the same G family, nor do they share any musical dna. At all. Soon I realized that Warren wasn’t going to pull out Kenny’s jass flute thing. The wildly appreciative audience knew every syllable of every profane lyric and not-hard to discern hand motions with a rain of language probably not heard outside the Oakland Raiders huddle in a losing game. He couldn’t make it halfway through a sentence or musical phrase without a MFGDSht!??!??!?@#$%@@@@!!!MFGDSht kind of cadence. The audience, including the four young oriental women in the table in front of us and the two Indian couples next to us rocked and danced and shouted along. . I would show you a picture, but it just didn’t seem like a time to whip out my iphone and capture the moment.

I had the impression that Warren wasn’t really the bad ass MFGDsht dude he let on. I’m a Baptist and I know role play when I see it. The whole thing reminded me of one of those mind-numbing praise music servicesthat I witness in the small town Baptist meetings I find myself in from time to time. Warren used MFGDsht sort of like some Christians use Jesus, more as a sound to mark the beat and help everyone now they are in the right show—the one they know the words to.

We all sing songs that, as we age and gain life experience, may not be quite as authentic as they once were.

Kenny G is a very talented jazz musician know for his mellow music. I have no idea how anyone could confuse him with Warren G.

Warren is 43 years old now and probably has a couple daughters. He wants wants a new song. Being from Oakland, he thought his home town adulating fans would like to hear his newest song. They did not. That’s the main point of his new song, which is exactly why his old fans didn’t like it. It was like they turned the fire sprinklers on.

Most of us do not like it when our cultural, religious or intellectual idols sing new songs because it suggests that we may should consider singing something new, too.

The next day I went down to LA with the Association of Professional Chaplains, a more honorable group I cannot imagine. It was a KennyG kind of crowd until the dozens of newly certified chaplains received their certificates marking the end of years of their grueling and sometimes gruesome process. Board Certified Chaplains complete three years of seminary, been ordained and then begun 1,600 hours of intensive and invasive reflective practice in a hospital before going through rigorous and, again, invasive review of written and personal interviews. So at the end of the process they do not want to lie prostrate before the bishop on the cathedral stone. Nope. It is more like WarrenG,;“chaplains gone wild” as one APC organizer names it. A conga line whooping, shouting, yes even sort of dancing.

The Conga line marked an ending; where does it go next? Rev. Valerie R. Storms laid out with devastatingly clarity that the line leads away from all that has been the chaplains’ norm into a new world. Chaplains, because of the radical changes in their medical world context AND in their religious world context need a new song.

Barney Fife and Andy Taylor of Mayberry, modeled on Mt. Airy, just north of Winston-Salem, NC

What is the kind of learning and knowing that helps us find the new tune when we can’t just pick up the beat from our elders?

We need Barney Fife research. We know about Barney because he and Andy lived in Mayberry, modeled after Mt. Airy just about 30 minutes north of Winston-Salem.

You can recognize Barney Fife data it because it offers up proof of the value of the old ways. It honors the crackling exoskeleton left hanging on the tree long after the living body of the insect has found new form and life. Barney found meaning, purpose and value by showing compliance to an extrinsic standard of behavior. He did the right thing by complying, and was scandalized when that right thing failed to be useful in real life. Hospitals need real help in finding their way to a new song, so are unimpressed and dissmisive of proof of mere compliance to their old life even when they pretend to honor it.

Anxious guilds and technology providers invest in research designed to prove their value in terms of the current business model. Of course, they do; the new business model doesn’t exist, yet. But that’s the one that actually matters most. That’s where the conga line is going.

Andy is comfortable with the complex messy pathos of humanity. He always looked for the truth and thus often found it in inconvenient places and unlikely people. Sometimes the truth didn’t make him look good, but he never blinked and made the choices that helped people do the next right thing. In technical research terms, Andy did “formative evaluation” which is designed to evaluate as the process lives, not after its finished and done. It fits what Tom Peters (via Tom Peterson) calls the “permament beta” we live in. The more fluid the situation and creative the process the more you need Andy and the less you need Barney.

A hint at what might be worth knowing comes from the very latest Institute of Medicine roundtable on accelerating the movement to health and health equity. With bold humility it looks at past social movements—many religious—in seek of wisdom to guide the movement we all know we need to seize the opportunity 21^st century science and policy opens up. They are looking for a new song, indeed : ><http://click.newsletters.nas.edu/?qs=0303e74e5f82782dc8ae27ef1e77b6dcc341581cc00a5d2976e414ffa228bb3db9b9a4653daf7745>.

Reverend Dr. Fred D Smith an authentic man of Oakland. — Reverend Dr. Fred D Smith, an authentic man of Oakland.

Our work in North Carolina is about adapting the long legacy of faith and health to a new place and time. We know we are singing a new song and we are tuning all of our tools and techniques to it. We are using a wide array of learning tools and methods to give us as much short-cycle feedback as possible. We are stopping to look carefully at each cohort of a hundred patients we are seeing in our various lines of work; dialysis, Supporters of Health, FaithHealthNC in Lexington. We are beginning the always surprising process of participatory mapping of community health assets using the African model (now on its 7^th iteration). We are doing deep data dives into the full patient populations from 2012 using two radically different analytical models. We are driving and walking the neighborhoods where we know our most vulnerable patients live. We are talking one-on-one to dozens of clergy and the care teams in their congregations. We are allowing all this to form us, not prove us.

The Chawumba event in Winston-Salem July 25-28 is a time for us to find an authentic song for our work and time. We want one that can disrupt our complicity to the old world so far from our hopes. Who knows what song will find voice?

(If you want to be part of Chawumba, it’s not to late to register. Go to StakeholderHealth.org. Or email dhall@wakehealth.edu)

Sin and Liberation

Didn’t expect that title did you? liberating structures

There is something about Good Friday coming in the same week as a day-long medical center budget meeting that turns my mind toward sin; and then, just when you least expect it, toward liberation.

Tom Peterson of Thunderheadworks turned me onto the book The Surprising Power of Liberating Structures by Henri Lipmanowicz and Keith McCandless in his brilliant blog about social change (http://www.thunderheadworks.com/liberating-structure/ ). The book is the fruit of years of work by a way smart group of social change-makers focused on making meetings and events smart and liberating. You may have noticed that most organizational meetings are not very liberating indeed, usually deadly.

Human gatherings can be powerful if built on their 10 basic principles and then artfully crafted with some of their 33 tools. It is easier and more natural than it sounds, because we are built for liberation. We use these tools in many of our FaithHealth trainings and retreats. We will use them in the Stakeholder Health Chawumba event in July (http://stakeholderhealth.org/chawumba/ ). We are looking forward to one of the masters of the craft, Arvind Singhal, being with us next month to teach us in person.

The ten principles of Liberating Structures in the book The Surprising Power of Liberating Structures by Henri Lipmanowicz and Keith McCandless.

The point of all this is not better meetings but a whole new world.

As soon as I read the principles I recognized what I experienced in Memphis through Bobby Baker, Chris Bounds and the hundreds of practical geniuses on that tough ground. The Memphis Model wasn’t just liberating meetings; it was a web of liberating relationships built over time in structures held together by trust. As Bobby would say, real work, not show.

The liberating relational structures of Memphis,–and now North Carolina–aren’t happy accidents. They are built on purpose for the purpose of setting people free from the bondage of what are usually called “social determinants” by healthcare professionals. Things like poverty and broken families are bad enough, but are especially insidious when experts believe they are so powerful that they determine lives. Left to drift, the patterns and privileges of race, wealth, education and law will replicate overtime with the predictability of gravity. However, social factors do not determine the future if a community builds liberating structures strong enough to bend Dr King’s “arc of history” toward justice. Humans can stand up on two legs and walk—even run and jump. But we have to choose to do so. And we can invest our time and resources to new relational architecture, but we have to choose to do so.

Do I even need to point out that budgets usually give in to organizational gravity? How often do you see a liberating budget? (Please don’t mention this column to anyone remotely linked with Wake Forest until after my Division budget closes in a few weeks.)

This gets us to sin, specifically the “deadly sins” of the health industry . Catherine Panter-Brick and Mark Eggerman of Yale University and Mark Tomlinson of Stellenbosch University have just published a bold piece in Global Health Action sure to generate a storm of uncomfortableness by looking at the field of global health through the lens of sin and virtue language. They are looking at global health, but every syllable pertains to the healthcare organizations in the United States that usually don’t think of ourselves as part of the world. The authors are tough: “Structurally, global health has broken faith with its core ethical mandate of addressing the root causes of poor health outcomes, falling prey to four main temptations—coveting silo gains, lusting for technical solutions, leaving broad promises largely unfulfilled, and boasting of narrow successes. These are capital sins in the sense that they engender serious misdeeds and careless misdemeanors, and necessitate a change of heart.” Sin does not get the last word, for there are cardinal virtues, too: “A sharper focus on values and dispositions—aligned with the cardinal virtues of justice, courage, prudence and restraint—is needed to transform global health action.”(http://www.globalhealthaction.net/index.php/gha/article/view/23411 )

The opposite of sin is liberation, which needs the human structures so that the waters might roll down into the parched lands as every prophet for several millennia has envisioned. Earlier this week some of our FaithHealth staff borrowed a church bus and road the tougher streets of Winston-Salem where our data indicated many of our “charity care” patients lived (those are Leland Webb’s ears). Even those of us who are strangers to these neighborhoods could see what is missing that determines so much suffering. We expected that. We were more surprised that once you get out and look, it is actually not hard to see the abundance of assets scattered in the very same neighborhoods.

The scattering of good works has not managed to achieve justice, of course. It is never wrong to give a bag of food or box of meds to someone in need. But surely, it is sinful to be proud of the narrow services that merely ameliorate suffering when so much more is possible—Panter-Brick’s uncomfortable point.

With some some humility (another virtue!) we can imagine liberating relationships that are not there, yet, but could be, if we applied art, discipline and time to bringing the possibilities to life.

Morning Star Missionary Baptist Church, a vital health asset co-led by Rev Charolette Leach, one of our CPE residents at the Medical Center. It sits only blocks from apartments considered to be the epicenter of hopelessness.

Could we imagine new structures, pathways and patterns that would amplify freedom and responsibility? Of course, we can. We just have to choose to do so.

It is impossible to think about sin and liberation this week and not notice that the whole point of Easter is that life breaks out where you least expect it; where you had given up all hope. Spoiler alert: he is alive and we are free. Why are you still satisfied poking around in the tomb among the dead?

Redefining Redefining

Life is messy, more like the picture on the left. From time to time healthcare helps, but life is not about health….care.

It is important to remember this amid the policy maelstrom and the basic fact that the healthcare industry absorbs about 18% of all economic activity in the US economy. I talked about this with a dozen very bright Wake Forest MBA students last week. Len Preslar, the former CEO of Baptist Hospital, leads the class which opened with a review of one of Michael Porter’s landmark analyses of the healthcare industry (http://hbr.org/2013/10/the-strategy-that-will-fix-health-care/ar/1#comment-1084800628 ). We just have to do better or MBA students 40 years from now will still be reading articles about redefining healthcare.

The problem is obvious to everyone outside the industry: healthcare is not a self-contained industry–it is just part of life.

Porter believes that healthcare can be redefined by optimizing the focus of competition among providers so that each incident of treatment is provided by the organization expert (and cheap) in that procedure. This is a good idea, but utterly misses the opportunity.

There is a persistent myopia in a vision of larger conglomerations of providers rationalizing their services as the way provide better value to patients and payers. This helpful but inadequate view of healthcare ignores the larger community context. The good news lies in what Porter leaves out.

Quietly over the past two years a growing number of faith-based and community-oriented healthcare systems have been meeting to ask a basic question: can they actually achieve their founding mission to care for the whole community, not just the insured? Most of these systems predate the birth of health insurance. They were founded by visionary religious bodies or people like Henry Ford, who saw in modern medical science a powerful tool for social justice. Is that vision a delusional relic? The learning group discovered that even amid the half-built policy scaffolding and confusion of state-level politics, we can do what we were intended to do—if we adopt an ensemble of practices very different from Porter’s list because we need more stakeholders to play critical roles. That’s why the group is now moving under the name of Stakeholder Health (you can sneak an official peak at the website stakeholderhealth.org).

Actually, the healthcare sees life even more simply that I was giving them credit for. — Actually, the healthcare consultants see life even more simply that I was giving them credit for.

The first step is to move toward the people (who are only sometimes patients) and the places where social and environmental conditions play a significant role in limiting economic opportunity, dashing the hopes of young people, and perpetuating negative health behaviors. These also happen to be the same communities where much of the Medicaid expansion will be concentrated. We must take focused action, and do so in serious partnership with the panoply of organizations (mostly not healthcare)
which care about these communities. This includes thousands of faith congregations and nonprofit organizations, as well as a growing number of business leaders—all totally invisible if you limit your focus to the healthcare sector.

You can see life whole by looking back on it, here in God's Acre, Old Salem. — You can see life whole by looking back on it, here in God’s Acre, Old Salem.

We must focus on proactive, compassionate problem solving rather than reactive charity. Omitted from Porter’s management view is the fact that the largest single item in the operational budget of almost every health system is charity care. In the case of Wake Forest Baptist Medical System, the total is $68 million last year. While we can’t predict exactly which person will need charity care, we know the census tracts where they likely live. If we engage those complex communities in real partnerships—including with our own lowest paid employees who live there—we could improve outcomes and provide the profound value we were founded for. We have to see the larger system and the full array of stakeholders. The good news is precisely in the larger team that cares about…..life.

Rochester Warming

I just spent two remarkable days in Rochester, New York with the grown-ups in and around its institutions of healing and learning. It was cold; the wind off the lakes gave the first early snow of the season. At one time this part of the country had seen such intense revivals that it was referred to as “burned over.” But Colgate Rochester School of Divinity, University of Rochester School of Medicine and its affiliated hospitals, Strong and Rochester General were warming things up and it felt like home. This was the home of my great uncle, Jessie Hurlburt the last ordained family member and the author of Hurlburt’s Stories of the Bible which my mother remembered hearing in draft form sitting on his lap. But I am more influenced by Walter Rauschenbusch who gave voice to the Social Gospel who taught at the Divinity School here.

Martin’s application picture to seminary.

Rochester knows a lot about how faith can shape politics for good. But it also knows to be suspicious of it and its capacity to make people mean and foolish. Susan B Anthony and Fredrick Douglas are buried here after a life of battle with those who used the language of faith as weapons against the future. Dr. King went to school here and learned much. Dr. Marvin McMiclkle is the new president raising up another generation, hoping for another young Martin.

Rochester was the proud home of Xerox and Kodak and the Erie Canal and remains the home of mystifyingly enduring racial disparities despite the fact the largest employers are some of the finest healthcare organizations in the world. Rev. Wade Norwood led 27 faith and community leaders to ponder how such an array of assets could be mobilized to finish the job Rauschenbusch and his friends started a hundred years ago.

Rev Bobby Baker and I were invited to facilitate conversations about what how the array of health and faith assets could find new energy and vision for what is possible. This city has taught the rest of us so much about what faith can do when organized and aligned with the best of a generations’ science. It is always hardest to remember those lessons in one’s own place, so it was helpful for two visitors from other tough cities to remind them of we learned from them.

They had heard of the hundreds of congregations aligned with the Beloved Community in Memphis. And they had heard about the rising up of the Environmental Services Workers at Wake Forest. So Chaplain Bill Reynolds helped them boldly open up the lecture hall in the heart of medical learning for a panel drawn from the Environmental Workers, interpreters and unit secretaries– for them to serve as faculty. Physicians, executives, brilliant students and community clergy listened, then engaged, the men and women normally only free to be brilliant among themselves.

Mr. White of Environmental Services makes a point while Dr. Berk, CEO, listens.

We gathered in the name of Janice Lynn Cohen who died at 9, but lives through the fidelity of her parents to nurture her memory for 33-years through a lecture series named after her. We also heard the name of 15-year old TeJean Williams who died as he threw his body in the line of fire in front of his grandmother just a couple of days before Bobby and I landed. The room was thick with lament for the two too-short lives. And yet we could see the other grown-ups leaning in, daring to hear. The CEO, Dr. Berk, came briefed to talk, but quietly listened as we all did, letting it in.

Does faith offer up anything of use in such times as these? Does it help grown-ups do our job of creating the structures and systems that give hope a better chance?

The Reverend Bobby Baker speaks of Jesus and Lazarus in Colgate Chapel.

Bobby preached at the Colgate Chapel with a new social gospel illuminated by John 9 story of Jesus releasing Lazarus from the tomb. He told the story through the Leading Causes of Life, so we also used them as lens to focus the panel in the medical school. There was a lot of life to hear.

The most basic spiritual competency is the capacity to listen to the whole life of the patient, colleague, friend, community in front of our eyes. We did that together as we listened to each other in the presence of these two children.

We need another competency that is hard and indeed very hard for many of us: to appreciate the limitations of one’s own history. It is a painful path to appreciate one’s own personal path of complicity with the patterns and powers and privileges so woven into the suffering. One would think that over time we would move toward maturity as we learn. But often what we learn is what we have been part of the wrong and the damage along the way. We –I–need to know forgiveness is possible in order for lament to not be the last word. That is not the last thing we need, of course. But it rolls away the stone, so Bobby Baker said in the chapel. It is never too late. Not while the spirit moves.

Life thanks you

The Reverend Fred Smith has been my guide and pathfinder for many years in the shared work of faith and, well, all sorts of things including health.

This morning Fred sent this kind of thanksgiving anthem to that circle of collegues. It came in while the bizzaro Macy’s thing was filling the streets of New York with balloons, rental elves and such. Just as I was descending into cynicism Fred pulled me toward deep gratitude.

Fred’s words:

I give thanks for
and to all of you.
for all the years
we labored together
in Faith for the Health
of all God’s People.

Let’s all give thanks
for all the inspiration
and soulful deliberations
that has shaped our
common vocations
together.

Life gives thanks
for those who have chosen it
and pursue living
with academic rigor
and the passion
of an evangelist
to a dying world.

From one end of the world
to the other
God gives thanks to all of you
who know
no boundaries
But are deeply woven
together in the Beloved Community

Shalom to you…