boundary leaders – Page 3 – garygunderson Blog

Runaway heart

My daughter Lauren is about to give birth to my second grandson, which, with her sense of dramatic timing will probably happen on Mothers’ Day. This also kicks off Nurses’ Week in hospitals. My wife and my (now former) first wife are both clinical professionals and moms. Most of my staff in the FaithHealth Division are women and the men are in touch with their feminine side or they couldn’t do their work of care for the bio-psych-social-spiritual dynamics of the thousands about whom we care. For ninety years our largest partner–the NC Baptist State Convention–uses Mothers’ Day to collect an offering for our most vulnerable patients.

So I’ve been thinking about the expansive caring going on; and the unknowable, but real limits to our reach.

Last Saturday it was my turn to lead the Medical Center’s daily “safety huddle”—the mundane miracle in which every operating unit of the health system from chief medical officer to security to food services and everything in between gathers to report on whether each of us has an event, concern or need to report. Even if we don’t, we have to say so out loud to our colleagues. Usually it moves fast, but sometimes it just stops the heart. Someone reported a situation with a runaway kid who had been compelled to come to the ED by her mom, who promptly run away herself, leaving the kid in our care. Except then the kid ran away from us, too. Everyone hurt hurt. We all dealt with our sense of profound limitations even when the 14,000 hospital people were multiplied by the police and social services. I couldn’t get it out of mind, so the next morning slipped in a prayer amid all the operational chatter:

As Jerry Winslow has noted, it takes a lot of sawdust to find the second life of a tree.

“Mother God, we pray today with thanks for the big heart and strong muscles you have given us so that we might be healers amid so many lives. Every morning we see how big a family of colleagues we have that is constantly present to do what is possible for all who come. Today we pray for all events that raise our concerns for all the needs we cannot satisfy that we cannot get out of our minds, hearts and bones. The runaway kid from yesterday with the runaway mom who left her. All the husbands without words sitting next to their wives with cancer about to leave the whole world behind. All the people who have lost their way to any hope except for the medical miracles that lie beyond us, too. Keep our hearts tender like a mother for all that love lets in. But keep it beating and open for each other and your great spirit so that we might be smart, gentle and kind for this one more day.”

The first cut through the pith lays open the astonishing grain of the burl.

The British Medical Journal has been thinking about this, too, although in grim language of “multimorbidity:” “Across the world healthcare systems are struggling to cope with increasing demands and costs. Rising life expectancy has been accompanied by an explosion in the prevalence of long term conditions and multimorbidity.

“Clinicians are working within legacy systems that were developed to deal with 19th century problems—they provide specialised responses to acute illness and infection. At the same time daily practice is strongly influenced by an ever expanding array of disease centred guidelines that don’t map neatly to the realities of clinical practice, in particular the ubiquity of multimorbidity. The result is fragmented, poorly coordinated health services for those most in need—vulnerable patients with multimorbidity. Today’s healthcare professionals are faced not only with rising disease-disease, drug-drug, and disease-drug interactions in multimorbid populations but with the increasingly evident consequences of socioeconomic disadvantage.

The rough and twisted bark hints at the pattern.

“Meanwhile, patients, their families, and their extended social networks experience not only the burden of symptoms but the burden of treatment. This is an emerging but underi-nvestigated phenomenon. It has received increasing attention recently, and interest has been growing in how to define and better understand the concept.” ( (BMJ Published 10 November 2014)

We could join the public chorus of complaint and rage about what the world is doing to us and demanding of us, as if expanded life span were a mean trick on all of us. Or we could work on what lies between us, the weak ties that could be strong, the empty spaces that could be filled with compassion and carefully tended connections. Even in our mean and stupid time, we are witnessing the dramatically hopeful emergence of webs of trust where you’d think they would be impossible—North Carolina, where you can’t even pee without the government telling you how or where. Good grief. But even here—maybe especially here, where powerful elites have told stigmatized and despised people where they could drink water and pee for generations—webs of compassion spring up on the bitter soil like desert blooms in random rain. Don’t ever be surprised by what a privileged but anxious elite will do badly. And don’t ever be surprised by the fruits of compassion, either. That’s what we are coming to call the North Carolina Way and it is big, strong and unafraid of tough neighborhoods and runaway everything.

When I hurt myself last June, I was drawn into being a partner in the healing of my own body. I have been learning in wonder how we – even me!—are made for healing. Of course we are, since we are also made to be bruised, wounded and broken. All of us, sometimes at others’ hands, but usually a mélange of our own mistakes along the random human way. (That dumb overreaching tennis decision wasn’t my only one!). I’ve been learning to turn wood on a lathe as I healed and found myself drawn to the wonder of hardwood burls, the growth that emerges where a tree has been broken or violated with some sort of trauma. The wood in the burl has a weirdly complex grain pattern, twisty, dense and wondrous. The mysteriously beautiful grain reduces me to respectful awe as the smooth cherry takes a beeswax polish. I think, of course, of Lauren’s pain and that of every woman in my life, of every nurse in every hospital, of every broken heart that manages to stay tender to the pain of the world.

No mom I know stops at the pain. They lend their life and every fiber to what remains possible for those they love. They never cease forgiving and hoping. They teach us not to stop at lament even though so much of what we see is deeply lamentable. They teach us that compassion is the heart of prophesy, of lovingly holding up what remains possible for each person, neighborhood and peoples alive.

The burl is what grows around the trauma experienced by the tree.

Mainsail

Charlie Wolfe, among my very favorite humans. His future is not determined, especially by any of the other 7 billion.

Perhaps you’ve met a human. You have noticed that we can be hard to help. Perhaps you’ve been to a planet like Earth and noticed the same thing, except 7 billion different ways. How do you help something with 7 billion moving parts be healthier?

Advancing population health depends on understanding not just the medical problems, but the drivers of health ….at community scale …over time. Those drivers are largely social and they are not determinants because none of the 7 billion of us humans are determined. Words guide our imagination, shape our ability to talk about what to fear and what to hope for. So it is a big deal to see the 100 Million Lives Campaign “determinants” for “drivers.”

It important for every grown up in any position to influence a single life to talk about life as changeable and chooseable—but shaped by power drivers that have to be confronted. This is especially true for the grown-ups in positions to influence the big social structures like hospitals or faith networks. Monday in Washington DC the Association of Academic Health Centers met to explore how their huge organizations can align themselves wit the leading edge understanding of the social drivers of health. This is a huge shift for them (us, as I am a VP of one….). They brought in the big voices including none other than Dr. Michael Marmot the author of the stunningly powerful studies of social position over time (The Health Gap.). And our friend Dr. Denise Koo one of the principle forces behind the new array of useful tools emerging from the CDC such as the Community Health Improvement Navigator. (http://stakeholderhealth.org/cdc-community-health-improvement-navigator/).

salamis The closing panel of the whole conference was our “ground game” in Winston-Salem. This was explained AND embodied by Jeremy Moseley our Director of Community Engagement and Annika Archie the lead Supporter of Health, with Dr. TC laying down the data beat like a bass player in a jazz ensemble. I had two minutes at the end to set a metaphor like a sail to catch the wind of the spirit moving where you wouldn’t expect it.

The social drivers engage the role of an hospital not just as a provider of therapies, but as a social presence—usually the very largest social/political/economic structure in a community and region. This requires us to see ourselves from a community perspective: inside out and upside down. In Memphis we found ourselves in a covenant relationship with more than 600 congregations that pulled us inside out. In Winston-Salem we have followed the deeply grounded intelligence found in some of our lowest wage workers into relationships that are not just inside-out, but upside down or, better, right side up. We were steering toward life, not just away from death.

Proactive mercy is way cheaper than reactive charity. That’s the whole and complete logic of “population health management.” But if you don’t understand the humans, you can’t expect to be proactive. Being proactive depends on the intelligence about– and trust with– the neighborhoods where the costs of reactivity are concentrated. This requires not just the preeminent brilliance of our surgeons, but of all 14,000 humans on the team. Dr. McConnell and Annika Archie embodied this new deep discovery in the video interview he did with her (and me) last week (click here).

That’s what works.

It is new for big organizations to hold ourselves accountable for social factors. That has always been on the side, a by-product, an unintended consequence. Now it is central. Some say we should think of ourselves as “anchor institutions,” but that image reinforces our worst habits of domination. What could be worse than focusing on anchors of determinants? I’m depressed just typing it!

krusenstern_mainsails — The mainsails are the ones low and large. You leave them up so the ship can keep moving even in heavy seas.

We should be mainsail organizations.

The mainsail is the large sail on a clipper ship low and strong that you leave up even amid the heaviest weather and hardest storm. This includes the storm-tattered neighborhoods you can see outside the windows of urban medical center. You leave the mainsail up because in deep and heavy water you have to keep going or the waves will overwhelm you. The last thing you need is to drop an anchor. That’s what you see in Annika, Jeremy and TC and their hundreds of colleagues setting themselves to catch the same wind of Spirit– surgeons, nurses, social workers and revenue cycle VP’s– that share a hope and mission.

You can even hear it now from some our community partners, glad that we have finally joined them in their journey toward health. They don’t want an anchor; they want to go somewhere new.

Last Saturday our own Rev. Dr. Francis Rivers received the major award from the Hispanic League of Winston-Salem honoring him (and the FaithHealth team) for leaning way into the heavy seas of anti-immigrant venom surging currently in North Carolina in creating the ID Drive. Francis’ award honored him, but also his mainsail organization–and not just the tiny part of it called FaithHealth. The medical center put up a big sail amid very heavy seas that helped other key institutions do their critical work. The Sheriff, police, DA, a network of churches called Love Out Loud, many Hispanic organizations and Que Pasa media). And don’t forget the most important FaithAction—the small faith-based organization that does the actual work of validating identity so that an ID card can be issued and trusted.

ship A fully rigged sailing ship is a very complicated thing with many sails and miles of rigging. So, too, is any network of partners committed to helping their community move away from the rocks and into a safe harbor. But none of the partners could have stepped into the heavy wind themselves, much less alone. That role was for the mainsail and a ship built for deep water.

You might be so embarrassed by all the mean hateful things religious people are doing these days that you want to stop the metaphor right there. But you’d be leaving out the most interesting part of sailing—the wind. The sail doesn’t have any power; it only catches the wind. Greek traces the same word for wind to breath and… Spirit.

We know in North Carolina that the Spirit can blow toward or away from the rocks; it depends on the skill of the sailors and the courage of those who climb up the rigging and set the sails. These are days filled with stupid religious venom, so I don’t blame anyone who wants to move culture and institutions and society without faith. But nothing at cultural scale ever happens without Spirit blowing really hard. You can stay below decks and hope for the best. Or you can find someone who know how to set a mainsail and head to deep water. Francis, Annika, Enrique and the others on the edge, live way up in the rigging where the wind blows with raw power. They teach us to its respect power, but not to fear.

Dr. King spoke realistically when he said “the arc of history bends toward justice.” It is a slow bending curve, more tectonic than sharp. We don’t choose this way or that, but lend our days to the slow bend, helping each other keep courage for the long turning. We set our sails for heavy seas and a long arc toward a horizon worth the journey.

Carolina tears

Sprouts find their way through the bullet holes in an old refrigerator in North Georgia.

Hearts break today in North Carolina.

I think of atheists as slightly over-educated modernists who are harmless, almost quaint, in their ardent non-belief. It had not occurred to me that non-believers were inclined to shoot people over parking slots. But now the Associations of Non-Believers have to explain, just as we Baptists have had to do for centuries, how their style of belief in UnGod can make one mean enough to be kill.

Of course, Atheism doesn’t make you mean any more than Islam, Christianity, Bhuddism or Hinduism. But every one of those structures of meaning have given harbor at some time to dangerous people who kindled the energy of belief into the fire of violence. Belief—and unbelief—can warm or burn.

Someone who believes in nothing is indistinguishable from one who says they believe in God but who do not believe in what that God tells them to do toward others. Groups of people, whether Islamic or Christian, can claim to follow God, but actually believe in their guns, banks, drones or grinding, blinding anger.

No French cartoonist, or student trying to park their car can be entirely safe from delusional nutters. Mental illness often hides in the fog of ardent belief and unbelief. It deserves pity, prayer and, often 21^st century pharma. Turning this man’s delusions into a reason for religious or anti-religious rant only serves the demons.

The most dangerous nutters are the ones who gain control over the instruments of state power. The mentally ill man who shot three students in Chapel Hill is not as scary to me as the elected wackos 25 miles away in Raleigh where an unhinged legislature is considering a bill to prevent Muslims from imposing Sharia Law on the good Christians of Northern Carolina. These guys have a whole police force, not just some guns in a closet. They don’t want your parking place; they want the whole enchilada.

We Baptists remember times when we were strangers in this land, too, and know to fear any government that thinks it is holy enough to know who to punish on behalf of God. The first duty of any Christian—or believer of any other faith—is to work to make their own faith safe for the world and especially for anyone who does not share your faith. You or your children might be a refugee someday, too. This is why every religion that lasted longer than a few seasons raising high the priority to care for the stranger, the weak, the poor, the widow or motherless child.

The actual followers of Islam who pay taxes here are mostly students and a previous generation of students now serving as our doctors, nurses, dentists, computer programmers and anchors of our civilized way of life. There is no clinic or hospital in the entire state (or any of the other United States) that could operate an entire week without the medical professionals from many faiths well beyond my own Christian circle. Our community strategy of “proactive mercy” depends on the powerful faith of saalam-seeking healers of Islam. So our grief extends to the families and friends of the UNC students in a double portion because we share their commitment to the healing arts their entire family so obviously embraced.

I’m a Christian, trying to follow Jesus. He said that God would sort out the right and wrong, sheep and goats later on. The twisting plot of the story made clear God’s decision would surprise everyone involved. Don’t guess God. In the meantime, love mercy, do justice and walk humbly.

Cry with us and lend us with your prayers of mercy.

City of Light

Carolos Latuff, one of hundreds of visual jounalists speaking into the horror of Paris.

Every religion is dangerous. Like fire, wind and water, religion is a fundamental element of human life that can drown, blast and burn. Religion guides our fear and frames our shame. And it can also strengthen our capacity for the courage shown in generosity, compassion, kindness and decency. It can be a wicked brew and also be like warm French cider on a bitter Winter day.

What are those of us who find our hopes in faith to do this week? What do we do when faith has been the language for nearly unspeakable acts? Do we just huddle behind the soldiers, or is there any place for our own actions to be as brave and relevant as the cartoonists like Carolos Latuff poking his pencil into the muzzle of terror?

Can mercy be brave as violence?

Although it filled up the CNN cash register this week, violence between religions is relatively rare and getting more unusual year by year. I’ve quoted the finding of Daniel Pink in earlier blogs, but worth remembering that all forms of violence continue to decline year over year over year. Most religious violence is between those who share a religion but find its variations deeply threatening.

While dozens died in Paris because of their secular differences from Islam, hundreds, probably thousands of moderate Muslims died last week because their 1,500-year-version of Islam embodied the radical hospitality, kindness and sacrificial generosity that fills up the pages of Islamic sacred writings. This is true of every religion. John Calvin burned–literally set fire and watched die–Christian theologians that it would take another theologian to figure out the minor differences in doctrine they were arguing about. He killed Christians not Muslims. I’m a liberal protestant writer who not have survived a week in Geneva. I thought about this when worshipping down the hill from Calvin’s towering grey church with an ecumenical gaggle of english-speaking Christians last July. He would have locked the doors of the World Council of Churches, torched the whole place and everyone in it….and than sung a hymn about it. And Presbyterians are relatively nice people. I’m a Baptist…….which I’m just guessing is more common among the Klan than their up-market Christian cousins.

It is always safer to have a radically different idea about god than a moderately different one using the same language. ISIS kills many more moderate Muslims more eagerly than Christians or those who believe in no god at all but humor. Every now and then they may travel to Paris for some especially flamboyant act of horror. But their every day killing is focused on the vast majority of fellow Muslims they find nearby who understand Islam as a faith of mercy and healing.

There is not much a Christian can do about radically violent Islam. But it would help to avoid accidentally strengthening the most despicable by implying they know anything about Islam. The “terrorists” aren’t radical about Islam, which is a religion of hospitality and charity; they are radical about their own projected fears, insecurities and delusions which are then wrapped in a weird and horrible way in the vocabulary of Islam. Christians know all about this process. Christian politicians are masters at wrapping their reptilian greed with Jesus’ words. But we don’t say of our nutters “those folks who blew up the Federal building in Oklahoma sure were radical about following Jesus!”

Do something to strengthen the moderate Muslims, for whom this is a special time of danger, not only from their traditional nut-cases on the far boundaries of Islam, but now from those of other faiths, including secularity, that will fear anyone they think is a Muslim no matter where they’re from (including Sikhs who stupid Americans confuse with Muslims all the time because of their turbans)(Oh, good grief…..).

TC and I took a check over to our friends at the Muslim Free Clinic on Waughtown Street that I’ve mentioned in my blog before. They were today, as they do twice every month, caring for whoever walked in from the neighborhood that needed healthcare, medical counsel or a clue about where to their pill prescription renewed. It is very mundane, as most mercy tends to be. The physicians and volunteers show up and do it because their faith has thought them to do so. They aren’t aiming for martyrdom; just happy to settle for basic grown-up integrity. They are, as a Christian philosopher once said, “grabbing the near edge of a great problem and acting at some cost to themselves.” It is all a Christian, Muslim, Jew, Sikh, Bhuddist, Zoasterian or cartoonist can hope to do with their lives.

Do this.

Soak in the TV, then turn it off and go find someone who isn’t of your tribe, class, color, faith or opinion and be kind to them in some practical way.

Do this.

And the God known by every name any human has ever uttered in hope will heal your fears and count you among the living.

Do this.

New blade

Six decades later I can still hear the screaming whine of this saw as my dad crafted cabinets with it.

I peered through a hole in our basement wall into a cloud of sawdust where my father fed a piece of wood into the spinning blade. The sound was painfully high loud and powerful, such that I can still hear it, now almost six decades later. I was two or so and learned later the wood was pine, as was all the rest of the cabinets in the home I grew up in, crafted with a mixture of love and parsimony by Dad. The saw, made by Rockwell, eventually became mine and used for most of my adult life as I, too, ripped, spliced, joined and paneled every place I’ve landed. The saw was a primal link to Dad, but over time whined, smoked and wobbled more and more. Once, back when I was earning my living with it doing remodeling, I was moving it from a job site when it bounced out of my nearly-as-old pickup truck, breaking on the pavement. Ken Sehested, knowing my despair, found a friend to weld the key cast iron gear back together, so it lived to wobble on in my life. But eventually the damn thing could no longer hold an angle, sometimes cutting a perfect 45, but more likely 50 or, the other day, 60 degrees. This makes very ugly joinery.

Now wobbling, smoking and whining, the saw prevents, not enables, good work. Dad would not be happy.

Dad would have hated the crappy quality the saw made inevitable and surely would have found any link with him something of an insult. I finally had to distinguish between clinging to nostalgia and actually honoring my Dad’s woodcraft. So I went to Lowe’s, channeled his spirit, and bought a solid Kobota table saw. I’m in the last stages of a new bathroom in TC and my condo near Old Salem and now have a chance at doing the finish work in a way that the Moravians and Dad would find acceptable.

Our lives are filled with the artifacts of those in whose shoes we walk, feeling our feet slightly too small for the journey. Just before Christmas I met with the ethics committee of the medical center, which had been established by the iconic surgeon, Eben Alexander, decades ago (he’s the dad of the recently famous one who wrote about “proof of heaven.”) The committee he started is still appointed by the chief medical officer, also a surgeon. Although medicine and the health sciences are less and less about what happens inside the medical hotel called “hospital,” the focus of the ethics committee continues to be almost entirely at the surgeon’s elbow. It thinks mostly about what the doctor should do or stop doing. Our current model of bioethics is not looking at the CFO’s spreadsheet, or COO’s deployment plans, or the Board’s capital decisions voting millions to build another office in the burbs, even those decisions shape the life and death for thousands of people over time. One can imagine Dr. Alexander shouting, “I started it; you go the next step!”

Surely dad is glad I finally put down the nostagia and picked up a decent tool for work that honors him. — Surely dad is glad I finally put down the nostalgia and picked up a decent tool for work that honors him.

Every nook and cupboard among the health field is filled with guilds, national associations (with local chapters!), honoring this and that habitual practice and committee that made some sense long ago. They all have founders and officers—and sometimes even endowments(!)—but have long lost their capacity to cut cleanly or make useful connections. They have not moved with the science that gives more and more power to the integrated strategies managing conditions over time outside the professional enclaves. We live a long time now mainly because of better food and pharma not because we get surguries frequently. So there are way more ethical implications in the price of drugs than when or whether a surgeon does a procedure. They obstruct and no longer aid the joining of good science to good intentions. We need to honor our moral legacy with a new set of intellectual tools nearly as much as I needed a new saw.

We honor those who have given us life by acting with the creative courage they showed in their time; not by doing the same things their courage demanded then, but doing what courage demands now. We grown-up humans build things out of brick and steel. And we craft habits and patterns of power that guide the flow of money and time to the new glass towers. All these artifacts look solid and lasting, but they are as blowing sand at the beach.

Twice a day the tides wash the in-between land of the marshes.

I am typing this at St. Helena Island, South Carolina watching another morning tide move another day’s load of sand a few feet up the shore. These are called barrier islands because they protect the vital salt marshes which the tides wash twice a day, nurturing its wildly generative life. Very little important happens on the beach; all the life stuff happens in the muck and goop where the shrimp and a zillion other things are born and nurtured before heading to sea. The sand islands protect this vitality because they constantly move and adapt dynamically to the next big storm and even the next shift in climate rising the level of the seas.

Old maps tell the tale: the beaches move; the marshes live on.

In the handful of centuries white humans have settled here, the islands have moved miles. From the top of the 132 foot high light house you can see a few miles to the waves north east where the old one once stood. This new one (1889) is built to move again. Geologists know the whole chain of islands have moved back and forth for millennia. They last because they are dynamic; they serve life because they change. They are like tools built for a season of good craft.

The scope points 8 miles away and a quarter mile off shore where the lighthouse once stood.

Those of us holding positions of influence in institutions like to think our work and our organizations are the key to the life of our communities. Smart people at Stanford play to this pretense by suggesting adaptive change is dependent on “collective impact” organized by “anchor institutions.” These ideas are not just wrong, but dangerously misleading. Living communities don’t need to be impacted, but nurtured; they don’t need more anchors but heart, muscle and guts that serve movement. They do need protection from the raw tides, heavy winds and bitter storms, but protection in the service of change, not protection from it.

What else does any leader have to do that protect the creative energy so that it generates life? Do we have something better to do than that. Whether we are stewards of a church or hospital or public health agency or community health center, the life does not come from the edges, but the heart. I learned in Memphis that if I could protect the creative space for those who usually don’t have much power, they would craft beautiful and useful structure perfectly joined to the possibilities the neighborhoods needed. That process is the “Memphis Model” not the specific apparatus that emerged at that point in time. Don’t confuse the craft (mercy and care) for the cabinet (the structure) and certainly not the wobbly saw (me).

Leaders give life a chance by protecting the generative spaces in which life emerges, especially when those spaces need the complex processes over time. Any human community is way more complex than any salt marsh.

This is almost exactly the opposite of the role big institutions want to play. The leaders of the big things like hospitals can always rent consultants who are happy to tell us to tell the neighborhoods how they should live and how they should change, not us. The model for this is the old way that beach engineers tried to build concrete barriers to stop the tides and the natural shift of the sand (sort of like the one now under 40 feet of water a quarter mile from shore). The more we think like anchors, the more we’re in the way of life, which will most certainly have its way with us.

Roots are a kind of anchor that serve for a time and then not.

This is why I find surprising hope in the small stirring of faith and faithfulness in the faith-inspired healthcare systems of Stakeholder Health. Just about the time when you think smart and cynical are the same thing, along comes life to surprise us. In reality sometimes, large institutions such as foundations and hospitals can provide some shelter amid the raw power of the market forces (the “hurricane” in my extended metaphor). We can be barrier islands against the forces of raw money power, preserving the neighborhoods’ function as the salt marsh where life flourishes and creates the next generation. It actually does happen sometimes. It could happen more.

Francis Rivers Meza, one of our faculty in the FaithHealth Division, shared an article by Patricia Fernández-Kelly (2012): “Rethinking the deserving body: altruism, markets, and political action in health care provision,” in the journal Ethnic and Racial Studies. (click here for the article). She explores the way that religious organizations, including the huge ones such as hospitals, sometimes choose to act against the logic of the capital markets, providing crucial buffering for neighborhoods of poor and often stigmatized people. And they do this on purpose with craft and skill year after year. The authors cite one of our stakeholder health friends, Baptist Healthcare of South Florida and their long term work in Homestead Florida, a place that knows all about the need for barriers against storms.

Life finds a way, Jonas Salk liked to say. Jason McLennan, writing in Yes! Magazine this month says, “If there is one thing that’s certain, it’s that the future hasn’t happened yet.” Bingo! Honor both past and future by helping life finding its next way, not by protecting our old way.

The lighthouse just across the inlet above the gull. Everything moves; life finds a way.

Pompless patriotism

Earl Williams led the gathering in prayer, reminding us that the first July 4th observance celebrated the end of a war, not the triumph of military. The two looking on would not have been allowed to vote, own property or be considered human, much less citizen then.

Jefferson, the pompless patriot, would have approved.

Thanks to the Daily Beast and my brother Ron who forwarded their article, I learned that exactly 1,003 steps from my home near the Square in Salem, the Moravians had created the very first July 4th celebration in 1783. The war had ended allowing the busy little pacifist outpost on the American wilderness to go back to creating a peaceful Christian village. This afternoon they did it again with their hallmark quiet dignity, prayer and brass–the musical kind, not the kind that Jefferson hated. (Read the terrific article here: http://www.thedailybeast.com/articles/2014/07/04/the-first-americans-to-observe-the-4th-were-moravian-pacifists.html )

The Moravians never miss a chance for brass music.

The Moravians, Jefferson and all of us citizens since are a curiously flawed and frayed, yet bold and hopeful, experiment. We’ve had better and worse moments. The failures have always and still do involve ones Jefferson knew well—race, global entanglements and religion that lived out its dumb and mean side rather than grace and hope.

The Moravians knew them, too, compromising on all of them at some point. Yet here they are 231 years later still trying with old prayers and renewed hopes.

We prayed now, as then, for peace and practical fruits of faithful virtues.

This week marks my second July in Winston-Salem after seven in Memphis and many more in Atlanta. I am at home with humble prayers, flawed movements and compromised leaders who are still trying to do the right thing despite it all. I am divorced and remarried, with all the good people involved bruised yet healing and sometimes joyful. I have new work colleagues, too, some still reeling from my arrival, but mostly forming into a smart, tough and bold team.

The reason I came—to help a very good academic medical center with a great heart find its way toward fulfillment of its mission of healing the community…sort of like happened in Memphis. Since I came the medical center has had its two worst financial years since its founding in 1920. But it has not blinked or paused to take some radical moves beyond its walls. This reflects the deep commitment of Dr. McConnell, the Board of Directors and many faith leaders who have followed Ray Howell at First Baptist of Lexington, the first signer of the FaithHealthNC covenant.

The site of the very first July 4th celebration, then on the edge of the American wilderness.

Tomorrow morning some of our physicians who model the integration of faith and health will hold a free clinic at the Mosque a mile to the south of Salem Square. Their Mosque is right in the middle of one of the census tracts the hospital knows because of the high concentration of charity care—and all the predictable conditions of poverty and exclusion. There are no medical care facilities for thousands of people–a clinical wilderness as profound as when the Moravians came to town a couple centuries before. The Muslim physicians will pray for the healing of the neighborhood and also for the end of wars far beyond.

God, who hates religious pomp unconnected from practical compassion, is probably trying to answer both prayers, looking all the time for flawed and frayed people to have enough faith to keep trying.

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?

Mapping Curiosity

These are such interesting days for hopeful people in our wildly dynamic world. Never before in the history of the species have we seen more radical emergence of vast numbers and forms of relational webs. More than two million non-governmental organizations have emerged in the last quarter century. Most of those are now morphing into a complex ecology of financial forms, mostly somewhere in between the old distinctions of faith, government, non-profit and for profit.

The technical name for our current version of we humans is homo sapiens sapiens: we are the creatures who know. And we know we know. I actually think we don’t know….much. But we are absolutely curious!

Jim tells of the curious story of the role of faith in the novel idea of "health for all." — Jim tells of the curious story of the role of faith in the novel idea of “health for all.”

Jim Cochrane leads the leading causes of life initiative. He has long argued that play should be one of the causes of life because from our first breath we poke, explore, crawl, play with our everything we can reach. Yes we do!(leadingcausesoflife.org). In recent months he has pretty much been captivated by…Emmanuel Kant because of the way he places creative freedom at the very center of human capacity.

Hope is possible because we have the capacity to think of entirely new things, and bring them to be. Almost everything nearby you this very moment is product of that creative capacity. The flat screen monitor or iPhone you are reading on which you are reading this are evidence, but indoor plumbing reflects quite a large number of creative moments, too. And there is still profound creativity going on at that end (so to speak) of human process that dwarf the iPhone for life and death significance: check out http://www.peepoople.com/ .

Because it is human, this capacity for creative freedom is social. It is rare for any of us to have a totally autonomous seminal thought of our very own. WE are creatively free, not just me or you. And the root of that social creative freedom is curiosity. When we are young it looks like play, beginning, I think with our body parts: ever watch an infant discover their toes? They are curious about them; study them and then start to figure out. Walking and the long journeys of life come quite later once we learn to talk and read.

We are curious about each others’ curiosity, which is how great creative teams thrive. My favorite new book, “The Surprising Power of Liberating Structures” (www.liberatingstructures.com) is a users guide to the social micro-structures that break and hold open the social space for us to explore what is possible in social webs. What opens up that space is not first imagination, but curiosity about what the group as a whole might discover is possible.

What you know is less interesting than that tickle just over the edge of your knowing just as the eye notices things on the periphery of clarity. The mind notices what moves, quickly ignores anything that stays the same. This isn’t always brilliant, of course. We forget things that matter and are easily distracted. The reason why we have so many rituals and reminders is precisely because we so tuned to what it not known and what might be possible. Nathan Wolfe calls that “adaptive novelty,” suggesting that humans can learn about this strategy for the billions of years virus have used that strategy.

Our most vital relationships and networks form on on a map of our curiosity. This is the terrain we walk from what we know to what we might be creatively free to do. The map of that terrain is rarely conscious, almost never on paper or even scrawled on a wall. Why not invent curiosity maps? Those would be dynamically generative and inviting.

Criterion Institute is a place of such generative mapping, which will be evident as it gathers for one of its astonishing “convergences” in Connecticut this week (http://criterioninstitute.org/convergence/). Later this week a different–but intersecting– map will emerge at the intersection of faith, peace and health at Lake Junaluska in the North Carolina mountains (www.lakejunaluska.com/peace/ ). Meanwhile, Stakeholderhealth.org vibrates with a constant flow of curious new findings about what is possible for faith and mission-driven hospitals to…..do.

Old Salem is still a place where new things might happen.

FaithHealthNC.org is a riot of things nobody thought possible that turn out to be very doable–and that we are creatively free to do. Nobody is planning all of it. We are finding ourselves living on a map of possibilities that is being drawn in real time by unlikely people asking, “what is we did ……together?” We closed the Global Health Symposium yesterday full energy because we were beginning to tune ourselves to the social network emerging from our shared hopes relationships.

Do you want a map of the future? Do you want to know what’s possible?

Map the networks of curiosity. And then live into and on that map with those you find there.

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.