religious health assets – garygunderson Blog

Strong

I rocked back in my chair as Becky brought the prayer to life in her voice. I actually heard my own prayer as if for the first time. We had gathered on a gorgeous Connecticut afternoon at Round Hill UCC using my book God and the People as a magnet. A dozen of us had convened to talk about “prayer as if for the first time.” Although mostly life-long church folks, everyone was more than a bit curious and wary of this talking to God thing. Becky read my prayer, “between clarities,” which in her voice was like opening a Springtime window: “Ever unfolding one, We live between clarities about the most important things. It makes it hard to pray. We are not clear if You invented us to have some to talk to or if we invented you for the same reason.”

That’s not something that would happen with a bowling team. Probably not many of the ten million “nonprofit organizations” in the world, either. Congregations are different social beasts. Their DNA holds distinctive strengths to find, form and express Spirit. Staggering out of COVID amid a European war, with dozens of other countries including our own simmering at the civil boiling point… we need prayer. Not religious chatter. No abstractions. Certainly not just about certainties. Prayer as honest dialogue, listening more than talking. Together.

Congregations have eight strengths which have long held my interest and kept hope alive in my life. I wrote about this nearly a quarter century ago at The Carter Center in Deeply Woven Roots, still in print and used in multiple seminaries. I name the eras of my life by the names of the congregations that held me: Milford Mill, Knollwood, Oakhurst, St John’s and Green Street. I usually sat near the door with friends outside wondering what I was doing within; and those inside wondering why I was not further in. My best thoughts grew here as doubts matured into commitments that have endured woven like threads into fabric.

Ed, Shannon, TC and Gary in the sanctuary of Round Hill Community Church

The idea that congregations have strengths is surprising to some (especially clergy!). On this side of COVID we are remembering that we have more than Zoom and social media to work with. We have things that bring humans together, woven like roots too hold us up and find nurture. We—together—have strengths. And those strengths are adequate to the vast challenges of our melting contentious planet.

These eight strengths have been tested for nearly a quarter century in many communities and congregations of many varieties and traditions. They are there for hard work, built for heavy lifting of entire neighborhoods. The National Academies of Sciences Roundtable on Population Health used this model to help grasp the role of faith-based health assets in communities. The logic of strengths is the taproot of the Memphis Model, which is about congregations, not the hospital. The strengths are the foundation of the large scale faithhealth ground game growing in the Carolinas. They are the positive power of the social determinants.

The strengths of congregations mainly function on the other side of the sidewalk from the hospital. This is why the FaithHealth Division of Atrium Wake Forest Baptist Health is part of the population health group, not solely in the clinical hospital group. We have superb chaplains who are there in the radical crises of the hospital and the poignant times of transition. But most of the time, Spirit and the congregations that nurture and express Spirit flex their social strengths in the neighborhoods where life is happening. This is why the videos based on those strengths are on the FaithHealth.org website that drives our broad “ground game” improving health.

A quarter century after discovering the framework of the eight strengths and writing Deeply Woven Roots, we’ve put up a short set of videos to help you discover your strengths and your roots. The videos are edited so you can take in the logic, or focus on each strength that seems most relevant. Prayers strengthen Spirit; the strengths give the Spirit form, sinew, muscle.

Round Hill Community Church on strong Greenwich Connecticut rock

My experience has mostly been among those trying to follow the Way of Jesus, but it turns out that the strengths are present in any temple, mosque or ashram. They are, I think, the way God has made us strong when we are humble enough to gather as we understand ourselves in the presence of the Ultimate.

We—together—are strong enough. Let me know how your strengths are expressing in the neighborhoods you love. Drop me a note at gary.gunderson@gmail.com

New systems of health

Sometimes when you’ve been walking a long time you forget how far you’ve come and far you can see from the crest. This happens more in the folded and forested Blue Ridge than in the wide open west. But even there above the tree line where it seems you can look right around the curve of the planet, you still have to remember to look up and notice the view.

That’s what I felt when I held the new book Stakeholder Health, Insights from New Systems of Health. It is collaborative learning at its best, edited by Teresa Cutts and Jim Cochrane, two synthetic thinkers who make everyone around them smarter. They were surrounded by 44 authors who were already pretty smart, but together the voice is brave and sure.

Dr. Teresa Cutts at the Rolling Release of the book at Chicago Theological Seminary.

In a time of fear and anxiety, Stakeholder Health writes with collective confidence that we—a very big we—are already well on the way to being new systems of health. We are certainly far enough along the way that we can see what we have to work with: a deep well of tested intellectual tools, street-smart tools for mapping community assets, clarity about the powerful integration of body, mind, spirit and social.

What is new about the new systems? Nearly everything. The new systems are marked by realizing they are systems, not just structures. And we are systems of systems interwoven in complex ways that are impossible to map neatly. But the chapter by Maris Ashe describes the tools we are finding useful in living into such complexity. The next chapter (not as smart, but not bad)(I led the writing team) describes the new ways of leading rapidly emerging in the upper reaches of hospitals today. The next, led by Dora Barilla and Eileen Barsi dives deep into the electronic connectional apparatus, which is how these sprawling systems find coherence and get work done at very large scale. Information technology (IT) is giving way to Relational Technology (RT), which changes everything.

Kirsten Peachey, of Advocate Health Care, outlining the chapter on Integrating Care to Improve Health Outcomes: Trauma, Resillience and Mental Health

The next three chapters are a sweet suite on intellect and testimony vibrating with hopeful, practicality. Nancy Combs of Henry Ford Health led the chapter looking through the lens of community navigators and the radicalizing affect they are having turning the new systems of health inside out. Teresa Cutts (“Dr. Honey” in our home) led a global quality team laying out the extraordinary depth of logic and practice allowing up to map community assets with as much rigor as we’ve long had to map needs. This chapter by itself will change the future of “community benefit” and its tame model of Community Health Needs Assessment. The chapter on integrating trauma, resilience and mental health, led by Kirsten Peachey, will likewise radicalize the thought and practice of “integrated health.” The three chapters together are positive bombshell with energy and intelligence released because of who is in a position to act on the new synthesis. It is profoundly good news, except for the old in-bred guilds trying to hold their power.

Kevin Barnett led the team building the case for a new financial accountability; indeed, a whole new financial logic that synthesizes all of the above so that we are a whole new business—health, and at large scale. This is taken to another radical edge by Doug Easterling and Alan Smart’s chapter on philanthropy. Between the two chapters, we can for the first time see the flow of money at the level of the whole system called health. We can begin to see how the old patterns of tame complicity can be cracked open to let the money flow through to the biggest opportunities.

Jim Cochrane led the writing for the chapter that puts all this American chatter into global context and thus accountable to world class intellect and practice. So much of what is old and creaky in our systems is peculiarly American; so much of the new now emerging is global. This sets up the chapter led by Jerry Winslow – a global citizen who happens to live in California—on mission and the heart of healthy community. Every bit of the book is a call to bold mission, not because of who started them, but because of who needs them—the world that God so loves. All the science, technique and technology fit the work of mercy and justice. Let it roll down.

Even the appendices have some bright lights where you wouldn’t expect them! The first appendix lays out the learning journey of Stakeholder Health, which began in a blizzard in Memphis, turned into the Health Systems Learning Group and found our way through an extraordinary array of learning experiences. I don’t think any of us realized how many steps we had take to the get to the the view (hence the mountain metaphor above). Appendix two is a rich collection of population health screening tools, sure to help many hospitals—and no small number of graduate students. The last appendix has numerous mission and vision statements new guiding hospitals and religious bodies in the field.

The book is in a “rolling release” in Chicago, Winston-Salem and next Tuesday in Oakland. Each bounce gives voice and visibility to the local authors and engages the networks most relevant to the local institutions. You can track it all, of course, on the stakeholderhealth.org website.

Most of the authors work for one or another of the new systems of health, so there is optimism but no happy talk. Most of the new systems are surprised to learn they are new because all of us spend the vast majority of our working days engaged in very old problems. Even when you are near the clearing at the summit with the great view, you have to watch where you put your feat rock by rock or you’ll hurt yourself. I happen to know that is true. The caution is not the whole story, however. It is significant that those of us inside the beast(s) can see the new emerging.

The book will be available for free download chapter by the chapter on July 1, which makes it a kind of textbook likely to be integrated into courses of many disciplines. And it is also available now to purchase on Amazon for $19.95. Just click here. Today.

CS010816-050 (1) — Rev. Francis Rivers, the Faith Health Division’s lead organizing an Identity card drive for the Hispanic/Latino community. Part of what is very new in our New System of Health

The cover picture was taken on a chilly morning in Winton-Salem where one of the New Systems of Health—our own little Wake Forest Baptist Health—found ourselves in the position of having done something really smart and right. We had lent our name, presence, religious voice and political weight to a program offering validated picture ID cards to hundreds of undocumented Hispanics. They were part of the new system of how our city works and who mattered. They honored us by trusting us enough to show up. We were helping each other find our way into the future we were already partly living in.

That’s why that gorgeous picture is on the cover: we are far enough along that we can learn from the journey, pause and testify that we’re on the right path.

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.

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.

Wild Water

“There is only one stream of water. What passes through the bodies of humans, passes through the bodies of animals, insects and plants. It flushes through our sanitation systems, flows through the rivers, seeps through wetlands, rises to the heavens to become clouds, and returns to nourish us and all living things. There is no life outside this cycle, and theology has to get real about it. Talking spirit without talking water is meaningless.” –Steve de Gruchy, Water and Spirit: Theology in the time of cholera.

Steve DeGruchy lived on the turbulent waves where theology was helping those in adjacent fields do hopeful labor amid fundamental vulnerability. Steve died earlier this year in, ironically, a wild river that he should not have been in. One of those emergent fields which Steve thought useful for life, was about Religious Health Assets which is how I became one small potato in his big bubbling stew of hopeful relationships. Last week, a group of us in the International Religious Health Assets Program (IRHAP) planted a tree on the Emory campus and gave papers in his honor at the American Academy of Religion.

Steve has been much in my mind as we get ready to open our “center of excellence in faith and health” in the heart of the hospital precisely because he constantly focused our attention outside of anything with walls toward the community—the social body.

Community is not just where we heal, but the thing that does the healing. This can only make sense when spoken with a theological accent, probably one with an African lilt. Shalom, like Bophelo, is a quality of a social body that is not “sort of like a body” or one only in the mind of a poet or prophet. It is, in the more crude language of our day, a network attribute. A network is not normally thought of as sacred but it can be. Shalom/Bophelo is the work of God, for Trinitarians, the work of the Spirit. We thrive because we are made into something capable of shalom or Bophelo.

Nobody even has an accurate count of how many religious hospitals have been born in the past two centuries. But it is important to note that every single one was formed out of a web of humans bound together in hopeful meaning capable of working amid chaos. Even a cursory glance at the tangled and tumbling stories of how the institutions of healing came to emerge alongside the wild Mississippi reveals a twisty bit of chaos. A hospital that was built to care for a very white Methodist pastor by a plantation owner in the heart of the Delta now provides the preponderance of indigent care for mostly African American men and women, upon whose ancestors’ backs and suffering that early wealth was built. Closely aligned academic and research institutions share the same intertwined ironies that are almost too incendiary to fully map. Today we are wrestling real relationships and caregiving from this bitter landscape partly by means of relationships that dare to bear the name of a “covenant” designed to weave a “web of trust.” We hope to do this even amid ongoing unpredictability at the heart of liquid modernity. We live on the banks of a very turbulent river that never lets us forget that history emerges from unpredictability which produces good, bad and tangled things all along the journey.

It is almost too painful to read Steve’s writings about the complex symbolism of water in which both life and death tangled and tumbled together in ways that can only be spoken of in song, poem and lament. Do not try that at home alone for any one life is too bounded and random on which to rest any hope of transformation. Surely, this is the most obvious thing in all of human history.

The testimony is not all about bleak unpredictability, for chaos has an upside. Both theology and public health wonder whether chaos actually trends toward upside or downside. Human plans are often swept away, but sometimes improved in the process.

The findings of IRHAP on the effectiveness of faith forming entities on improving health outcomes remains somewhat mysterious precisely because the impact is inseparable from the ritual spiritual practices that form, sustain and reform and express faith. Worship, prayer, practices of accompaniment, hope and lament are not advanced by stripping them of their religious essence to be explained by the more barren language of functional outcomes. Health is a by product of an essentially mysterious process of faith. At least that is what those practicing in the context of the faith forming entities say. Steve listened to them, which is why his research and analysis has been so strikingly vivid and bold. May we be so, too.

Gary