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Paul Hüster & Sabine Wißdorf {*}

Hospitals as Religious Places

A German-American Exchange Programme


From: Herder Korrespondenz, 2/2012, pp. 97-102
webmaster's own, not authorized translation


    For three years the 'Dortmund Kommende' has been organizing an intensive exchange between providers of Catholic hospitals in the U.S. and representatives of providers in Germany. Now on the German side, the first pilot projects start in which the transferability of an American management model for the development of the corporate identity of church hospitals will be tested.


The 'Kommende' in Dortmund Brakel, the Social Institute of the Archdiocese of Paderborn, cultivates via its Director Peter Klasvogt an intensive exchange between providers of Catholic hospitals in the United States and representatives of interested providers in Germany. This involves the questions: How can an economically run hospital in a competitive health care market continue to form a distinctively Catholic corporate identity? By which concepts can a social enterprise in a sustained manner control the synergy of business administration and pastoral care? After three years of a lively German-American exchange first cooperation projects are launched.

But are Catholic hospitals in the U.S. and Germany comparable at all? The initial situation of church hospitals in Germany is in one point very similar to that in the U.S. where more than 600 hospitals are in the traditional way run by the church. In Germany, according to the Catholic Hospital Association (KKVD), about 435 Catholic hospitals are currently working nationwide. This means that here every fourth patient is treated in a Catholic institution. In the United States every sixth patient makes use of a Catholic hospital. The non-profit institutions of the Church in Germany and the United States participate thus with considerable market shares in the economic competition with competing providers.



Many church-run hospitals in Germany have meanwhile formed mergers, because smaller houses are rarely able to work commercially successful. This trend is continuing. The new provider associations have inwardly and outwardly to align their corporate identity. This challenge has also parallels in the provider associations of the American hospital scene: Due to shortage of new members the religious orders in the U.S. have withdrawn from attending the patients and are now securing the institutional structures. Now the 'secular' management of the church institution is faced with the expectation to form and carry on the Catholic corporate identity without the tangible presence of monks and nuns.

In Germany in the past, many providers and hospital managements have redrafted their Catholic corporate identity by means of elaborate mission statement processes. They created thus a corporate identity in order initially to provide the basis for a professionalized public relations and marketing work (see HK, April 2011, 200 ff). Many of the large provider associations of hospitals of religious orders specifically established offices for working on ethical and theological basic issues and for forming a permanent corporate identity, in order to give their mission statements a lasting effect.

The St. Mary's House Ltd. of the Waldbreitbach Franciscan nuns for example, with their more than twenty hospitals and fifty other social institutions has long-since embodied the responsibility for forming its Christian corporate identity in the specially created positions for the executive personnel. For this health care group, it has in an exemplary way become a matter of course to train the senior staff as supporter of the Christian corporate identity. They have developed management tools with the help of which the management can orientate the health care and the development of the organization towards the values of the mission statement. For the quality management of church institutions, the Catholic Hospital Association has also developed a means of securing the Christian corporate identity by the additional certification 'proCum Zert'.

Nevertheless, much remains to be done. As experience teaches, after completed hospital mergers the questions of economic survival and the reorganization of the medical services come to the fore. In these houses the break of tradition and the loss of ecclesiastical corporate identity cause rather a vague perplexity, for which the American partners have little understanding. Bill Brinkmann, a partner of the German-American exchange, puts it in a nutshell: "If a Catholic hospital with its distinct Christian commitment to people does not qualitatively work demonstrably better than other homes on the market, then it is not needed."


The Religiosity of the Employees Constitutes an Integral Part of the American Hospitals

But what are the differences between Catholic hospitals in the U.S. and Germany? With the help of the recently passed health care reform by President Barack Obama, now 32 million previously uninsured Americans are to get health care coverage. Many poor people can up to now not afford an adequate health care. A primary feature of the Catholic hospitals in North America is the practised solidarity with the needy, because the Catholic homes promise to leave behind nobody unprovided. That's why they collect actively sponsorship money and donations in order to alleviate suffering. For those in need, here the particular corporate identity of a religious provider becomes apparent existentially and clearly in the solidarity with the poor.

Furthermore, in the American healthcare system the "training on the job" is coached and a matter of course. The training and instruction of the staff, which has become necessary for imparting the Catholic corporate identity, can seamlessly be linked to it.

Finally, religious beliefs are less "privatized" in America. They are more offensively made known to the public. That's why in training and at work the providers of hospitals without reserve integrate the practised religion of their employees.

The intercultural exchange is beneficial for the differentiation: Fundamentals which had been taken as a matter of course, are re-examined and the own positions emerge more clearly. This applies particularly to the question: How reliable is the official ecclesiastical support for "the great structure" of the Catholic hospitals in Germany? In the past year here significantly new developments began to emerge. They still intensify the weight of expectation regarding the development of a specific corporate identity and thus the concern of the German-American concept transfer.

Until now, latent enquiries by the bishops, "whether there are still Catholic contents where the label 'Catholic' is found," rather left open whether they regard the structure of the church's support in its entirety as fit for the future. In recent statements, the positions and expectations are outlined more clearly.



In the context of a public forum in November 2011 the auxiliary bishop of Cologne Heiner Koch, the future chairman of the Diocesan Caritas of the Archdiocese, e.g. stated that he initially sees the demographic development and the lack of identification with the Church as a dilemma for religious institutions. He estimates that the number of young people who are ready to work in institutions of the church will significantly decrease. As a way out of this dilemma Koch drafts the vision of Caritas as a "place for learning of faith": In the institutions and services of Caritas people could come into contact with faith - because faith is life assistance. Caritas strengthens through its work faith and church affiliation.

In the future, church providers are to succeed in creating, within the corporate culture, places for learning of faith, and thus enable also employees who are 'distant from the church' to identify personally with the charitable mission of the Church. This vision opens pathways, but it is not yet sufficiently backed by proven concepts or established practice.


The Sick and the Church Belong Together

In the journal "Das Krankenhaus" (No. 7/2011), the Munster Bishop Felix Genn has formulated under the title "The Significance of the Catholic Hospitals in the Church" a clear statement: "From the mission of the Church the sick and the Church belong together - from the beginning." He develops his concept from the perspective of the sick people, who expect in the existential situation of disease also personal assistance and support regarding their spiritual and religious experience.

But the church-run hospitals remain a secular area within the Church, "because virtually all the world is there at home, especially due to the patients. Christians seek to make this hospital world a world where the Christian faith comes alive and tangible, where they also find the sense of their life, and where they possibly and hopefully meet God. In this respect, a church hospital is an excellent place of the Church."

Thirdly, an event in the diocese of Essen in 2011 (the same happend simultaneously in America) highlights a controversial challenge: For economic reasons a majority holding at the Katholisches Klinikum Duisburg (KKD), an acute care hospital at four sites, was taken over by the private hospital operating company "Helios". Via the newly established "Cosmas and Damian GmbH", the diocese of Essen holds together with the "St. Elisabeth GmbH" Waltbreitbach 49 percent of the shares in order to preserve the Catholic corporate identity. Within the sold hospital network, for this purpose the administration 'Corporate Culture and Values' has been set up, in order to ensure that also in future under the provider "Helios" the orientation towards Christian values is guaranteed.



There are comparable developments in the American provider landscape. The umbrella association for Catholic hospitals in the United States, the Catholic Health Association (CHAUSA) plans to compile until June 2012 a decision paper on the question of whether profit-oriented healthcare institutions which want to maintain a Catholic corporate identity are allowed to remain members of the governing body.

All these highlights show: bishops who stand by their Catholic hospitals are also looking for concepts of forming their corporate identity. It is time to develop professional management tools for securing the corporate identity of church institutions.


Typical American Enthusiasm and Christian Sense of Mission

In the United States the health care institutions which once were almost exclusively run by religious orders are today affiliated to large provider associations, as e.g. "Ascension Health". This in St. Louis based provider association alone maintains eighty hospitals. It develops policies for all sites and educational programs for a joint corporate identity of Catholic providers. "Ascension Health" has been cooperating at this for years with the Veritas Institute for Catholic Social Doctrine of the University of St. Thomas in Minneapolis.

With the typical American enthusiasm and sense of mission, the Catholic University and the Catholic hospital provider are quite prepared to allow the German exchange partners to examine the development of their concept and their management practices. Visits of delegations and open specialist conferences took place in Dortmund and Minneapolis.

The social ethicist Dean Maines and the professor of theology Michael Naughton are protagonists of the exchange. They work at the Veritas Institute. Bill Brinkmann, Maine and Naughton developed the so-called Catholic Identity Matrix (CIM), in order to ensure that the principles of the Catholic provider permeate the everyday work of the hospital, and outwardly contribute to forming its Christian corporate identity.

Resulting from the German-American exchange, in the Kommende a project steering group was formed. It consists of scientists, experts in organisational development, and provider representatives and has to secure the systematic transfer of knowledge and concepts. After two years of spadework, this expert group is now launching pilot projects in German hospitals, where the applicability of the American management model to the corporate identity development of church hospitals is tested: What was started as scientific exchange bears now pastoral fruits.

In October 2011, the second German-American conference took place in the Catholic Academy Schwerte, where 60 participants together with the American guests examined the applicability of the 'Catholic Identity Matrix'. The Paderborn Auxiliary Bishop Manfred Grothe opened the meeting by stating that the institutions for health care and senior citizens as places of practised faith make an important pastoral contribution to forming the Church and faith.

The participants from the various occupational groups in the German health care system and care for senior citizens wanted to know how it is possible to raise their employees' awareness for Christian values so that they are implemented in their professional area of activity, and which requirements arise for the executives. The managing directors wanted to know how it is possible, despite scarce resources, to connect the development of the Christian corporate identity with other processes, regarding management and organizational development.

In a supervised self-evaluation process, the Catholic Identity Matrix enables the institutions to measure the level of implementation of the defined Christian principles. At the same time, this instrument makes it possible systematically to plan and implement measures for improvements.

These are the six principles of the matrix: solidarity with those who live in poverty, holistic care, respect for human life, participatory community of work and mutual respect, stewardship, and acting in communion with the church. They are mirrored by the following management steps: planning, orientation, process, training, evaluation, and impact. Each principle is linked with a questionnaire that enables an accurate assessment of the implementation in the respective management tasks.


Catholic Identity Matrix

Management tasks
Planning Alignment Process Training Measurement Impact
solidarity with those who live in poverty            
holistic care            
respect for human life            
participatory community of work and mutual respect            
act in communion with the church            
Common good and human dignity



The management initiates the process and enlists a total of 36 persons. For each of the six principles a so-called assessment team is formed in the self-evaluation phase. Six people from all the occupational groups concerned and hierarchical levels work in each of these teams. They are able to make relevant statements to the respective principle. The assessment teams are initially introduced to the contents and procedure of the CIM. Then they go through the questionnaires of Christian principles. About all questions there takes place a self-assessment by the assessment teams. This self-assessment is based on documents of the institution, which are compiled by the respective team members. Here the rule applies: "No anecdotes!" because the self-assessment must not be based on intuition alone but be objectively verifiable.


Pastoral Opportunities

Finally, the assessment team jointly evaluates the extent to which the institution is imbued by these Christian principles. If the group is unable to find an agreement, the different assessments are documented. It is not about a forced decision by consensus, which would possibly obscure conflicts and problems of the institution. The accompanying consultants document the results of all six assessment teams. In joint consultation with the administrative management now possible follow-up actions are discussed, prioritized and planned. The management determines whether and which measures are to be implemented.

This self-evaluation process based on the CIM takes several years. It supports the institution in the implementation of Christian principles. Unlike many processes of quality management, the objective is not a certification. Of course, the results find also expression in the public presentation of the institutions. The discussion about the Christian principles and their implementation in everyday practice remains nevertheless the primary objective. CIM thus contributes reliably to forming the corporate identity of Catholic institutions. The identity formation according to the CIM principles takes place systematically at the level of the organization. First, the professional work of the qualified employees in the field of health care has to be guaranteed. Another focus is on imparting theological knowledge and religious competence for the charitable mission. In America there are graded training and continuing education programmes for this task. Also other management processes, as e.g. developments regarding the staff and the organization as well as controlling elements for business management are of course orientated towards the Christian principles.

These principles are as standard in the same way applied in areas such as leadership, conflict management, issues of participation and co-determination in an institution, sustainable financial and resource management, and in dealing with people needing help and with their families.

There are pastoral opportunities by applying CIM, because the Christian principles are not more or less imparted from the outside and, at worst, imposed as weight of expectation on the institution by theologically well versed experts. On the contrary: The CIM process allows all employees to deal with the Christian principles and make them come alive in their everyday work.

The corporate management bears the responsibility. It likewise orients the strategic regulation of core processes, management and support processes towards the Christian principles. A process that includes all levels and areas of work can only in this way be successfully directed along the same lines within an enterprise. This saves resources and contributes to the internal credibility of the efforts.

Users of CIM in Germany must now examine whether these six principles, which in America were defined on the basis of the Catholic social doctrine, are also here relevant. The way of proceeding of the American identity matrix is based on the "Malcolm Baldrige National Quality Award." One uses thus a procedure that is known from quality management, organizational development and management theory. It can easily be connected with the usual quality management.


No Systematic Catechesis for all Employees

CIM is not a program for a systematic catechesis for all employees. This is out of the question, for the simple reason that many employees belong to other faith communities, and that many people in need have a deliberately detached attitude to the Christian faith. At the organizational level, however, all people who work in Catholic institutions have to know the Christian principles, to esteem them and to implement them in their professional work. At the individual level, many people will begin personally to reflect on their faith and their faith experiences; many of them will, due to measures of religious education, gain qualifications and will contribute these skills to their work.

These are American experiences. Here one speaks of the "group of inspired people," people who in charitable institutions discover their Christian faith. They practise it in such a way that the institution credibly gains in Christian identity and presence.



In his speech at the beginning of the German-American conference, Auxiliary Bishop Grothe, chairman of the Diocesan Caritas of Paderborn, has drafted a future model of cooperation of committed Christians and employees with rather humanistic beliefs. "People who work in such a dedicated and responsible way are invited to participate in the Church's charitable service, because their service is valuable." They shape thus the Catholic community of servants in the sense of a community of joint beliefs and active responsibility.

It is too early yet to assess all the experiences of the German-American exchange. What is needed now in Germany is the practical test in cooperation with social institutions which create opportunities for developing their corporate identity, despite the intensification of work and economic pressure. But the experiences of the American partners are convincing. They show that the "group of inspired people" in church institutions is growing and the Catholic identity of the hospitals can be experienced better, due to systematic efforts in steering the implementation of Christian principles.


    {*} Paul Hüster (born in 1958) is a theologian and public relations consultant. He works as special adviser on communications and spiritual foundations for the St. Augustine Clinics, a large Catholic healthcare provider at the Lower Rhine. In the context of the Rotthaus Academy, Cologne, he offers short seminars on the "added value" of church providers. Currently, he is building a network for relevantly interested and committed people. Contact:
         Sabine Wissdorf (born in 1966) is an independent organizational consultant at the Institut für Sozialplanung und Organisationsentwicklung (INSO) and a member of the steering committee for the German-American exchange in the Kommende.


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