The challenge of the times for Catholic hospitals is not how to improve the value of care, but how to demonstrate the value of the designation "Catholic" in "Catholic hospitals." I know, because I've been privileged to manage Catholic hospitals, serve as a board member for them, and -- as a consultant -- advise them on reducing costs and improving quality of care. I also happen to be Catholic, which I hasten to clarify is about as important to this topic as being Cambodian; it's an unbending characteristic of Catholic hospitals to embrace all people and faiths, so in Catholic hospitals, you get no inner-circle status for being Catholic. I only mention it because it is one reason why I care about the future of Catholic hospitals.
In the late nineteenth and early twentieth centuries, the importance of hospitals being "Catholic" was simple: the church, or more accurately courageous nuns, started hospitals to serve poor communities that desperately needed care and could not provide it for themselves. For example, in 1886, when there were few hospitals (178 hospitals existed in 1872) and no health insurance, and many operations were still performed on kitchen tables, a Sister "Mother Joseph" founded a 31-bed wooden hospital called Sacred Heart in Spokane, Washington. She founded this "refuge for the homeless, poor and dying" to serve impoverished railroad workers, miners, and their families. Today, the mission statement of the health care system Mother Joseph started still expresses that early, Christ-inspired passion to meet the needs of the most vulnerable: "As people of Providence we reveal God's love for all especially the poor and vulnerable through our compassionate service."
But in 2013, health care in America has changed dramatically, and with this change the value of a hospital being Catholic, versus secular non-profit or even for-profit, has become less clear. One big change is simply a decrease in need. There are now 5,724 hospitals in the United States (over 630 are Catholic), ensuring that most communities have a hospital nearby. And 84 percent of patients now have some financial means, such as commercial insurance, Medicare, or Medicaid, to pay for care. This has led Catholic hospitals to compete alongside other hospitals for patients. But the most important change is that those courageous nuns I mentioned are almost extinct: 56,000 nuns exist in the United States today, which -- although it may sound like a large number -- is a 70 percent decline from 1995. Also, 91 percent of them are over 60 years of age. With the loss of nuns, Catholic hospitals have also lost the steady navigation they brought, borne of a lifetime commitment to personal poverty and selfless service to those in need. Also, as nuns retired from Catholic hospital leadership positions, and "professionals" replaced them, the leadership culture of Catholic hospitals began to resemble that of non-faith-based hospitals: for example, business strategies to become the "community hospital of choice" -- for all -- surpassed in preeminence the provision of services to the poor and vulnerable.
The era of nuns leading hospitals has passed. The question is not how to go backwards, but how to clearly define the value of a hospital being "Catholic" in today's society and culture. It's an important question, because existing ambiguity has already caused many to define Catholic hospitals unflatteringly, by the clearest difference they can find: what Catholic hospitals don't do, namely sterilization and abortions, rather than what they do provide.
Even more importantly, this ambiguity hinders the religious "sponsors" of Catholic hospitals from determining the best use of resources in their mission to serve the most vulnerable. For example, is it still "Catholic" hospitals, or is it education or the homeless? Is it here in the United States or in the third world?
My answer is that "Catholic" hospitals are still as needed in the United States today as in 1886. But the unmet health care needs of the vulnerable are much less obvious than before. Catholic hospitals must search for them and have the leadership courage -- dare I say the faith -- to meet them. For example, every Catholic hospital should be a leader in "palliative care," which ensures the best quality of life (e.g., alleviation of pain, discomfort, nausea, and shortness of breath) for seriously and terminally ill patients. Palliative care is poorly reimbursed, which is why it is a largely unmet need, but it delivers compassion and human dignity -- core values of Catholic hospitals. Another unmet need is low-cost or free health care for the uninsured. I mean actively seeking and serving them, not just giving discounted or free care -- as most hospitals do -- when patients arrive at emergency departments or clinics.
In short, as it was in 1886, and as it always will be, it is about leadership. When "Catholic" hospitals lead the way in finding and meeting the unmet needs of the vulnerable, they will rediscover themselves.
Dr. Andrew Agwunobi is a leader of the Hospital Performance Improvement practice at Berkeley Research Group.