All top and middle managers at SSM are required to attend SSM University, a leadership training course with five modules. The first module is focused on the system roots, heritage and mission, which is stated simply: "Through our exceptional health care services, we reveal the healing presence of God." The goal is that when leaders are faced with decisions like whether to send nurses home on a day of low census or whether a financially strapped service line is worth maintaining, they will have the tools to decide based on the mission.
"Bottom line pressures sometimes dominate. It is difficult to keep the mission, and it's difficult to keep our ministerial commitments at the forefront as market pressures dominate," Panicola says. "And I don't see that easing up anytime soon." Many of the most difficult decisions matching operations and mission inevitably trickle up to the CEO. Brian Keeley, CEO of Baptist Health South Florida, is rarely faced with having to close services because the six-hospital, Miami-based system has a strong enough bottom line. But in a system with so many moving parts, he always starts with one question, he says.
"When we look at everything we are involved in, the first thing we look at is, does it support our mission, or does it detract from our mission?" Keeley says. "It starts with the board and me. When you talk about all the challenges we have, all the opportunities, all the initiatives we have under way, my job is to make sure it supports our mission." Often, the number that is most closely associated with mission is the provision of charity care. Baptist Health and other nonprofits--whether faith-based or not--have come under increasing scrutiny from Congress and the public on the level of charity care they provide.
Baptist Health South Florida established a charity care committee of the board that sets direction for the $150 million in charity care provided by the system. In practice, the chaplaincy and pastoral care staff of 30 administer the charity care program. While Baptist Health South Florida still has a number of Baptist clergy on its system board, Keeley emphasizes that for the boards of the system's hospitals and other affiliated boards, members of all faiths are invited. The only requirement is that they support the mission--something that has allowed Baptist Health to thrive in a complex market.
"The number of Baptists in South Florida right now is miniscule," Keeley says. "The dominant faith now is probably Catholic primarily because of the Hispanics. The fact that we reach out and are inclusive has been embraced by the community."
Ethics and religion
Beyond the challenges of staying true to a mission based on a single faith heritage, the curious cocktail of hospital mergers and market forces have formed some faith-based systems with multiple backgrounds. What makes sense for business often leads to enormously complex reconciliation of ethical and religious directives--nowhere more so than in Denver, where Exempla Healthcare is in the midst of a messy family squabble.
Exempla was created in 1998 as a merger of two hospitals: 400-licensed-bed Lutheran Medical Center and 565-licensed-bed Saint Joseph Hospital. In 2004, 202-licensed-bed Good Samaritan Medical Center was added to the network. Today, Good Samaritan and Lutheran are nonsectarian and sponsored by the Community First Foundation, a small community-based foundation, and by the Sisters of Charity of Leavenworth Health System, a Catholic system composed of nine hospitals in California, Kansas, Colorado and Montana. Saint Joseph is owned by SCLHS, and its governance and management are left to a 16-member board and Exempla President and CEO Jeff Selberg.
The split became apparent when Sisters of Charity offered $300 million to the Community First Foundation to buy its sponsorship in Good Samaritan and Lutheran, a move that would effectively give control of the three-hospital system to SCLHS--and would necessitate that healthcare services at those hospitals meet ethical and religious directives of the Catholic Church that prohibit such services as tubal ligations and terminations of pregnancy. The issue is ongoing, with pieces playing out in the court of public opinion by advocacy groups concerned with abortion and end-of-life care, as well as in the courts, as the Exempla board has filed a lawsuit to block the proposed transaction.