Catholic healthcare systems have moved increasingly toward involvement with other healthcare organizations and providers, and while there may be similarities to relationships formed by and between secular organizations, there will also be differences.
Similarities
In terms of similarities to partnerships entered into by and between secular healthcare systems, the players may have common desires, such as sustaining the ability to provide a continuum of care (United States Conference of Catholic Bishops, 2009; American Medical Association, 2022), becoming more economically efficient (Council on Ethical and Judicial Affairs, 2018), improving access to quality, affordable health care services for their communities (Idler et al., 2019; Alliance of Catholic Health Care, 2021), sharing/conserving limited resources (USCCB, 2009; Levin, 2016), and advancing technologically or pursuing other innovations to improve healthcare (Urquhart, 2015). Maintaining compliance with regulatory bodies might be another similarity shared by Catholic and secular healthcare partners in a proposed merger.
Differences
Nevertheless, forming a new partnership between Catholic healthcare services and a secular healthcare system is different and will present different challenges. Per the Catholic bishops’ directives, the Catholic organization needs to complete a moral analysis of any potential partner, limit its participation in activities judged to be morally wrong by the church and protect itself from any risk of scandal, while the secular partner is expected to respect the church’s teaching (USCCB, 2009). Also, the merger process may be more time-consuming as Catholic leadership or governance must be involved in and approve of any development of partnership and binding agreements are often re-assessed (USCCB, 2009; DiVarco & Slattery, 2018). Healthcare leadership will need to think these challenges through well as these unions are considered.
System Level Elements
At a systems level, new partnerships have a great effect on the multiple elements involved in caring for patients, including management structure, leadership culture, policy development, clinical guidelines, delivery and support structure, information technology, and education.
The AHA-AMA’s Principles
The AHA-AMA’s principles for Integrated Leadership for Hospitals and Health Systems urge integrated health systems to promote the characteristics of adaptive institutional culture, including a focus on the health of the population served, agreement on a common mission, vision, and values; mutual understanding and respect; and a sense of common ownership of the entity and its reputation (American Hospital Association, American Medical Association, 2015, as cited in CEJA, 2018). Individual employees tasked with making and adapting to these changes will be the ones who make the system work. Physicians and other health care professionals regularly confront the effects on patients’ lives and well-being of the institutional arrangements through which care is delivered and have a responsibility to advocate for the resources patients need, as well as to be responsible stewards of the resources with which they are entrusted.
Physicians and other health care professionals regularly confront the effects on patients’ lives and well-being of the institutional arrangements through which care is delivered and have a responsibility to advocate for the resources patients need, as well as to be responsible stewards of the resources with which they are entrusted. The exercise of conscience by individual caregivers also comes into play (CEJA, 2018).
Consolidation – Providers
Consolidation among religious and secular healthcare entities can be a source of tension for physicians and other healthcare professionals who are employed by the new entity (American Medical Association, 2022). For example, the Catholic provider may feel they must compromise their moral principles to comply with the policies or clinical guidelines of the consolidated organization. Spiritual beliefs of physicians bring additional complexity to difficult clinical decisions. For example, the Catholic healthcare provider is motivated to offer care that addresses the physical, psychological, social, and spiritual dimensions of the human person, not just the treatment of a disease (USCCB, 2009).
Consolidation – Patients
Conflicts may arise related to spiritual assessment, referral to pastoral care providers, end-of-life decision-making, and delivery of spiritual care (Levin 2016). Consolidation among healthcare systems with diverging value commitments and missions may also limit the services that are available to patients (American Medical Association, 2022; Penan & Chen, 2019) or health consumers may be unaware of any newly permissible care or religiously based restrictions on care, and thus not know what services they can or cannot receive due to increasingly complex and clouded partnerships (Solomon et al., 2020).
Leadership Participation
Individual providers must consider how they can participate in leadership and create a culture of collaboration to make the system work and maintain a transparent professional-patient relationship. As the delivery of care becomes increasingly multidisciplinary and technologically advanced, innovation is becoming a collective endeavor. Many new tools and practices introduced in healthcare organizations are complex and require coordinated use by many individuals and professional groups. Thus, there must be a high level of interdependency among individuals in the system (Urquhart, 2015). All of these challenges must be negotiated in order to practice “compassionate medicine” and “to do what is best for the patient” (Puchalski, 2001, p. 35 as cited in Levin, 2016)
Given the many changes and challenges facing healthcare today, the formation of partnerships is becoming necessary to optimize healthcare.
Advantages
Karam, Brault, Van Durme & and Macq (2018) note that interprofessional and inter-organizational collaboration have become important components of a well-functioning healthcare system. These collaborations will be able to integrate knowledge throughout the system and solve challenges while delivering efficient, high-quality, compassionate patient care. Browning et al., (2016) maintain that rapid innovation and adaptation to change require a collaborative, interdependent culture and solutions that cut across function, region, and profession, and thus, encourage leaders to shift away from an “individual expert” model and towards a model that leverages cross boundary groups and teams and spans disciplines, levels, functions, generations, and professions. Aims to foster interdisciplinary and inter-organizational collaboration are improving communication, teamwork, professional roles, conceptual underpinning, and the coordination of care (Simons et al., 2022). Browning et. al. (2016) maintain that rapid innovation and adaptation to change require a collaborative, interdependent culture and solutions that cut across function, region, and profession, and thus, encourage leaders to shift away from an “individual expert” model and towards a model that leverages cross boundary groups and teams and spans disciplines, levels, functions, generations, and professions. Aims to foster interdisciplinary and inter-organizational collaboration are improving communication, teamwork, professional roles, conceptual underpinning, and the coordination of care (Simons et al., 2022).
The impacts described include increased knowledge, improved collaboration, improved communication, enhanced role clarity, and developments around the systemic level of collaboration (Simons et al., 2022). The Alliance of Catholic Health Care maintains that partnerships between Catholic healthcare providers and secular academic health centers have improved the accessibility and affordability of health care services enabled efficient care coordination and sharing of expertise and training opportunities (Alliance of Catholic Health Care, 2021).
Cautions to Consider
Cautions that should be taken into account by each partner in a proposed partnership, particularly the Catholic church examined in this setting, include the possible effect on the identity of the institution, its ability to implement its directives, the effect on the existence of other affiliated institutions and services, and diminishment of autonomy and/or ministry (USCCB, 2009).
References
Alliance of Catholic Health Care. (2021). Frequently asked questions on partnerships between California’s Catholic health care and secular providers. thealliance.net. Web.
American Medical Association. (2022). Mergers of secular & religiously affiliated health care institutions. ama-assn.org. Web.
Browning, H. W., Torain, D. J., & Patterson, T. E. (2016). Collaborative Healthcare Leadership A Six-Part Model for Adapting and Thriving during A Time of Transformative Change [White Paper]. Center for Creative Leadership. Web.
Council on Ethical and Judicial Affairs. (2018). Report of the council on ethical and judicial affairs (CEJA report 2-A-18). Ama-assn.org. Web.
DiVarco, S. M., & Slattery, K. B. (2018). Compliance concerns for Catholic health care collaborations. McDermott Will & Emery Law 360. Web.
Idler, E., Levin, J., VanderWeele, T. J., & Khan, A. (2019). Partnerships between public health agencies and faith communities. American Journal of Public Health, 109, 346-347. Web.
Karam, M., Brault, I., Van Durme, T., & Macq, J. (2018). Comparing interprofessional and interorganizational collaboration in healthcare: A systematic review of the qualitative research. International Journal of Nursing Studies, 79, 70-83. Web.
Levin, J. (2016). Partnerships between the faith-based and medical sectors: Implications for preventive medicine and public health. Preventive Medicine Reports 4, 344-350. Web.
Penan, H., & Chen, A. (2019). The ethical & religious directives: What the 2018 update means for Catholic hospital mergers. National Health Law Program. Web.
Simons, M., Goossensen, A., & Nies, H. (2022). Interventions fostering interdisciplinary and inter- organizational collaboration in health and social care; an integrative literature review. Journal of Interprofessional Education & Practice, 28, 100515. Web.
Solomon, T., Uttley, L., HasBrouck, P., & Jung, Y. (2020). Bigger and bigger: The growth of Catholic health systems. communitycatalyst. Web.
United States Conference of Catholic Bishops. (2009). Ethical and religious directives for catholic health care services. (5th ed.). USCCB. Web.
Urquhart, R., Jackson, L., Sargeant, J., Porter, G. A., & Grunfeld, E. (2015). Health system-level factors influence the implementation of complex innovations in cancer care. Healthcare Policy, 11(2), 102–118. Web.
Van der Schors, W., Roos, A-F., Kemp, R., & Varkevisser, M. (2021). Inter-organizational collaboration between healthcare providers. Health Services Management Research, 34(1), 36-46.