21 June 2019
Dear Interested Readers,
Critical Choices and Uncommon Courage
I have a new “hero,” guru, and role model. She is Sister Joan Chittister, an 83 year old Benedictine nun. Her latest book, The Time Is Now: A Call to Uncommon Courage has been an eye opening, and unexpected surprise. If you have about eleven minutes to invest, click on the link and listen to a conversation from April between Lisa Mullins of WBUR’s “Here and Now,” and Sister Chittister. If you have just a couple of minutes, click here to go to her website and listen to her plead for us to reclaim the spiritual vision that made this country great. There is no question that her message is articulated in biblical terms, but she is not focused on heaven. She is advocating for social justice here now, and is cut out of the same cloth as social activist and founder of the Catholic Worker, Dorothy Day, Vietnam War protestor, Father Daniel Berrigan, and the martyred, now sainted, Oscar Romero.
Let me backup and explain how I found Sister Chittister before I tell you why I think that her message is relative to healthcare.
I have become involved with a group of about twenty people who have come together around the issues of poverty and the social determinants of health in our community. The group is eclectic, except that most of us are over sixty. Politically we range from conservative Republicans who voted for Trump to progressive Democrats who grow rigid at the sound of his name. About eighteen months ago most of us participated in a course called “Seeking Shalom” presented by an Atlanta based organization, the Lupton Center. The two most important things to come from the seminar were the idea was that shalom describes the state of abundance where everyone has what they need, and the ability to pursue happiness in a community where they are respected. For me that definition resonates with the concept of the Triple Aim. The other big concept was that just giving charity does not promote shalom, it perpetuates poverty while making the “givers” feel good about themselves and leaving the “receivers” in poverty feeling marginalized and devalued.
There are a few principles:
- Mutuality: A collective need for community; no us/them
- Participatory: Dignity not Deficiency; not based on brokenness
- Holistic: Comprehensive
- Lead with Mind: As well as with heart. Businesslike/ best practices
- Measure Impact: Not based on activity; not based on what is given away
Real progress requires horizontal partnerships that build a stronger community. You may say that shalom is an impossible utopian image, just like the Triple Aim. My response is that just because the vision seems impossibly distant and not achievable within your lifetime or mine, real social progress can occur over time because there are those among us who feel that we must continue to explore how to continuously improve our communities and the world. Some people align themselves with the concept because they feel it is a moral obligation. Some people align themselves with the idea because they realize that it is the only path to sustainability, and they owe it to their children and grandchildren to get involved. Other people, like Sister Chittister, believe that to seek shalom is to follow the will of God.
The larger group has spun off some smaller discussion groups. Over the last several months a few of us have been meeting on Monday mornings as a discussion group to explore the connection between the community and our faith. We have just finished reading and reviewing Convictions: How I Learned What Matters Most by the theologian Marcus Borg, and the question was where do we go next. One participant suggested that we explore Sister Chittister’s book. Borg is definitely aligned with the concept of shalom and with Sister Chittister. They both reference the “prophets” as voices to be heeded. Borg writes:
God’s passionate love for those victimized by the systems of “this world” is the foundation of “the law and the prophets,”…prophets as radical critics of the economic exploitation and systemic violence of the domination systems of their time proclaimed God’s passion, God’s dream, for a world of justice and peace in which everybody had enough, war was no more, and nobody needed to be afraid.
Let’s be objective. We have in every newspaper on a daily basis evidence that “economic exploitation and systemic violence of the domination systems” is a continuing problem in our time. If religion and a religious origin for a world of “shalom” are offensive to you, I offer you John Lennon’s “Imagine” which is a pretty good description of a vision of “shalom” in a secular world.
Imagine there’s no heaven
Its easy if you try
No hell below us
Above us only sky
Imagine all the people
Living for today (ah ah ah)
Imagine there’s no countries
It isn’t hard to do
Nothing to kill or die for
And no religion, too
Imagine all the people
Living life in peace
You may say that I’m a dreamer
But I’m not the only one
I hope someday you’ll join us
And the world will be as one
Imagine no possessions
I wonder if you can
No need for greed or hunger
A brotherhood of man
Imagine all the people
Sharing all the world
You may say that I’m a dreamer
But I’m not the only one
I hope someday you’ll join us
And the world will live as one
If you clicked on the WBUR link for the conversation between Sister Chittister and Lisa Mullens you would have seen the transcription of the forward that Sister Chittister wrote for her book. It begins:
We have a choice.
You and I stand in a space between two worlds. The first world is the one we were told— and never doubted— would last. The statue of Lady Liberty stood in the bay of the Port of New York and welcomed foreigners to our shores. The Constitution rested on its three-part government, each one serving as a check and balance on the other two, all of them devoted to answering the needs of the entire country. That was then.
Now the statue still stands there but the welcome is an illusion that is too often measured by color and ethnicity. The Constitution still exists, yes, but its interpretation now rests more on the prejudices of partisanship than on universal national concerns.
The second world in which we are steeped, the one we are living in now, defies everything we were taught to expect. Immigrants in dire straits are locked out of the United States. Members of Congress barely speak to their counterparts across the aisle, let alone feel required to respond to their needs. Long- standing international alliances are fracturing. The proliferation of nuclear weapons has raised its ugly head again after years of negotiation— even in countries long considered too small and remote to be a threat to anyone. As Americans, we are the first country to unilaterally violate an international treaty. In our withdrawal from the treaty with Iran that constrained its nuclear ambitions, we undermine international negotiations. A secure and stable national future for a global community can no longer be taken for granted.
That is copy that could have been written for anyone of the twenty plus candidates vying for the Democratic nomination for president. She has a lot more to say about our world today and I hope that you will take the time to read it. Further along she says:
This moment is a daunting one. At every crossroad, every one of us has three possible options: The first choice is to quit a road that is going somewhere we do not want to go. We can move on in another direction. We can distance ourselves from the difficulties of it all. We can leave the mission unfinished.
The second alternative is to surrender to the forces of resistance that obstruct our every step toward wholeness. We can succumb to the fatigue of the journey that comes from years of being ignored, ridiculed, or dismissed for our ideas. We can go quietly into oblivion, taking on the values of the day or going silent in the face of them. This choice, in other words, is to crawl into a comfortable cave with nice people and become a church, a culture, a society within a society. We can just hunker down together and wait for the storm to calm down, go by, and become again the nice warm womb of our beginnings.
The third choice is to refuse to accept a moral deterioration of the present and insist on celebrating the coming of an unknown, but surely holier, future. The third choice is to go steadfastly on, even if we are not sure what we will find at the end of it. …
The third choice is a choice that demands great courage. But courage, however apparently fruitless, is not without its own reward. Anaïs Nin wrote once: “Life shrinks or expands in proportion to one’s courage.” And courage is a prophet’s road.
The prophets had a choice.
So do we.
Sister Chittister is writing in reference to our whole society. Her reference to prophets is biblical and she has a spiritual worldview, but what she implies should resonate with you even if her language and images don’t. We do have modern day prophets that tell us what we can expect if we fail to heed the evidence that we are cooking the planet, moving more and more wealth to fewer and fewer people, and failing every day to provide for the basic needs of tens of millions of our neighbors.
Over the last several months I have been in several meetings, and have privately spoken to other healthcare leaders, where the three choices that Sister Chittister offers have parallels to the strategic discussions that I believe are occurring everyday in healthcare organizations, large and small, urban and rural, and in academic and community practice, across the country. What surprises me is that there is rarely a sense of urgency in these discussions until there is red ink on the balance sheet. Even when it is obvious that there are impending problems, there is rarely a discussion of a need to change. Usually there is a discussion of possible affiliations that might provide relief with a change no greater than loss of autonomy. I do not hear people considering the way forward in terms of the multiple choices that Sister Chittister outlines. In healthcare terms the choices are:
1.“…quit a road that is going somewhere we don’t want to go.” The road I see people quitting is the pursuit of the Triple Aim. It’s like the idea of going to the gym to get in shape. Organizations find it hard to transition to the payment structures of ACOs or the realities and learning curve of population health. The ideas were once attractive, but the work has become too hard. It is easier to continue to rely on Fee For Service even though we all know that it drives behaviors that increase the cost of care. As Sister Chittister says, “We can leave the mission unfinished.”
2. “Surrender to the forces of resistance that obstruct our every step…” The status quo is a most powerful force. Learning “a new way of walking” is hard. There are vested interests that like things the way they are. Why not just imagine that we are in the midst of a storm that will pass. Things will settle down. We will just wait and see. Today’s work is import and exhausting. We will deal with tomorrow when it comes and trust that our experience and skill will be sufficient.
3.“…go steadfastly on, even if we are not sure what we will find at the end of it.” That is the hardest choice, but it is likely to be the only one with a future. That choice requires managerial courage and the courage of a trusting “followship” that is willing to be a part of a team. Choice 3 takes courage. It occurs after considering the difficult message of a “prophet.” Even If an organization does make choice 3, it is easy to loose focus and slide back from 3 to 1, and from 1 to 2. Choice 3 requires persistence. Choice 3 in healthcare is much like the 3rd Era of Medicine, The Moral Era, described by Don Berwick.
What is most difficult for us is to look up from today’s busy work and listen to the “prophets” that advocate the changes that will put us on the difficult road of the third choice before before the frenetic anxiety of imminent failure arrives. That is the situation that makes the good sister’s reference to the Hebrew prophets instructive. Nobody listened to Jerimiah, Hosea, Amos, or Micah. It was inconvenient. Everybody was busy with the status quo. It is the same today, it is inconvenient to give up carbon fuels or to focus on cost reduction in healthcare. We would rather talk about revenue generation because cost reduction has all the appeal of going on a diet. We know the Bible stories, and the horrific outcomes that came to those who ignored the prophets. In the end everyone suffered, but those were just stories.
Deeper into her book Sister Chittister makes a very painful point that is also applicable to healthcare. She points out that “charity” is always applauded and makes people feel good. Asking for a fundamental change, as in working to abolish the issues that perpetuate inequality and the social disparities that lead to compromised health, are always disparaged and resisted. The advocates for changing the system to one that does not need charity are rarely appreciated. Look around and think about it. Her observation is easy to confirm.
Sister Chittister issues a request for courage and action. In healthcare it is easy to feel like we are doing our best even as we are paddling our boats ever closer the waterfall. A change in direction is not easy at either the individual or the corporate level. A change in direction requires the courage to act, and the courage to stay the course once we have accepted the more difficult up hill road to healthcare equity rooted in a more generous society. The same principles apply whether the issue is combating global warming, addressing economic inequity, or continuing the difficult road toward the Triple Aim.
I am just getting into Sister Chittister’s book. I am sure there will be more to ponder. She is a great stimulus to “musings.” Just as I am sure that she has more to tell me, I am certain that I will have more to pass on to you. I will make you a distant member of our little study group as we ponder Sister Chittister’s call to uncommon courage.
Rhodies Everywhere
For the last couple of weeks I have seen beautiful rhododendrons everywhere I go. This year I have noticed and enjoyed them more than I can remember in a long time. Perhaps I am sensitive to them because of the frequency of gloomy, rainy days we have had to endure this spring. It also seems that they have come later and stayed longer than I remember from the past, but I am not a reliable observer.
One of my sons and his wife are graduates of Reed College in Portland. I have been going to Portland since the mid eighties when a close friend and colleague moved there. There are a lot of rhodies as well as Reedies in Portland. One of the things that I enjoyed most about going to Portland is visiting the Crystal Springs Rhododendron Garden that is next door to the Reed Campus. In May when the rhododendrons are in bloom, the garden is a magical place.
The rhodies in today’s header live at the interface of a little patch of woods between my parking area and the lake. They are there for me to enjoy each time I pull out of my garage. When I go for my walks down Little Sunapee Road I see rhodies around almost every house I pass.
When I was a runner, my buddy, an interested reader, and I would frequently run around Lake Waban which was a nice three mile loop near our homes in Wellesley. You should click on the link which will connect you to a site that tries, but fails, to give an adequate sense of the beauty of the loop. We would often go around several times. As the map shows, about a third of the shore line is occupied by Wellesley College, about a third is along the sloping lawns and by European style topiaries of magnificent estates that have been there since the nineteenth century, and the rest is through woodlands and wetlands. At the interface between the estates and the woodlands, the trail passes through a magnificent stretch of about 30 yards that is a cathedral like forest of rhododendrons that must be over a hundred years old. When the rhodies are in bloom it is a jog like few others one could ever take anywhere.
Rhodies aren’t the only flowering shrub or tree that I enjoy, but they are dramatic. I love forsythia, but their dramatic yellow blooms don’t last long. Dogwoods, especially the ones in the woods are wonderful, and lilacs are great, but nothing beats rhodies. I am no horticulturist, but it seems like the rhodies persist longer than forsythia, dogwoods, magnolias, cherry blossoms, and lilacs. Whether that is right or wrong, I am loving them for as long as I can this year. If you live in the Boston area and have never been to Lake Waban, check it out this week. I hope their rhodies are still in bloom. The good news is that the “natural” rhodies at Rhododendron State Park near Mount Monadnock in southwestern New Hampshire don’t bloom until July! I will be there to check them out.
Be well, take good care of yourself, let me hear from you often, and don’t let anything keep you from doing the good that you can do every day,
Gene
