Monday, September 28, 2015

"How Can the Church Learn from the Emergency Room?"by Craig T. Kocher and Keith Kocher from Alban Weekly in Durham, North Carolina, United States for Monday, September 28, 2015

"How Can the Church Learn from the Emergency Room?"by Craig T. Kocher and Keith Kocher from Alban Weekly in Durham, North Carolina, United States for Monday, September 28, 2015  How Can the Church Learn from the Emergency Room? by Craig T. Kocher and Keith Kocher
The metaphor of the church as hospital is a rich one, and the relationship between curing the body and caring for the soul lives in the anatomy of Christian tradition.
The medieval church birthed the first hospitals, and biblical scholars and theologians regularly liken the work of the Christian minister to that of a doctor, one who welcomes the sick, binds up the broken and soothes the suffering.
The Gospel writer Luke was trained as a physician, which may explain why the famous example of the Good Samaritan, who bandages and cares for the beaten and bloody man by the side of the Jericho road, appears in his Gospel and no other. Likewise, Luke's medical training surely influenced his account of the early church as possessing healing power in the book of Acts.
And this connection continues to the present day. From our vantage points as a university chaplain and a medical researcher, we see how the hospital -- in particular, the emergency room -- can offer lessons to leaders of the church.
Keith was the lead investigator on a University of Michigan study that looked at differences in patient outcomes for those cared for in emergency rooms. The hypothesis: Those ERs that are exposed to higher volumes of patients and certain types of critical conditions show improvements in their patient care.
What the study found was that patients are less likely to die if hospitalized through busier emergency rooms. While that might seem counterintuitive (you might think that a slower ER would offer more benefits), researchers in fact found that busier ERs likely allow the entire team to develop more experience with any particular illness. That also can put in place the resources to more quickly and efficiently respond to particular types of time-critical illnesses, such as heart attacks, strokes, overwhelming infections and injuries. Key in this process is for the entire health care team to function with a consistent and coordinated approach. This type of coordinated emergency care requires experience, organization and repetition.
One of the major challenges (and thrills) Keith finds working in the ER is the rapid identification and sorting of the true emergencies from the lesser urgencies that require treatment but not immediate intervention.
For example, most patients with chest pain are not having a heart attack, yet they all need a speedy assessment. A small minority of those are experiencing a particular type of heart attack that could benefit immediately from clot-busting drugs or angioplasty. In those cases, the ER team has to manage the patient's current condition while also seeking response from a separate health care team that may not even be at the same hospital.
Emergency room personnel need hard skills that are developed over time through experience and repetition, reflection and action, and organizational focus. It's not far-fetched to see a parallel to the emphasis on the formation of Christian practices that has emerged in recent years as a means to talk about Christian leadership and personal discipleship.
Aristotle and other philosophers and theologians across the centuries have suggested that excellence of skill and character is the product of good habits. In the same way, Christians and the institutions they serve become more like Jesus by doing Christlike things in Christlike ways again and again.
We suggest that these research findings about excellence in health care point to three lessons for Christian leaders and their teams.
First, regular challenges are an opportunity for practice and improvement. Physicians and religious leaders alike encounter constant challenges, though in different forms. In the ER the difficulty may be the proper diagnosis of a potential heart attack, while in the Christian institution it may be the faithful handling of a conflict with staff, gaps between present realities and missional aspirations, or cultural trends that are destabilizing assumed patterns of ministry.
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Busy emergency room
Bigstock/leaf
It might sound far-fetched to look for Christian leadership lessons in the emergency room, but two brothers -- one a university chaplain, the other a doctor -- find similarities in how to achieve excellence in both settings.
The metaphor of the church as hospital is a rich one, and the relationship between curing the body and caring for the soul lives in the anatomy of Christian tradition.
The medieval church birthed the first hospitals, and biblical scholars and theologians regularly liken the work of the Christian minister to that of a doctor, one who welcomes the sick, binds up the broken and soothes the suffering.
The Gospel writer Luke was trained as a physician, which may explain why the famous example of the Good Samaritan, who bandages and cares for the beaten and bloody man by the side of the Jericho road, appears in his Gospel and no other. Likewise, Luke’s medical training surely influenced his account of the early church as possessing healing power in the book of Acts.
And this connection continues to the present day. From our vantage points as a university chaplain and a medical researcher, we see how the hospital -- in particular, the emergency room -- can offer lessons to leaders of the church.
Keith was the lead investigator on a University of Michigan study that looked at differences in patient outcomes for those cared for in emergency rooms. The hypothesis: Those ERs that are exposed to higher volumes of patients and certain types of critical conditions show improvements in their patient care.
What the study found was that patients are less likely to die if hospitalized through busier emergency rooms. While that might seem counterintuitive (you might think that a slower ER would offer more benefits), researchers in fact found that busier ERs likely allow the entire team to develop more experience with any particular illness. That also can put in place the resources to more quickly and efficiently respond to particular types of time-critical illnesses, such as heart attacks, strokes, overwhelming infections and injuries. Key in this process is for the entire health care team to function with a consistent and coordinated approach. This type of coordinated emergency care requires experience, organization and repetition.
One of the major challenges (and thrills) Keith finds working in the ER is the rapid identification and sorting of the true emergencies from the lesser urgencies that require treatment but not immediate intervention.
For example, most patients with chest pain are not having a heart attack, yet they all need a speedy assessment. A small minority of those are experiencing a particular type of heart attack that could benefit immediately from clot-busting drugs or angioplasty. In those cases, the ER team has to manage the patient’s current condition while also seeking response from a separate health care team that may not even be at the same hospital.
Emergency room personnel need hard skills that are developed over time through experience and repetition, reflection and action, and organizational focus. It’s not far-fetched to see a parallel to the emphasis on the formation of Christian practices that has emerged in recent years as a means to talk about Christian leadership and personal discipleship.
Aristotle and other philosophers and theologians across the centuries have suggested that excellence of skill and character is the product of good habits. In the same way, Christians and the institutions they serve become more like Jesus by doing Christlike things in Christlike ways again and again.
We suggest that these research findings about excellence in health care point to three lessons for Christian leaders and their teams.
First, regular challenges are an opportunity for practice and improvement. Physicians and religious leaders alike encounter constant challenges, though in different forms. In the ER the difficulty may be the proper diagnosis of a potential heart attack, while in the Christian institution it may be the faithful handling of a conflict with staff, gaps between present realities and missional aspirations, or cultural trends that are destabilizing assumed patterns of ministry.
Institutional leaders would do well to assume that they will face repeated challenges -- and then welcome those challenges as part of an unfolding story of strengthening and progress. Hidden in each experience of disruption may be a medicine to improve the health of the organization.
Second, improvement happens through reflection and constructive action. Just as health care teams in effective emergency rooms gather to reflect on specific experiences and probe what might be done to improve processes and outcomes, so Christian leaders would do well to build in regular opportunities for personal and corporate reflection in response to challenges within the life of the institution.
Third, teams need to understand strengths and limitations. The research suggests that busier ERs deliver better care in certain circumstances, but that does not make them better in all circumstances. Patients will receive better care at different places depending on a patient’s particular needs and an institution’s distinct capacities. This insight speaks to the core of organizational mission.
No institution can be all things to all people. Leaders and their teams should regularly assess their fundamental purpose in light of their internal abilities, knowing that other institutions will serve other worthy aspirations.
One of the challenges Craig faced in his first year as chaplain at the University of Richmond dealt with the proper role of Christian worship in a largely secular university. The traditional 11 a.m. Sunday chapel service had languished.
Significant numbers of influential alumni and some faculty and staff assumed that Craig’s responsibility was to “fix” that service and re-create a grand mainline Protestant expression, complete with a lengthy choral procession, rumbling organ music and 800 students dressed in their Sunday best.
Other influential voices assumed that university-sanctioned Christian worship had no place in modern academia and voiced strong opposition to any suggestion to the contrary.
Craig’s response was to listen widely and move slowly, recognizing that the question at stake was less about Christian worship specifically and more about who and what the university chaplaincy would be in the midst of a historically Baptist school that now actively welcomes people of all religious backgrounds.
Eventually, Craig’s team started an understated Christian service that is generously orthodox in theology and gathers at the student-friendly and culturally insignificant time of 8 p.m. on Tuesdays, thus satisfying the desires of the first group while calming the anxieties of the second.
What felt like a crisis became an opportunity to reflect and take constructive action, grounded in a careful assessment of mission, strengths and limitations, allowing them to get better at who they were and move toward what they aspired to be as an organization.
Christian leaders and communities have much to learn from other institutions, especially those who share a common mission of bringing healing and wholeness to God’s people. The emergency room may be a helpful metaphor for Christian leaders and the institutions they serve.
Welcoming each challenging experience as an opportunity for improvement, developing healthy habits of reflection and action, and discerning strengths and limitations as a means of calibrating missional focus can help cultivate specific practices that lead to a more excellent way of serving the kingdom.
Monday, September 28, 2015

Approaching the postmodern era as a tremendous opportunity, Jill Hudson identifies 12 characteristics by which we can measure effective ministry for the early 21st century. Based on those 12 criteria, Hudson has created evaluation tools - "an early measuring stick" - to help congregations evaluate their work in this new era. Not everything of the past is ineffective and best discarded, she says, nor will everything we try in the future be successful. But by faithfully listening for God's guidance and carefully evaluating progress using Hudson's tools, looking at the ministry of the whole people of God as well as that of the professional staff, congregations can improve their ministry.
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Ideas that Impact: Creating a Learning Culture
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Creating a Learning Culture" by L. Gregory Jones
Corporations have chief learning officers. The former dean of Duke Divinity School and senior strategist for Leadership Education at Duke Divinity says that Christian institutions should, too.
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Corporations have chief learning officers. L. Gregory Jones says Christian institutions should, too. 
Duke Corporate Education recently interviewed chief learning officers at major corporations in the United States and Europe to understand how the economic downturn had affected the training needs of their employees, including senior leaders. As I studied the findings, I was struck that Duke Divinity School could not have participated in this survey.
We don’t have a chief learning officer. I couldn’t think of a single Christian institution that does.
Why do corporations have them, and we don’t? Yes, we are nonprofit institutions whose very purpose (in the case of seminaries) is education, so everyone is a “learning officer.” Our institutions are usually relatively small, so perhaps we don’t have the funding for a full-time chief learning officer.
Yet those explanations seem defensive and shortsighted rather than compelling. Ironically, educational institutions, Christian and otherwise, have become complacent in a conviction that we “know” what it means to teach and learn. Might we gain significant insights about teaching and learning in formal classrooms if we became more explicit about the learning needs of our own employees and other practicing professionals? Might we more effectively achieve our mission if we invested in our employees the way we invest in our students? The answer is a clear and unequivocal yes.
I found the insights in the Duke CE report to have enormous implications for how Christian institutions could focus the work of a learning officer to support practicing Christian leaders in their own vocations. The report advocated building organizational capabilities rather than just individual competencies; changing mindsets rather than simply cultivating skills; team-based learning to change everyday behaviors; web-based platforms for training and development; and keeping learning close to the work (this presumes that people have also received formal, formational education in degree programs that are crucial to their basic work).
I was intrigued to discover the 70-20-10 principle among chief learning officers for continuing training and development needs: 70 percent of learning occurs in the workplace, 20 percent from coaches/mentors and only 10 percent from formal educational “continuing education” programs. Yet in Christian institutions we typically have reversed these numbers and presume that most learning for Christian clergy, laity and institutional leaders will occur through formal learning opportunities.
To reverse this trend, CEOs of Christian institutions need to look first at their own practices. It is far too easy for a CEO to become single-mindedly focused on the lecture circuit -- that is, delivering his or her vision to employees and expecting it to take hold. But that pattern does not take into account the way most adults learn. It creates a culture in which employees receive information rather than actually learn, initiate and innovate. What would it mean to focus our Christian institutions on what we need to learn, rather than what we already know that we are going to share? How much more effective might we be if we think of ourselves first as learners rather than lecturers?
There is clear theological warrant for doing so. Given our convictions about the ways in which sin, personal and systemic, causes moral and epistemological blindness in ourselves and others as well as our organizations, we of all people and institutions ought to place a premium on the importance of lifelong learning.
But CEOs of Christian institutions don’t have the bandwidth to serve simultaneously as chief learning officers. And there is great urgency, in this time of great ecclesial and cultural transition, to create learning cultures within our organizations. We can learn from A.G. Lafley’s strategy at Procter & Gamble, explored in Roger Martin’s “The Design of Business.” Lafley knew he needed more innovation in the organization, and that he had neither the time nor the temperament for the job. So he promoted a gifted woman to serve on his senior leadership team as Procter & Gamble’s first vice president for design strategy and innovation. In so doing, he told this woman that her responsibility was to consistently ask the uncomfortable questions about innovation that people in the organization would otherwise not raise.
Christian institutions of any size ought to do something similar: Designate a specific person to focus on learning and serve as a member of the senior leadership team. I suspect such a person would also serve to foster innovation and new opportunities for partnership and connection with constituencies. That would be the first step to creating a learning mindset that begins at the top and stretches throughout an organization.
Cisco Systems is well-regarded as perhaps the most innovative organization in the world. To hear Cisco’s CEO John Chambers tell it, that reputation is not primarily because of his style or that of the senior leadership team. Chambers attributes Cisco’s success to its commitment to learning. He says that if you rely on your own ideas for innovation, you will always be behind the curve. But if you are willing to learn wherever you can, from whomever you can, you will likely be far more creative and innovative than you could ever have been on your own.
Where can you go to expand your own learning? Whom can you empower to help you?
"The Need for Embodied Learning for Adults" by Gretchen Ziegenhals
Watching children form a living tableau to make art come alive raises the question: How willing are we to learn by placing ourselves in the middle of the action?
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 "How StepUp Ministry is Learning to Do Good, Better" by Jonathan Wilson-Hartgrove
An already-strong organization cultivated the practice of prophetic honesty to improve its services and help more people rise out of poverty.
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An already-strong organization cultivated the practice of prophetic honesty to improve its services and help more people rise out of poverty.
When StepUp Ministry called Steve Swayne to be its third executive director, it was already a strong organization.
Born out of White Memorial Presbyterian Church in 1989,
StepUp (link is external)had grown from a small group of people passionate about serving the homeless into a $300,000-a-year jobs program committed to putting people back to work in Raleigh, N.C.
Over the course of two decades, this ministry had steadily built a reputation for doing good in the community. In 2008, at the beginning of the Great Recession, they helped 140 unemployed people find jobs.
Five years later, they'd increased that number significantly, helping 363 people find work in 2013 -- more than half of whom had criminal records. And today the organization has a $1.6 million annual budget with operations in two cities and plans to expand through a new organization, StepUp NC, in 2015.
By almost any measure, StepUp’s five-year transformation is an on-the-ground example of what it looks like to transition “from good to great.” But what does this sort of change look like in an organization? What makes it possible for a ministry to learn to do good, better?
It has become a truism in leadership that organizations who want to grow must embrace
failure -- that we have more to learn from our mistakes than from our successes. Still, each of us lives and moves and has our being in a competitive, performance-driven culture.
Sure, the Fortune 500 CEO can say, “Embrace failure.” But most of us worry that someone else is going to figure out we don’t know what we’re doing. Maybe faith inspires radical self-honesty, but self-preservation says, “Don’t let them see you sweat.”
So what makes it possible for the leadership of a church or ministry to embrace self-honesty and move beyond patting people on the back to helping them become more than they already are?
Swayne says it’s trust -- something he learned at a church camp for youth where he and his wife worked after college. “Our goal was discipleship, so the question was, ‘How can you help kids grow in Christlikeness?’” The key, he learned, was to build trust with the kids. “But you’re not just becoming their buddy. From a foundation of trust, you challenge them to grow.”
A decade later, when he was running a publishing company, Swayne applied the same principle to an organization: if you love it, you challenge it to grow. But you do it from a foundation of trust, built in each relationship.
“When I came to StepUp, we had this great jobs program that people had built with their own sweat and tears,” Swayne said. StepUp was good at getting people ready for work. But Swayne noticed that when a woman on her way to a job interview stopped by to get a copy of her résumé, only the job counselor who had worked with her knew how to find it.
The system was inefficient. Often, that counselor was working with someone else.
“I’d call them on their cellphone, but they couldn’t answer right away,” Swayne said. “I knew our people deserved better than that. So we started to build a back-end engine to plan and track everything we do.”
What was needed didn’t require a huge grant or a revolutionary change in daily operations. Instead, it took careful attention to detail and the trust of each staff person and program participant. They employed software called Salesforce that was free to nonprofits; every staff person already had a computer.
“Today, we have an up-to-date file on 800 people, available to every staff member,” Swayne said. “If someone walks into the office needing a résumé, anyone can print it off.”
What’s more, when a StepUp employment recruiter sits down to talk with an employer, she can show him hard data on people who’ve proven that they can do the work when given an opportunity.
But a culture of self-honesty isn’t created by simply using a database, of course. Swayne said this kind of attention to detail is about taking people seriously.
Helping people who are unemployed set goals and evaluate their progress toward them is a concrete way of listening to them and building trust. At the same time, acknowledging the concerns of business owners and answering them in a language they can understand is also about building trust.
Trust is what makes it possible to build a diverse community of people committed to ending poverty. A good database, Swayne said, is one means to that end.
But equally important is what an organization does with the data it has. Beka Dominguez, who leads StepUp’s jobs team, says executive leadership has had to learn not to wait when people on the front lines say something needs to change.
Case in point: a recent reorganization of StepUp’s staff to better align with their strategic goal of moving every employee they place to a living wage
Swayne emphasizes that a culture of honesty depends on leadership that is committed to building consensus among a diverse team. Inviting new people into that conversation was essential to StepUp’s growth.
“When I came, 60 percent of our annual budget still came from the church where StepUp had started,” Swayne said. “If the community was really going to own this, I knew we had to diversify.”
As with any “helping” ministry, the biggest diversity issue for StepUp is economic. How can resourced people learn to listen to those they serve? At the same time, how might people in the vulnerable position of needing help ever trust that they can speak honestly?
“This is our biggest learning curve,” says Art Ross, longtime StepUp board member. “We’re learning how to learn from our clients.”
As a start, StepUp began hiring its own graduates. “We had this great jobs program with hundreds of graduates and hundreds of employers who’d hired them, but we weren’t hiring our own grads,” Swayne said. “We knew we had to start there. It just made sense.”
But the board immediately realized that employees wouldn’t necessarily speak freely about what they heard and saw within the organization. The board decided it also needed to hear from other graduates at the beginning of every board meeting. In time, alumni of the program started to join the board.
Listening to their own graduates again helped StepUp build trust and gather data. What they learned, Swayne said, has challenged the organization to grow in new ways.
“Here were our success stories -- people who’d been through our jobs class, held down a job and graduated from our yearlong life skills class. But they were telling us, ‘You can’t raise a family on $9 or $10 an hour.’”
The so-called working poor taught StepUp board members, staff and volunteers how poverty magnifies everything -- how a flat tire, for example, which might lead to missing an appointment, can be a tragedy for someone living paycheck to paycheck.
“We learned that we’re called to proclaim a living wage,” Swayne said.
So StepUp started to share this challenge with the employers whose trust they had won. “They know we send them good people. To them, we’re a really good pre-employment screening agency. So we’ve started to say, ‘We know you need good workers. Now, our people need a living wage. Let’s work together to see how we can get them there.’”
The honesty StepUp has cultivated is prophetic in its challenge. But it is firmly rooted in a trust that keeps everyone coming back to the table together. “I know this may sound idealistic,” Swayne said, “but I think we can tackle this issue in the business community. People … can learn to see that a living wage just makes sense.”
Years ago, before Swayne was part of StepUp, Art Ross helped facilitate a large contribution to the ministry from an anonymous donor in his congregation. Seeing the potential in StepUp’s approach, the donor wanted to help the organization grow.
“When I went back to tell this donor what we’d done with his money, I started to thank him,” Ross said. “But he looked at me and said, ‘No need to thank me. If this works, it will help me become the person I want to be.’”
With income inequality higher than it has been since the 1920s in America, StepUp’s goal of stability for all is daunting. Swayne is the first to admit that they have a long way to go.
But the gift of prophetic honesty within an organization means that the circle of those who have a stake in this conversation is ever-growing. Still, no one at the table is here for a pat on the back. If it works, they know, StepUp will help them become the community they want to be. In the end, that’s what prophetic honesty is always about.

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