Catholic Health Research Articles

The Catholic Church and Its Hospitals

In this conversation from a recent episode of SoundPractice, the discussion focuses on Patricia Gabow’s book *The Catholic Church and Its Hospitals: A Marriage Made in Heaven?*. We delve into the role of bishops and Ethical and Religious Directives (ERDs) in shaping policies within the Catholic health system. We reveal surprising statistics about the reach and influence of Catholic healthcare and discuss the implications for patient care and physician understanding, especially regarding reproductive and end-of-life care. Gabow’s book also addresses considerations for the Catholic health system’s return to mission fidelity.

The role of catholic faith on health - post-pandemic: theological reflection

Health is one of the main elements in human life. Everyone always gives ample space for their health. However, sometimes people forget this when their life goals are not well understood or are limited to certain achievements. This scientific work examines the reinterpretation of the Catholic faith as a search for human nature and how the Catholic faith and health are actually an inseparable unity because humans are complete creatures. Apart from that, this scientific work also reflects the ideal human attitude in facing crises, especially health crises in the new post-pandemic era, namely "Being human also means being a healthy human being" because humans who are able to find faith can understand it. the importance of health in their lives. For those who understand the integral relationship between the Catholic faith and health, this provides confirmation of the true dignity of human beings, including their relationship to "the Divine."

How Do Church Rules Influence Care in Catholic Health Systems? Find Out Here

How Do Church Rules Influence Care in Catholic Health Systems? Find Out Here

Principled Conscientious Provision: Referral Symmetry and Its Implications for Protecting Secular Conscience.

"Conscientious provision" refers to situations in which clinicians wish to provide legal and professionally accepted treatments prohibited within their (usually Catholic) health care institutions. It mirrors "conscientious objection," which refers to situations in which clinicians refuse to provide legal and professionally accepted treatments offered within their (usually secular) health care institutions. Conscientious provision is not protected by law, but conscientious objection is. In practice, this asymmetry privileges conservative religious or moral values (usually associated with objection) over secular moral values (usually associated with provision). In this article, we first argue for a legal right to one kind of conscientious provision: referral for procedures prohibited at Catholic hospitals. We then argue that a premise in that argument-the principle of comparably trivial institutional burdens-justifies legal protections for some additional forms of conscientious provision that include, for example, writing prescriptions for contraception or medical abortions. However, this principle cannot justify legal protections for other forms of conscientious provision, for instance, the right to perform surgical abortions or gender-affirming hysterectomies at Catholic hospitals.

Conscience, Caricatures, and Catholic Identities.

Catholic health care is often viewed as antithetical to secular conceptions of autonomy. This view can engender calls to protect "choice" in Catholic facilities. However, this view is built on a fundamental misunderstanding of the Ethical and Religious Directives for Catholic Health Care Services (ERDs). This commentary, which responds to "Principled Conscientious Provision: Referral Symmetry and Its Implications for Protecting Secular Conscience," by Abram Brummett et al., seeks to demonstrate the nuance of the ERDs as well as to address some of the challenges various Catholic identities have when interpreting and living out the ERDs so that all patients receive high-quality, compassionate care. By highlighting the Church's desire to protect all people at every stage, I hope to dispel the caricatures that often result from misunderstandings by Catholics and non-Catholics alike.

Medical group governance for better organisational integration

Today, three of four US physicians are employed by hospitals, health systems or corporations. Forward-thinking healthcare leaders are looking for ways to leverage the intellectual capital of their employed and affiliated physicians and tighten physician–hospital integration as a means to improve care management and coordination, improve access and quality and reduce costs. Structured medical group governance is one such approach taken by healthcare leaders to enable meaningful and intentional physician–hospital joint decision making and better integration. Governance enables providers to unify and speak with one collective voice, influence the business side of clinical matters, build a unified brand and culture within the organisation and set policy or standards needed to be adopted at scale, to name just a few. Since 2019, Providence Health, a national not-for-profit Catholic Health System providing services across seven states with nearly 9,000 employed or affiliated physicians, has developed a multi-tiered medical group governance structure to coalesce on strategic direction and the major decisions that influence the clinical practice. This paper describes Providence Health’s journey in designing and maturing its medical group governance structure. In this case study, the authors describe the why, the what and the how of medical group governance and provide lessons learned and specific examples of the impact Providence Medical Group boards have had on clinician integration, engagement and alignment across the system.

Spiritual Support Staff Influence Stress Among Hospital-Based Health Care Personnel: A Cross-Sectional Study.

Stress negatively affects well-being, relating to poor physical, emotional, and occupational outcomes for health care personnel. Health care professionals faced extreme stressors in the context of the COVID-19 pandemic, making occupational stress relief a top priority for hospital administrators. Many health systems employ specially trained spiritual support staff as one strategy to alleviate work-related stressors. It is unclear whether health care personnels' perceptions of the availability of spiritual care staff influence self-reported stress. The purpose of this study was to explore relationships between perceived stress and perceptions of availability of spiritual support among acute care health care personnel. This study analyzed cross-sectional, survey-based data collected between February and April 2022 from 1352 interdisciplinary health care staff working in a large, nonprofit Catholic health system in the Western United States. Bivariate tests and multivariate linear regression models were conducted to test for factors influencing perceived stress. Results support that high stress was prevalent in the sample. Perceived availability of spiritual support staff in the hospital and seeking coworker and professional support for work-related stress all independently influence stress in this population when controlling for confounders. Stress of health care personnel may be influenced by the perceived availability of specially trained spiritual support staff. Hospital administrators should advocate for spiritual support staff availability in all health care settings as one strategy to mitigate occupational stress that health care professionals may experience through providing high-stakes patient care. Further research is warranted to uncover targeted spirituality-related strategies to reduce stress and preserve well-being of health care personnel.

Assessing the Variability in Interpretation of the Catholic Directives Pertaining to Reproductive Health Services: An Exploratory Qualitative Study of Two Hospitals on the American East Coast.

The ethics in Catholic hospitals are guided by the Ethical and Religious Directives for Catholic Health Care Services, which provide direction on many topics, including family planning. Previous research has demonstrated there is variability in the availability of prohibited family planning services at Catholic hospitals. This study aims to research a potential source of variability in interpretation and application of the directives through interviewing ethics committee members. Participants were recruited from two different hospitals on the east coast with a total sample size of eight. Ethics committee members were asked questions regarding their personal approach to ethics, their hospital's approach to ethics, and the permissibility of specific family planning methods at their hospital. Most ethics committee members stated that the Catholic faith and/or directives were important in their hospitals' approach to ethics. Most participants stated that they had instances in which their personal approach to ethics conflicted with their hospital's approach, citing women's health and end-of-life care as common causes of conflict. All but one ethics committee member stated that hormonal contraception was forbidden under the directives; however, many members stated that this was either a gray area or permissible under certain circumstances. Reproductive health issues rarely came before the ethics committee at either site with one participant referring to them as "black and white issues." This research suggests that ethics committee members did not see the directives governing family planning services to be ambiguous. However, given the low frequency in which these issues come to the attention of the ethics committee, it is difficult to determine whether the opinions expressed by our participants contribute to the variability between Catholic hospitals when it comes to reproductive healthcare provision. An interesting topic for future research would be interviewing executives at Catholic hospitals to determine where this variability arises.

Tracheal Stenosis in Open Versus Percutaneous Tracheostomy.

This study aims to investigate if there is an increased risk of developing tracheal stenosis after tracheostomy with an open versus percutaneous tracheostomy. The patient cohort included patients receiving open or percutaneous tracheostomies at Catholic Health Initiatives Midwest facilities from January 2017 to June 2023. The primary aim was to compare the differences in the risk of developing tracheal stenosis between open and percutaneous tracheostomy techniques. Between-technique differences in the risk of developing tracheal stenosis were assessed via a Cox proportional hazard model. To account for death precluding patients from developing tracheal stenosis, death was considered a competing risk. A total of 828 patients met inclusion criteria (61.7% open, 38.3% percutaneous); 2.5% (N = 21) developed tracheal stenosis. The median number of days to develop tracheal stenosis was 84 (interquartile range: 60 to 243, range: 6 to 739). Tracheal stenosis was more frequent in patients who received a percutaneous tracheostomy (percutaneous: 3.5% vs. open: 2.0%); however, the risk of developing tracheal stenosis was statistically similar between open and percutaneous techniques (HR: 2.05, 95% CI: 0.86-4.94, p = 0.108). This study demonstrates no significant difference in the development of tracheal stenosis when performing an open versus a percutaneous tracheostomy. Tracheal stenosis is a long-term complication of tracheostomy and should not influence the decision about the surgical technique used.

Faith-based healthcare in Africa: stylized facts from data collected by the Catholic Church

While research on faith-based healthcare in Africa covers a rich array of topics, we still need to better understand some of the basic features of the sector, including its size. This editorial provides a brief discussion of the size of the faith-based healthcare sector globally and in Africa and some of its characteristics based on data on the number of facilities operated by the Catholic Church in Africa, the largest provider of faith-based healtcare globally and on the continent. Africa is the region of the world where the number of Catholic health facilities operated by the Church has increased the most in the last 40 years, but there is a lot of heterogeneity between countries in terms of the number of Catholic facilities in operation.

Effect of a Spiritual Care Training Program to Build Knowledge, Competence, Confidence and Self-awareness Among Australian Health and Aged Care Staff: An Exploratory Study.

The aim of this study was to evaluate a new spiritual care training program with health and aged care staff. A four-module program was delivered to 44 participants at a large Catholic health and aged care provider in Australia. Pre, post and 6week follow-up surveys were administered and included measures of spiritual care competency, confidence, perspectives of spirituality and spiritual care, spiritual well-being, and satisfaction. Paired sample t-tests showed total scores of participants' spiritual well-being, spiritual care competency and confidence significantly improved following the training and were largely maintained at follow-up. Perspectives on spirituality and spiritual care did not significantly change over time.

No Strings Attached: How Catholic Institutions Prospered at the Expense of the Administrative State and Patient Autonomy.

Catholic hospitals and health systems have proliferated and succeeded in American healthcare; they now operate four of the largest health systems and serve nearly one in six hospital patients. Like other religious entities that Wuest and Last write about in this issue, in their article Church Against State, they have benefited by and supported the long reach of conservative efforts to undermine the administrative state.

Does Catholic Health Care Have a Responsibility to Those Harmed by Pollution?

Pollution results from humankind’s failure to be good stewards of creation. Guided by Catholic environmental bioethics, Catholic health care organizations have reduced their contribution to this pollution, but they also encounter its human cost. Catholic hospitals treat countless patients sickened by pollution, which most strongly impacts the poor and disenfranchised—those whom the Church expresses a preferential responsibility to care for, in part via the charity care that Catholic health care provides. The poor encounter another cost of pollution: the financial cost of seeking health care, particularly in the US. The authors argue that Catholic health care institutions should take the moral harm of pollution seriously by reducing the financial burden on those sickened by pollution. As an example, they highlight the situation of those sickened by lead exposure in the US and outline how Catholic health care institutions could consider lessening the financial burden of treating this sickness.

Master Plans, Medical Centers, and Medicare: The Struggle to Restructure Catholic Health Care in the Diocese of Brooklyn in the 1960s

Master Plans, Medical Centers, and Medicare: The Struggle to Restructure Catholic Health Care in the Diocese of Brooklyn in the 1960s

Catholics United on Brain Death and Organ Donation

Catholics have long debated whether brain death (BD) represents true death. Endorsers of this statement represent a broad range of specialties and—whether they reject whole BD as true death, accept whole BD as true death, or remain undecided about whole BD—all agree that the BD criteria found in the American Academy of Neurology (AAN) guidelines and used in current clinical practice do not provide moral certainty that a patient has died. Given that the Catholic Church requires moral certainty of death as a condition for removing organs when this would otherwise kill the patient, that the majority of organ donors are declared dead using the existing BD criteria, and that there is no expectation that the guidelines will be revised any time in the near future in such a way as to establish moral certainty of death, the endorsers recommend a number of concrete actions for Catholics and Catholic health care institutions.

Age-Friendly Framework in Post-Acute and Long-Term Care: Implementing the 4Ms in Long-Term Care

Age-Friendly Health Systems is an initiative of The John A. Hartford Foundation and the Institute for Healthcare Improvement, in partnership with the American Hospital Association and the Catholic Health Association of the United States that uses a framework to ensure high-quality, person-centered care for older adults. The framework, called the 4 Ms, includes what matters, mobility, medications, and mentation. This work outlines a practical, evidence- based approach to implementing 4 Ms care in long-term care (LTC).

Transforming health care: A large health organizations' journey to become an age-friendly health system (AFHS) and beyond.

In 2017, the John A. Hartford Foundation partnered with the Institute for Health Care Improvement, American Hospital Association, and Catholic Health Care Organization to define the 4Ms framework to improve quality of care and health outcomes for older adults. The senior leadership of one of the largest integrated healthcare organizations (HCO) in the country recognized the relevance of these recommendations to the aging demographic of the United States. The health system provides care to over 2,000,000 unique patients annually, about 20% of whom are aged ≥65. We describe how commitment to becoming an Age-Friendly Health System (AFHS) has taken this HCO beyond the targets set by the initiative. Steps guiding evolution of the AFHS model of care are as follows: Initiation, assessment, planning, implementation, sustainability. An AFHS leadership team including geriatrics and quality improvement expertise oversees the initiative. Plan-Do-Study-Act cycles are utilized at multiple stages to develop structures for data collection and reporting outcomes. Initiation and assessment stages identified key champions and existing efforts and programs that were leveraged to implement 4Ms best practices. Working committees with relevant expertise for each M selected evidence-based quality measures and designed/adapted training materials. The EHR is used to integrate quality measures and gather outcome data to inform changes in care. Dashboards capturing quality measures for each M have been implemented and pilot-tested at a community-based hospital and these processes are being adapted and disseminated to other settings. Leadership and stakeholders convene regularly to review lessons learned and next steps. On the health system level, partnering with quality management leaders has led to development of processes that feed into organizational level data used to track longitudinal improvements in patient outcomes. Outcome data in each of the 4M domains are presented. Learning points are shared to help others take a systems-approach to age-friendly change.

Catholic Church’s Efficacy in Alleviating Health Care Provision Normative Challenges in the Catholic Diocese of Kericho, Kenya

The study examined the efficacy of the Catholic Church in healthcare provision in Kericho Diocese, Kenya. It employed the descriptive research design to determine the respondent’s feelings and experiences in relation to the Catholic Church healthcare provision. A total of 384 randomly sampled primary respondents participated in the study through questionnaire. Additionally, key informants including the bishop, a medical coordinator, 9 priests, 4 healthcare personnel and 8 recovered patients were purposely selected for interviews. Quantitative data was analysed descriptively while qualitative data was analysed thematically. The study concludes that the teachings of the Catholic Church on healthcare provision centre on defence for human dignity, common good, solidarity and fundamental option for the poor. The teachings, however, were not fully reflected in the provision of the healthcare service in the Catholic Church healthcare facilities under investigation. Therefore, the church in the Diocese of Kericho has not been adequately effective in healthcare provision. Based on the conclusions, the study recommends that the Catholic Church health facilities in Kericho Diocese should provide health care services in accordance to the Catholic’s teachings on human dignity. The healthcare provision sector should implement personalist ethics of care by respecting the human person in the healthcare service provision.

Catholic Health Care and the Mission Leader: A Religious Exercise.

Inspired by the Divine Healer Jesus of Nazareth, Catholic healthcare has been a religious exercise since its inception. First practiced in the setting of the monastery in the earliest centuries AD and incarnated over two millennia by a variety of religious orders of consecrated men and women, Catholic healthcare today faces a crisis of identity. The role of the mission leader, envisioned by the religious brothers and sisters who founded various Catholic healthcare organizations, was a primary conduit to preserve the charisms of the founders and ensure the identity of Catholic healthcare as a religious exercise and ministry of the Church. With data from a recent survey of Catholic healthcare mission leaders, a number of critical challenges currently confront the role of mission leader and will potentially inhibit that role from fulfilling its original mandate. This article will present the findings of this survey, analyze the resulting challenges and present specific recommendations to strengthen the role of the mission leader and ensure Catholic healthcare will remain true to its ethos as a ministry of the Church and religious exercise.

Christ the Physician: A Theological Framework for Healing in Catholic Health Care.

The metaphor of Christ the physician features prominently in the gospels and the preaching of the Church Fathers, emphasizing that Jesus' work of healing extends beyond bodily ills to spiritual healing as well. Given that the end of medicine is "health," which involves wholeness of body and soul, Christ is uniquely able to accomplish this in us-beginning with grace in our souls in this life, and culminating in the resurrection of the body and restoration of body and soul in glory at the end of time. Drawing on the thought of the Church Fathers and Thomas Aquinas, this paper considers how Catholic health care is distinctly positioned to continue Christ's work of bodily and spiritual healing through medical and sacramental approaches-as we await our perfect and ultimate healing upon Christ's return in glory.