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Faith-based health care

Gary Shorb leads Methodist Healthcare, a Memphis, Tenn., health care network, always mindful that it is a faith-based organization.

September 14, 2010

For Gary Shorb, president and CEO of Methodist Healthcare in Memphis, Tenn., access to affordable health care is not an abstract political concept but a concrete way that Methodist Healthcare expresses its faith. Being a benefit to the community, Shorb says, should be “the reason that we exist.”

Before being named Methodist Healthcare’s president and CEO in 2001, Shorb served 11 years as the system’s executive vice president. Before that, he spent four years as president of the Regional Medical Center in Memphis.

His awards include the Corporate Leadership Award from Volunteer Memphis’ Corporate Volunteer Council and the Alexis de Tocqueville leadership award from United Way of the Mid-South. In 2007 Shorb received the Meritorious Service Award from the Tennessee Hospital Association. Shorb has also worked as a project engineer with Exxon and was a lieutenant commander in the U.S. Navy. He received a master’s degree in business administration from Memphis State University (now the University of Memphis).

Shorb spoke with Faith & Leadership about what it means to be a corporate leader inside the United Methodist Church. The video clip is an excerpt from the following edited transcript.

Q: What is the idea behind “faith-based” medical institutions like Methodist Healthcare?

Faith-based hospitals went through a period where they became more of a corporate operation than a mission-driven operation. We were coming out, in the late ’90s, of more of a corporate, bottom-line mentality than a true mission mentality. I mean, we always had connection back to the church, but we decided to better define that and make it more a true part of our culture. We’re the largest provider of services to the poor in the state of Tennessee, so we do more Medicaid and no-pay than any other health system. But really, that wasn’t enough in terms of our outreach to the community and our true commitment to missions. We decided to redefine that, and reclaim it.

Q: How does the idea of mission express itself concretely in the day-to-day medical work?

There are a lot of ways to measure it. The components that we’re looking at are, one, the commitment to the entire community, which is defined by caring for everybody regardless of their ability to pay.

Secondly, commitment to education -- much like Duke, a university, academic-oriented health system that does have a commitment for educating health professionals, doctors, nurses and other allied health care professionals.

Thirdly, outreach to the community. How can we really change the health status? Should that be a part of who we are? And we’ve decided, yes, it should be. We are working to define how we could better utilize our resources and other assets in the community to improve health. That resulted in the whole strategy around congregations, and our connection with them; we’re now in a covenant relationship with about 220 congregations, working in partnership with them to improve the health status of their congregants. We’re getting some pretty good results, and we’ve only been at it for about two years.

Q: How do you work with those partners to improve health?

We enter into a covenant relationship where we have certain expectations of them and they have certain expectations of us that are fairly well-defined. Our expectations of them are that they will work in partnership with us on health education, on health promotion and on allowing us, when needed, to help congregants navigate the health system.

Health systems are very confusing, especially for the poor. They’re hard to access and hard to understand. Even for those of us who have the resources, it’s very difficult to find your way at times. We have navigators that we’ve hired that work with each of the congregations.

And what we’re finding is, as we get members of the congregation signed up and involved, they have results that are better than people who are not signed up. By results I mean fewer readmissions. Let’s say you have congestive heart failure. Because of the interventions, both at the church and within our health system, we’re not seeing you readmitted as frequently. Fewer high-blood-pressure issues resulting in fewer strokes, diabetics who are more in control of their diet and have, as a result, fewer reasons to go to the hospital or the emergency room -- a lot of different indicators are pointing to success so far. It looks like that part of what we’re trying to do around mission is really making a difference.

Q: Does your organization pay a cost to keep the focus on its mission, either a financial cost or otherwise?

We take a portion of what we generate through our operating revenue -- and that’s revenue that comes from commercial payers [or] through Medicare or Medicaid -- and dedicate it to mission. We’re trying to find other resources or other avenues for grants and sources of income, and right now it’s a pretty good environment in which to do that. There are a lot more federal monies becoming available. There are various aspects of the health reform bill that are putting a lot of focus on innovative ideas and health promotion, health education activities.

Q: Does your faith-based, not-for-profit status impact your decisions around medical care?

That’s a tough question. I think if we weren’t in connection with the church, if we weren’t a not-for-profit, there would be pressure among stakeholders to focus more on what generates your financial margins. But thankfully, that’s not the case. I mean, we are part of the church; we do have a mission, and we’re very committed to it.

Q: How does a health care organization function as a Christian institution? What defines it as a Christian institution?

Our mission statement is to provide health care to the entire community and do so in a manner that’s consistent with the social principles of the United Methodist Church. All three bishops sit on our board, for the three conferences that founded us; that’s where everything starts. That’s the soul of the organization. And built on that mission you have values, and you instill those values, or try to, in all 10,000 people that work in our organization. You not only instill values but also try to instill that sense of purpose, that sense of meaning. You’re there for a really important reason, and that’s to care for people. And it’s in caring for people that we execute our mission. The better we do it, the better the organization is going to do from almost any perspective.

Q: Many important, enduring institutions such as hospitals were founded by Christian organizations. Do you think it’s still possible that other new and enduring institutions could be founded out of the church?

I think it is possible. I think we’re going to have to rethink existing institutions and how they’re utilized, how we can better pull all of the United Methodist institutions together to get a focus that is more consistent. We all are off kind of doing our own thing, and the church is currently in decline in terms of the numbers of members, and having its own financial struggles, so unless we make better use of the resources we have, I don’t see us being able to do a lot of creating of new institutions similar to what was done decades ago. I do think there is that opportunity to do that, but we are going to have to partner and reconnect in a different way than we have in the past.

Q: Have you had to do that within Methodist Healthcare?

We have. We’ve had to really take a hard look at all of the assets that we have and make some tough decisions. We had some rural hospitals that were part of our system, and we decided that if we really wanted to focus on our academic enterprise, on our children’s hospital and recapitalizing it, on the work we’re doing with the CHN [Congregational Health Network], that we couldn’t continue to have them as part of our health system, so we had to sell those hospitals. So sometimes you have to shrink to grow. Sometimes you have to make the tough decision about reallocation of resources, and that was one that was not easy. But the board supported [it], and we did it almost 10 years ago, and it was one of the best moves we’ve made. So those are the kind of decisions I think the church in general will have to make.

Q: It’s analogous to the situation many denominations face, having to close small churches in order to focus on others, which is always painful.

It’s a perfect analogy. We keep a lot of churches on life support, consuming resources, both human resources as well as financial, that really should probably be assets sold for other uses, and consolidate some of that mission into larger enterprises. It’s a tough decision to make. It’s very difficult to do. But those are the kinds of things that we need to be about.

Q: You’re active as a layperson in the United Methodist Church. Could you talk about what this means?

I’ve been a United Methodist my whole life. I love the church. I love the Wesleyan tradition. It’s a church that has a tremendous amount to offer, and I love the mission of the church. To make disciples of Jesus Christ for the transformation of the world -- what more compelling mission can you possibly have than that? I try to offer some leadership capacity to my local church and to the greater church whenever I have the opportunity.

Q: How do you navigate between the two big institutions that you’re part of, one as a volunteer and one professionally?

There are a lot of parallels. In the hospital world there is always a lot of questioning about the value that “corporate” brings to hospital operations, because we have a larger corporate overhead that supports the seven hospitals that we have as part of the system -- just as there are questions about the boards and agencies of the United Methodist Church.

We’ve been in dialogue for the last day about the future of the church and leadership and what it means to be more of a “corporate” leader in the United Methodist Church. There is a lot of interest among the bishops and the church leadership in continuing to evaluate how we can more effectively meet our mission, and how we might reconfigure resources and reorient people, build skills and really get back to what it means to be United Methodist in the United Methodist Church. The church is challenged right now to make changes, and change is always difficult.

Q: How is this hospital different because it’s specifically a United Methodist hospital?

One is, the social principles are part of our mission, so that definitely ties us back to what it means to be a United Methodist. Secondly, the influence of the board, in that the board is 60 percent United Methodist; and, as I said, the three bishops who sit on the board certainly shape the culture and shape the direction of the organization. It really is a function of leadership at the board level that continues to drive us, and keep us close to the church and keep us connected. Obviously, management and senior leaders have to buy into that and support it. One of the challenges, I think, for any organization is to have succession planning in a way that ensures you don’t have leaders follow one another who are taking very strong right or left turns. We’re working hard on that. That can happen at times to organizations that are in the connection, that kind of go in a different direction, with somebody who may not be as mission-focused, who may want to focus more on the financial side of the enterprise, and decide to take it that way.

Q: How do you do your job in a way that conveys your role as the leader in a mission-focused, faith-based institution?

Well, I try to never forget that we are faith-based, and a ministry. Even in the midst of some very difficult business or financial decisions, I try to keep that in mind in terms of my own personal leadership. I also rely on a team of people to ensure that that balance continues. I have a senior vice president of faith and health who reports to me, Gary Gunderson. He’s at the table in any discussion of strategy or the future; he does a great job of being somebody who is representative of the mission.

The mentality of my team is mission-oriented. Even our chief financial officer thinks in mission terms. He can be very hard-nosed about some difficult decisions, but he’s always mindful of why we’re there. It’s not to provide shareholders with returns. It really is to provide benefit to the community, and that first and foremost should be the reason that we exist and we continue to exist.