Articles

The following article was originally published in the March 1996, edition of "Canadian Health Care Management" . It has since been updated and is reprinted here with permission.] 

Health Care Facilities with a Religious Mission 

Survive and Thrive through Health Care Reform in British Columbia 

And, at the same time, they are determined to make a positive contribution to the process! 

With the provincial health care system in a state of transition, health care facilities in British Columbia with a religious mission see themselves as the calm in the eye of the storm. By virtue of the Master Agreement signed on March 16, 1995, between Paul Ramsey, Minister of Health for BC, and Gerald Herkel, then-Chair of the Denominational Health Care Facilities Association (the name has subsequently been changed to the Denominational Health Association), twenty-six owners have maintained their right to the ownership and governance of their thirty-five health care facilities in the province. At the same time, the owners of these facilities made a commitment to participate in initiatives to coordinate, rationalize, plan and deliver health care services within BC. As the government, through regional health boards, proceeds with the process of taking over the ownership and management of some nondenominational facilities in the province and as other volunteer boards of directors are summarily dissolved, DHA member owners are actively upholding their part of this agreement - - seeking out and engaging in ways to support and cooperate in attaining the Health Minister’s goals. The signing of the Master Agreement is not seen by DHA members as a "special deal", but rather as a commitment to work with the provincial government, regional health authorities and other health care providers in support of the principle that changes must be made in the delivery of health care. 

How the DHA came to be 

The British Columbia Royal Commission on Health Care and Costs (the Seaton Commission) released its findings in November 1991 in a document entitled "Closer to Home". This document was formulated as a result of an eighteen month study in which commissioners spoke with hundreds of people and received 1500 submissions. While conceding that we already have a great health care system in BC, the report concluded that 

" .... there is a lack of direction in health care in BC. There is a lack of local influence complicated by a heavily centralized bureaucracy with a pervasive sense of secrecy that separates it from the people it serves. Again and again, individuals, organizations and the representatives of institutions - even employees of the Ministry of Health - told us that the system is littered with barriers that reinforce inequities, kill initiative and stifle changes.  

And changes are what the submissions speak mostly about: changes to the philosophy of care; changes to legislation and educational qualifications, standards and mandates; changes in the influence various professions have over the system; changes in accountability and accessibility; changes to improve the system, to make it more flexible and more representative of the health care needs of British Columbians. Changes to increase personal independence, support self-esteem and ensure that people get the right care in a timely and caring way." (See Vol. 1, Summary of the Report of the British Columbia Royal Commission on Health Care and Costs, Crown Publications Inc., 1991, page 4)

The owners of faith-based facilities in BC initially felt threatened by this report and its recommendations and the subsequent recommendations of then-Health Minister Elizabeth Cull. In October of 1992, the Catholic Health Association of BC submitted a written presentation to Ms. Cull that responded to the Seaton Commission’s findings and to her recommendations. While this presentation assured the Minister that CHABC endorsed the general thrust of the document and that the Association could be seen by the Minister as an ally in helping to accomplish its goals, it also addressed some of the Association’s concerns. CHABC asked that it be given the opportunity, prior to any decisions being made, to discuss with the Minister those that would affect Catholic institutions. Of particular concern was the need to preserve the tradition and values inherent to Catholic health care and to honour the heritage and significant contribution made by the founders of Catholic health care. Shortly after this presentation was made, Mr. Paul Ramsey replaced Ms. Cull as Minister of Health. 

In the fall of 1993, CHABC’s president, Gerald Herkel, reached out to the ten other religious denominations that owned and/or operated health care facilities in the province. An ad hoc group of more than eighty individuals came together that was comprised of CEOs, board members and twenty-six owners from thirty-five facilities that represented a total of about 4900 beds and operating budgets totaling close to $400 million. An executive was selected to work on a proposal to the new Health Minister. Early in 1994, a proposal went to Mr. Ramsey that gave him a brief BC history of people of faith and their health care ministry. The Executive was also successful in securing a date to meet with him to discuss their concerns about potential health care reforms. In the meantime, copies of the proposal were forwarded to each MLA in the province who had one or more denominational health care facilities in their riding. 

Reaching an Agreement 

The first meeting with Mr. Ramsey was a positive one and the feeling of those who attended was that they would be successful in reaching an agreement with the government that would allow the owners of denominational heath care facilities to retain their ownership and governance. Over the next full year, many negotiation meetings were held between the Deputy Minister of Health and the Denominational Group Executive, the results of which could best be termed as unpredictable and often disappointing. What were seen by the group as being positive and productive meetings and discussions frequently resulted in little follow-through on actions or documentation development on the part of the Ministry. Eventually, the Denominational Group drew up a draft "principles" document that was subsequently used as a basis for negotiations and helped to shape the final agreement. Late in 1994, when it became apparent that an agreement was attainable, the Denominational Group was fortunate to obtain the pro bono services of Victoria, BC, lawyer Ian Stewart who drafted a legal agreement and entered into final negotiations with Ministry lawyers. At the same time, the formerly ad hoc group attained legal status as the Denominational Health Care Facilities Association. The Master Agreement was signed at the Louis Brier Home and Hospital, the Jewish Home for the Aged in Vancouver, by Health Minister Ramsey and Gerald Herkel, Chair of the newly formed DHCFA. In attendance for the signing of this historic covenant was the Archbishop of Vancouver, Adam Exner, who gave the initial incentive to CHABC to join with the other denominations to embark on the road to the agreement. Also present were Vancouver MLAs Dr. Tom Perry and Bernie Simpson, both of whom had supported the group through the long negotiation process. 

 Partnerships and other Developments 

While the owners of denominational health care facilities deservedly breathed a huge sign of relief with the signing of the Master Agreement, they recognized that their work regarding health care reform had really just begun. While they now had the sound assurance of continued ownership and governance of their facilities, they were, at the same time, cognizant of the second part of the agreement in which they had committed to working towards the Minister’s goals of achieving a rational, integrated health care system in BC. Indeed, some owners had been working in that direction for several years, with a proactive and cooperative attitude. In October of 1994, three existing, autonomous Catholic health care societies in Vancouver had officially amalgamated to form the Chara Health Care Society, an organization that promotes an integrated approach to health and health care. The three founding partners - - Mount Saint Joseph Hospital, Youville Residence and Saint Vincent’s Health Care Society - - previously operated facilities on six sites in the city. 

Also during 1994, the Vancouver Health Board was busy developing its plan for all health care organizations in the entire city. A consultant commissioned by the Ministry of Health, working with a number of CEOs and other representatives from health care organizations in the region, developed a document entitled "The Vancouver Region: Acute Care and Rehabilitation Services Study" that was presented to and approved by the Health Ministry. It recommended the merger of Vancouver health care organizations to form four "clusters", each of which would be governed by its own board within the Vancouver Health Region. These four new boards would replace the ten boards currently governing Vancouver’s hospitals and care agencies. One of the four groups would be comprised of Saint Paul’s Hospital, Holy Family Hospital and the newly formed Chara Health Care Society. The founding orders of the facilities involved accepted the recommendation of the Vancouver Health Board to a merger and, in 1997, amalgamated to become the Vancouver Catholic Health Care Group. 

The now-expanded Vancouver/Richmond Health Board continues to study how best to deal with long term care in the region. Nine of the facilities that will be affected by this study are members of the Denominational Health Association, but are representative of several denominations, unlike the denominational acute and rehab facilities in the city which are all Catholic. Representatives of these nine facilities met on several occasions to plan a cooperative course of action. They approached the regional authorities with a proposed terms of reference for the study and requested that their group have representation and input into the study. All were in agreement that a study was needed to address necessary changes in long term care. 

Similarly, the representatives from denominational facilities in the Capital Health District in Victoria on Vancouver Island formed their own group with the same purpose - to be proactive and cooperative with regional authorities in determining a positive and meaningful role for their facilities in the regional health care system. They have worked together for some time now to develop a template for an affiliation agreement that will be used by each denominational facility in the region. 

Numerous other members of DHA report that discussion and planning is underway in the area of forming potential partnerships and sharing of services between facilities. The denominational facilities’ owners and management realized that the status quo was not an option and that they must seek out and take advantage of every opportunity to rationalize and integrate services. 

Working with the Health Employers’ Association 

While the facilities whose owners are members of the DHA work together to achieve efficiencies through forming partnerships and sharing services, a subcommittee of the DHA, called the Denominational Human Resources Issues Group (DHRIG), has been working to build a positive relationship with the Health Employers’ Association of BC (HEABC). One of the major points in the Master Agreement gives the owners of denominational facilities employer status, just as the new regional authorities are deemed to be employers with respect to nondenominational facilities. The mandate of the DHRIG is to ensure that the denominational owners are recognized as employers in new documentation that is being developed by HEABC to deal with the new realities in health care. One of their objectives is to review and make recommendations on labour relations and human resources issues that may directly affect denominational employers in any upcoming bargaining. They will also offer guidance on policy and strategies pertaining to bargaining for denominational employers. It is the underlying goal of the DHRIG to achieve and maintain ongoing cooperation between DHA and HEABC. Representatives of this group continue their efforts to make a positive and constructive contribution to the process of making changes in BC’s health care system with regards to labour relations issues. 

Partnership with the Strategic Alliance Group 

Another aspect of the BC health care reform process, similar to what has happened in some other provinces, was the necessity to look at the current number of health-related associations and consider an equitable means of forming a new provincial health association. Since early 1995, members of the Catholic Health Association of BC have been informally representing both CHABC and DHA at a series of meetings devoted to studying this sensitive issue as well as other common concerns regarding health care reform. In all, eleven existing associations made up the original, informal Strategic Alliance Group. They were the Associated Boards of Health, the BC Association of Community Care, the BC Association of Private Care, the BC Association of Substance Abuse Programs, the BC Health Association, the BC Healthy Communities Network, the BC Palliative Care Association, the BC Public Health Association, the Canadian Mental Health Association - BC Division, the Catholic Health Association of BC and the Provincial Mental Health Advisory Council. Representatives from this group met several times with members of the Task Force of the Regional Chairs. At the request of the Task Force, they developed a discussion paper and guiding principles on which they hoped to base any new structure. It appeared at one point that only five of the above mentioned associations would be directly affected by the formation of a new provincial association, those being the Associated Boards of Health, the Association of Substance Abuse Programs, the BC Association of Community Care, the BC Association of Private Care and the BC Health Association. In the end, only BCACC and BCHA were merged to form the Health Association of BC in November of 1997. While the existence of neither the Catholic Health Association of BC nor the Denominational Health Association was threatened by these particular changes, as members of the new association, our representatives continue discussions with HABC executives to ensure that we have fair representation in the new association. A Task Force will be established to study the role of associate members and will include representatives from both DHA and CHABC. 

Identifying "What it is" that Facilities with a Religious Mission Bring to Health Care in BC 

Earlier, it was stated that the member owners of the DHA do not believe that they were given a "special deal" with the signing of the Master Agreement. One of the major challenges facing this Association now is to address some concerns expressed by various regional authorities, Health Ministry personnel and sometimes by personnel from nondenominational facilities that the Master Agreement may constitute a "special deal". The DHA members believe simply that, by signing this Agreement, the BC government recognized the selfless and unique contribution made by the religious founders of health care facilities in the province. The Agreement is an acknowledgment that there was a time in BC when almost every health care facility was established because of the interest and concern of people of faith. In fact, the very first hospital in BC was built in Victoria almost one hundred and forty years ago by the Sisters of Saint Ann, just one of the many religious orders and organizations of a number of denominations whose fundamental values produced the very health care system that we enjoy in BC today - - a system that developed as a result of their motivation. The Agreement was also an acknowledgment that the owners of denominational facilities continue to be good stewards of the health care dollar in the provision of compassionate, professional care to the people of BC. 

DHA members are sometimes asked what led to their success in achieving the Agreement. The answer is four-fold. First, the eleven member denominations represent 52% of the population of BC, according to figures taken from the 1991 census. There is strength in numbers! Second, the group had the unwavering support of a number of MLAs in the province who believed in their cause and who took their concerns to the Health Minister and the Premier. Third, DHA was extremely fortunate that lawyer Ian Stewart so generously gave of his time and professional services. Fourth, more than eighty people from eleven denominations were able to set aside their specific beliefs and come together amicably and cooperatively to fight for a common cause in which they all fervently believed. 

The Association held its first AGM in late March of 1996, and at that time established the first full board of directors. A dedicated Executive comprised of the following people negotiated the Master Agreement and had been carrying on the work of the Association since the group first came together in late 1993: Gerald Herkel (Executive Director at Saint Michael’s Centre in Burnaby), Rita Akselrod (board member for the Louis Brier Home and Hospital in Vancouver), Michael Crean (board member for Saint Mary’s Hospital in New Westminster), Maureen Harrison (Administrator of the Fair Haven United Church Homes in Burnaby and Vancouver) and Howard Johnson (Regional Administrator with the Baptist Housing Society of BC). Ex officio members are Jim McPherson (board member for the Fair Haven United Church Homes) and Michael Pontus (Executive Director at Saint Joseph’s General Hospital in Comox). The office of the Catholic Health Association of BC is the secretariat for DHA. A second AGM was held in May of 1997, at which time the name was officially changed to Denominational Health Association. 

The signing of the Master Agreement with the provincial government was just one step on the path the representatives for BC denominational facilities are following in the health care reform process. They now faced the challenge of entering into individual agreements with their respective regional authorities. Several organizations have already successfully done so. Members have also taken advantage of opportunities for discussion and explanation with some government bureaucrats who do not fully comprehend the implications of the Master Agreement. DHA members are encouraged by their successes to date and by the fact that their progress is perceived positively by the BC health care community, as witnessed by this statement describing denominational health care facilities: " .... they appear to be in the lead in health reforms through their willingness to embark on partnerships and cost-saving initiatives." (From BCHA/news, 95/10,11, Volume 26.) 

In addition to the unique challenges facing denominational facilities, our members also deal with those issues that are common to all health care providers. With cuts to federal transfer payments and with cuts in provincial funding, all face having to do more with even less money. Tough decisions are continually being made about service provision and staffing - - the challenge is to make these decisions about rationing the health care dollar as humanistically as possible and never forgetting about why we are health care providers - - the focus must always be on those for whom we give care. 

Denominational Health Association members recognize that they must continue to make a concerted effort not only to clearly identify the unique contributions they make to health care in BC, but to continue to demonstrate how they make that difference. As changes continue to occur in health care, this will be accomplished by the board, administration and staff of each denominational organization faithfully witnessing to their respective traditions, mission and values that motivate and inspire their service to their patients and residents.