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Context: Catholic hospitals represent a large and growing segment of U.S. health care. Because these facilities follow doctrines that restrict reproductive health services, including miscarriage management options when a fetal heartbeat is present, it is critical to understand whether and how women would want to learn about miscarriage treatment restrictions from providers., Methods: From May 2018 to January 2019, semistructured interviews were conducted with 31 women aged 21-44 who had had exposure to religious-based health care; all were drawn from a nationally representative survey sample. Participants responded to a hypothetical scenario regarding the anticipatory disclosure of miscarriage management policy during routine prenatal care. Responses were inductively coded and thematically analyzed using modified grounded theory to understand women's attitudes and considerations related to receiving anticipatory miscarriage management information., Results: Respondents supported the routine disclosure of miscarriage management policies during prenatal care. Some expressed concern that this might increase patient anxiety during pregnancy, but most felt that the information would serve to prepare and empower patients, and likened the topic to other anticipatory health information provided during prenatal care. Identified themes related to how providers can disclose this information (including the need for a precautionary framing to reduce patient stress), sharing the rationale for institutional policy, and the importance of provider neutrality to ensure patient autonomy., Conclusions: To respect patient autonomy, health care providers working in Catholic hospitals should routinely discuss institutional miscarriage management policies with patients, and anticipatory counseling should give patients the balanced information they need to decide where to go for care should pregnancy complications arise., (Copyright © 2020 by the Guttmacher Institute.)

Context: Catholic hospitals operate under directives that prohibit the provision of contraceptives, sterilization and abortion. Little research has examined women's awareness of these institutions' policies, which affects their ability to make informed decisions about where to seek care., Methods: In 2016, some 1,430 women aged 18-45 were recruited from a U.S. probability-based research panel for a survey about hospital care. Respondents were randomized to a hypothetical Catholic or nonreligious hospital group and asked about their expectations for receiving nine specific reproductive services. Multivariable logistic regression analyses were used to evaluate associations between participants' characteristics and their correctly identifying a hospital as Catholic, as well as between characteristics and expecting that birth control pills, tubal ligation or abortion for serious fetal indications would be provided there., Results: Women randomized to the Catholic hospital group were less likely than those randomized to the nonreligious group to expect provision of birth control pills (77% vs. 86%), tubal ligation (70% vs. 78%) or abortion for serious fetal indications (42% vs. 54%). Income level was associated with correctly identifying the Catholic hospital: Compared with individuals with the lowest income, those in three of the four other income groups were more likely to identify the hospital as Catholic (odds ratios, 1.9-2.2). In comparison with women who misidentified the Catholic hospital, those who identified it as Catholic had lower expectations that the hospital would provide birth control pills (0.3), tubal ligation (0.5) or abortion (0.2)., Conclusions: Many women do not realize the breadth of restrictions on reproductive health care at Catholic hospitals. Without institutional transparency, patient autonomy and health outcomes may be compromised., (Copyright © 2019 by the Guttmacher Institute.)

We aimed to investigate Catholic Identity and Mission communication specifically how nurses were expressing the Catholic healthcare values in practice. A mixed-methods, case study design was used and included non-participant observation, a mid-level manager focus group (n = 7) and online surveys (n = 144). Document and observational data analysis revealed the organisation's commitment to visible indication of Catholic values adherence. Focus group analysis revealed two themes, 'Catholic values in action' and 'taking the extra step'. The impact of Catholic Identity and Mission on nurses and nursing care recipients remains elusive and warrants further understanding.

Context: Catholic Church directives restrict family planning service provision at Catholic health care institutions. It is unclear whether obstetrics and gynecology clinics that are owned by or have business affiliations with Catholic hospitals offer family planning appointments., Methods: Mystery callers phoned 144 clinics nationwide that were found on Catholic hospital websites between December 2014 and February 2016, and requested appointments for birth control generally, copper IUD services specifically, tubal ligation and abortion. Chi-square and Fisher's exact tests assessed potential correlates of appointment availability, and multivariable logistic regressions were computed if bivariate testing suggested multiple correlates., Results: Although 95% of clinics would schedule birth control appointments, smaller proportions would schedule appointments for copper IUDs (68%) or tubal ligation (58%); only 2% would schedule an abortion. Smaller proportions of Catholic-owned than of Catholic-affiliated clinics would schedule appointments for birth control (84% vs. 100%), copper IUDs (4% vs. 97%) and tubal ligation (29% vs. 72%); for birth control and copper IUD services, no other clinic characteristics were related to appointment availability. Multivariable analysis confirmed that tubal ligation appointments were less likely to be offered at Catholic-owned than at Catholic-affiliated clinics (odds ratio. 0.1); location and association with one of the top 10 Catholic health care systems also were significant., Conclusions: Adherence to church directives is inconsistent at Catholic-associated clinics. Women visiting such clinics who want highly effective methods may need to rely on less effective methods or delay method uptake while seeking services elsewhere., (Copyright © 2017 by the Guttmacher Institute.)

Life in the church changes and evolves. So do the ministries of the church, for the church’s works must remain relevant as the times change and evolve. Thus the relationship between the church and the Catholic health care ministry has been adapting to a modern era in which founding congregations gradually relinquish control of the entities they created.

Religious sponsors have led every step of the way in the Catholic Health Association’s community benefit work. Since the Ursuline Sisters’ 1727 arrival in New Orleans, women religious have modeled community health improvement by looking around, seeing what needed to be done and finding ways and means to improve the lives of poor and vulnerable people.

They’re all over the place today — Star Wars characters, superheroes, pirates, Minnie Mouse, witches, Minions from “Despicable Me” and, of course, nurses dressed as they usually are in your health care institutions, in white fishnet and 6-inch heels!

Spirituality” names an important domain of human experience that has contours influenced by varied religious traditions, but it is not always tied to any religious tradition in particular. It is influenced by the vast array of individual experiences of inner life, especially as transformed by the transcendent.¹ These individual expressions sometimes become part of religious traditions, spiritual classics handed on from generation to generation.²

Since 1727, when the Ursuline Sisters came to the United States, Catholic health care in the U.S. has sought to be a courageous and faithful reader of the signs of the times. It has tried to be attentive to the ongoing newness of God’s desire in responding to the health needs of people.

Enthusiastic statements like these stunned me when, years ago, I began leading formation groups. The goal was to help leaders pass on the Catholic health care tradition, not change their lives. Yet many participants said that’s what was happening. Today I have come to expect that although most formation participants will say the program improved their leadership, some also will say it was life-changing.¹

We often don’t see the extent of life-transforming changes, and the circumstances and decisions that led to them, until we look back. That’s because in the midst of such a transformation, we are busy taking the next step, and then, based on reflection and evaluation, the step after that. We are deeply involved in being present to the moment, knowing we are being led by something much greater than ourselves and trusting that movement. For 18 years, the Franciscan Sisters of Mary (FSM) have been in such a process. They still are deeply immersed in the next steps.

In 1999, the Sisters of the Holy Cross and the Sisters of Mercy of the Americas came together, assessed the past, examined the present and created a new future for Trinity Health. Their goal was to preserve Catholic health care; their mission was to ensure that the human right to health care become a social right as part of a national understanding of promoting and providing for the general welfare. Thanks to the work of those prescient and courageous women religious, Trinity Health now is governed by a “mirror board” — a group of persons who carry canonical and civil responsibilities both as sponsors of Catholic Health Ministries and as directors of Trinity Health’s civil board.

I have a confession to make: I was a mission leader for seven years before I had a good understanding of what sponsorship in Catholic health care is all about. I used to be embarrassed by it, until I discovered that many other senior leaders and middle managers also have no idea what sponsorship is. Many leaders are not able to tell you the names of the individuals who make up their sponsoring board or PJP. And the term PJP — public juridic person — is understood by even fewer leaders within Catholic health care. Unfortunately, for many leaders and front-line associates, sponsorship and the individuals who make up our sponsoring boards are shrouded in mystery. One of the goals of this Health Progress issue is to pull back the curtain and begin to demystify sponsorship. This article will show the relationship and conections between sponsorship, governance and mission integration.

I had not heard the concept of ministerial sponsorship before joining the Catholic Health Initiatives. At first, it struck me as arcane jargon that was relevant only in the niche of Catholic health care.

Background: Catholic hospitals play a critical role in the provision of health care in the United States; yet, empirical evidence of patient outcomes in these institutions is practically absent in the literature., Purpose: The purpose of this study was to determine whether patient perceptions of care are more favorable in Catholic hospitals as compared with non-Catholic hospitals in a national sample of hospitals., Methodology: This cross-sectional secondary analysis used linked data from the 2008 American Hospital Association Annual Survey, the 2008 Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, the 2008 Medicare Case Mix Index file, and the 2010 Religious Congregations and Membership Study. The study included over 3,400 hospitals nationwide, including 494 Catholic hospitals. Propensity score matching and ordinary least-squares regression models were used to examine the relationship between Catholic affiliation and various HCAHPS measures., Findings: Our findings revealed that patients treated in Catholic hospitals appear to rate their hospital experience similar to patients treated in non-Catholic hospitals. Catholic hospitals maintain a very slight advantage above their non-Catholic peers on five HCAHPS measures related to nurse communication, receipt of discharge information, quietness of the room at night, overall rating, and recommendation of the hospital; yet, these differences were minimal., Practice Implications: If the survival of Catholic health care services is contingent upon how its provision of care is distinct, administrators of Catholic hospitals must show differences more clearly. Given the great importance of Catholic hospitals to the health of millions of patients in the United States, this study provides Catholic hospitals with a set of targeted areas on which to focus improvement efforts, especially in light of current pay-for-performance initiatives.

American hospitals were started by religious, ethnic and community groups to serve local health care needs. Immigration into the eastern cities and the constant movement west of the frontier required the creation of educational and service facilities to serve these populations and localities. In the nineteenth century, Catholic sisters went all across the country establishing schools and hospitals. They were motivated to care for the sick, establish charitable institutions and spread their religious beliefs. Their impact on the development of the American health system was enormous. They also supported the importance of nursing for the provision of scientifically based medical care and created schools of nursing. Their historical record as founders, builders, financiers and managers of hospitals is unmatched by any other group between 1850 and 1950. And, this was accomplished at a time when women played no similar leadership and institutional ownership role elsewhere in society.

Introduction: In the United States, ectopic pregnancies are relatively common and associated with significant maternal morbidity and mortality. The Ethical and Religious Directives for Catholic Health Care Services (the Directives) govern the provision of care in Catholic-affiliated hospitals and prohibit the provision of abortion in almost all circumstances. Although ectopic pregnancies are not viable, some Catholic ethicists have argued that the Directives preclude physicians at Catholic hospitals from managing tubal pregnancies with methods and procedures that involve "direct" action against the embryo., Methods: We undertook this qualitative study to explore the relationship between the Directives, hospital policies regarding ectopic pregnancy management, and clinical practices. We recruited participants at non-Catholic, longstanding Catholic, and recently merged facilities and conducted focused interviews with 24 physicians at 16 hospitals in 10 states., Findings: Participants from three Catholic facilities reported that medical therapy with methotrexate was not offered because of their hospitals' religious affiliation. The lack of methotrexate resulted in changes in counseling and practice patterns, including managing ectopic pregnancies expectantly, providing the medication surreptitiously, and transferring patients to other facilities. Further, several physicians reported that, before initiating treatment, they were required to document nonviability through what they perceived as unnecessary paperwork, tests, and imaging studies., Conclusion: Our findings suggest that some interpretations of the Directives are precluding physicians from providing women with ectopic pregnancies with information about and access to a full range of treatment options and are resulting in practices that delay care and may expose women to unnecessary risks., (Copyright © 2011 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.)

This article analyzes the tensions and uneasy negotiations, based on a case study, that occurred among Catholic sisters, administrators, bishops, physicians, and the Vatican for more than seven years at a hospital in Austin, Texas. Here, the largest health care system in the city, which was Catholic, joined with the local public, tax-supported hospital that provided the majority of reproductive health care services in the region. A clash resulted over whether the hospital could continue providing sterilization and contraceptive services to its primarily poor patients. This article examines the fierce debates that occurred, especially over emergency contraception and attempts to develop creative solutions after a hierarchical crackdown from the Vatican. The end result was a compromise that included the creation of a "hospital within a hospital."

Background: Catholic health systems represent a unique sector of nonprofit health care delivery organizations because they must be accountable to institutional pressures of the Roman Catholic Church, in addition to responsiveness to market pressures. Mission statements and values are purported to be the driving force of Catholic institutional identity. Central to the understanding of the Catholic health care delivery sector is the exploration of variation in mission and values statements across the homogeneous field of organizations., Purposes: The purposes of this study were to identify expressed organizational identity variation-in terms of keywords in mission statements and values-of Catholic health systems in the United States by applying a methodology that integrates text and social network analytical techniques., Methodology: Data were obtained from the Web site of The Catholic Health Association of the United States and the Web sites of 50 Catholic health systems in 2007. Catholic health system mission statements and values were assessed using a cross-sectional study design. Text analysis and social network techniques were employed to identify the most central words in the texts and linkages among mission statement components and values., Findings: This study identifies the components of a common mission statement and the most shared and unique values for a Catholic health system. Even with tremendous similarity, there is also evidence of intrasectoral variation between Catholic health system keywords in mission statements and values., Practice Implications: Management implications include the consideration of word relationships developing and constructing mission and values statements to form the framework for strategic vision and management decision making, to assess potential partnership arrangements based on expressed mission statements and values, and to use in executing due diligence in mergers and partnerships.

As Catholic-owned hospitals merge with or take over other facilities, they impose restrictions on reproductive health services, including abortion and contraceptive services. Our interviews with US obstetrician-gynecologists working in Catholic-owned hospitals revealed that they are also restricted in managing miscarriages. Catholic-owned hospital ethics committees denied approval of uterine evacuation while fetal heart tones were still present, forcing physicians to delay care or transport miscarrying patients to non-Catholic-owned facilities. Some physicians intentionally violated protocol because they felt patient safety was compromised. Although Catholic doctrine officially deems abortion permissible to preserve the life of the woman, Catholic-owned hospital ethics committees differ in their interpretation of how much health risk constitutes a threat to a woman's life and therefore how much risk must be present before they approve the intervention.