As North Americans wrestle with the social and political implications of providing affordable healthcare to more than 360 million people, the Seventh-day Adventist Church’s healthcare system on the continent is also reshaping itself to meet the needs of the changing market. Adventist World editor Bill Knott, on behalf of Adventist Journey magazine, recently interviewed Terry Shaw, since December 2016 president and CEO of Adventist Health System, the largest of the five Adventist healthcare systems in North America. This interview, published in the April 2018 edition of Adventist Journey, is part of an occasional series about this important piece of Adventist identity.

Bill Knott: You recently told a group of healthcare and church leaders that following the example of Jesus at Adventist Health System should be “disruptive, inclusive, innovative, and outwardly focused.” Some of those terms are familiar. But the last time I heard an Adventist leader state that a chief goal of the organization he led was to be “disruptive” was — well, never. Most large organizations, including Adventist ones, are searching for stability. What does that word “disruptive” mean to you?

Terry Shaw: When I study Jesus’ life, He was disruptive. He brought a different thought process to caring for others. He brought a different thought process to what worship really means. He brought a different thought process to whom it was OK to associate with. He expanded the kingdom to being more than just for His own people, the Jews. In today’s world, “inclusiveness” is also part of being “disruptive.” With that as our guide, I want Adventist Health System to disrupt itself and move away from a model that says, “You come to me when I’m set up to deliver care for you, and open my door, let you in, and shut the door when I’m ready to leave.” I want us to move toward a process that runs 24/7 and is adapted to your needs as a person seeking care.

So it’s “disruptive” in the context of your own history as a healthcare organization?

It’s “disruptive” in terms of our focus. Instead of being a passive participant in a healthcare environment, I want us to move into an active participation. We want a single mom who has a 2-year-old with an earache to know where she can actually go to get the right care for the lowest cost — and get that quality every time. We want the lacrosse player who gets hurt at 7:30 at night — we want his dad to understand treatment options that may not require a visit to the ER. We want health and information to get to people in a way that we’ve typically not been the best at. We need to transform our organization into a consumer-mind-set organization to help the consumer get the wholeness they need and the care they need in the environment they need it in — as opposed to setting up a building and expecting everybody to come to us in our timeframe.

You’re describing a new kind of community engagement.

The wholeness perspective we preach and try to practice is disruptive in terms of how many people today view healthcare. When people come to one of our 46 hospitals, it’s our highest goal that they experience that mind/body/spirit perspective that’s at the heart of Adventism. But there’s so much of life that goes on outside the four walls of a hospital, and we own the responsibility to bring good news to people who may not even need our hospital care.

I heard you say that 92 percent of all your system’s patient interactions are with outpatients. I’m guessing most Adventists in North America have no idea that your outpatient engagement is that high. It’s probably easier to bring the values you’re describing to bear in a traditional hospital setting. But how do you make them real at urgent care centers, at physicians’ offices, at assisted living centers, and the other venues in which you work? How do you get these values out of the clouds and onto the ground?

It takes a lot of energy to move a culture — to change a culture. And it takes 10 people, and then a hundred people, and then a thousand people — all buying into a vision of what we can become. You start with 10, then you go to the one hundred, and that’s where we’re at today — at the one-hundred level — and we’re rapidly moving to the one-thousand level. We’ve put goals in front of ourselves for what we want to look like in 2020, but we keep asking the question, “What are we doing about those in 2018?” Here’s a specific: How do we take spiritual care and put it in our employed doctors’ offices? How do we make spiritual care resources available for people who come to each one of those 2,000 doctors? Once we are doing that well, we’ll go to our Centra Cares (urgent care facilities), and then we’ll tackle that, because we have almost 50 of those. As we start applying the principles we’ve committed to, we’re learning new techniques, because the outpatient setting isn’t neat and crisp like it is in a hospital.

Healthcare these days seems to be about trying to control all possible variables, but it sounds like you’re acknowledging that you’re going to have to innovate new delivery methods in settings you can’t fully control.

In an outpatient setting, you have to deal with social issues, food issues, transportation issues, family issues. So many of those we meet have major spiritual care needs: they’re praying about things that they can’t control themselves, that they need help with. This is where we get to practice the grace of Jesus. He was an advocate for the little person. Everywhere He went, He took care of somebody that nobody else wanted to take care of — the leper, the disabled person. People believed that their illness was a sign that they weren’t loved by God or close to Him. We have the same issues in our marketplace. How do we take this “whole person process” that we believe we do well within the four walls of the hospital box and start drawing concentric rings out into the community? You can’t tackle the entire thing at once, so you’ve got to decide: What’s my next set of concentric rings?

It’s one thing to announce a sweeping goal — to “move a culture.” But it’s another to actually change that culture — change the way it delivers care, especially spiritual care. Tell me about your methodology.

We produced a series of 8- to 10-minute videos on the key things that we’re really trying to tackle, and we have given them to each of our leadership teams. We’ve provided open communication and feedback from those teams to us. We’ve taken those responses, collated them, and adjusted our process. After spending six months in this process, we summed it up: “OK, we’ve communicated out; you’ve communicated up. Here’s where we think we’re headed as an organization.” We’re going to pivot. Don’t get me wrong: we’ll still have a lot of hospitals. We’re adding hospitals. But if 92 percent of our culture accesses healthcare without coming to a hospital, we probably ought to think more about the impact we can make in our market.

You have a goal of delivering spiritual care at one of those end-points, like a physician’s office. What does that look like? You must have a metric to determine if you’re being successful. What does it look like to deliver spiritual care in a mixed-faith or even non-faith environment?

Not every physician associated with our system is going to be comfortable with this, but the majority are. Instead of you just getting a medical checkup, the physician will also conduct a spiritual checkup.

You’re overtly encouraging that?

Overtly. It’s a part of the medical record. You’ll be asked, “Do you have a faith tradition? Do you have a faith family? Do you have some-body you can turn to when you have a need from a faith perspective? And if you don’t, and you need that, what can we do to help you?”

This will be part of the formal patient inventory?

Absolutely. So, when a patient walks into a physician’s office, you’re not only going to get medical care. You’re going to get thoughtful inquiries that seek to find out, “Are you a spiritual person?” And if you are, do you have spiritual support? And if you don’t, how can we help you with that? But we’re not just leaving our 2,000 doctors to figure this out on their own. We’re resourcing them — across our system — with trained personnel who end up serving as spiritual ambassadors to that physician in the office. Most physicians also want spiritual support, and when it’s available to them, they take advantage of it.

So, the liaison person is part coach, part chaplain, part implementer—

Each of these liaisons serves between 25 and 35 physicians. And yes, it’s a significant investment we’re making.

Has Adventist Health System ever done this before?

No, not until now. And I don’t know how to pay for it, and I’ve told my team I don’t know. But I’ve also told ’em, if we’re going to make a difference in the lives of the people in our community, we have to deal with faith first. You can bring great medicine, but anybody can bring medicine to the market. If we’re not bringing faith with it, I think we’re losing a golden opportunity for the gospel.

Estimate how many FTEs (full-time equivalent employees) you’re going to employ to support physicians with frontline spiritual care.

We’re looking at close to 35 new personnel. We’ve agreed to spend $5 million on this each year for the next three years. And that $5 million is simply putting spiritual resources in places where people can’t get to it today. My guess is, Bill, we could spend $50 million. We don’t know that $5 million’s the right number. But one thing I’ve learned over the years is that if you don’t start, you don’t ever do. So we’re going to start, and then we’re going to figure out where it takes us.

I know you aren’t going to start something you aren’t going to measure. How are you going to measure impact in something as unique as spiritual care? Are you going to survey patients to ask about their interactions with that physician network?

Number 1: We’ll know in the medical record whether or not we have physicians who are actually doing the spiritual assessment, and we’ll know the numbers of patients who are impacted by that. Number 2: We’ll keep track on a per-person basis the number of interactions in physicians’ offices and with other people at physicians’ offices that have been tapped to provide spiritual resources in a manner that they haven’t in the past. Number 3: We’ll have referrals out of this process to a set of chaplains and other resources, and we will track those.

Several months ago, I heard you say that “no one should ever be discharged from our care.” That sounds like a very Adventist “whole life” goal. That’s a major promise.

Yes — it’s our goal that people who come to us for inpatient care, when they leave our hospitals, they have a follow-up doctor visit, and they know where they’re going. Somebody calls them within 24 hours to ensure their questions are being answered. They leave with medicine so that they don’t have to go to the pharmacy and wonder what they’re going to do for four days.

And you intend that they never be discharged from your spiritual care as well?

Absolutely. If we do this right and we look at our concentric rings of influence, we’re going to wake up in five to seven years in a metropolitan area such as Orlando with 2 million people in it, and we will have touched a million people. And if we finish — if we don’t discharge them from our care — if we do it with intentionality, it won’t be just a wash. We’ll know not only their medical care but the number of times when they had access to spiritual care. When I talk about our care, I’m not just talking about delivering good emergency department care or Centra Care services or even high-quality visits to our physicians’ offices — which we definitely have to do. I’m talking about care in its totality — how we help you along your faith journey as a human being. We want the best care for you, our teams treating you and caring for you like they would the person they love the most.

We clearly want excellence in care, but we want that surrounded with uncommon compassion. And I’d love to tell you that every one of our 5 million interactions is perfect every year, and I can only tell you that it’s not. I live in a neighborhood where everybody knows what I do. Every time they interact with our system and it wasn’t perfect, I get to hear about it. So I get a first-hand account of every time it went wrong. I also get first-hand stories of when it went right. I want people who work in our organization because they fundamentally feel in their heart that we care enough about them and the patient they’re caring for that it makes a difference. That’s what I want: I want uncommon compassion. I want somebody who can solve their problem.

Those who come to Adventist Health Systems — wherever they engage us — should know that our teams strive to serve every patient, every time, with the standards of: “Keep me safe.” “Love me.” “Make it simple” — and “Own it.” If we accomplish those four things across 80,000 people 24 hours a day, seven days a week, we’ll change the way America experiences healthcare.