St. Louis — When Sister Mary Jean Ryan entered the convent as a young nurse in 1960, virtually every department of every Catholic hospital was run by a nun, from pediatrics to dietary to billing. After her retirement on July 31 as the chief executive of one of the country’s largest networks of Catholic hospitals, only 11 nuns remained among her company’s more than 22,000 employees, and none were administrators.
Sid Hastings for The New York Times
“We can't be maudlin about this,” Sister Mary Jean Ryan said of the changing situation for nuns.
Franciscan Sisters of Mary
The Franciscan Sisters of Mary arrived in St. Louis in 1872 and later took on ministering to patients in hospitals.
For SSM Health Care, a $4.2 billion enterprise that evolved from the work of five German nuns who arrived here in 1872, Sister Mary Jean’s departure after 25 years as the company’s first chief executive marks a poignant passing. The gradual transition from religious to lay leadership, which has been changing the face of Catholic health care for decades, is now nearly complete.
In 1968, nuns or priests served as chief executives of 770 of the country’s 796 Catholic hospitals, according to the Catholic Health Association. Today, they preside over 8 of 636 hospitals. With Sister Mary Jean’s departure, only 8 of 59 Catholic health care systems are directed by religious executives.
SSM, which is now led by William P. Thompson, a Catholic layman and longtime company executive, had been the largest Catholic health system still managed by a nun. Formed in 1986, the St. Louis firm consolidated the management of 15 Catholic hospitals and two nursing homes in Missouri, Illinois, Oklahoma and Wisconsin.
As with other healing orders that have ceded control, the Franciscan Sisters of Mary prepared for their inevitable detachment from SSM with more planning than sentiment.
“We can’t be maudlin about this,” said Sister Mary Jean, 73, who still presides over the company’s board. “I mean, yes, we are a dying breed. We are disappearing from the face of the earth and all of that. That being said, perhaps this is a moment for people to acknowledge the contribution that has been made by women religious throughout our history in the United States.”
The leadership shift has stirred angst in many Catholic hospitals about whether the values imparted by the nuns, concerning the treatment of both patients and employees, can withstand bottom-line forces without their day-to-day vigilance. Although their influence is often described as intangible, the nuns kept their hospitals focused on serving the needy and brought a spiritual reassurance that healing would prevail over profit, authorities on Catholic health care say.
In the case of SSM, that has meant turning away business arrangements with doctors who decline to accept Medicaid. It has meant discounting treatment for the poor and offering charity care to the uninsured, just as the order’s founders did. The St. Louis nuns’ earliest ledgers denoted patients unable to pay as “Our dear Lord’s.”
The near extinction of nuns from American hospitals stems largely from the drastic decline of religious orders that accompanied the women’s movement, the sexual revolution, ethnic assimilation and the Second Vatican Council’s opening of the church to lay leadership.
Even as the country’s Roman Catholic population surged by nearly 50 percent over the last half-century, the number of nuns dropped precipitously, to 56,000 today from 180,000 in 1965, according to the Center for Applied Research in the Apostolate at Georgetown University. In 2009, 91 percent of all nuns were at least 60 years old.
Sister Mary Jean’s order has dwindled to about 100 from a peak of more than 500. Most moved out of their convent last year and into a retirement and nursing home. There has not been an initiate for 25 years, and several years ago the sisters reluctantly stopped looking.
“It was painful,” Sister Mary Jean said in an interview in her modest apartment, “but I think it was also courageous to say we’re just not going to recruit any more. Let’s just live out the rest of our lives to the fullest that we possibly can and thank God for what we’ve been able to do. And when the time comes, as they say, the last person turn the lights out.”
Along with parochial education, health care has long been a central mission of nuns in this country, a natural outgrowth of the Catholic insistence on the sacredness of life. Since 1727, when the Ursuline sisters landed in New Orleans, they have built 12 of the country’s 40 largest health care systems. In 2009, Catholic hospitals accounted for one of every six admissions in the United States, according to the Catholic Health Association.
Other than crucifixes on the walls and marble Madonnas in the lobby, Catholic hospitals do not look particularly different from secular ones. But their administrators say that what makes them distinct is a values-driven approach, reflected at SSM in a mission statement that pledges to use exceptional care to “reveal the healing presence of God.”
Catholic health systems have been criticized, along with other nonprofit hospitals, as not dedicating enough resources to the community’s benefit. But surveys also show that, on average, they provide higher-quality performance than other hospitals and are more likely to offer specialty services that are not profit centers.
Sister Mary Jean, who was dispatched by her order to earn a master’s degree in hospital administration, has managed her realm with iron-willed competence and unblinking compassion, SSM executives said.
She is both stern and good-humored enough that the company’s vice president for communications, Suzy Farren, felt comfortable writing a farewell tribute that depicted her as “at times, gruff and demanding and stubborn.” Michael R. Panicola, the company’s vice president for ethics, remembered thinking during his job interview that he was facing “the female version of Mickey,” the crusty trainer in “Rocky” played by Burgess Meredith.
Those who underestimated the nuns as managers “made a mistake,” Sister Mary Jean said, volunteering that many hospital executives with multimillion-dollar salaries were “arrogant” and “overpaid.” Having taken a vow of poverty, Sister Mary Jean worked for free, although SSM paid the Franciscan Sisters of Mary an annual fee — $1.96 million in 2009, according to tax forms — as compensation for their labor.
Operating revenues at SSM (the initials honor the Sisters of St. Mary, a predecessor order) more than quintupled during Sister Mary Jean’s tenure, to $3 billion in 2010. The company produced net income that year of $247.9 million and provided $115.4 million in uncompensated care.
A decade ago, Sister Mary Jean led SSM through a relentless campaign to improve performance that was recognized with the first Malcolm Baldrige National Quality Award given to a health care company.
But her legacy also extends to preaching about the dignity of patients, paying blue-collar workers above scale, making her hospitals smoke-free, banning the use of foam cups and plastic water bottles, and insisting on gender-neutral and nonviolent language. There are no “bullet points” in SSM presentations, and photographs are “enlarged,” never “blown up.”
Even Sister Mary Jean can struggle to define precisely what the nuns brought to their hospitals. “There is this thing called presence,” she said, explaining that she was trained to see Jesus in the face of every patient, “and I think that’s the piece that is lost.”
Mr. Thompson, Sister Mary Jean’s handpicked successor, said he planned to hold fast to her commitment to patients, the environment and nonviolence. But he also acknowledged that he would be “trying to drive more efficiencies in the system.”
“I would hope,” he said, “that those two things never come into conflict, at least no more than they ever have in the past.”
© 2011nytimes.com
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