Living on Purpose: Franciscan Mission in Health Professions Today

Fr. David B. Couturier, OFM. Cap, "Living on Purpose: Franciscan Mission in Health Professions Today." Keynote given at the Living with Purpose Conference for Occupational Therapists at St. Bonaventure University's DePerro School of Health Professions (October 12, 2023).

Introduction

Thank you for that wonderful introduction. It’s both a pleasure and an honor to be here tonight with all of you, and, in a special way, `with my faculty-colleagues in the School of Health Professions, with our dedicated students and great staff, and with all of you who are involved in one way or another with the health care system in Western New York. Thanks to all who have organized this wonderful event and suggested that we discuss the issue of purpose in the Health Professions.

It was the African-Caribbean psychiatrist, social philosopher and activist, Dr. Frantz Fanon, who once said: “Each generation must discover its mission, fulfill or betray it, in relative opacity.”[1] 

Fanon argues that it is not enough for us in our global world to live simply by chance or fate. It does not serve our personality or our times to live by profit alone, with all due respect to the economist Milton Friedman.[2]

It is the call of every generation now to discover in the signs of the times and in the problems of the moment its distinct and unique mission in the world and to fulfill it. Notice that Fanton does not speak about an individual or personal sense of mission. He is speaking of a corporate or generational mission. It is a life of purpose beyond our selves, that we share with others and for others. Our call, then, is not simply to a personal job or an individual career. It is not enough simply to find a strategy to make money in the most lucrative way and in the shortest amount of time, however tempting and enticing that might be. Each of us, he advises, is called to a mission, a purpose that we share with our generation.

Fanon’s advice, however, comes with a warning. Fanon cautions that coming to mission will not be easy. He says that each of us must come to the experience of mission in what he calls a “relative opacity.” A strange word, “opacity.” Merriam-Webster defines it as a condition of inscrutability, ambiguity, obscurity, or darkness.[3] In short, a life of purpose and mission will require sacrifice. Life on purpose takes passion, generosity, and dedication to the common good (not just private interests) and what Robert Spitzer calls “contributive happiness.”[4]

Seven years ago, when this room was simply a dusty former chapel and this building was living off its memory as a once flourishing seminary for the training of priests, St. Bonaventure’s University Planning Commission (UPC), after months of research and analysis, made two bold proposals to the University’s Board of Trustees regarding the strategic future of this university. They were:

1. to enter full throttle into the field of health professions, and
2. to do so with a fully intentional sense of Franciscan mission.

In our research, we looked around the Western New York region and asked ourselves – where do our passions and this region’s greatest needs intersect? What can we do to help?

Suddenly, a university known for its cautious, conservative, and often risk-aversive demeanor found its courageous and innovative voice. It was an exciting and adventurous moment. When we made those proposals, we did so with the best analytical tools at our disposal and with some of the most talented minds on this campus. Even so in 2015, we could not have predicted the challenges that would face health professions in a mere five years. No one could have foreseen a global pandemic that would stress and stretch every level and all dimensions of a global community health system in every part of the world. The Covid 19 years were traumatic on so many levels. The Office of Health Policy in the US Department of Health and Human Services recently described what many of us experienced during the long-lingering Covid pandemic:

The COVID-19 pandemic has put extreme stress on the health care workforce in the United States, leading to workforce shortages as well as increased health care worker burnout, exhaustion, and trauma. These pandemic-related challenges have taken place in a context of significant preexisting workforce shortages and maldistribution, as well as in a workforce where burnout, stress, and mental health problems (including an ongoing risk of post-traumatic stress disorder) were already significant problems.[5]

It’s only been three and a half years since we were in that maelstrom of extreme stress. In many ways, we have tried to put those dire days and traumatic trials in a corner of our minds, hoping that we would never have to revisit them again. And yet, we know that Covid is not yet done with us. Its effects and its lessons are still waiting for our resolution and our resilience.

Taking on mission and a life on purpose is not a ride on easy street. Living on purpose means living in the moment and meeting challenges with the ingenuity and creativity that mission provides.

The Organization for Economic Cooperation and Development (OECD), a global policy forum for international economic cooperation and policy development of which the United States is a signatory and global partner, has been tracking how Covid continues to transform how we think about our economies and our societies.[6] Living on purpose in health care today means dealing creatively with: (1) the way that the pandemic revealed and exacerbated mental health stress and anxiety, and (2) labor shortages and talent deficits that Covid 19 appears to have accelerated.

Workplaces are Struggling to Support Good Mental Health

The OCED has concluded that one of the most tenacious consequences of the pandemic has been that high-intensity workplaces are struggling to support the good mental health of workers in health professions.[7] Statistics on trust in America indicate that most Americans have lost trust in institutions. Only 3 institutions garner more than 50% of Americans’ trust: the military, the police, and small businesses.[8] If these statistics hold up, many Americans are working for companies and in conditions they do not usually trust for their well-being.

The pressures of health care workloads have been increasing, along with job insecurity, for years; staff shortages have been accelerating and the changes in ways of working introduced a whole new level of mental health challenges, as well. And while the expansion of teleworking and telehealth technology has increased flexibility and work-life balance for some health care workers, the impact on feelings of social isolation and the difficulty in supporting a healthy separation between work and home life outweighed many of the benefits that technology delivered in the pandemic era.

Labor Shortages and Talent Deficit

The OCED also notes that workers in health care professions are facing rising expectations and ever greater job instability. People have been changing jobs at a faster pace, with one in five workers experiencing a change every year. One of the most significant trends in health care today is known as “the great resignation,” health professionals continuing to burn out, burn in place or walk out because of the problem of working too many hours with too few staff for less and less money.[9]

A review of the trends and challenges in the field of health care today suggests considerable complexity and significant turbulence into the future. These conditions will test the mettle of everyone who enters the field from day one to retirement and beyond.

I hope I have not painted too bleak a picture. But health care planning professionals like McKinsey and Company have described the situation as nothing short of a “gathering storm” that could potentially force even the well-motivated among us to find other professions and ways of working.[10]

The Revitalization of University Mission

Things would indeed be bleak if the University had stopped at only taking notice of the challenges. But the university did more. The University Planning Commission did not simply propose a refurbished building and a new curriculum of studies. We also proposed (at the same time) a revitalization of our university mission, one that would embolden every division and department of this University to become partners in a missional transformation of what we do and why we do it. Without sacrificing scientific and clinical precision in the least, we have proposed and started a series of innovations that will ground our science in a humane missional anthropology that is positive, progressive, palliative, and collaborative, drawing out from each of us a deeply compassionate attitude of service.

The mission we are relying on is not the product of statistics. You won’t find it in organizational self-help books at Barnes and Nobles. The mission of which we speak tonight is time-tested over eight centuries and it is derived from the story of a young man who discovered his generation’s mission and fulfilled it among the poorest of the poor, the people with leprosy of his day. It begins when Francis of Assisi confronts the health care crisis of his day. His commitment to people with leprosy and his living among them in an experiment he called “fraternity” brought about a new humanism in Western civilization and led to the West’s commitment to human rights, even to this day.

Let me quickly review that mission and help you see its potential in the highly complex environment of health care today.

Franciscan Mission

When we first meet Francis of Assisi (1182-1226), he is a young man in his twenties, and he is standing naked in the public square. Across from him is his wealthy father who once pinned his pride and dreams on this young man just come home from war. A once proud father now sees his son as nothing more than deranged, deluded, and dangerous. Beside the naked figure stands a bishop uncertain as to whether this public display is just an ugly squabble breaking a family apart or a religious delusion beginning to fracture a young man’s mind and his future. Naked in the public square, this young man begins a revolution that would critique the violence and greed of his time and pass judgment on both the civil and religious leaders of his day. This provocative display of nudity, with its incarnate wisdom centered on minority, simplicity, and a cosmic fraternity, created a new ethical space in the medieval world.

Francis of Assisi lived in a time of incredible violence and enormous greed.[11] As the son of a wealthy cloth merchant, he lived the high-life and fast lane adolescence of an up-and-coming new generation of financial entrepreneurs. His adolescent dream was simple and direct; he believed that he was destined for fame and fortune. He was a walking advertisement for his father’s high-end fashion business, and he was his father’s promise for an economy based on hard work and merit not inheritance, as was the way of wealth in medieval times. He and his father were devoted to a new social ideal whereby families could work their way into the upper class and create status for those not born into privilege. Francis’ father wanted to create a new model whereby people made money in a new-fashioned way: they would earn it. It was a radical ideal that Francis and his father, Pietro, promoted vigorously. It was also a dangerous one for the times in which they lived.

Francis’ adolescent dreams were of becoming a knight for the good and glory of Assisi. Francis’ father was all too willing to support his son’s military dreams. He outfitted Francis with the best military gear available. Francis, the playful darling of his friends, went to war with the blessing and the hopes of his family, his church, and his town. But something happened to Francis at the Battle of Collestrada, something that shook him to the core of his soul. Taken prisoner of war, he languished in prison for the better part of a year until ransomed by his father. He was never the same afterwards.

Like many soldiers before and after him, Francis had seen the fatal consequences of war. He had seen his friends, the ones he used to party with as minstrels on the streets of Assisi, now butchered on the bloody floor of the Umbrian Valley. Francis was deeply shaken by what he experienced. Francis would never pick up a sword again. However, Francis went further by questioning the roots of the violence and greed that had consumed his time and imagination. He understood something that many had missed in their justifications for violence in the name of privilege, namely that God was being implicated and even convicted by association with the greed of the day.

Something changed in his view of God after his experience of war. Francis converted to a dramatic and radical love of the humble God, the naked divinity, and the approachable incarnate Christ of the Gospels.

Francis came to the conviction that it was this tender, humble, and kind God that was being defaced and defamed by the violence and greed of his world and its economic schemes. And so, it became Francis’ mission to reveal once again the goodness of God.

A New Mission

Francis embarked on a new mission – to see and experience the world in the fullness of a God who was good, all good, supremely good, all the time and to everyone. Francis resolved to do this by entering into the vulnerability of the poor, the marginalized and excluded.

Most of Francis’ contemporaries believed that attention on the poor and vulnerable was a waste of time. His contemporaries believed that the way to God was through an imitation of majesty and the accumulation of power, prestige, and privilege. Francis had learned just the opposite. The way to fullness was by emptiness and generosity. Francis wanted to thrive in the simplicity of life that called on the brothers and sisters to live in communion and not in competition with one another. Francis wanted his fraternity to experience the fullness of God, away from aggression and power-building that depletes us all.

Francis of Assisi finds his generation’s mission in the health care crisis of his day, the inability and unwillingness of contemporaries to find a solution to the emotional and social problem of leprosy. Francis doesn’t expect a medical cure; that is too much to ask. But Francis wants to deconstruct the distance that society has created to define the disease. Francis intends to build a new social experiment that he calls “fraternity,” that will inspire other young men and women like himself to work in total service to the very poor among them. They will renounce everything they now own or could own in the future to draw people with leprosy and the poor out of the shadows of their loneliness and marginalization. He will bring them close, indeed he will draw lines of connection through everything in the cosmos. In his Canticle of the Creatures, he will create a vision of a universal fraternity where everything in creation becomes a brother or sister. Nothing is above or below. Nothing dominates and nothing is deprived. Hierarchies of power and privilege are dismantled so that everyone can enjoy the basic freedoms, the original goodness of life received humbly and simply by everything and everyone, from a good and gracious God.

The frequently used words today for mission like dignity, respect, participation, dialogue, and discovery seem mild and, indeed paltry, before the magnitude of the mission that Francis of Assisi is proposing. Francis, when dealing with the health care, does not speak of “chairmen,” “presidents,” “chief operating officers.” He never uses paternal or military terms in this regard. He speaks in powerfully maternal terms. The brothers should act like mothers; they should gather the poor and sick like “hens gathering their chicks.” His words reflect intimacy, not bureaucracy.

Francis knows that he is turning social roles upside down, not simply to disrupt the greed and violence that had such a corrosive effect on the health care of his day. Francis wants to break down the distance that keeps the people with leprosy and all the poor not only marginalized in society, but also excluded from the basic benefits of social life. His vision requires a social reconstruction that puts clinicians and leaders, administrators and staff, doctors, nurses, occupational therapists, physician assistants and patients into a new ethical space of mutual support. His new form of hospitality is an ethical space of mutual care, provided in humility by both patient and caregiver, who are to see Christ in one another. The technical skills of one are of no greater import than the humble reliance and resilient courage of the other. In Francis’ mind hospital space is not stratified by economic class, professional degrees, technical skills, or salary compensation. In a mission driven by Franciscan principles, these are replaced by new fraternal relationships, where highly skilled physicians and weak indigent patients are brothers and sisters needing one another.

St. Bonaventure University’s Mission and Health Care Today: Living on Purpose

We live in a time of competing values in the delivery of basic health care. As Americans we have not yet decided whether we believe that health care should be considered a basic human right or whether we should treat it as a privilege that belongs only for those who can afford its high costs.[12] We have yet to confront the fundamental inequities emerging in our hospital systems. As many in this audience know: the average hourly pay for nurses in the U.S. is $42.80 for registered nurses, according to the U.S. Bureau of Labor Statistics.[13]

The average hospital CEO pay per hour by hospital type and the ratio of the CEO wage to other workers' wages, according to a study published in Health Affairs last year indicates: 

In Major teaching hospitals -

• Average hospital CEO compensation per hour: $529 
• Ratio of CEO wage to other workers' wages: 14:1 

In Non-teaching hospitals -

• Average hospital CEO compensation per hour: $197
• Ratio of CEO wage to other workers' wages: 7:1.[14] 

The growing chasm between CEO pay and the pay of other workers bespeaks a widening mindset differential that positions many CEOs in America in an isolating orbit of private interests versus the common good, what Pope Francis calls a technocratic paradigm and globalization of indifference. In his latest apostolic exhortation on climate change published on October 4^th, the pope goes to the root of so many of our existential concerns in business today. The problems facing us are not technical so much as they are anthropological in nature. We have the scientific know-how, the mechanical prowess to tackle the most difficult challenges facing us. What blocks us in our scientific age is not mechanics but mindsets. Pope Francis writes,

Mistaken notions also develop about the concept of “meritocracy,” which becomes seen as a “merited” human power to which everything must be submitted, under the rule of those born with greater possibilities and advantages. A healthy approach to the value of hard work, the development of one’s native abilities and a praiseworthy spirit of initiative is one thing, but if one does not seek a genuine equality of opportunity, “meritocracy” can easily become a screen that further consolidates the privileges of a few with great power. In this perverse logic, why should they care about the damage done to our common home, if they feel securely shielded by the financial resources that they have earned by their abilities and effort?[15]

We have lived for far too long under the illusion that higher and higher salaries for an elite few, whether in health care, higher education or in athletics, serve as a clear and inevitable incentive for better health or greater wisdom. What we need is a commitment to purpose for the common good. Again, Pope Francis states mission requires a new way of thinking, a new mindset, and a new procedure for decision-making:

            … since the one put in place several decades ago is not sufficient nor does it appear effective. In [a new] framework, there would necessarily be required spaces for conversation, consultation, arbitration, conflict resolution and supervision, and, in the end, a sort of increased “democratization” in the global context, so that the various situations can be expressed and included. It is no longer helpful for us to support institutions in order to preserve the rights of the more powerful without caring for those of all.[16]

It is our mission here at St. Bonaventure to claim an ethical space for today’s poor and vulnerable in the discussion of how health care is managed and delivered. This is, I believe, part of our purpose as a university dedicated to excellence in the Franciscan tradition.

Our Franciscan Mission: Justice

The challenge of health care is always a question of justice. In a global world, who will have access to health care? Who will benefit from this generation’s discoveries in health sciences? Who will thrive because of our commitment to health care and who will be left behind?

As a Franciscan University, our mission is tied to solidarity, a recognition that those on the margins and those normally excluded from conversations about the distribution of the world’s goods, have a right to be part of the decision-making over the distribution of health care.

One of my heroes in the field of public health, Dr. Paul Farmer, a Harvard graduate who spent his life in the poorest regions of the world extending the reach of today’s most advanced forms of medicine, spoke about what we have been conditioned to expect of health services in the world. He said:

This is something I’ve been struggling with since I was a student: socialization for scarcity. But scarcity for ourselves? No. Scarcity for our mom? No. For our own kids? No. We’re socialized for scarcity for other people, and they’re usually black or brown or poor. So, then we start cutting corners. Like saying we can treat drug-susceptible tuberculosis but not drug-resistant tuberculosis. We can give vaccines in Liberia but not chemotherapy. We must focus on prevention of trauma, or AIDS, in such settings, but not treatment. It might sound OK in a classroom, but such logic is lethal on the ground. [17]

In a Catholic-Franciscan university like ours, we recognize that our curriculum of studies must match our excellence for science with our excellence for justice. We must challenge our students to seek beyond profit and to discover the power of purpose. We cannot settle for a philosophy of scarcity, especially when that scarcity is never meant for us and for our family or group. The Franciscan mentality is rooted in a theology of abundance – that God is good, all good, supremely good, all the time and for everyone.

Last semester I taught a course on “The Theologies of Disability.” It was premised on a question – what do we see and what do we learn when our focus and attention changes to the sight and meaning of the incarnate God, Jesus, disabled on the cross? What happens to our assumptions and biases when we notice Jesus’ identification with those who have been disabled by trauma, accidents, and society?

In my experience, the floodlights come on and we begin to see clearly and nakedly the economic sub-structures and power-platforms that have been put in place to advantage the already-privileged in society and to (even-unconsciously) disadvantage those already struggling with their “backs against the wall.”

In the floodlights, we see how tenuous our profit margins are, how limited our compensation structures have become, not because we serve the poor, the vulnerable, and the shrinking middle class so well, but because we have bound ourselves so tightly to an economic logic that the already privileged deserve even more. We have become satisfied with the reality that the poor can’t have enough, and the rich can’t get enough. We have become used to the poor and vulnerable becoming our designated and permissible victims.

Therefore, living on purpose in the Franciscan tradition means living for justice.

1. To live on purpose is to be committed to the excellence of our science and our justice. Because we are “dedicated to excellence,” we will keep the highest standards in our classrooms, clinical internships, and laboratories. And we will do so not simply to please our accreditors, but to be true to our mission, to satisfy the needs of our patients, especially those who are most vulnerable. It is not enough that we check boxes on standard exercises of accountability. We need to continually check our corporate conscience to see how we are fulfilling our mission. The corporate scorecard and dashboard that the University Planning Commission implemented is a valuable tool for this.
2. To live on purpose is to be is to be committed to the emotional health of our students, staff, and patients. The American health care system can no longer treat students and their teachers, patients and health care professionals as simply cogs in the wheels of profitability, dispensable and collateral expenditures in the pursuit of margins and C-suite compensations. Their dignity and worth as humans in the image of the divine needs to be valued and protected in ways that a greedy corporate conscience will never do.
3. To live on purpose is to be committed to the building of fraternity on this campus and at our clinical sites, even though we live in a deep cultural context of private interest, social isolation, and distrust of every institution that dares to make a claim on us. Health care systems will never be perfect; they will never be heaven on earth. But they do not need to be brutal in their treatment of those who work in them. And so, we need to think carefully about the kind of leadership skills we must foster. We need to advance not only personal ethics in all our dealings with one another. We need to advance organizational ethics so that we train our future leaders on how to build practices, offices, departments, and health care systems that are ethical, fair, just, and meaningful in their policies, procedures, and practices.
4. To live on purpose is to be known personally and professionally as compassionate, collaborative, and integrated team players who use our skills and develop our wisdom for love, especially toward those who are most vulnerable in our society and those most in danger of falling through the wide cracks developing in our health care systems. But we advocate for more than collaboration. In a global world where dignity and diversity are constantly threatened, we must advance solidarity as a commitment to look after those on the so-called underside of society, those most often and most effectively marginalized because they are among the most powerless. In the best tradition of our OT, PA, nursing, public health, and health sciences history, we must learn to be advocates for our patients as well as health practitioners. It is to train our patients to be effective advocates for themselves, to be patients impatient for justice.
5. To live on purpose is to become agile and comfortable thinking outside of our cultural boxes because we, like Francis of Assisi, have learned how to hear the cries of the poor, even those who are the most muffled or drowned-out by systems now satisfied by serving only the “deserving poor.”

Conclusion

In conclusion, we live in a time of incredible challenges. And our students are being prepared to take up their generational mission and to fulfill it.

St. John Henry Newman once wrote a prayer about mission that you may find helpful, especially when times get tough. I pray that it will inspire and support you.

 “God has created me to do Him some definite service. He has committed some work to me which He has not committed to another. I have my mission… I am a link in a chain, a bond of connection between persons. (God) has not created me for naught. I shall do good; I shall do His work. I shall be an angel of peace… Therefore, I will trust Him, whatever I am, I can never be thrown away. If I am in sickness, my sickness may serve Him, in perplexity, my perplexity may serve Him. If I am in sorrow, my sorrow may serve Him. He does nothing in vain. He knows what He is about. He may take away my friends. He may throw me among strangers. He may make me feel desolate, make my spirits sink, hide my future from me. Still, He knows what He is about.”[18]

Thank you and God bless all of you!

 _______________________________

David B. Couturier, OFM. Cap., PhD., DMin., is Associate Professor of Theology and Franciscan Studies, Executive Director of The Franciscan Institute and Director of University Planning at St. Bonaventure University. His latest books are: Integrating Missions: Organizational Identity and Founding Stories in Multi-Partnered Health Systems Today (2023) and The Earlier Rule: History, Theology, and Vision (2023).